Pro-biotics, Pre-biotics or No-biotics!

Restoring gastro-intestinal flora and function is not always cut and dried. There are some good places to start and probiotics are usually part of this, however sometimes the bacteria in the probiotic is not actually beneficial due to an over-abundance of it already present. This tends to be the Lactobacillus strain which is likely to indicate a high level of D- lactate appearing in a urine or stool sample. Sometimes bacteria in your gut also fail to process histamine and lead to a probiotic intolerance.

Fermented foods, the natural probiotics, tend to be very high in histamine, and some people have either a genetic mutation that impairs their production of the enzyme that breaks down histamine. Other people have disruptions in the gut flora, which makes them less able to tolerate histamine, and so when they eat fermented foods like cheese or yogurt or sauerkraut or wine or vinegar, they can experience symptoms ranging from headaches, hives, skin issues, fatigue, bloodshot eyes, nausea, a tingling or altered sensation on their tongue, all of which are mediated by histamine, and causes an allergic response.

The specific nature of your dysbiosis (a bacterial imbalance) can be multi-factorial, allergy, intolerance, not enough good bacteria and too much bad bacteria that can cause probiotic intolerance, pH imbalance, gut infections from parasites, yeast and inflammation from an undetected cause.

Many people opt for a colonoscopy only to find that they are free from anything sinister, but at the end of the day, they have a major problem with the functioning of their bowels and it is not able to be explained by conventional testing.

It is not easy to find a clinician who understands the intricacies of an irritable bowel when tests all come out as negative to disease. It is unlikely then that you are going to die of irritable bowel syndrome, but it is also very hard to live with the multiple symptoms which mostly can be reduced, if not healed over time.

One of the most elected nutrition tests for digestion, weight and other unexplained irritations that can be causing inflammation in all parts of your body is a Food Intolerance test. Food allergy, intolerance and sensitivity all in fact have one similarity in that they are measuring an abnormal reaction to foods.

If protein is not the cause, then FODMAP intolerance should be explored. These are carbohydrate foods that will ferment in the gut in the company of bacteria, an altered pH, poor enzyme support and decreased transit time. People who are sensitive to FODMAPs, I’ve found, can sometimes be more sensitive to probiotics and fermented foods. Allergy is characterized by the production of IgE antibodies and the release of histamine and other chemical mediators, almost immediately upon exposure to an allergen ie. Peanuts, shellfish, pollen, sulphites.

Restoring a healthy bowel flora is in the long term very important but while on that journey, we have to be able to get probiotics and probiotic foods to colonise and the biggest influence on this is to supply pre-biotic foods. The issue here could be that you are intolerant of many starches and sugars, these are also the pre-biotic foods that feed good and bad bacteria.  Most people with gut issues are really sensitive to prebiotics and FODMAPs, but fermentable fibers, which is what FODMAPs are and prebiotics, are absolutely crucial to restoring a healthy gut flora over the long term. In fact, the most recent research has shown that probiotics do not quantitatively affect levels of beneficial bacteria in the gut long term, but rather they seem to have more of an immune-regulatory effect, tuning and regulating the immune system and the gut immune system, which is incredibly beneficial. Prebiotics, or fermentable fibers, like resistant starch, non-starch polysaccharides like inulin and fructo-oligosaccharides and galacto-oligosaccharides, are what promote the good bacteria by providing food for the beneficial bacteria in your gut to greatly increase their levels. It is a bit of a catch-22 where you have someone with FODMAP intolerance who can’t handle any kind of fermentable fiber or prebiotics, and therefore you have to very gradually introduce these foods over time so that eventually they become less intolerant of FODMAPs and fermentable fiber because their gut flora is in a better situation.

The first step, if possible, is to get some testing done to see if you have Small Intestinal Bacterial Overgrowth which affects the nerve s and muscles of your small bowel (SIBO), dysbiosis (bacterial and yeast imbalance), gut infections, FODMAP intolerance, food allergy or sensitivity. Knowing what you’re dealing with can really accelerate things in terms of what kind of treatment you want to do. If testing is not an option, a functional medicine nutritionist with experience in this field will certainly be able to make a good start and help you avoid medications and further suffering.

Whether you are armed with test results or a very indepth history, the next step is to use a protocol to knock back some of the bacteria in the small intestine that may be making you intolerant of these probiotics and certain foods to get to the root of the problem quickly and effectively.

Many people who opt for a food intolerance IgG test, may well come up with a food that is also known to be a big player in the fermentable sugars protocol, especially wheat, pulses, corn, soy, lactose, nuts and peas. Crossovers will probably exist but the symptoms of fermentation are always bloating, gas, and sometimes a smelly hydrogen breath, cramping constipation and diarrhea. A food sensitivity IgG can also have these symptoms but they are also going to have a strong link with weight management, mood, memory, fatigue, ability to exercise and immunity. Fermentable sugars will knock around the functioning of the gut to cause a functional disturbance and in the long term, may cause intestinal damage; food sensitivities are a measure of dysfunction and will influence your biochemical systems and physiology.

From a dietary perspective, a low FODMAP diet can be really helpful. If you’re not tolerating probiotics or fermented foods, it’s likely you have FODMAP intolerance or dysbiosis of some kind, and a diet which follows a simple plan based on clean protein, vegetables and good fats is very helpful.

Probiotics do need to be part of this but they should be started in low doses and built up rather than just bringing in the army. A capsule may well be your best option as well as some pickled vegetables such as sauerkraut or a dairy probiotic. If kefir is available, starting with ½ tsp might be all you can tolerate until you build up a tolerance. Even if you are lactose intolerant, kefir and yoghurt are very low in lactose as it has been soured to lactic acid which removes the sugar as well as the increased bacteria in the product using the sugar up.  You might also be able to source out some other fantastic fermented products such as beet kvass. On the whole, if you cannot tolerate lactic acid-based probiotics, you can probably tolerate soil-based organisms. If you can source out some products from the nutrition shops, Prescript Assist is very good from the US.

When you seriously suspect that fermentable fibres from starches and sugars are the foods mostly fueling your symptoms, as part of the healing process, and following a low FODMAPS dietary plan, it might be easier to actually take a powdered supplement of perbiotics available from either pharmacy or a nutrition shop. Fermentable fibres from wholegrains are better in the long term but it is often hard to find the balance to begin with.

Resistant starch such as potato starch is often used, as well as powders which are a blend of non-starch polysaccharides, to stimulate the growth of different kinds of bacteria in the gut. Resistant starch will stimulate growth of a certain type of groups of bacteria, and then the non-starch polysaccharides will have an effect on other types of bacteria. Always err on the side of caution when finding your way and don’t launch in and take a full dose as recommended. For many of us whom have had episodes of gastro-intestinal issues in the past and present, we all know some foods that just aren’t tolerable and leave us gasping for breath or curled up with intense pain thinking we are having an appendicitis where in fact we have trapped air. The amount is going to be a bit of a trial on yourself knowing that negative consequences can happen. Essentially over time by getting the environment right and introducing the bacteria, you’re changing your gut flora.

Some fantastic foods for digestion as long as you are able to tolerate them are probiotic foods such as sauerkraut, plain kefir yoghurt, kiwifruit and papaya, artichokes, oats, coconut and coconut oil, botanicals slippery elm, aloe vera and milled flaxseeds if they are not too fibrousy. A more agressive approach will add targeted supplements for healing, enzyme and pH support, and if absolutely necessary, pharmaceuticals to deal with overgrowth of flora and parasites and anti-spasmotics.