A reader wrote with positive results:

“Ever since I developed Sjogren’s,  I started researching a method to get back to normal.  One of the more interesting studies in Pubmed I came across was the use of Vancomycin to manipulate the gut biome for autoimmune recovery, so naturally, I had to try this.
https://www.ncbi.nlm.nih.gov/pubmed/11083284

  Since Vancomycin pretty much stays in the gut similar to Rifaximin, it tends to be safer than most other antibiotics, so I decided to use 250 mg 4 times daily for 14 days, as per a study that was recently run by NYU in another autoimmune related study.”

• “Vancomycin became available for clinical use >50 years ago but was soon discarded in favor of other antibiotics that were deemed to be more efficacious and less toxic.” [2006 – full text, review of the history of vancomycin]
  • “Prior to its release, vancomycin was used to treat an entity called “postoperative micrococcal colitis” [2]. The response to vancomycin was excellent, and the presence of this disease, also called “acute staphylococcal ileocolitis,” became an indication for the use of vancomycin [29]. Although Clostridium difficile is the primary agent of pseudomembranous enterocolitis, Staphylococcus aureus is clearly an occasional cause of the disorder [30]. Because vancomycin is active against both pathogens and is poorly absorbed from the intestinal tract, it became the drug of choice for treating pseudomembranous enterocolitis [31]”
  • “With the increased use of vancomycin came data suggesting that vancomycin might not be equivalent to β-lactams.”
• “[In Rats] Vancomycin significantly altered the microbiota, which was restored to control levels by 8 weeks of age. Notably, vancomycin-treated animals displayed visceral hypersensitivity in adulthood without any significant effect on anxiety responses as assessed in the elevated plus maze or open field tests... a temporary disruption of the gut microbiota in early-life results in very specific and long-lasting changes in visceral sensitivity in male rats, a hallmark of stress-related functional disorders of the brain-gut axis such as irritable bowel disorder.” [2014]
  • Visceral hypersensitivity means a general increase in pain sensation experienced in internal organs. It is common in IBS sufferers. [source]
• “In patients experiencing an acute episode of recurrent Clostridium difficile infection (CDI), a single Fecal transplantation by enema was not significantly different from oral vancomycin taper in reducing recurrent CDI. ” [2017] – in other words, it may be as effective as a fecal transplant… more studies are needed.
  • “To date fecal transplant cures Clostridium difficile infections with more efficacy than vancomycin, and prevents recurrence.” [2015]
• Short- and long-term effects of oral vancomycin on the human intestinal microbiota [2017]. FULL TEXT
  • “oral vancomycin remains the treatment of choice for severe C. difficile infection (CDI). Despite its effectiveness against CDI (cure rate of ∼90%),”
  • “microbiota alterations induced by vancomycin may promote intestinal colonization by other pathogens, including VRE, Klebsiella pneumoniae or Escherichia coli.¹⁰Moreover, oral vancomycin therapy may predispose to other microbiota-related disorders, including obesity, asthma or diabetes.^7,11,12“
  • “By contrast, microbiota richness was greatly reduced upon vancomycin administration. Following antibiotic cessation, microbiota richness gradually increased, although it never recovered to baseline levels. A similar result was obtained when the Shannon diversity index was calculated (Figure 1c and Figure S3), which takes into account the number of OTUs and their relative proportion. In this case, however, baseline levels were recovered 22 weeks after antibiotic withdrawal.”

Bottom Line

Vancomycin seems close to doing a disk format and re-install of the operating system on a PC. You need to reinstall all of your programs (i.e. populate with probiotics) — unfortunately you no longer have most of the installation disks….

If you do use Vancomycin, I would strongly suggest having as many human-sourced probiotics as possible on hand, and start them 2-6 days after the last dosage, for example:

• Symbioflor-2
• Mutaflor
• Lactobacillus Fermentus ME3
• Biogaia Lactobacillus Reuteri
• Enterococcus faecium SF68

As well as these SBO

• Prescript Assist
• General Biotics Equilibrium

A reader posted on facebook

” Hi Ken, have you heard anything about L. Salivarius being bad for CFS patients? I’m trying Custom Probiotics d-lactate-free formula at the moment. There’s a patient on the PhoenixRising forum who believes L. Salavirus permanently worsened their condition, and also claimed it can destroy beneficial bacteria a la antibiotics. Have you ever read anything along these lines?”

