Probiotics May Make SIBO Worse

I have been suspecting this for a while.

Rather than make my own case, I've copied "Kevin's" excellent post from an IBS forum. I put a link to the original post and discussion at the bottom.


"I have finally cured my SIBO, after relapsing 5 times in the past. This is basically a dump of all my info and research (with citations), and details of how I finally beat it. Hopefully this is my last post, I’ve been on and off the board for 3 years and it has helped me a lot. But rather than disappearing I wanted to share what I have learned.

The method I used uses Antibiotics to intitially get rid of the SIBO. Ginger and Grapefruit seed extract to keep your SIBO at bay whilst Glutamine repairs your gut until it can defend itself again. I believe probiotics were the biggest cause of my relapses and I will explain why.


The facts you need to know to help you cure SIBO

Immune System
60% of your body's immune system is in the intestines. Antibodies that fight infection live in the fragile lining of your intestines. This lining becomes damaged by the bad bacteria that triggered your SIBO, and therefore the intestine’s ability to protect itself is diminished.
http://ajpgi.physiol.../full/291/1/G82

http://en.wikipedia.org/wiki/Gastrointesti...Immune_function


Probiotics
Television, Marketing & advertising for yoghurts, actimel, yakult....etc.etc. Lead us to believe that 'Friendly bacteria', 'probiotics', 'yoghurt', 'probiotic drinks', 'probiotic supplements' are essential for digestion. The truth is that bacteria actually play a minor role in the digestive process. The first 24 feet of the intestines (the small intestine)contains no bacteria (or only a very small amount – less than 1000 bacteria per ml of fluid; digestion in the first 24 feet uses bile, acid and enzymes. Anything more than 1000 bacteria per ml in the small intestine is classed as SIBO). The final 6 feet of the colon is where all your digestive bacteria live (1 Billion per ml of fluid), the bacteria here basically feed on the small amount that is left over after the small intestines.
http://www.enchanted...tomy/digestive/



What causes SIBO
E-Coli, Samonelia and other bad bacteria are biologically similar to any other type of bacteria but have a nasty side-effect: They produce toxins when they feed. These toxins damage the sensitive lining of the gut, inflaming it and wearing it down to the extent that your small intestine’s ability to cleanse and protect itself is reduced. With this protection diminished. Bacteria: (good or bad) is able to overgrow in your small intestines.

If there was one piece of advice that I can give you to prevent your SIBO from relapsing it is this: THROW AWAY YOUR PROBIOTICS. If your problem has the words “Small intestine” in it – then bacteria are not part of the equation because bacteria are not part of the digestive process in the small intestine. If your problem has the words “Bacterial Overgrowth” in it, then you have too much bacteria – adding more bacteria won’t help you!! With your intestine’s ability to cleanse and protect itself diminished, good bacteria can overgrow just as much as bad.

To quote “A new IBS Solution” by Dr. Mark Pimentel
Page 93: Chapter 7: “Another problem with probiotic supplementation is that the cleansing waves in the small intestines of IBS patients are inadequate. It’s possible that a person with diminished cleansing wave capacity who takes probiotic supplements could find his or her situation worse, as the probiotics accumulate in the small intestine where they don’t belong”

I blame probiotics as the biggest culprit in my 5 relapses. My poor understanding of how the human digestive process works, and blindly absorbing in the yoghurt companys’ “friendly bacteria” marketing cr&p led me to believe that bacteria and probiotics would help me when in fact they were re-triggering my SIBO.

“But probiotics alleviate my IBS symptoms!”

A lot of people get relief from Small Intestine Bacterial Overgrowth by taking loads and loads of probitics. Flooding the small intestine with good bacteria temporarily 'overruns' the bad bacteria. The good bacteria don't produce the toxins so things improve. But bacteria aren't supposed to digest food in the small intestine - so although things are somewhat improved (no toxins) you still get the bloating (bacteria produce gas) and you still get hungry all the time (the bacteria are eating your food, not you). This isn't how the small intestine is supposed to work!! Yes it gives relief but its not solving the problem.

