In today’s email I got this comment on my older post on Lactobacillus Acidophilus:
“When I eat alkaline vegetables (which are most vegetables), my urine smells badly of bacteria, like a dirty urinal, I get bladder discomfort and I constantly have to urinate (almost to the point of incontinence). Taking apple cider vinegar alleviates the situation but I have to stop eating veggies. Thus it’s been hard for me to take probiotics while eating a diet diverse in plant fiber …. It’s really frustrating because it seems impossible for me to do a probiotic regimen without lactobacillus….My CFS became really bad years ago after a high dosage of Levaquin so maybe I have some crazy dysbiosis. What do you think?”
I will not give advice of what to do — I am willing to assemble notes from my usual resources (which is hard to do for the brain fogged). I will attempt to create a model that fits the information.
Any conclusions from my notes should be discussed with your knowledgeable medical professional before starting.
Simple question: What bacteria may be involved?
- Levaquin (levofloxacin) is a fluoroquinolones [see this earlier post]
- Not effective against Staphylococcus aureus, bifidobacterium
- Effective against some E. Coli (per wikipedia)
- Effective against Lactobacillus
- greater activity towards Gram-positive bacteria( but lesser activity toward Gram-negative bacteria
- Urine smell,
- “The presence of bacteria in the urine, such as with a urinary tract infection (UTI), can affect the appearance and smell of urine. When there is an infection in the urinary tract, the urine may take on a foul-smelling odor as well as appear cloudy or bloody.” [medicinenet]
- “The E. coli strains causing recurrent UTI were identified in the periurethra of at least 75% of the women and in the urine of at least 35% 1 week prior to the onset of a new UTI.” 
The Levaquin killed off what was left of good E.Coli and you happen to have antibiotic resistant bad E.Coli. When you eat green vegetables, you are providing sulfoquinovose (see this post), which the bad bacteria thank you for and quickly multiple. Vinegar does inhibit pathogenic E.Coli . This same study found that vinegar and salt worked better than vinegar alone (hmmm…. Salt and vinegar — just add fish and chips 😉 . Glucose reduced the effectiveness of vinegar.
There are two ways of fighting E.Coli — antibiotics to kill it, or E.Coli probiotics to displace the bad E.Coli. I strongly favor the latter — the reader had tried various probiotics but did not list any of the following in the list:
- Symbioflor-2 : 6 E.Coli strains, one of which is documented to colonize and last for many weeks after a single dose.
- There have been no studies on it’s impact on UTI
- Mutafor – E.Coli Nissle 1917. There are several studies on PubMed
- Miyarisan – Clostridium butyricum
- “t dietary supplementation with C. butyricum promotes immune response, improves intestinal barrier function, and digestive enzyme activities in broiler chickens challenged with E. coli K88. There is no significant difference between the C. butyricum probiotic treatment and the colistin sulfate antibiotic treatment.”  
- Ability of Clostridium butyricum to inhibit Escherichia coli-induced apoptosis in chicken embryo intestinal cells. 
Now, Lactobacillus also inhibits E.Coli.
The apparent issue is that you can control the bad E.Coli with Lactobacillus. The challenge of needing to replace them with good E.Coli. You can kill off some of the bad E.Coli with antibiotics, but there are two issues to consider:
- antibiotic resistant E.Coli
- what will replace them
Going the route of good E.Coli probiotics overwhelming them seem a better approach. First, use Miyarisan in increasingly large dosages (watch out for herx!) and then stopping, and 24 hrs later start with Symbioflor-2, again ramping off the dosage.