First thing is simple: L. Salivarius does kill other bacteria – the questions is whether it kills the good ones or the bad ones (or kills randomly!). The “antibiotic” that it produces is called a bacteriocin. “bacteriocins are being tested to assess their application as narrow-spectrum antibiotics.^[1]“

This may depend on the strain — unfortunately, the strain is often not put on to many commercial probiotics.

• “an up-to-date overview of all L. salivarius strains, isolated from different origins, known as bacteriocin producing and/or potential probiotic.” [2013], from the complete article:
  • … are producers of unmodified bacteriocin of subclasses IIa,IIb and IId…
  • inhibits … Bacillus, Listeria, Enterococcus and Staphylococcus
  • .. against Lactobacillys delbrueckii subsp bulgaricus (used in many yogurts)
  • .. against Enterococcus faecalis, E. faecium and Neisseria gonorrhoeae
  • .. against S. mutans, Streptococcus pneumoniae, Staphylococcus aureus, micrococcus flavus and Salmonella enteritidis
  • … against Campylobacter jejuni
  • .. active against more phylogenetically divergent Gram-positive bacteria and occasionally against Gram-negative bacteria.
  • … against L.monocytogenes…
  • Antibiotic susceptibility profiles showed that the strains of L. salivarius were sensitive to the majority of antibiotics tested..
  • … induces Interleukin (IL)-10… IL-6
    • IL-10 is low in CFS patients [2015] and “CFS/ME patients displayed significant increases in IL-10″[2011]
    • “while low levels of IL-6 suggested early ME/CFS, the reverse was true in subjects over 18 years of age ill for more than 2 years.” [2016]

Studies on CFS/IBS/FM?

• On CFS – Zero
• On fibromyalgia – Zero
• On Irritable Bowel Disease
  • Effects of Lactobacillus salivarius 433118 on intestinal inflammation, immunity status and in vitro colon function in two mouse models of inflammatory bowel disease[2008]. “the data therefore suggest that this Lactobacillus subsp. has limited potential as a prophylactic or therapeutic treatment for inflammatory bowel disease”

Bottom Line

There is no evidence that Lactobacillus salivarius is of any benefit to CFS/FM/IBS/IBD. Within the family is a wide spectrum of bacteriocins – and the lack of positive effects suggests that it does not invoke a shift that is desirable for these conditions. There is reasonable evidence that the report forwarded by a reader may be accurate/true.

I would rank lactobacillus salivarius as a “to be avoided” probiotic.

A reader contacted me about her blood pressure changing significantly from day to day. I said that I would research and prepare a summary of what is known. High blood pressure is known as hypertension and means pressure over 140. Hypotension is the medical term for low blood pressure (less than 90/60).

• ” the mean values for the left ventricular end-diastolic diameters, stroke volume index, and cardiac index as well as the mean blood pressure were all significantly smaller in the ME group than in the Controls.” [2016]
• “As many as [CFS] 50 participants were randomised; mean age 49 (SD 13) years,…. mean baseline office blood pressure 128/78 (18/12) mmHg” [2015] i.e. 17% was over 146.
• ” CFS-POTS patients experienced significantly lower baseline diastolic blood pressure (P = 0.002), significantly higher heart rate and lower pulse pressures at each standing measurement.” [2014]
  
• “psychological stress contributes …..heart rate, systolic and diastolic blood pressures, and plasma levels of noradrenaline and adrenaline increased during the interview” [2013]
• “Serotonin and noradrenaline reuptake inhibitors… elevated blood pressure” [2013]
• “objectively measured abnormalities of blood pressure variability in CFS and that these abnormalities have the potential to be a bedside diagnostic tool.” [2012]
• Elevated nocturnal blood pressure and heart rate in adolescent chronic fatigue syndrome [2011].
• ” In the control group, but not in the [FM] patients, blood pressure was inversely associated with mental performance. This finding is in line with the well known cognitive impairment in hypertension. The lack of this association in FMS confirms previous research showing aberrances in the interaction between blood pressure and central nervous function in the affected patients.” [2012]
• From 2012
  
