• A reader forward me a link to Bismuth for IBD and IBS-D study from Australia (2013 Full Text) which states:
  “Bismuth has antidiarrheal, antibacterial, and anti-inflammatory properties…Bismuth is minimally absorbed and so has negligible potential for toxicity in patients with normal renal function. Any absorbed bismuth is mostly excreted in urine unless renal function is severely impaired…. Although many of these disease entities are known to have spontaneous remissions and relapses, it seems unlikely that the unremitting diarrhea in some of our study patients lasting for months to years, despite being on standard treatment, would suddenly settle in its natural course when bismuth was initiated. “
• They used oral colloidal bismuth subcitrate (CBS) – used in De-nol and Pylera
  • Pepto-bismol is bismuth salicylate.

So what more do we know about bismuth?

• ” It is concluded that all patients with irritable bowel syndrome and diarrhea show altered composition of intestinal microflora, morphological signs of moderate chronic inflammation of intestinal mucosa. Most of them have apparent bacterial activity. Treatment with de-nol [bismuth tri-potassium di-citrate] and spasmolytics for 3 weeks effectively eliminated clinical manifestations of the disease, restored normal composition of intestinal microflora, normalized faeces properties, and resolved active inflammation.” [2008]
• Bismuth(III) deferiprone effectively inhibits growth of Desulfovibrio desulfuricans ATCC 27774 [2016].
• “BISMUTH SUBSALICYLATE

  Bismuth subsalicyclate (BSS) has been shown to provide up to 65% protection against TD when taken as 2 tablets 4 times per day for a maximum of 3 weeks.²⁵ It is usually well tolerated in young healthy adults. However, clinicians must warn travelers about blackening of the stool or tongue when taking this drug. BSS can decrease absorption of doxycycline, which may be used concomitantly for malaria prophylaxis.²⁶ A careful review of the traveler’s medication list should be performed to look for potential drug-drug interactions. Although BSS provides moderate protection against TD, the need for frequent administration decreases the overall compliance and makes it a less attractive choice for most travelers.” [2016]

  • “The percent protection provided by BSS was 62% for the group that received 4.2 g/d, 65% for 2.1 g/d, and 40% for 1.05 g/d, when compared with the corresponding placebo group.” [1990]
• Mitigation of in vitro hydrogen sulfide production using bismuth subsalicylate with and without monensin in beef feedlot diets [2015].
• Saccharomyces boulardii and bismuth subsalicylate as low-cost interventions to reduce the duration and severity of cholera [2015].
• Antimicrobial activity of bismuth subsalicylate on Clostridium difficile, Escherichia coli O157:H7, norovirus, and other common enteric pathogens [2015]. “Collectively, our results confirm and build on existing data that BSS has antimicrobial properties against a wide-range of diarrhea-causing pathogens.”
• Effect of licorice versus bismuth on eradication of Helicobacter pylori in patients with peptic ulcer disease[2014].  “Our study showed that licorice is as effective as bismuth in H. pylori eradication; therefore, in patients whom bismuth is contraindicated, licorice can be used safely instead.”
• Inadvertent exaggerated anticoagulation following use of bismuth subsalicylate in an enterally fed patient receiving warfarin therapy [2013].

Bottom Line

We see above that 2.1 g/day of Pepto-bismol (BSS) appears to be the minimal effective dosage for altering the risk of traveler’s diarrhea (and thus effective protection against some bacteria shifts).

There appears to be significant evidence that it may reduce some symptoms of CFS/FM/IBS in a subset of patients and thus should be discussed with you medical professional. The duration of many studies appear to be approximately 4 weeks.

As always, consult with your medical professional before adding or changing medications.

Another reader have had good results from Symbioflor-1 with Symbioflor-2, but not taken in the usual way. A reader messaged me with an approach that he found on another site and the results.

21 MARCH

22 MARCH

27 MARCH

Ken, myreport:

It has been 5 days with symbioflor 2 enemas.

