We often talk about fixing and restoring the microbiome. What does that actually mean?

I believe the ideal microbiome would be one seen in healthy 20 year olds. There are actually some studies of those (and younger individuals) too. “when an individual’s large intestinal gut microbiota has reached its stable climax community, it appears to be stable for a significant period of time as Faith and colleagues showed (200). This study followed 37 health adults and reported that after 5 years 60% of the original strains were still present.” [2015] In other words, about 8% of the strains disappear each year.

“Furthermore, centenarians had a different and less diverse microbiota than adults and younger elderly people.” [2015] – this suggests that a supplementation of a very diverse collection of probiotic species and families may slow aging. see The human intestinal microbiome at extreme ages of life. Dietary intervention as a way to counteract alterations[2014].

The article Role of the normal gut microbiota[2015] illustrates the multiple regions of the microbiome and how they are different.

The study below is on some healthy individuals in their 20’s.

Bifidobacterium

“B. longum and B. pseudocatenulatum, which are detected at levels of 10(7) CFU/g (wet) in samples and the detection rates are 90.48% [of study individuals] and 85.71% [of study individual] respectively. In addition, B. adolescentis, B. bifidum, B. infantis and B. thermacidophium have also been found.” [2005]

Lactobacillus

“L. mucosae, L. fermentum, L. salivarius, L. ruminis [Catenabacterium catenaforme], L. gasseri and L. plantarum are isolated from the stools. L. mucosae (3.68 log10 CFU/g (wet), detection rate 71.43%) and L. fermentum (3.97 log10 CFU/g (wet), detection rate 52.38%) are two dominant species of Lactobacillus.” [2005]

So, L. Acidophilus is NOT found!!!!!! It is found only in certain cultures/life styles/diets.

Infants Differences

“It has been reported that a ‘geographical gradient’ exists in the European infant microbiota where infants from Northern areas have higher levels of Bifidobacterium spp. and some Clostridium spp. and Atopobium spp., while Southern infants had a higher abundance of Eubacteria, Lactobacillus, and Bacteroides (50). Significant differences between the microbiota of Finnish and German infants (57) or between that of Estonian and Swedish ones (58) have been also reported.” [2015]

“Malawian infants had higher counts of lactobacilli than their Finnish counterparts (7.45 log cells/g vs 6.86 log cells/g, P < 0.001, respectively) and the Lactobacillus community was richer and more diverse in the Malawian infants. Leuconostoc citreum and Weissella confusa were the predominant species in both study groups… Moreover,

• Lactobacillus ruminis(59.1% vs 0.0%, P < 0.001),
• Lactobacillus gasseri (38.6% vs 9.7%, P = 0.004;),
• Lactobacillus acidophilus (29.5% vs 0.0%, P < 0.001;), and
• Lactobacillus mucosae (22.7% vs 3.2%, P = 0.017, ) were detected more often in the Malawian infants .
• Lactobacillus casei group species, however, were only detected in the Finnish infants.” [2015]

So Lactobacillus acidophilus is missing from the western infant gut (0.0%)!! So where do we get a Lactobacillus ruminis probiotic????

“Bifidobacteria were dominant at 6 months of age in all of the infants, although in greater proportions in Malawian (70.8%) than in Finnish infants (46.8%; P<0.001). Additional distinctions in bacterial group composition comprised

• Bacteroides-Prevotella (17.2% vs 4.7%; P<0.001) and
• Clostridium histolyticum (4.4% vs 2.8%; P=0.01), respectively. The species
• Bifidobacterium adolescentis, Clostridium perfringens, and Staphylococcus aureus were absent in Malawian but detected in Finnish infants.” [2012]

Bottom Line

We really do not know what a “restored microbiome” should be.  Diet impacts the microbiome. Environment impacts the microbiome. I suspect it should include significant of:

• B. longum – probiotic exists
• B. pseudocatenulatum – unknown
• L. mucosae, – unknown
• L. fermentum, – unknown
• L. salivarius – in a mixture L.Plantarum/Rhamnosus/Salivari 100c (F) Allergy Research
• L. ruminis – unknown
• L. casei – multiple probiotics for western life style.
• L. acidophilus – most common probiotic
• L. gasseri – multiple probiotics
• L. Reuteri – multiple probiotics
• L. plantarum – multiple probiotis

L. Gasseri is one of the species in BIFIDO|MAXIMUS, a Histamine-Free and D-Lactate Free Probiotic [20 Billion CFU of L. gasseri] which attempts to address two subsets of CFS patients. It is also available as a single species from Swanson [3 Billion CFU]. Neither indicated the strain(s).

“In humans, L. gasseri elicits various health benefits through its antimicrobial activity, bacteriocin production, and immunomodulation of the innate and adaptive systems. The genomic and empirical evidence supporting use of L. gasseri in probiotic applications is substantiated by clinical trial data displaying maintenance of vaginal homeostasis, mitigation of Helicobacter pylori infection, and amelioration of diarrhea.” [2013]

Role in Pregnancy and New Borns

It appears to be one of the species that appears to be transfer to new borns and dominate the vagina during pregnancy. “L. crispatus, L. gasseri and/or L. jensenii were present…  but as their estrogen levels rose, their flora composition altered, to become dominated by one of the three species most common in a normal, healthy vagina.”[2008]

• Lactobacillus gasseri OLL2809 is effective especially on the menstrual pain and dysmenorrhea in endometriosis patients: randomized, double-blind, placebo-controlled study [2011].
• “L. rhamnosus and L. gasseri were the most common species in this period [in 6 months after birth].” [2005]

• Probiotic potential of 3 Lactobacilli strains isolated from breast milk[2005]. L.gasseri strains were two of these.

Allergy (i.e. Histamines)

• Orally administrated Lactobacillus gasseri TMC0356 and Lactobacillus GG alleviated nasal blockage of guinea pig with allergic rhinitis (2007).
• Lactobacillus gasseri suppresses Th17 pro-inflammatory response and attenuates allergen-induced airway inflammation in a mouse model of allergic asthma.
• Efficacy of oral administration of a heat-killed Lactobacillus gasseri OLL2809 on patients of Japanese cedar pollinosis with high Japanese-cedar pollen-specific IgE[2009]. “was found to be effective in reducing symptoms in subjects with a high predisposition to allergies by modulating systemic immune systems.”
• “Among the lactobacilli tested, L. gasseri OLL2809 showed the highest activity in reducing the level of antigen-specific IgE…is a good candidate for potential probiotics in terms of either the prevention or amelioration of allergic diseases or both.” [2006]

Anti-Infection

• Oral administration of Lactobacillus gasseri SBT2055 is effective for preventing influenza in mice[2014].
  • Heat-killed Lactobacillus gasseri TMC0356 protects mice against influenza virus infection by stimulating gut and respiratory immune responses[2012].

• [Postive] Effect of Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, B. bifidum MF 20/5 on common cold episodes: a double blind, randomized, controlled trial [2005].

• Lactobacillus gasseri SBT2055 reduces infection by and colonization of Campylobacter jejuni[2014].

•  Lactobacillus salivarius and L. gasseri  down-regulate Aggregatibacter actinomycetemcomitans exotoxins expression.

•  Probiotic mechanism of Lactobacillus gasseri OLL2716 strain against Helicobacter pylori [2012].

• Oral administration of Lactobacillus gasseri TMC0356 stimulates peritoneal macrophages and attenuates general symptoms caused by enteropathogenic Escherichia coli infection[2014].

• Inhibition of Staphylococcus aureus by H2O2-producing Lactobacillus gasseri isolated from the vaginal tract of cattle[2006].