• “The present results extend on our previous work with maximal exercise and show that CFS and CFS + FM differ in their responses to steady-state exercise.” [2012]
  
• Lower ambulatory blood pressure in chronic fatigue syndrome [2009]. “Compared with the control population, the CFS group had significantly lower systolic blood pressure (p < .0001) and mean arterial blood pressure (p = .0002) and exaggerated diurnal variation (p = .009). There was a significant inverse relationship between increasing fatigue and diurnal variation of blood pressure in both the CFS and PBC groups (p < .05).”
• “Gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) patients had lower blood pressure, “[2015]
• “[With adolescents]At night (sleep), HR, mean arterial blood pressure and diastolic blood pressure were significantly higher in CFS patients as compared with controls (p < 0.01). During daytime, HR was significantly higher among CFS patients (p < 0.05), whereas blood pressures were equal among the two groups.” [2011]
  • “CFS in adolescents is characterized by reduced systolic blood pressure variability” [2011]

Treatment

• “There is limited moderate evidence supporting Far  Infra Red Saunas efficacy in normalizing blood pressure”[2009] see this post on Infrared Saunas.
• “cardiovascular effects of probiotics Lactobacillus fermentum CECT5716 (LC40), or L. coryniformis CECT5711 (K8) plus L. gasseri CECT5714 (LC9) (1:1) …exert cardiovascular protective effects in genetic hypertension ” [2015]

Bottom Line

Recording blood pressure and pulse is a should do for CFS/FM patients. You should record daily at the same time and average the week to observe any trends. There can be significant variation from day to day.  If you are able to do some light steady exercise daily, you should also record the blood pressure every 4 minutes during the exercise(use the above charts for reference). Blood pressure should go up if a treatment is successful.

I found this probiotic writing my post on Lactose Intolerance .  There were some interesting characteristics of it, so I thought a deeper dive was warranted. It is also known as  Lactobacillus acidophilus strain LA1.

• The effects of the DDS-1 strain of lactobacillus on symptomatic relief for lactose intolerance – a randomized, double-blind, placebo-controlled, crossover clinical trial [2016]. “The DDS-1 strain of Lactobacillus acidophilus, discovered in 1959 by Dr. Khem Shahani at the University of Nebraska, is a unique strain of L. acidophilus on deposit with the FDA Agricultural Research Service (ARS) with the catalog number B-3208. It is currently manufactured by Nebraska Cultures, Inc. A recent study demonstrated the DDS-1 strain of L. acidophilus to be superior to other strains of lactobacillus in the ability to establish in the human gastrointestinal (GI) tract [43]…can provide symptom benefit compared with placebo among individuals who consume the product for a course of 4 weeks.”
• ” LA1 induced the production of higher levels of IL-1 alpha and TNF-alpha than other lactobacilli and bifidobacteria.” [1997] Both IL-1 and TNF-alpha are HIGH with CFS so not a good choice. [1999] [2012]
• “These results do not support a beneficial effect of Lactobacillus acidophilus strain DDS-1 and Bifidobacterium longum strain UABL-14 on plasma lipids” [2008]
• “The administration of a probiotic mixture containing L. acidophilus DDS-1, B. lactis UABLA-12, and fructo-oligosaccharide was associated with significant clinical improvement in children with atopic dermatitis  (AD), with corresponding lymphocyte subset changes in peripheral blood. The efficacy of probiotic therapy in adults with AD requires further investigation.” [2010]

Bottom Line

This “best of class” lactobacillus acidophilus is NOT what you want to take with CFS or any condition with high TNF-Alpha or IL-1.  My ongoing advice to avoid all lactobacillus acidophilus appears to have some basis.

I have known chronic fatigue syndrome (CFS) patients that prior to CFS had no problem with lactose. As CFS progressed they became intolerant.

In reviewing PubMed Studies, I found that CFS patients with lactose intolerance was excluded from some studies of CFS [2002]. Other papers report overlap of IBS and LI [2005]. A 2011 study summarized it nicely “Substantial overlap of symptoms and comorbidities occur not only between irritable bowel syndrome and other functional gastrointestinal disorders but also with gastrointestinal disorders that are not related to motility (eg, celiac disease and lactose intolerance) and to somatic conditions (eg, fibromyalgia and chronic fatigue syndrome).” [2011]

Lactose intolerance as a result of a persistent shift of gut bacteria appears consistent.

