In my post summarizing survey results, coconut oil featured high. One form of coconut oil is monolaurin this I have mentioned in several posts. “Monolaurin is found in coconut oil and may be similar to other monoglycerides found in human breast milk.^[1]” 

So what is the difference? Coconut oil have additional active compounds which may come into play.

• Monolaurin has antibacterial, antiviral, and other antimicrobial effects in vitro.^{[2][3][4][5][6][7] Wikipedia}
• Monolaurin also shows promising effects against bacteria (both gram-positive and gram-negative), yeast, fungi, and protozoa. Bacteria including E. Coli,^[13]yeast including Candida alibcans,^[14] Helicobacter pylori (H. pylori),^[15] Giardia lamblia,^[16] Staphylococcus aureus (Staph),^[17] and other microbials have all been neutralized by monolaurin in scientific studies. [Wikipedia]
• Coconut oil alters the microbiome [1998]
• “we showed that adding coconut oil to the diet could become the first drug-free way to reduce Candida albicans in the gut.” [2015]
• fermented drinks from coconut palm, produced toxins against “Bacillus subtilis, Listeria monocytogenes, Listeria innocua, Streptococcus agalactiae, Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Salmonella typhimurium, and Salmonella spp” [2015]
• “In vivo, the groups receiving vancomycin, monolaurin, or the combination showed some protection–50-70% survival, whereas the protection from the coconut oils were virtually the same as control–0-16% survival.” [2013] – monolaurin seems superior.
• “In time-kill studies, lauric acid and monolaurin + lactic acid combinations added at their minimum inhibitory concentrations produced a bactericidal effect…n contrast, virgin coconut oil (10%) was not active against S. aureus.” [2012]
• “Monolaurin has statistically significant in vitro broad-spectrum sensitivity against Gram-positive and Gram-negative bacterial isolates from superficial skin infections. Most of the bacteria did not exhibit resistance to it.” [2007]
• “the minimum inhibitory concentrations for monolaurin were 25 microg/mL against Escherichia coli, 12.5 microg/mL against Staphylococcus aureus, and 30 microg/mL against Bacillus subtilis….The interaction with food components revealed that the antibacterial effectiveness of monolaurin was reduced by fat or starch while the monolaurin activity remained unchanged in the presence of protein. ” [2009]
• “Monolaurin was cidal to S. aureus and M. terrae but not to E. coli and K. pneumoniae. Unlike the other two gram-negative organisms, H. pylori were extremely sensitive to monolaurin. …Because of their longstanding safety record, … monolaurin, alone or combined with antibiotics, might prove useful in the prevention and treatment of severe bacterial infections, especially those that are difficult to treat and/or are antibiotic resistant.” [2005]
• Anti-inflammatory and antioxidant effect of Kerabala: a value-added ayurvedic formulation from virgin coconut oil inhibits pathogenesis in adjuvant-induced arthritis [2017]. “Kerabala (CB) is a novel ayurvedic formulation used for treating various inflammatory diseases. This formulation was made from virgin coconut oil and it comprises extracts of Sida cordifolia (Bala), coconut milk and sesame oil…has an antioxidant, anti-inflammatory and anti-arthritic activity in experimental arthritic model. CB as an anti-arthritic drug has beneficial effect for treating inflammation, tissue damage and pain associated with arthritis.”
• Antibacterial synergy of glycerol monolaurate and aminoglycosides in Staphylococcus aureus biofilms[2014].
• Inhibition of Bacillus licheniformis spore growth in milk by nisin, monolaurin, and pH combinations [1999].
• ” The most effective antimicrobial compounds against all morphological forms of the two tested Borrelia sp. [causing Lyme disease] were baicalein and monolaurin. ” [2015]
  • Inhibits doxycycline effectiveness against Lyme [2016]
  • “acted synergistically with gentamicin and streptomycin” [2014]
  • “In vivo, the groups receiving vancomycin, monolaurin, or the combination showed some protection–50-70% survival, whereas the protection from the coconut oils were virtually the same as control–0-16% survival.” [2013]

Bottom Line

• Monolaurin should definitely be used periodically, since it is similar to other monoglycerides found in human breast milk it likely has a significant impact on forming a healthy gut.
• Monolaurin should not be taken with fat or starch, including milk. Fats inhibits its effectiveness.
• Do not take bacillus probiotics at the same time.

Glutamine, an amino acid, has been cited in several studies dealing with CFS as an abnormality. For example, “zinc + glutamine.. was associated with highly significant reductions in initially increased IgM-mediated autoimmune responses” [2014][2008] and many studies for IBS.

• “Patients with higher Fibromyalgia Impact Questionnaire (FIQ) scores showed increased levels of glutamine …,” [2017]
• “Fibromyalgia patients exhibited a differential expression of 421 genes (p<0.001), several relevant to pathways for pain processing, such as glutamine/glutamate signaling and axonal development.” [2016]
• “In comparison with healthy controls, patients with FM showed higher levels of glutamate/glutamine (Glx) compounds” [2010] i.e. more glutamate than glutamine..
• ” Our results showed a significant reduction of glutamine (P=0.002) and ornithine (P<0.05) in the blood of the CFS samples." [2012]
• Reduced hippocampal glutamate-glutamine levels in irritable bowel syndrome: preliminary findings using magnetic resonance spectroscopy[2011].
• Dietary L-glutamine supplementation modulates microbial community and activates innate immunity in the mouse intestine [2014].
  • “In the jejunum, glutamine supplementation decreased the abundance of Firmicutes, while increased mRNA levels for antibacterial substances in association with the activation of NF-κB and PI3K-Akt pathways.”
  • “In the ileum, glutamine supplementation induced a shift in the Firmicutes:Bacteroidetes ratio in favor of Bacteroidetes, and enhanced mRNA levels for Tlr4, pro-inflammatory cytokines, and antibacterial substances participating in NF-κB and JNK signaling pathways. These results indicate that the effects of glutamine on the intestine vary with its segments and compartments.”

This effect is not desired:

• “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]

I was unable to find any published studies on glutamine supplementation of CFS/FM/IBS. In 2010, there was trial sponsored by NIH (link), but no apparent publication resulted (which implies no benefit was found, and could imply that it may have had a negative effect) – with 2015 status stating no study result posted.

Bottom Line

The available evidence suggests that glutamine supplementation may worsen the shift of bacteria seen in CFS/FM/IBS.  The absence of study results being posted suggests there were no positive results seen. In FM, higher levels are associated with worst symptoms. Conclusion: do not supplement with glutamine.

For early notes on other amino acid supplementation, see this post.

NOTE: if you have uBiome results, supplementing with glutamine may be good for some bacteria genus overgrowths. See this post . For example: Dorea, Pseudobutyribibrio and Oscillospira overgrowths

• 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!!/?!!