To quote “A new IBS Solution” by Dr. Mark Pimentel
Page 93: Chapter 7: “While a reduction in IBS Symtoms is certainly a good outcome, it is not the same as elimination if the IBS itself. According to current scientific study probiotics have not been found to eliminate IBS”

Once again, to stress this point. THROW AWAY YOU PROBIOTICS.

* SMALL INTESTINE BACTERIAL OVERGROWTH - THINK ABOUT IT....
* If your problem has the words “Small intestine” in it then bacteria can’t help you because digestion in the small intestine doesn’t work with bacteria.
* If your problem has the words “bacterial overgrowth” in it bacteria can’t help because you’ve got TOO MUCH bacteria – adding more to an already overgrowing population won’t help!!!



Any notion of “replacing the bad bacteria with good bacteria” as some people are suggesting on these forums is cr&p. You are trying to eradicate all bacteria from your small intestine. To quote Pimentel again (Page 91) “When it comes to the gastrointestinal tract, the concept of “good” bacteria is a misnomer...very few of the 400 strains of bacteria are in fact “bad” or “good” rather they simply represent the various strains of bacteria that are normally found in the colon (or large intestines). It is when these strains of bacteria leave the areas of the gastro-intestinal tract in which they properly belong the problems occur."
ANY bacteria in the small intestine is bad – THROW AWAY YOUR PROBIOTICS!!!

Here are the items you need to buy help you beat SIBO:


Rifaximin/Neomycin
These Antibiotics act only in the small intestines and are not absorbed into the blood stream. There is plenty of info in the forums about these Antibiotics . I would suggest at 400 - 600mg Rifaximin 3 times per day. It might help to have a systemic Antibiotic as well e.g. Ciproflaxin. If you can, get a few extra rifaximin and take 400mg once every couple of days for another 10 days after that as a maintenance dose just to keep your SIBO from coming back.

Glutamine - to repair the lining of your gut and allow it to defend itself again

(get it on ebay – search for “glutamine powder” – you’ll need about 1kg)
http://shop.ebay.com/?_from=R40&_trksi...-All-Categories


Glutamine is one of the 20 amino acids encoded by the human genetic code - these are the building blocks of proteins from which your body is constructed and are essential for repair.
quote“Glutamine is the preferred 'fuel' for the cells lining the mucosa of the small intestine (enterocytes). These cells have the ability to take up glutamine directly rather than waiting for it to be supplied through the blood. Glutamine is also required for the production of both intestinal mucus and Secretary Immunoglobulin Type A (SIgA) antibodies. As a result of these functions, a generous supply of glutamine will help repair and maintain a healthy small intestinal lining. These functions, as well as glutamine's ability to prevent translocation of bacteria from the gut to the bloodstream, have been established in a substantial number of clinical studies both in animals and in human patients with diseases involving impaired intestinal permeability” Citation: http://www.ei-resource.org/treatment-optio...rome-treatment/



Grapefruit Seed Extract and Fresh Ginger - to keep the SIBO away while your gut is being repaired by Glutamine

Get grapefruit seed extract drops on ebay –not capsules. http://shop.ebay.com/items/?_nkw=grapefrui...r&_osacat=0

These are natural anti-microbial supplements, so like antibiotics they kill bacteria. Take these during your course of antibiotics and for at least 1 month after. These will keep the bacteria from overgrowing while the glutamine is repairing your gut so that it can defend itself again.

I use the ready grated ginger in vinegar that you get in a jar for cooking with (in the condiments aisle). It tastes really sharp at first but I actually learned to enjoy it. You could buy root ginger and grate it yourself if you don’t mind. Fresh garlic does the same if you can stomach it (I can’t!), but I don’t think ‘odourless’ garlic tablets do anything.

Putting the whole thing together.