Additional Features

• Probiotic (yogurt) containing Lactobacillus gasseri OLL2716 is effective for preventing Candida albicans-induced mucosal inflammation and proliferation in the forestomach of diabetic rats[2015].
• Lactobacillus gasseri KS-13, Bifidobacterium bifidum G9-1, and Bifidobacterium longum MM-2 Ingestion Induces a Less Inflammatory Cytokine Profile and a Potentially Beneficial Shift in Gut Microbiota in Older Adults: A Randomized, Double-Blind, Placebo-Controlled, Crossover Study [2015].
  • Anti-inflammatory properties of Lactobacillus gasseri expressing manganese superoxide dismutase using the interleukin 10-deficient mouse model of colitis[2007].
• Heat-killed Lactobacillus gasseri can enhance immunity in the elderly in a double-blind, placebo-controlled clinical study[2015]
  • The consumption of two new probiotic strains, Lactobacillus gasseri CECT 5714 and Lactobacillus coryniformis CECT 5711, boosts the immune system of healthy humans[2006].
• Anti-obesity effect of Lactobacillus gasseri SBT2055 accompanied by inhibition of pro-inflammatory gene expression in the visceral adipose tissue in diet-induced obese mice[2014].
  • Effect of Lactobacillus gasseri BNR17 on Overweight and Obese Adults: A Randomized, Double-Blind Clinical Trial.[2013] “Despite there being no change in behavior or diet, administration of only the supplement of BNR17 reduced weight and waist and hip circumference.”
  • Anti-obesity effect of Lactobacillus gasseri BNR17 in high-sucrose diet-induced obese mice [2013].
  • [Positive] Effects of heat-inactivated Lactobacillus gasseri TMC0356 on metabolic characteristics and immunity of rats with the metabolic syndrome [2013].
• Gassericin A: a circular bacteriocin produced by lactic acid bacteria Lactobacillus gasseri [2013]. This is one of the antibiotics it produces. It is in the same family as the one produced by L.Reuteri.
• Yogurt containing Lactobacillus gasseri OLL 2716 (LG21 yogurt) accelerated the healing of acetic acid-induced gastric ulcer in rats[2010].
  • Oral administration of two probiotic strains, Lactobacillus gasseri CECT5714 and Lactobacillus coryniformis CECT5711, enhances the intestinal function of healthy adults[2006].
• “Lactobacillus gasseri BNR17 has a suppressing effect on blood glucose levels and improved diabetic symptoms in db/db mice.” [2009]
• Hypocholesterolemic effect of Lactobacillus gasseri SBT0270 in rats fed a cholesterol-enriched diet [2001].
• “Adherent strains of bacteria such as Lactobacillus gasseri (ADH) on are likely to survive passage through the gastrointestinal tract and thus have greater metabolic effects.”[1995]

Bottom Line

This lactibacillus species is definitely one that should be considered in the rotation of probiotics. Speculation: because of its involvement in female reproduction, females may be far more sensitive to it’s reduction than males, thus accounting for the difference of incidence between man and women.

In my prior posts, there were probiotics and herbs that may cause a mild, moderate or severe Jarisch-Herxheimer reaction.

Model

I prefer to start from a model instead of random actions or incidental reports from various people. A model leads to alternatives.

With the model that the herx is largely the dumping of inflammatory toxins into the system. These toxins decreases blood flow:

• by swelling blood vessels,
• reducing the flow of oxygen and blood to the brain

This suggests several approaches:

• vascular dialators (see this Wiki article for references)
  • niacin (as nicotinic acid only) – the FLUSHING TYPE – fast acting
  • L-arginine
  • heparin
• Increasing blood flow /oxygen delivery
  • Anticoagulants:
    • Aspirin (every few hours) if fine taking it
    • Alpha Lipoic Acid (ALA)
    • Piracetam
    • See this post for more choices.
  • Hot baths (with Epson salts) or infrared sauna –
  • Increasing fluids – done with electrolyte mixtures such as Recuperation. Avoid those with sugars added.
• Anti-inflammatories -these may slow down the rate of toxins being dumped into the blood systems as well as reducing inflammation.
  • Benfotiamine
  • Turmeric (some herx risk, because it is an antiviral against EBV)
  • Boswellia (again, anti-EBV herx risk)
• Some herx in CFS appears to be associated with histamine
  • Anti-histamine such as Benadryl. The problem is that many anti-histamines can cause brain fog similar to herx, so it becomes unclear it is increasing or decreasing.

