Category Archives: Treatment

Unknown's avatar lassesen 3:04 am on April 3, 2014  

How to determine if an antibiotic is a good candidate?

A reader asked me about the antibiotic Rifaximin. Rifaximin is a sweet antibiotic because it does not enter the blood system much.   Lubiprostone, linaclotide and rifaximin with low systemic bioavailability and has been used for irritable bowel syndrome [2014] with some 90 articles on PubMed. On the downside, it is not officially approved and runs $600-$800 /month (likely not covered by US insurance).

So how do you determine if it is a good candidate? I did a brief example in an earlier post.

Criteria 1: Has it shown to be effective for IBS? Ideal is X% remissions, acceptable is improvement. Antibiotics for IBS have been far better studied than CFS, and with 90% of CFS having IBS, it’s a good proxy.

Criteria 2:  Reduces known overgrowth and does not impact undergrowth.

From an early post, we know what to look for. So take the antibiotic name and each of the items below and see what is known on PubMed.

Klebsiella/Enterobacter HIGH lesser activity against species of Enterobacteriaceae [1995]
Enterococcus HIGH  good activity against [1995]
Streptococcus HIGH  good activity against [1995]
E.Coli LOW  inhibited in vitro 85.4% of Escherichia coli, [2014]
Bifidobacterium LOW  an increase in concentration of Bifidobacterium [2010]
Lactobacillus LOW increase in members of the genus Lactobacillus [2012]

And from the gut analysis posts earlier we add:

Rhodospirillales LOW Nothing
Actinomycetales LOW Nothing clear
Fusobacteriales LOW Nothing
Flavobacteriales LOW Nothing

Criteria 3: Does it release histamines (part of the Herx Reaction)? Because this does not enter the system, it is semi-moot.

  • Nothing found on PubMed

Criteria 4: Does it promote coagulation or does it thin the blood? In general, you want thinners or should have heparin available if it thickens.

  • Nothing found on PubMed

Bottom Line: If you are going to supplement with Mutaflor(E.Coli Nissle 1917) and d-ribose  immediately after using this antibiotic, then it is a reasonable choice. If you do not have Mutaflor , it is likely a poor choice because of it’s impact on E.Coli. This may be why it only improved IBS and does not result in remission.

Unknown's avatar lassesen 2:18 pm on March 31, 2014  

West Australian doctor talks about gut issues in CFS

A reader forwarded me these two YouTube talk-segments by a MD from Australia CFS talk.

and

Unknown's avatar lassesen 4:54 am on March 29, 2014  

A mouth full – for better or worst

This post deals with the role of Oral Probiotics. My model of CFS is that it is a microbiome (gut bacteria) dysfunction that has become stable. The first question is a real simple one: How did the bad bacteria get to your gut? The answer is real simple — through your mouth? A kiss from a friend, a lick from a pet, air bacteria landing on food, bacteria on dust. The bad bacteria while you were sick found your gut much more friendly than usual and they survived and prosper. Your illness, stress level, immune response to vaccine allow the bacteria to take up residence.

The CFS gut has low biodiversity — how do you correct that! Again thru the mouth, either thru probiotics or food. At this point, my wife would say… oh no, here comes the “A spoon full of dirt make the autoimmune go down” jingle is about to happen. In other words, the hygiene hypothesis.

In the land of CFSers, there is often talk about reserves of infections. If we are talking about gut bacteria dysfunction, we have to consider the bacteria in the mouth as being a reserve for potentially dysfunctional bacteria.  Bacteria that will tag among on your next swallow and attempt to reinfect your gut. Yes, you could brush your teeth and use a mouth wash — but would it not be better to then repopulate with non-harmful bacteria then trust random bacteria? Today there are several oral probiotics available, including:

  • Now Foods OralBiotic on Amazon (60 capsule for $14) – Streptococcus salivarius BLIS K12
  • Oragenics Evora Plus Probiotic on Amazon (30 mints for $16) – Streptococcus oralis, Streptococcus uberis, and Streptococcus rattus
  • Swanson Oral Probiotic: Blis K12® S. salivarius, L. rhamnosus, L. plantarum, L. reuteri, L. paracasei, L. salivarius
    • This one was a delight to find because it contains L.Reuteri which is hard to find in a probiotic. This one looks the most promising of all of the Oral Probiotics.

Recently, the question of “soil bacteria” came up in a comment. It seems that while they are often found in the soil they are also found in healthy human guts BUT many of them do a disappearing act in the gut of a CFS person. So, the pointed question is how do you restore biodiversity of gut bacteria to become healthy– that is the question that must really be answered. Eating yogurt will never do that.

