Some doctors are now recommending that people with Crohn’s and Colitis NOT take probiotics. They are saying that people with IBD do not have a normal response to beneficial bacteria and therefore probiotics can aggravate these conditions.

Back when I was diagnosed with Crohn’s (1984), the medical establishment maintained that Crohn’s  was an autoimmune disorder rather than an immunodeficiency. In contrast to this, a friend (who is also a scientist) recently said: “I had noted that those I knew who had Crohn’s tended to be more vulnerable to certain types of bacterial infections, but had assumed that this is due to the drugs they are on. However, after looking into the matter – it seems that a faulty immune system is actually an inherent characteristic of the condition. Is this something that you have noticed with those you help? It seems quite a tight walk to expose oneself to “good bacteria” and trusting the immune system to respond appropriately. I want to suggest this route (i.e. the probiotic route), but given the tendency to pathogenesis to organisms that would normally not be problematic for most others – I don’t want to add fuel to the fire….”

This approach is actually not new, it is just becoming more prolific in the literature. Here are some excerpts from Listen To Your Gut (2006) where I talk about factors pertaining to this:

“It’s also important to ingest the right strain of each probiotic species. Different strains of acidophilus (for example) can produce completely different results. Out of 200 different strains of acidophilus, only 13 have potent antibiotic and antiviral capabilities. If you have IBS or IBD, you need to ingest potent strains that are capable of wiping out the bad bacteria in your gut, strong enough to protect against re-infection, and capable of restoring your mucosal lining and helping to balance your immune system.”

“Some species that are routinely included in commercial probiotic blends simply do not have a long-term record of human safety and not enough is known about their actions/ramification in the gut under varying conditions. For example, a study on immunodeficient mice found that supplementing with a certain strain of L. reuteri (used in many probiotic blends) caused some of the mice to die, leading the researchers to recommend “the need to proceed cautiously when using high doses of this strain in neonatal, immunocompromised hosts.”(10) Therefore, you only want to purchase a probiotic supplement that contains species and strains with a proven, long-term record of human safety.”

“So, you need to be very careful when choosing a probiotic brand to supplement with as the field of misinformation in this arena is vast. In my opinion, probiotics are so powerful, they should be stringently regulated and undergo routine, independent testing. Swallowing live microorganisms, which are highly adaptive, intelligent beings, should be undertaken with great caution and safety should always be paramount. Unfortunately, currently probiotics are not regulated at all, and many probiotic manufacturers do not even comply with labeling guidelines. In addition, when I refer to ‘probiotics’ I’m referring to food-cultured beneficial bacteria only.”

“When I first began recommending Natren probiotics to my readers, I did so for one reason only; they worked. At that time, I knew a fraction of what I know now about probiotic strain selection, manufacturing, storage, and other factors effecting potency and efficacy. I had experimented with different brands of probiotics off and on for seven years and each time I tried supplementing, my symptoms (gas, bloating, bleeding) worsened. Although the science behind probiotics and why they should benefit me seemed sound, my experience proved contrary. When I was nearly ready to give up on the whole subject, my naturopathic physician Dr. David Wang, convinced me to try Natren brand probiotics. He insisted they were the best brand he knew of and that I would see good results from them. I started with just Natren’s Bifido Factor powder (Bifidobacterium bifidum Malyoth strain) and for the first time, experienced an improvement as a result.

Prior to taking Natren’s B. bifidum, the only thing that had worked to stem my chronic diarrhea was L-Glutamine (on an empty stomach only). However, within three doses of Natren’s bifidobacteria, my stools began to firm up and excess water was reabsorbed. I tried Natren’s Megadophilus (Lactobacillus acidophilus DDS-1) next but did not tolerate that as well as the bifidum. In searching for reasons why, I came across this bit of research that showed that in states of inflammation the overall tolerance to bacterial flora is greatly reduced:

“It is possible that the products of the commensal flora promote inflammation in the presence of an impaired mucosal barrier or injury to the mucosa… These results indicate that, in health, there is tolerance to autologous [your own] but not allogeneic [foreign source] intestinal flora, and tolerance is lost during inflammation. Evidence also exists that animals are tolerant to their own flora in health but not after colitis develops.”(13)