So far so good

• Bloarting decreasing
• Perfect stools, dark coloures

Ive been taking 80 drops in enema

However one side effect. I freezeing with cold hands soon after. Maybe cause the probioitic is getting down my blood pressure

1 APRIL

hmmm..Started one week ago with symbioflor 2 enemas, same benefits and no counter indications (low blood temperature when increasing doses and anxiety at mega doses (80-100 groups at one shot). But don’t know if its due to poor methylation (im digging into this thx to …  ), the effect of too much serotonin due to high intake of e.coli…die off and not handling it well..

i have not been retest but , in terms of gut symptoms, I’ve been the best in 10 years since i got sick…Im right now with 4 mutaflor before sleep (only gives me the best effect at this hour)..and the symbioflor 2 enemas…

also i am able to deal with H2S , hydrogen sulfide, if taking enteric coated alkaline the first thing in meals…No signals of burping H2S (even when eating carbs)

---

 The liquid nature of these probiotics simplifies their use in enemas. The German site listed is for a professional group of MDs in Germany and Austria that have been active since 1953. This site contains a list of probiotics available in those countries that the group uses .

Some of those listed on this site, like Symbioflor-1, Symbioflor2,  Symbiolact B (Bifidobacterium bifidum, Bifidobacterium animalis subsp lactis) is available from Paul’sMart- Europe. P.S. We have ordered from them for delivery to the US with no problems (with US Customs — so far).

A reader who just received a chronic Lyme diagnosis forwarded his KyberKompakt results (done in Spain).  Prior to doing this test he was on Prescript Assist and Equilibrium for  two months.

For reference, see other reports shared — Nov, 2016, Feb 2017, Mar 2017

• E. Coli is low normal range.
• Entercoccus spp is very low
• Other proteolytic microorganisms – High
• Bifidobacterium spp low
• H202 Lactobacillus low
• Faecalibacterium prausnitzii low
• Akkermansia muciniphila low
• Candida albicans high
• Lactobacillus spp — low normal

All of these 4 reports have the same pattern for almost all.  Variation are one below the bottom of the normal range, and another is at the bottom of the normal range. Entercoccus spp is the exception with 3 being very low and 1 being very high.

Compare to the other 3 results, this patient had:

• Highest Bifidobacterium
• Highest E.Coli
• 2nd highest Lactobacillus

While there is no direct evidence that this is caused by Prescript Assist and Equilibrium (i.e. we would need to have a before lab results), I favor this as an explanation of the better results.

The patient is about to start with Symbioflor-1 (Enterococcus faecalis) in the hope of raising the low Enterococcus faecalis. Since the E.Coli is in the low normal range, I would suggest discussing taking Symbioflor-2 with Symbioflor-1 with their medical professional. The two appears to amplify each other.

The high other proteolytic microorganisms (Proteolysis is the breakdown of proteins into smaller polypeptides or amino acids [wikipedia]) is likely causing a shift of metabolities (chemicals) which cause symptoms and cascade elsewhere in the body. Neem and Tulsi may be reasonable supplements to experiment with to reduce those.

Concerning low  Akkermansia muciniphila there is just over 100 articles on PubMed. This increases with a high fat diet with Capsaicin (Chili peppers!)  [2017]. It is not available as a probiotic (but being considered) [2016]

• Pili-like proteins of Akkermansia muciniphila modulate host immune responses and gut barrier function [2017].
  • Akkermansia muciniphila improves metabolic profiles by reducing inflammation in chow diet-fed mice[2017].
• Pomegranate ellagitannins stimulate the growth of Akkermansia muciniphila in vivo [2017].
  • Pomegranate extract induces ellagitannin metabolite formation and changes stool microbiota in healthy volunteers[2015].
• “Supplementation with rhubarb extract changed the microbial ecosystem (assessed by 16S rDNA pyrosequencing) in favor of Akkermansia muciniphila” [2017]
• Aguamiel concentrate from Agave salmiana and its extracted saponins attenuated obesity and hepatic steatosis and increased Akkermansia muciniphila in C57BL6 mice [2016].

Hmm…. Rhubarb and pomegranate pie with chili peppers!!/?!!

There is a subset of CFS/IBS/FM patients that are histamine sensitive.  The probable cause according to the model is overgrowth of histamine producing bacteria, for example, some (not all) strains of Escherichia coli ,Lactobacillus sp., Proteus morganii, Proteus sp. , Pseudomonas reptilivora and Streptococcus sp.   With CFS we see massive overgrown of bacteroidetes — the species that tag-team to cause this to happen, vary from patient to patient.

A reader asked about antibiotics and histamine interactions. That is a good question which I have not attempted to research and very relevant if you have a MD willing to prescribe antibiotics AND have histamine issues.

