VSL#3: A Remedy for Constipation

Probiotics and their efficacy for individuals with SIBO is a controversial topic for which I have been on both sides.  At times, probiotics have worsened my SIBO symptoms and at other times they have been very beneficial.  But no probiotic formula has been as effective for me as VSL#3.  In this post I will discuss research that has been conducted on VSL#3 in regard to improving symptoms of constipation.  VSL#3 has also been studied for a variety of other conditions- I encourage you to search on PubMed for more information.

Having regular bowel movements is extremely important for detoxification because it is a process by which waste is removed from the body.  Alarmingly, it is estimated that as much as 27.1 percent of the US population suffers from functional constipation [1]. Fortunately, low-risk remedies such as probiotics exist to aid in this important detoxification process.  Studies have indicated that administration of VSL#3 can positively impact symptoms of constipation.  It is unclear whether the benefits of VSL #3 probiotic supplementation are temporary or whether they can provide lasting improvement.

VSL#3 contains eight probiotic strains including Streptococcus thermophilus, Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis, Lactobacilus acidophilus, Lactobacillus plantarum, Lactobacillus paracasei, and Lactobacilus delbrueckii subsp. bulgaricus.

A 2015 study [2] regarding the efficacy of the probiotic formulation VSL#3 showed positive benefits in individuals with functional constipation selected based on Rome III criteria.  Before administration of the probiotic, lower amounts of bifidobacterium and bacteriodes species were found in the stool of these individuals than in controls.  Seventy percent of individuals with functional constipation noted symptom improvement from administration of the probiotic.  Additionally, participants noted increased frequency of bowel movements from an average of 2.5 +/- 1.3 per week to 6.3 +/- 3.1 per week.  Stool consistency (based on the Bristol Stool Chart) improved from an average of 2.6 +/- 0.7 before treatment to 4.1 +/- 0.9 after the two week probiotic therapy.  Unfortunately, the results were not lasting.  Of the participants who experienced symptom improvement during probiotic administration, 61 percent reported return of hard stools or less frequent bowel movements within one month of the study’s completion.

It appears that VSL#3 may be only a remedy, not a cure.  At a cost of approximately $9-10 per day, administering VSL #3 at the dose utilized in this study may be prohibitive for many individuals.  However, VSL#3 may be an effective and welcomed means of symptom relief for individuals with chronic constipation.  No adverse reactions were noted in the study I analyzed, indicating that these protocols may be safe treatments for promoting elimination and therefore, detoxification.  Of course, it is always recommended that you consult your physician to ensure safety.

References:

[1] Schmier JK, Miller PE, Levine JA, et al. Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model. BMC Public Health. 2014;14:374.

[2] Kim SE, Choi SC, Park KS, et al. Change of Fecal Flora and Effectiveness of the Short-term VSL#3 Probiotic Treatment in Patients With Functional Constipation. J Neurogastroenterol Motil. 2015;21(1):111-20.

Thai Lettuce Wraps

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Caution: raw vegetables can be problematic for individuals with poor digestion.  This recipe is intended for individuals who have reintroduced raw veggies or are using this recipe as a way to see if they are ready.  Dr. Siebecker recommends remaining on the SIBO diet for 1-3 months before introducing raw veggies (see SIBO Food Guide).

I have always been a big fan of Thai food, especially salad rolls with a delicious peanut sauce.  Unfortunately, there are all sorts of ingredients in those that I can no longer eat (rice, garlic, peanuts, sugar, soy, who knows what else!).  Here is my take on SIBO-friendly salad rolls, also known as Thai Lettuce Wraps.

This recipe is perfect for the end of the week for several reasons: butter lettuce lasts a while if you leave it attached to the stem, the sauce is super quick and easy to make, and the filling ingredients are flexible which allows you to use up any veggies left in the fridge.

Enjoy!

Ingredients:

Butter lettuce leaves (approximately 3 large leaves)- the loose bunches are easier to pull apart without breaking the leaves

1/5 or 1/4 lb chicken or turkey breast (cooked to your liking)- I like to bake mine at 350 degrees for about 20-30 minutes

Sauce (all you have to do is add the ingredients to a bowl and stir):

1/4 c finely chopped fresh Italian parsley (approximately 1/2 c loosely packed before cutting)

1/2 teaspoon finely grated ginger

2 T salted almond butter (or unsalted and add some sea salt)

1.5 teaspoons coconut vinegar (substituting apple cider vinegar should be fine)

1.5 teaspoons walnut oil

1.5 teaspoons coconut aminos (this is a soy sauce alternative that can be found at natural grocery stores)

Optional Filling Ingredients: thinly sliced cucumber, beets (boiled then thinly sliced), shredded carrots (these might be too hard to digest), sliced tomato (nightshade- might cause inflammation).