To me, Prescript Assist is a start, having an organic garden and not washing every strawberry or blueberry before eating them is also a risk that I am willing to do.

What is your answers to this question? “Somehow” is not an answer — it is an evasion.

 

Unknown's avatar lassesen 11:33 pm on March 25, 2014  

Starting up on Probiotics – my thoughts

<Disclaimer>As always, discuss with your knowledgable medical professional before doing any changes in supplements or probiotics, etc </Disclaimer>

A reader sent me the following email:

Hello Ken,
 
I am preparing to test out various probiotics.  I want to see how I react to the various probiotics prior to starting on the herbs.
 
I plan on trying:
 
1. Align
2. BioGaia Protectis
3. 4X probiotics (If I can find a company that will ship it to Canada)
4. Jarrow Femdophilus
5. Mutaflor
 
Probably in that order.
 
I would appreciate your recommendations on how long I should try each probiotic, and what maximum dose I should aim for, for each?
 
Also, do you recommend taking the probiotics with food or on an empty stomach?
 
Should I take a break in between each probiotic?  If so, how long?
 
 
I thank you, in advance, for your input.

Comments

My general comments are:

  1. Start with one capsule (or if in tablet form, 1/2 tablet) for the first 3 days, then increase every three days unless your body is clearly adjusting to it. Once an adjustment starts — keep on that dosage until it stops.
    1. If it does not stop within 7 days stop.
    2. When it stops, increase the dosage for another 3 days
  2. Maximum time on any probiotic should be 10-14 days – I prefer the pulsing model.
  3. Maximum dosage is 2x recommended dosage — there are some studies suggesting a negative return from higher amounts. Of course, we do not know where that threshold is.
    1. Remember, the purpose is nudge your gut bacteria in the right direction — not to clobber it with “strangers”.

Keep notes on any changes that you experience. If you are living with a significant other, ask them to note any changes of mood, speech etc.

When / How to take

My usual pattern is to take the probiotic just before bed-time. This is a habit from the antibiotics days — if a herx or other reaction starts, you would rather sleep thru it! In some cases, it will help with sleep. I would suggest a 100% rye bread (no wheat flour) slice as an evening snack because rye bread appears to be encourage more diversity of gut bacteria. My usuals can be purchased on Amazon or my local grocery store (and likely a few deli’s).

Additionally, supplement with D-Ribose. It is the food for e-coli (Mutaflor)

Specific answers:

Unknown's avatar lassesen 12:30 am on March 25, 2014  

Thick Blood – a 15th year Retrospective

Before Dave Berg of Hemex Labs retired (and the Lab sold), I had several occasions to talk with him, both at CFS conferences and hosting online interviews. The transcriptions are available here:

For those not around and interested in CFS back in 1999, I should provide some links to his publications:

There were many presentations / poster papers that year, including this one at AACFS Conference. My family had panels done at Hemex and with remission, the panels normalized. A few blood draws were sent to a different lab, and the results were similar. My panels are in the PDF of my 1999-2000 remission.

Science Dropped The Ball

Standard scientific practice is to have another lab/person attempt to replicate the results using the same methods that were described (to make sure it was not a lab error). No one stepped up to do this. The result is that his findings, some 15 years later, are still not confirmed or disputed. They are largely ignored. His model did not interest any one doing research.

A new perspective on thick blood

Recently I was introduced to the histamine model for CFS. Histamine is released from mast cells. It was interesting to discover these have “many granules rich in histamine and heparin.”  Last night a light shone — mast cells releasing the contents of the granules is the result of chemical signals. One signal (to release histamine) is an allergic reaction, the other signal (to release heparin) may be low oxygen levels (or some related condition that suggests heparin is needed).

Consider this scenario, thick blood triggers the granules and while the amount of heparin released have the desired effect, the amount of histamine is more than the body can handle — i.e. histamine overload (just like you can get heparin overload).

Checking PubMed for histamine and altitude, some studies suggests that histamine release increases with altitude [1985], I suspect as a result of the body trying to get more oxygen by thinning the blood (by releasing heparin).

This suggested that for a histamine reduction treatment, that there are three facets that should be considered:

  • Altering volume of bacteria that converts histidine to histamine
  • Reduced consumption of histamine and histadine
  • Improving blood circulation and oxygen penetration into the tissue (to reduce the chemicals asking granules to discharge their contents).

This also means that histamine overload can be a factor for a subset of CFS patients — especially those that have some low level hypercoagulation (which may not clinically present). For those patients, heparin — either injections or sublingual — may reduce the histamine sensitivity because the heparin is being obtained without the release of histamine.

We are back to the story of blind men describing an elephant. It is all one creature with various textures and characteristics. If we feel around long enough, the parts start to form a complete picture of what we have.