I know this post is long, but I think it’s very good information and it took me a while to put it together:


I found Dr. Leo Galland’s website (http://www.mdheal.org/) one day while I was doing a search on Metagenics, a company that makes supplements. I spent a lot of time reading his articles and looking at his slide presentations. He is very generous with his material. A lot of the stuff on his site has to do with gastrointestinal health and its connection to chronic disease. (not just IBS, Chrons, IBD) I found his monograph “Gastrointestinal Dysregulation: Connections to Chronic Disease” on the Integrative Medicine site, and I purchased it. (119 pages, softbound, $60) It is meant for physicians, but I read it and got a lot out of it. I think this approach was preferable to a phone consultation with him ($400 for 30 min).

I am working on Dr. Galland’s recommendations for probiotics (and pre-biotics), because that is where I am with my healing journey. I ‘only’ have IBS. I did the elemental diet for two weeks in the Spring, and now I am able to eat fruit. I have had good but unfortunately temporary results from various probiotic sources, including raw milk (which I still cosume, a glass at bedtime), and I can’t take large quanities of the Natren products without getting constipated, so I thought I would do more research and try other probiotics. I am currently taking one capsule of Natren’s Bifido factor and one capsule of the Megadopholis in the am on an empty stomach and again just before bed with the raw milk. I feel better than I have in several years, but I have to be very careful about what I eat, and I continue to have extreme fatigue and gut pain every afternoon from about 2-6. I am having a formed stool, finally, and I’m grateful and very exited about that. I take no other supplements at this time, but eat lots of whole fresh food and drink triple-filtered water to the exclusion of all other beverages.


I have researched Dr. Galland’s suggestions on Probiotics in his monograph and put the results in a table which I have included below. It would be great to have help deciding which to try first.

The information on providing a substrate, or prebiotic, in the form of vegetable or fruit fiber that is digested by gut bacteria in the large intestine is something I wish I’d found out about before now. I feel that I might have been able to get the probiotics to “implant” after the ED, had I thought earlier about the substrate issue. I am actively eating foods that will be a good substrate. Again, I am now able to eat apples, after the elemental diet experience, and this helps (pectin).

Next up I will be adding fermented foods, as it seems more logical to me than popping capsules over the long term.

Here is a long interesting quote from the monograph. In the table that follows, I’ve highlighted the strengths of each probiotic he recommends. I don’t know which to try first, as the research makes them all sound great (!).

[brackets are mine]

From the Appendix -- 4R Program (Remove, Replace, Reinoculate, Repair)

“’Reinoculate’ is the third step in the 4R gastrointestinal support program Reinoculate refers to the reintroduction of desirable bacteria, or “probiotics,” into the intestine to reestablish micro flora balance. Bacterial balance in the intestine is critical for proper intestinal permeability. Over 400 different species of microorganisms reside in the human gastrointestinal tract and the overall balance of these organisms can profoundly influence gut ecology and health.

Probiotics serve a variety of functions in the gastrointestinal tract. Perhaps the most important function of probiotics is antagonistic activity toward pathogens, which they perform in a variety of complimentary ways. First, probiotics assist in colonization resistance-- the ability of normal flora to protect against the unwanted establishment of pathogens. Second, probiotics may produce various antimicrobial substances. For instance, lactobacillus casei GG has been shown to produce substances inhibitory toward a broad spectrum of gram-positive and gram-negative pathogens. Competition for nutrients is a third mechanism. By competing for available nutrient substrate, beneficial bacteria can inhibit the growth of other less favorable flora. Competitive inhibition for bacteria adhesion sites is a fourth mechanism of probiotics. For instance, lactobacillus acidophilus inhibits the adhesion of several enteric pathogens to human intestinal cells. A final mechanism involves systemic host response. For instance, L. casei GG may decrease the likelihood that pathogens will develop resistance against probiotic agents. Thus, probiotics may be viewed as a vehicle to neutralize on inhibit pathogen activities, or increase or stimulate host immune stimulant activities to the intestinal tract, or both.

A variety of supplemental sources may be considered helpful in reinoculation. These include cultured and fermented foods containing live bacteria, refrigerated liquid supplements containing live bacteria, or freeze-dried bacteria packaged in powder, tablet, or capsule form. Frequently supplemented species include Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillus thermophilus, Lactobacillus sporogenes, Lactobaccillus casei GG, Lactobacillus NCFM, Saccharomyces boulardii, Bifobacterium bifidus, Bifidobacterium longum, Bifidobacterium breve.

In addition to directly reintroducing the bacteria, the reinoculate step may also involve indirectly bolstering the healthy microflora with prebiotics, which selectively promote beneficial synergistic flora without silmultaneously supporting pathogenic bacterial growth. When prebiotics are included in the diet, increased levels of fecal fermentation and intraluminal concentrations of SCFAs [short chain fatty acids], such as proprionate, acetate, and butyrate, are produced from fermentation of the fibers by the colonic microflora. SCFAs are thought to supply up to 70% of the energy used by colonic epithelial cells; therefore, prebiotics support improved intestinal integrity and promote intestinal cell regeneration. Prebiotics include fructans [jerusalem artichokes, chickory root, belgian endive are rich sources, supplements are made out of the chickory root], inulin [asparagus, artichoke, onion, banana, chickory root] and fructooligo- saccharides [jicama, jerusalem artichoke], arabinogalactans [radishes, leek seeds, reiki, mushroom. Food sources are said to provide minimum amounts. Supplements are made of the wood of the larch tree. Should we really be eating that?] and some soy fibers. The incorporation of soluble fiber [pectin as in apples, oatmeal (not instant) numerous supplements exist for this ] another important nutrient substrate for probiotics, may also help the reinoculation process.”