I skipped anti-inflammatories and anti-coagulants that have a significant risk of causing additional herx. For example. biofilm breakers.

Of course, the last alternative is to decrease or stop what is causing the herx. A herx is not a required phrase for getting better.  A severe “herx” that does not fade out within 24 hours of pausing a supplement/antibiotic may be an adverse reaction. See comments on this post for a case report. If you are unsure, see your medical professional — there are tests that may clarify what you are experiencing.

Differentiating between a Herxheimer, a flare and an allergic reaction to the drug

“Laboratory tests can help differentiate between a worsening of disease (RA flare), a Herxheimer reaction to microbial toxins, and an allergic reaction to medication:

1. White Blood Count will elevate in a Herxheimer and lower in a flare.
2. A Herxheimer will also exhibit a coincidental elevation of SED rate, gamma globulin and total globulin ,and a fall in serum albumin and hematocrit. Patients who exhibit this flare reaction accompanied by anemia, depression of serum albumin, elevated total globulin and gamma globulin are probably reflecting a more intense reaction pattern to anti-L substances than in hematologically mild cases.
3. A marked increase in eosinophils (for instance about 30%) is an indication of an allergic reaction to the drug.” [source]

Stopping and working up to a comfortable level is ideal. However, with probiotics, the time for the herx to stop may be longer (days) because some may take up residence.

I did a longer write up on Herx that may be downloaded as a pdf.

In my last post, I looked at a variety of herbs and spices to correct the shift of the microbiome (gut bacteria) seen with CFS. In this post, I am attempting to do a similar summary for probiotics.

Why is this important? Consider Bifidobacterium which is very low in CFS patients. It has been found to “synthesize at least 19 amino acids and (…) all of the enzymes that are needed for the biosynthesis of pyrimidine and purine nucleotides” [2015]  The question of why CFSers are low in various amino acids appears to have an answer.

Similarly, “Lactobacilli and bifidobacteria strains from VSL#3 and Lactobacillus GG did not induce interleukin 8, whereas both cell debris and cell extracts from E. coli Nissle 1917 [Mutaflor] induced interleukin 8 production in a dose-dependent way.”[2002]. E.Coli is extremely low in most CFS patients.

Not just CFS – but likely most autoimmune conditions

This does not apply only to CFS but also Rheumatoid Arthritis[RA] “The signs of 3rd degree dysbiosis [in RA], by reducing the concentration of Bacteroides spp., Bifidobacterium spp., Lactobacillus spp. populations, typical strain E. coli. with [high levels of] Enterococcus (Hly+), Klebsiella spp., Proteus spp., Staphylococcus spp., lactosonegative and E.coli (Hly+) ” [2014]

Persistance

When taking probiotics, you need to be aware that some are “flow thru” and others may take up residence.

“After oral consumption of probiotics, E. coli [Mutaflor] and enterococci [Bioflorin] could be detected in stool samples (57% and 67%, respectively). In contrast, with only one exception, ingested lactobacilli and bifidobacteria could not be detected in human feces.” [2007]

The results for lactobacilli and bifidobacteria may be heavily influence on when and how the later two probiotics are taken as reported in this earlier post.

Strain differences

“In children, L. casei rhamnosus Lcr35, but not L. rhamnosus GG, showed a beneficial effect.” [2010] The literature is very sparse on this information. 😦

Finding PubMed (reliable) literature of probiotic interactions is more time consuming  and difficult then with herbs and spices. I have constructed a table below based on my current findings. Feel free to forward any solid PubMed articles to me that you find to fill in the gaps.