SIBO-Friendly Convenience Foods

One of the most challenging aspects of following a strict SIBO-friendly diet is finding foods that you do not have to make for yourself.  Convenience foods are necessary when you do not make enough food or things just do not go as planned.  The first several months (and even beyond), it can be really challenging to predict exactly how much food you need to make for the week.  Also, the prep time for making your food for the entire week can really eat into your weekend (assuming you batch-cook on weekends).  Luckily, if you search hard enough, there are convenience foods out there for us SIBO sufferrers!  In this post, I am going to share with you some of the ones that I have found.  Please feel free to leave comments about your go-to SIBO-friendly convenience foods.

1) Mario Snack Olives- Kalamata with a Hint of Thyme:  These are lightweight and easy to keep in your purse for emergencies.  Although they are only 100 calories and therefore not that filling, they can get you past those I NEED FOOD NOW!!! moments.

Mario Camacho Foods Pitted Snack Olives, Kalamata with a Hint of Thyme, 1.05 Ounce (Pack of 12)

2) Diestel Brand No-Salt Turkey:  Although labeled just as “no-salt” it is also sugar free and actually, the only ingredient is turkey.  If you eat it plain, it is pretty boring.  I like to dip slices of this turkey in olive oil and sea salt (kind of ironic considering it is no-salt added turkey).    The only place in Portland that I know carries this is Food Front Co-Op.  Last time I checked (yesterday) they charge $11.99/lb.

Diestel_SK_077

3) Unsulphured Shredded Coconut– Coconut can be a touchy subject in the SIBO world.  Personally, I have not found it to negatively effect me.  In fact, I find it to be an excellent source of calories with minimal carbohydrates.  One cup contains approximately 500 calories and 20 grams of carbohydrates.  The reason that I buy unsulphured is that I believe I am sensitive to sulfur.  You can read about that here and here.

Shredded Coconut

4) The Smokery Smoked Salmon (Simply Salmon variety only, unless you can tolerate honey)– This one can be purchased at the Portland State University Portland Farmer’s Market on Saturdays.  It is pretty expensive, but truly delicious.  It lasts in the fridge unopened for several weeks, so it is good to have around in case of emergencies.

smoked salmon

5) Sardines Packed in Olive Oil– Okay, I will admit, I saved this one for last because it is not my favorite.  However, the health benefits and convenience have me going back to it in times of desperation.  The first can of sardines I ever purchased sat in my cupboard for probably two months before I ever tried it.  When I finally toughened up and tried them, I was pleasantly surprised that they were not nearly as bad as I imagined they would be.  Some people even say they enjoy them.  Sardines are packed with omega-3’s and are therefore a really great anti-inflammatory food.  Just give them a chance, you might be pleasantly surprised as well!

sardines

Rainbow Carrot Fries

Rainbow Carrot Fries

carrot fries

Ingredients:

  • 1/2 lb rainbow-colored carrots (or regular carrots)
  • 1 tablespoon olive oil
  • 1/4 teaspoon sea salt

Kitchen Tools:

  • Oven
  • Baking Sheet
  • Metal Spatula
  • Cutting Board
  • Sharp Knife

Directions:

  • Preheat oven to 410 degrees
  • Cut carrots lengthwise into thirds, then cut into “fries” (see photo below).  The more equal in size that each fry is, the more evenly they will cook.
  • Place olive oil on baking sheet.  Use metal spatula to spread oil evenly.
  • Distribute carrots evenly on tray so that they are not overlapping.
  • Bake for 25-30 minutes, flipping half way through.  They do not have to be perfectly flipped, but ideally each fry will be touching the baking sheet. 
  • Sprinkle with sea salt. Enjoy!

carrots- before

The Importance of Healing Your Gut

This is a must-read for those with food intolerances & seasonal allergies

Did you start by removing gluten from your diet? And next maybe dairy or soy?  Have you slowly discovered more and more intolerances?  Maybe you even feel that you would rather just not eat ANYTHING because it seems that you react to EVERYTHING?  

If this sounds like you, take a look at the following excerpt from Dr. Natasha Campbell-McBride’s GAPS Introduction Diet:

“The reason for allergies and food intolerances is so-called “leaky gut” when the gut lining is damaged by abnormal micro flora.  Foods do not get the chance to be digested properly before they get absorbed through this damaged wall and cause the immune system to react to them.  Many people try to identify which foods they react to.  However, with damaged gut wall they are likely to absorb most of their foods partially digested, which may cause an immediate reaction or a delayed reaction (a day, a few days or even a couple of weeks later).  As these reactions overlap with each other, you can never be sure what exactly you are reacting to on any given day.  Testing for food allergies is notoriously unreliable: if one had enough resources to test twice a day for two weeks, they would find that they are “allergic” to everything they eat.  As long as the gut wall is damaged and stays damaged, you can be juggling your diet forever removing different foods and never get anywhere.”

via INTRODUCTION DIET.