“Lactose malabsorption and milk products intolerance symptoms are the most common alimentary tract disorders. Lactose intolerance is a result of lactase deficiency or lack of lactase and lactose malabsorption. Three types of lactase deficiency were distinguished:

• congenital,
• late-onset lactase deficiency and
• secondary lactase deficiency.

Lactose intolerance means the appearance of clinical gastrointestinal symptoms after ingestion of lactose. To the clinical symptoms of lactose intolerance belongs: nausea, vomiting, abdominal distension, cramps, flatulence, flatus, diarrhea and abdominal pain.” [2009]

“All the patients with lactase deficiency(LD) were detected to have small intestinal (SI) bacterial overgrowth (BOG). An inverse correlation was found between LD and the degree of SI BOG (r = -0.53; p < 0.001). 73.7% of the patients with moderate LD showed a positive effect of probiotic therapy ….. No improvement occurred in 73.8% of the patients with severe LD.”[2015]

“secondary lactase deficiency (SLD) was detected in 59.4% of patients with postinfectious IBS [i.e. IBS resulted from an infection]. Mild SLD was determined in 43.5% of patients, and severe SLD – in 15.9% of patients.” [2012]

• “lactase deficiency (LD) was identified in 36.5% of the patients with PI-IBS. There was an inverse correlation between the degree of LD and SI BOG. The good therapeutic effect of probiotics in LD suggests that the symbiotic gut microflora positively affects the activity of lactase in the human SIM. No therapeutic effect of probiotics in patients with severe LN serves as the basis for a search for more active probiotic therapy.” [2015]

“The majority of people with lactose malabsorption do not have clinical lactose intolerance. Many individuals who think they are lactose intolerant are not lactose malabsorbers.” [2010]

“A recent meta-analysis permitted to show that almost all lactose intolerants tolerate 12 g of lactose in one intake and approximately 18 g of lactose spread over the day.” [2015]

“In spite of public knowledge and advertising, controlled studies did not prove the beneficial effect of either a lactose-free diet, enzyme supplementation or probiotics in an evidence-based manner.” [2015]

” Most individuals with LI can tolerate up to 12 grams of lactose, though symptoms became more prominent at doses above 12 grams and appreciable after 24 grams of lactose; 50 grams induced symptoms in the vast majority. A daily divided dose of 24 grams was generally tolerated. We found insufficient evidence that use of lactose reduced solution/milk, with lactose content of 0-2 grams, compared to a lactose dose of greater than 12 grams, reduced symptoms of lactose intolerance. Evidence was insufficient for probiotics (eight RCTs), colonic adaptation (two RCTs) or varying lactose doses (three RCTs) or other agents (one RCT). Inclusion criteria, interventions, and outcomes were variable. Yogurt and probiotic types studied were variable and results either showed no difference in symptom scores or small differences in symptoms that may be of low clinical relevance.” [2010]

A 2004 article recommends DNA testing “Attention should be paid to appropriate interpretation of genetic detection in order to avoid potentially harmful reduction in dairy intake or misdiagnosis of secondary lactase deficiency.”  ” These are C/T 13910 and G/A 22018 substitutions.”[2009] “The LCT(T/C-13910) polymorphism is associated with subjective milk intolerance, reduced milk calcium intake,” [2004]