Unfortunately, this bit of research doesn’t specify which species of bacteria the body loses tolerance for, and which strains of which species – perhaps all of them? Nevertheless, it provided me with a clue by which to proceed, and I stayed on just the B. bifidum bacteria for another three months before trying the L. acidophilus again and I then tolerated it well. By that time (I surmise) the B. bifidum and other supplements I was taking had healed my intestine to the point where it was able to tolerate – and benefit from – additional probiotic supplementation. About a month after that, I added Natren’s L. bulgaricus and tolerated that successfully as well. I have since continued to recommend the same conservative course of action to my readers.

However, in March 2005, Gastroenterology journal published results of a human trial on 75 people with IBS, supplementing with 10 billion cfu of B. infantis, once per day in a malted milk drink. Now, Bifidobacterium infantis is, as the title suggests, a strain typically used for infants. But as Dr. Quigley and his colleagues note in their paper, the symptom relief achieved with B. infantis in the trial was comparable to that seen with Zelnorm (tegaserod) and Lotronex (alosetron) – two drugs used in the treatment of Irritable Bowel Syndrome.(14)

B. Infantis is the predominant bacteria found in the bowel of healthy breastfed infants. As the infant begins to eat solid foods, the more ‘adult’ strains like B. bifidum come to dominate. However, what if you never had a healthy bacterial flora as an infant? Then maybe it would be best for you to start with what was missing from the very beginning and work up from there? This approach makes sense to me both logically and intuitively. Interestingly, I had a bottle of Natren’s Life Start (B. infantis) in my fridge (that I had given to my daughter) and about six months before this research came out I had begun taking it myself (along with the three adult species/strains) just because I intuitively felt like trying it.

In light of this research, you may want to consider beginning probiotic supplementation with B. infantis, especially if you try B. bifidum and can’t tolerate it. And just to confuse you even more, I have talked with readers who couldn’t tolerate B. bifidum at first, but could tolerate L. acidophilus. So, essentially, I’ve provided you with a guideline, but within that you may need to experiment and find what works best for your particular body and gut environment. The only thing I can tell you for sure is: Don’t give up! You do need to establish a healthy bacterial flora (consisting of all three species) to enjoy long-term, lasting health.

I know many people have experienced good results from more aggressive supplementation and also from beginning supplementation immediately (with ulceration and bleeding still present). Feedback from hundreds of readers has confirmed the effectiveness of the slower approach (as outlined above), but it certainly does take more time to see results since you’re proceeding so slowly. However, if your gut is really toxic, proceeding slowly helps minimize the die-off effect (Herxheimer Reaction), so while it takes longer to see any results, at least you don’t have the nausea, bloating, headaches, etc. that can result from a rapid die-off of pathogens in the gut. As in all things, please follow your own gut instinct first. If you feel you should pursue aggressive supplementation, then please do so. I know of a colon clinic in Sydney, Australia that treats people with active, bleeding Crohn’s with high doses of Natren brand probiotics orally and also via retention enemas and they have had good success with this approach.”

Experiential Knowledge

Now, having said all that, over the years we have also found that people get the BEST results from starting with Jini’s Wild Oregano Oil Protocol (which has you taking wild oregano all day and then one dose of probiotics before bed). And then from there (once infection is under control and the mucosal lining strengthened) transitioning onto high dose oral probiotic supplementation three times per day. Some also do Jini’s Probiotic Retention Enema too at that point. If you are interested in just those protocols (without the rest of the book), we sell the eBook here:
http://www.listen2yourgut.com/blog/probiotic-retention-enema/

BUT when we tested with people ONLY using the pathogen killer (wild oregano oil) without the daily dose of probiotics, many people couldn’t tolerate the protocol and results were not as good.

Likewise, my new experimental Intestinal StrictureHeal protocol also involves killing pathogens first, and then one dose of probiotics before bed.

At the end of the day, research results can swing all over the place, but the bottom line is WHAT WORKS? Hence I keep stressing to people that you have to use a multi-pronged approach (see the 8 Steps To Healing on my homepage) to get the best results.