Rather than slowly eliminating foods one by one, I wish I had begun a gut-healing protocol such as the GAPS introduction diet  presented by Dr. Campbell-McBrideI  when I first noticed signs of intestinal distress.  I certainly would have added homemade bone broth as a dietary staple.

My Journey with SIBO

SIBO? IBS? What are they? Why do we use acronyms to describe them?

SIBO and IBS are digestive conditions.  IBS is estimated to plague approximately 20 percent of Americans (to varying degrees), yet, like many other people in the non-medical community, I had not heard of this condition until I was diagnosed three years ago.  I scheduled an appointment with a gastroenterologist for my abdominal pain, excessive gas, atypical bowel patterns, and itchy skin that kept me up at night.  The doctor told me that I had Irritable Bowel Syndrome (IBS).  She said that it was not curable and that I would just have to learn to live with it.  First, she recommended eliminating dairy.  This seemed to ease my symptoms initially, but as time went on, my symptoms worsened and I returned for another appointment.  I was frustrated.  I was embarrassed.  I didn’t want to be controlled by my digestive disorder.  I just wanted to feel young and healthy like a normal twenty-year-old college student should.  At my second appointment, the gastroenterologist showed up 45 minutes late, saw me for five minutes, and prescribed me a colon relaxer (after I told her that I did not want to take any prescriptions).  It was at this point that I utterly gave up on the Western medical model.

Luckily, I did not give up on my goal to become healthy.  And fortunately, I found a medical model that matched my goal to figure out the root cause of the problem and not just cover up the symptoms: naturopathic medicine.  A simple Google search led me to the amazing Dr. Erika Siegel.  She is a compassionate listener and attentive naturopathic doctor who gave me the hope and support I needed to keep striving for optimal health amidst many setbacks.  Over the past year that I have been visiting Dr. Siegel for bi-weekly or monthly appointments, my symptoms have improved dramatically (from a “10” one year ago down to a “5” (on a 1-10 best to worst scale)).  Sometimes it is difficult to remember how much progress I have made because there is still so much more progress that lies ahead.

About four months ago (shortly after NCNM’s first SIBO symposium), Dr. Siegel introduced me to the idea that I may have Small Intestine Bacterial Overgrowth (SIBO) and she recommended testing.  This next statement may seem odd, but I was ECSTATIC the day that I learned I tested positive for SIBO.  Why?  Finally, I was being told that what I had could be cured.  I would not have to suffer for the rest of my life.  The results indicated that I was suffering from SIBO induced IBS (too many bacteria that were supposed to be in my large intestine had traveled into my small intestine and were causing me all of this agony).

Moving forward, Dr. Siegel has referred me to Dr. Keller in order to utilize her expertise and personal experience with SIBO to ensure continued progress.  My first appointment with Dr. Keller reminded me how important sharing knowledge of personal experiences will be to creating a society that is no longer plagued by embarrassing, silencing, digestive discomfort.

Now to my final question: why do we use acronyms?  My theory is that the reason we use acronyms such as IBS and SIBO is that they are a little less embarrassing than telling people you have “small intestine bacterial overgrowth” or “irritable bowel syndrome”.  These terms do not exactly ring like wind chimes.  But why is our society so afraid of talking about poop?  I laugh every time I think of my little sister Amina’s response when the doctor asked her about poop.  We took her to see Dr. Erica Peirson, a wonderful naturopath who specializes in Down Syndrome.  In Amina’s comprehensive new patient examination, Dr. Peirson said to Amina: “so tell me about your poop”.  The look on Amina’s face and accompanying “Pooooop???” remark led everyone in the room to burst into laughter.  Our society teaches children from a young age (“no potty talk”) that it is completely taboo to talk about our bowels. Yet, there is so much to learn from paying attention to this oh-so-important and oh-so-natural indicator of health.  If I had known from a young age that it was not normal to go two or three days without a bowel movement, I could have saved countless time and money.  I would have seen a naturopath when my gut flora imbalance first appeared as embarrassing acne in high school.

But there is no reason to dwell on the past.  In a weird way, I am grateful that I have had to struggle with SIBO at a young age because my journey with SIBO has provided me with the ability to help others recover from chronic illness.  My goal is to make it easy for busy people to heal by providing them access to meal plans, grocery lists, cooking lessons, and more that I had to spend hours of self-study learning about because there were not enough trained individuals to help make my journey feasible with my career.