Treatment

• ” The results indicated a definitive change in the fecal microbiome of lactose intolerant individuals that were clinically responsive to dietary adaptation to short chain galacto-oligosaccharide (GOS), named RP-G28″[2013]
• ” in 1996, 20 people, with various ethic backgrounds, and who were all poor at digesting lactose, were randomly assigned to take either a small dose of lactose or one of dextrose, a different sugar, for 10 days… Encouraging, the course of small lactose doses did improve tolerance: after the 10-day course of lactose,” [1996]
  • Thus complete avoidance as was advocated for peanuts (the common belief) is likely not ideal
  • ” In the absence of guidelines, the common therapeutic approach tends to exclude milk and dairy products from the diet. However, this strategy may have serious nutritional disadvantages. Several studies have been carried out to find alternative approaches, such as exogenous beta-galactosidase, yogurt and probiotics for their bacterial lactase activity, strategies that can prolong contact time between enzyme and substrate delaying gastrointestinal transit time, and chronic lactose ingestion to enhance colonic adaptation.” [2009]
• The effects of the DDS-1 strain of lactobacillus on symptomatic relief for lactose intolerance – a randomized, double-blind, placebo-controlled, crossover clinical trial [2016]. “The DDS-1 strain of Lactobacillus acidophilus, discovered in 1959 by Dr. Khem Shahani at the University of Nebraska, is a unique strain of L. acidophilus on deposit with the FDA Agricultural Research Service (ARS) with the catalog number B-3208. It is currently manufactured by Nebraska Cultures, Inc. A recent study demonstrated the DDS-1 strain of L. acidophilus to be superior to other strains of lactobacillus in the ability to establish in the human gastrointestinal (GI) tract [43]…can provide symptom benefit compared with placebo among individuals who consume the product for a course of 4 weeks.”
  • ” Treatment of lactose-maldigesting subjects with and without hypochlorhydria with Lactobacillus acidophilus BG2FO4 for 7 d failed to change breath-hydrogen excretion significantly after lactose ingestion.” [1999] – so it is strain specific
• “In lactose intolerants, tilactase strongly improves both LBT results and gastrointestinal symptoms after lactose ingestion with respect to placebo. Lactobacillus reuteri also is effective but lesser than tilactase.” [2010]
• “Feeding yogurt that was pasteurized following fermentation, with only trace amounts of microbial beta-galactosidase activity, results in a threefold increase in lactose malabsorption as compared with feeding yogurt with a viable culture.” [1987]
  • “There is a poor correlation between lactose maldigestion and intolerance; in some studies,” [2001]
• Beneficial effects of long-term consumption of a probiotic combination of Lactobacillus casei Shirota and Bifidobacterium breve Yakult may persist after suspension of therapy in lactose-intolerant patients [2012]. “Four-week consumption of a probiotic combination of L casei Shirota and B breve Yakult seems to improve symptoms and decrease hydrogen production intake in lactose-intolerant patients. These effects may persist for at least 3 months after suspension of probiotic consumption.”
• “Sixty patients with moderate secondary lactase deficiency (SLD) were randomized to 2 groups: 1) 41 patients received basic therapy (mesim forte as one tablet t.i.d., no-spa, 40 mg, t.i.d.) and combined probiotic bifiform (Ferrosan) containing Bifidobacterium longum 107, Enterococcus faecium 107 as one capsule t.i.d. for 14 days….After a 14-day course of therapy with the combined probiotic bifiform, restoration of eubiosis in the small bowel lumen was achieved in 70.8% of the patients,” [2013]
• “the probiotic Bifiform, composed of Bifidobacterium longum 10(7) and Enterococcus faecium 10(7), demonstrated efficiency in correction of mild SLD in patients with postinfectious IBS and can be used to prevent SIBO.” [2012]

Vitamin D and LI

• A relationship between vitamin D, parathyroid hormone, calcium levels and lactose intolerance in type 2 diabetic patients and healthy subjects [2016]. “levels of plasma 25-OH vitamin D (total), parathyroid hormone and serum calcium were more decreased in lactose intolerant diabetic patients than lactose tolerant patients. Sixty seven percent (67%) of diabetic patients suffered from osteoporosis and 20% of controls. Eighty percent (80%) diabetic patients and 16% controls with osteoporosis suffered from lactose intolerance.”

Bottom Line

There is weak evidence that Lactobacillus Reuteri, Lactobacillus casei Shirota (Yakult), Bifidobacterium Breve and  explicitly Lactobacillus acidophilus DDS-1 may reduce LI but will make CFS worst (increase TNF-alpha even higher). Ferrosan Bifiform has stronger evidence. It is surprising that relative few probiotics have been tested. The association with IBS suggests that IBS probiotics may also reduce LI: Prescript Assist, Mutaflor, Symbioflor-2, Align.

Vitamin D levels may play a role, and thus supplementation of 10-15000 IU of vitamin D should be discussed with your medical professional.

Complete lactose avoidance appears to be unnecessary, and may actually make LI worst.

Lactobacillus acidophilus DDS-1 is available as a single probiotic – read this post on it,