Should I continue with Bifidobacterium and Lactobacilli

The simple answer is yes! But selectively!!!!

• Bifidobacterium probiotics are often mis-identified, so unless it is a single strain, don’t worry about it and change brands regularly. See this post. We want their transitory benefits until the dysfunction is corrected.
• For Lactobacilli — only a few families and strains should be considered. L. Reuteri is one of those. L. Acidophilus should be totally avoided.

Bifiform

During my research, I came across this probiotic shown above. It is available in Denmark, Sweden and eastern European countries. It contains:

• Lactobacillus rhamnosus GG (LGG^®) 100 million cfu**
• Bifidobacterium BB-12® 100 million cfu**
• Thiamin (B1) 0.4 mg
• Vitamin B6 0.5 mg

A reader wrote a comment and link on my Rifaximin post,

“Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth”

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030608/

The link has a table of 4 different capsules, each with different herbs.  I have a working model that CFS/FM/IBS is a overgrowth of (Klebsiella, Enterobacteria, Enterococcus,Streptococcus) and very low levels of (E.Coli, Bifidobacterium, Lactobacillus) reported first in 1998.

The advantage of having a model is the ability to estimate probable impact from different herbs, spices, antibiotics etc.

Below, I took each of the herbs and attempt to cross-reference them to their impact on the above bacteria families to see if there are specific ones that are really well suited for CFS. The score is done as follow:

• Overgrowth
  • Effective 1
  • No Info/Weak 0
  • Resistant 0
• Undergrowth
  • Effective -2
  • No Info/Weak -1
  • Resistant 0

Feel free to use your own formula if you disagree.

Undergrowth is more important because those bacterias as they increase will reduce the overgrowth. Killing the overgrowth will leave a vacuum which may well be repopulated with dysfunctional bacteria. The Ideal Herb or spice would be a THREE (3). The best found was a Zero (0)

You must rotate herbs, I have seen this reported in multiple studies:

“In general, the development of adaptation varied according to the bacterial strain and the essential oil … it is important to use essential oils at efficient bactericidal doses in animal feed, food, and sanitizers, since bacteria can rapidly develop adaptation when exposed to sub-lethal concentrations of these oils.” [2015]

There is a single candidate “super” herb/spice (1) . Has any one tried Thyme oil or Thyme mouth wash? Please comment.

• Thyme (Thymus vulgaris)

The best ones (0) are:

• Mastic Gum (Chios Mastic Mastiha) – ideally chewed in the mouth

• Neem (Azadirachta indica)
• Oregano (Origanum compactum/vulgare) – used by the person in the letter I published.
• Olive Leaf (Olea europaea)
• Pau D’Arco (Tabebuia spp)

• Tulsi (Ocimum tenuiflorum)

The second best ones (-1) are:

• Cinnamon ( Cinnamomum verum)
• Ginger (Zingiber Officinale)
• Licorice (Glycyrrhiza glabra)
• Rhubarb (Rheum rhabarbarum)
• Sage (Salvia officinalis)
• Thyme (Thymus vulgaris)
• Wormwood (Artemisia)

The chart is based on whatever could be found. In some cases, some strains were killed and others were resistant. Your response will likely vary to each of the above.

For CLARITY to the brain fogged

• 3 VERY VERY GOOD
• 1 Unusually Good
• 0 Recommended
• -1 Acceptable
• -2 You may be doing more harm than good
• -3 You are shooting craps — we have no solid information on what will happen
• -4 You are probably harming yourself
• -5 You are making yourself worst!

There is an excellent article on more unusual Indian herbs. “The millenarian use of these plants in folk medicine suggests that they represent an economic and safe alternative for treatment of Urinary Tract Infections.” As well as this article.

The Image:

The Table