Antibiotics for 10 days
Take the antibiotics with food as the antibiotics only work when the bacteria are feeding/reproducing (Pimentel page 76).

Each morning eat 1 large dessert spoonful of Glutamine in a bowl of porridge oats with lactose free milk. Glutamine is highly soluble so drinking in water alone will mean that it gets absorbed early in the digestive tract. The oats transport it through the whole length of your small intestines.

Drink grapefruit seed extract in water (approx 15 drops in half a pint of water – I usually put a few extra drops more than on the instructions.... enough to taste the sharp taste of grapefruit) 3 times per day and also with your lunch and dinner (drinking it with food helps attack the bacteria when they are feeding and also helps transport the liquid through your intestines rather letting it absorb early).

Eat some fresh grated ginger before and after each meal including breakfast – about as much as you can pinch between your thumb and finger (this has a very very strong effect on SIBO. I take ginger root supplements as well for good measure – but I don’t think they’re as good as fresh ginger.

Take some more glutamine in the evening 2 heaped teaspoons in a non-probiotic dessert – I used non-probiotic Alpro soya desserts (beware of probiotic Alpro – with added bacteria). Remember bacteria /probiotics are bad – I tried the glutamine in normal bio-yoghurt but my symptoms got worse again.

Continue the glutamine/ginger/grapefruit seed extract for 1 month after stopping the antibiotics. This will keep the SIBO at bay while the glutamine works to repair your gut, and allows your digestion to defend itself. Avoid sweetners and sugars as much as possible, during this month.

Right now I am off the ginger and grapefruit seed extract and my bowl movements have been solid and daily for 3 weeks. I'm going to keep taking the glutamine in my oats until my supply runs out, but I'm pretty sure I'm cured now.

I am personally staying off the probiotics forever (I don't think taking bacteria in that form and numbering in their billions is either healthy or necessary). I am also going to stay off the yoghurt for at least 6 months. If you take anything away from reading this its that the small intestine doesn't work with bacteria and a bacterial overgrowth can't be fixed with more bacteria! I can't stress this enough! Throw away your probiotics!

That’s it. Hope this helps somebody.

Good luck
Kevin.



Added 20/6/09

Here are details of my 5 failed attempts at beating SIBO:

1. Rifaximin 400mg 3 times per day for 7 days probiotics immediately after
Initial good results, got solid regular bowel movements by about day 3. IBS-D symptoms came back 2 days after stopping.

2. Rifaximin 400mg 3 times per day for 10 days probiotics immeidately after
Initial good results, got solid regular bowel movements by about day 3. IBS-D symptoms came back 2 days after stopping.

4. Rifaximin 600mg 3 times per day for 14 days + LOTS of probiotics, Yackhult, natural yoghurt
No change - the rifaximin was totally ineffective

5. Rifaximin 400mg + Neymycin 1000mg Co-amoxiclav (Augmentin) 500/125mg 3 times per day- probiotics immediately after
Good results whilst on the medication, symptoms returned almost immediately

6. Ciproflaxin 500mg, Rifaximin 600mg, Neomycin 1000mg, all 3 times per day for 12 days Plus grapefruit seed extract, fresh ginger, glutamine.
Very watery diareeha started about 3 days into the treatment. I persisted because allthough it was very watery, it was perfectly digested (no traces of food). I also felt a lot better, and had a lot more energy and could sleep better, so I stuck with it. The watery diareeha continued for over a week after the end of treatment. I continued to take the grapefruit seed extract, ginger and glutamine. I assumed that I had " Antibiotic associated diareeha" due to the amount of antibiotics I had taken, so I took 500mg of Flagyl (Metronizodole) 3 times a day. The diareeha stopped after 2 days, continued with Flagyl for 7 days. Had perfect, regular digestion since. Did not take any probiotics."

Original Link:

http://www.ibsgroup.org/forums/index.php?/topic/102286-after-5-relapses-now-c...

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