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.

Health Update: Goodbye Antimicrobials

It has been a while since I have shared an update on my healing journey.  I am pleased to announce that it has been 5 months since I have taken antimicrobials and over a year since I have taken antibiotics.  Previously, I had been reliant on antimicrobials, prokinetics, and a strict low FODMAP, limited fruit, low sulfur (low thiol, specifically) diet for managing my SIBO.  I could sometimes go two weeks without antimicrobials, but my symptoms would slowly return bringing about a sense of hopelessness.

My decision to abandon antimicrobials was inspired by the results of my Genova Comprehensive Stool Analysis.  The test showed non-existent lactobacillus and bifido bacteria as well as very low microbial diversity.   I attributed this to a variety of factors: heredity, a low FODMAP diet and antimicrobials for an extended period of time, and antibiotic use throughout my lifetime (especially IV Vancomycin to treat Toxic Shock Syndrome at age 17).

Since discontinuing antimicrobials, I have had ups and downs in regard to my symptoms, but the overall trajectory has been positive- I have greatly expanded my diet and have continued to have healthy daily bowel movements (some days are better than others).  I figured it might be helpful to share my current routine with you all to give you a launching pad for ideas to discuss with your physician.

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SIBO-Friendly Beef Chili

@againstallgrain Slow Cooker Beef Chuck Chili (I adapted to make SIBO friendly) topped with cilantro and @ieatrealfood.recipes Zucchini Cheese #sibo #sibofriendly #ibs #ibsdiet #lowFODMAP #easy #dinner

Would you believe it if I told you that it only took me 10 minutes of active prep time to make last night’s delicious chili recipe?  I threw the ingredients in my crock pot before I left for work and came home to a delicious smelling house and warm food.  Note: if your crock pot does not have an automatic switch to turn from low to warm, you will need to make this on a day where you can manually change it after six hours.

Ingredients:

  • 1 T ghee or coconut oil
  • 2 lbs beef stew meat (preferably grass-fed)
  • 2 red bell peppers
  • 1 cup green onion (green part only for low FODMAP), finely sliced
  • 26.46 ounce container POMI chopped tomatoes
  • 2 Tablespoons chili powder (make sure to find one that does not contain garlic or onion)
  • 2 teaspoons sea salt
  • 2 teaspoons cumin
  • 1/2 teaspoon paprika
  • 1/2 teaspoon cinnamon
  • 1/4 teaspoon cayenne pepper
  • 1 cup water

Instructions:

1. Add ghee or coconut oil to slow cooker / crock pot.  Turn to low and allow slow cooker to preheat while you chop bell pepper and green onion.

2. Add beef stew meat, bell pepper, green onion, POMI chopped tomatoes, spices, and water.  Give chili mixture a good stir.  Heat on low for 6 hours.  Serve with any of the below optional toppings.

Optional toppings:

  • Fresh Cilantro, finely chopped (SIBO friendly if you do not have issues with sulfur/high thiol foods)
  • Avocado, diced (generally not SIBO friendly due to FODMAP content- use with caution)
  • Zucchini Cheese- (SIBO friendly)- make ahead of time using this recipe
  • Coconut Milk Yogurt (Dreamboat brand is sugar free)- not SIBO friendly due to probiotic content

Add-Ins to stretch recipe: do you have a large family?  Or perhaps it is not realistic (or healthy) for others in your family to be on as extreme of carbohydrate restriction as you?  No problem!  You can make this recipe stretch by cooking up some beans and rice to go along with it or serving with a side of starchy veggies.

  • Beans & Rice (not SIBO friendly)
  • Sweet Potato (not SIBO friendly)