Drug allergy syndrome may be connected to the drug impact on histamines. “When oral tolerance tests were performed, only doxycycline was tolerated whereas levofloxacin, clarithromycin, nimesulide and tramadol caused mild urticaria [ hives]” [2007]

• Fosfomycin Tromethamine  – “…suppressed the release of histamine in a dose-dependent manner…We concluded that some antibiotics, particularly fosfomycin, have the capacity to suppress histamine release mediated by various secretagogues, suggesting they may possess an anti-allergic property as well as a bactericidal activity. ” [1987]
• Polymyxin B  ( derived from the bacterium Bacillus polymyxa.) “…suppressed the release of histamine in a dose-dependent manner. ” [1987]

Tetracyclines

• Tetracyclines reduces histamines [2005]
• Minocycline reduces histamine [2011]
  • “…suppressed the release of histamine in a dose-dependent manner. ” [1987]
• Doxycycline reduces histamine [2014]

Macrolides

• rapamycin – “Bouts of scratching induced by the histamine-dependent… were significantly reduced” [2015]
• Inhibitory action of roxithromycin on histamine release and prostaglandin D2 production from beta-defensin 2-stimulated mast cells[2009].

Beta-lactams

• “beta-lactams and aminoglycosides, none had the capacity to enhance antigen-induced histamine release,” [1987]

Aminoglycosides

• “beta-lactams and aminoglycosides, none had the capacity to enhance antigen-induced histamine release,” [1987]

Cephalosporin

• Cefaclor etc – appears to increase histamine [2015]

Penicillin

• Amocixillin —Anti-Amoxicillin Immunoglobulin E, Histamine-2 Receptor Antagonist Therapy and Mast Cell Activation Syndrome Are Risk Factors for Amoxicillin Anaphylaxis [2015].
• “penicillin treatment directly elicited rapid histamine release.” [2016]

Fluoroquinolones

• “levofloxacin…  induces histamine release from the connective tissue-type mast cells distributed mainly in the liver, somewhat in the cutaneous tissue, through the activation of pertussis toxin-sensitive G proteins.” [2001]

Bottom Line

This is an incomplete list but does cover some common families of antibiotics. If there are additional ones that you wish be to research, just add a comment to this post!

Two of the families of antibiotics (tetracycles and macrolides) that inhibits histamine release are very important in Dr. Jadin’s protocol.

A reader forwarded the above test and ask for comments. It is a nice test for the brain fogged because information is presented with graphics and reference controls (CTRL) patients results

The first chart illustrates what many studies report, a major shift of the ratio of bacteroidetes to firmicutes. “patients presented … a decrease in several Firmicutes populations.” [2013][Full Text] This is the general pattern seen with CFS and IBS patients at the highest level. The breakdown under this is where things change with symptoms. Biodiversity decreasing or being normal appears to vary according to how it is calculated.

• “in the stool samples there was a higher relative abundance of Bacteroidetes and lower abundance of Firmicutes observed in ME/CFS patients compared to healthy controls.” [2015]
• “IBD patients have increased bacteroides, adherent or invasive Escherichia coli, and enterococci, and reduced Bifidobacteria and Lactobacillus species”.^[40][Medscape]

CFS is one step towards UC and Crohn’s Disease.. “In chronic fatigue syndrome patients they found bacterial profiles with less diversity. This is similar to those seen in people with two bowel diseases: Crohn’s disease and ulcerative colitis, the researchers said.”

The second chart show several families that are overgrowths. This is followed by a chart looking at specific elements. Notice that often one column is 0 and the other is not, that is, what is normal is not there and what is usually not found, is there.[Cornell University]

So what should be consider for treatment? It is clear that we want to increase Firmicutes. There are more than 270 genera in it, some of these are Lactobacillus, Bacillus, Clostridium, Staphylococcus.   The bottom line is that there are no available probiotics for most of these.

There appear to be some relationships to work from:

• Taking Lactobacillus, increases Lactobacillus and decreases E.Coli and Bifidobacteria in general [2012]
• Taking Bifidobacteria, increases Lactobacillus and Bifidobacteria, decreases E.Coli slightly [2012]
• Taking E. Coli, increases Lactobacillus and Bifidobacteria [2016]
• E.Coli and Enterococcus probiotics taken together cause a bigger effect than E.Coli alone. (i.e. Symbioflor-2 and Symbioflor-1 taken together, or Mutaflor with Bioflorin)

Bacteria inhibit or encourages other families of bacteria. The relationships are complex and poorly understood — hence we need to both research and hope for data; if no data, experiment on ourselves (taking notes and sharing results — such as in the last post)