From Gastrointestinal Dysregulation: Connections to Chronic Disease, a monograph, 2008, available from the Institute for Functional Medicine
http://www.functionalmedicine.org

author: Leo Galland, M.D. with Helen Lafferty

Adapted from Lukaczer D. The “4R Program” in Jones DS, ed. Textbook of Functional Medicine, Gig Harbor, WA: The Institute for Functional Medicine

Unable to post table at this time. Request assistance.

Hi, karoe.

There was a person who did some experimentation with prebiotics (and I specifically remember that the brand he was trying was cultured on larch wood). He had Crohn's and was, I believe, at an earlier stage of healing than you. I don't think he saw the results he was hoping for. (You'd be able to find his posts on the main forum.)

It is very interesting research, though. I would definitely like to know how you make out with prebiotics if you decide to try them.

Of the probiotics mentioned, the only one I would absolutely avoid is Lactobacillus sporogenes. If you do a search on the main forum, you'll find a post from Jini regarding this species.

I look forward to hearing more!

Take care,
Nicole

Nicole:

Thanks for your note. I did search on L.Sporogenes and did not come up with anything. Can you help? That would be good info, as it did strike me as odd, taking a yeast.

I am interested in Jini's opinion on the entire substrate issue which I discussed in my post. If we make an analogy to a garden, merely planting seeds is not enough, the soil must be prepared or the seeds won't grow. If I am tossing expensive probiotics into an unfriendly environment, how can I expect to see results? With Chron's and IBD patients, and I guess IBSers who have really serious food limitations, the option may not be there to introduce the pre-biotic substrate with food, but I'm healthy enough to eat some of the right stuff and see if it will make a difference. (Needless to say, I'm not taking any supplements to accomplish it -- food only). Please note that this idea is not unique to Dr. Galland, he just sums it up real well. The activity of intestinal bacteria in producing Short Chain Fatty Acids and the benefits of this to the organism is abundantly documented in the scientific literature.

Thanks very much to Jini for taking a moment to add what she knows to this discussion.

Hi, karoe.

Here's a thread that talks about L. sporogenes:

post2314.html#p2314

I have asked Jini to review the discussion thread and comment, as well.

Take care,
Nicole

The whole prebiotics issue is very much a 'test and see' situation. Some people find it makes their gas and bloating much worse. Others do okay on it.

You won't know how it will work for you until you try it - again, follow your gut leading.

If you can follow the eating principles in Nourishing Traditions, then that will give you your most solid foundation for intestinal and whole-body health - based on REAL LIFE populations, studied over the long-term.

There are lots of things that sound wonderful in theory, but the reality can be very different. Or there can be many things (soil organisms, for example) that work very quickly to seemingly affect the desired result - but what are the long-term consequences?

all the best,
Jini

Thanks for the notes, all:

Yes, I've had the experience of reading about something that sounded wonderful, and then either using it or finding out BAD THINGS about certain supplements, vitamins etc. That is PRECISELY why I don't like to use supplements (I do, but only particular ones) and prefer WHOLE FOOD.

I am doing pretty well with eating inulin/fructan rich foods. Just adding new things to my menu and keeping up with my reading. I just posted my recipe for a Jerusalem Artichoke Gratin. I will also post a link to the site of a homeopath who has reproduced a very lengthy article on on the function of resistant starches and bacterial activity. It's absolutely fascinating and makes so much sense. If you think back on it, our species evolved eating tubers and leaves. Now that we have precious little of that in our diet, no wonder we have such health problems. If you have the time, read this, and also be aware that it was written for the commercial inulin industry. The facts are good, but the punch line is all about taking the supplement, Inulin. I say eat the food.

Hi, karoe.

Interestingly, in Part 7 of that article - Safety and Tolerance - it indicated that inulin is best-tolerated when part of a regular diet and eaten in some quantities throughout the day, as opposed to taking a single dose. Doses too high result in diarrhea.

As a note, in my opinion, someone already suffering from diarrhea should proceed cautiously or wait to try it until symptoms have improved.

I so much agree with you on the importance of getting nutrients from whole foods. Thank you for posting your recipe; I'll definitely check it out.

My husband is out and about seeing clients most days and wanted to try Jerusalem Artichoke. One of his clients had it growing at the side of the building (not on purpose, but it was there). Anyway, he dug it up and cooked some. Delicious. I will note (not with the intent to rain on anyone's parade) that it gave everyone in the family unbelievable gas. I wonder if that would improve if it was a more regularly eaten food, though...

Nicole:

I had no gas problem, in fact the combo of probiotics and the resistant starch lessened my gas, but yes I have read that the JA will produce gas in some people. I would urge you to find new source, cook it differently, add a small amount to your diet and work up from there. Don't get discouraged!

Hi, karoe.

Yes, that makes a lot of sense. (And thank you for the encouragement! )

The online article that karoe posted also included a list of foods that are rich in inulin. Jerusalem Artichoke seems to be the champion, but there are others, so it's worth checking out the list and trying those, too.

Asparagus is one of them, if I recall, and even people following the Reduce Diarrhea Healing Diet can generally tolerate it well.

Take care,
Nicole