This picture of lots of chronic digestive issues seems to be common with chronic Lyme patients.
There are many discussions around the same topic in the last week under various headings.
It is also a topic I have researched a great deal and experimented with in my own health journey with some success - so I will try to put down some of what I have found in the hope it will help others.
this picture of ongoing digestive issues in lyme disease makes a lot of senses when we understand that inflammation and immune dysfunction ( which we all certainly have - lead to downstream effects on the gut and our ability to keep it in homeostasis ( the condition that it likes and works well for our bodies).
this homeostasis also includes maintaining a happy balance of the right organisms in our gut to be ones that are symbiotic and work for us - rather than those that are pathogenic and work against us.
( on the Vitamin D and VDR thread there is a discussion of the way the body uses this part of the immune system to manage the microbiome - and that this is the exact same part of the immune system that Lyme suppresses by a factor of 50x)
some specific co-infections make this situation significantly worse because of their direct action on the gut - Bart for instance is known to infect the cells that line the gut( epithelial cells) and this is a very immune active part of the body.
science dos not yet fully understand all of these reactions - and our microbiomes differ significantly from one person to the next - as does our own immune systems and of course our current diet and genetic makeup.
this huge variation of many factors that makes each individual's reaction to any specific probiotic ( or other gut treatment for that matter) highly variable and makes it pretty hard to make any one-size-fits-all approach for probiotics for people with Lyme.
but here are a few thoughts/principles that may help shed some light:
1 - Holistic thinking
thinking holistically about
the body and one's health helps - as anything that affects the gut affects our general health and overall symptoms - and vise-versa - anything that detracts from our overall health also tends to worsen out gut symptoms ( by increasing the burden on the overall system and lessening the bodies ability to maintain homeostasis )
this is one of the reasons why sleep, appropriate exercise, diet, stress management etc all help - as much as if not more than any pill or potion we can buy. ( believe me, I have tried dozens and dozens)
this doesn't mean there isn't any that can help - but we have to be selective and we cannot, unfortunately, consider probiotics as a standalone concept.
2 - Dosing
while someone in the general population might be able to take a 50billion CFU dose of any particular probiotic with little more than a bit wind - people with Lyme and already dysregulated digestive system, microbiome/ immune system/ inflammation may react adversely to even a small fraction of that. that is not to say they can be no benefit - but we may need to start on tiny doses - eg a tiny fraction of a capsule or a single shred of sauerkraut - and work up slowly from there.
BTW the same principle applies to most things that affect the gut in Lyme.
3 - SIBO
when SIBO is present ( signs are bloating, discomfort, GERD tiredness after meals - especially after meals with carbs or sugars) the above situation will be increased and it will be hard to put anything much in that doesn't cause more symptoms.
-anything that adds more bacteria will tend to cause the overstimulated immune system to react
-anything that feeds the already overgrown bacteria will likely cause more symptoms
-anything that kills the bacteria already there (including out-competing them for food) - will tend to release endotoxins ( bits of dead bacteria and by-products ) that will cause further immune activation and symptoms.
therefore we typically need to deal with the SIBO before we can tolerate much of any of the above.
this can be difficult to do as the system and micro-environment are disrupted and suiting SIBO - due to Lyme - and that ultimately is what needs to be changed.
this also loops back to the general health principles in 1.
it may be that SIBO in Lyme has to be more managed than cured - in this way its impact on overall health may be minimized as far as possible - and then as Lyme is resolved the SIBO can be effectively treated or will often resolve itself ( as the conditions are removed)
this has been the case for my partner - who is 90% recovered now and her digestive issues are now gone.
perhaps the best home test for SIBO - is to try a fully Keto diet for 3-4 weeks the bacteria need sugar and starches to live on and to proliferate in the small intestine - they are much less able to feed on protein, fats or fiber or protein so diets that lack carbs and instead have fats and protein remove their primary food source while providing you with everything you need ( contrary to what it may say on the cereal packet - humans doe not need carbohydrates to prosper). They have only 1-2hrs to feed on them before they reach the large intestine.
if you eat less than 20g of carbs per day for a few weeks (you may well feel off for a week or so as you adjust) - but if you have SIBO this will be offset by a dramatic reduction in SIBO symptoms and increased energy/wellbeing. ( my Lyme symptoms, especially fatigue, reduced by around 50%)
It's also a cost-free test method.
breath tests are OK - fairly reliable - but you need to do the right one - do it exactly as it says on the tin ( mistakes and compliance issues ) and they can be hard to interpret. even then they do not detect all SIBO cases.
Aspiration is the gold standard - but unpleasant and expensive.
fiber from many sources is generally good in the digestive tract - it aids motility, softens stools, absorbs toxins, feeds healthy bacteria in the colon ( where you want them to ferment stuff) provides lots of healthy anti-inflammatory compounds like short-chain fatty acids, and contributes to a diverse healthy gut microbiome more than any other group of nutrients and typical western diets contain much less quantity and diversity than ideal.
however, when the system is already inflamed it tends to aggravate rather than promote all of these benefits. if you have SIBO or other forms of digestive distress you may need to limit both the quantity and quality of fiber in the food you eat to help relieve the load on the digestive tract and reduce symptoms. limiting all fiber is not good in the long run - but short term to get things back under control it may be necessary to reduce to a minimum.
5 - the type of probiotics:
there are many types of probiotics and this is a complex subject in itself.
but it should be noted that what can be taken as oral probiotics is currently a very small percentage of the families, genera, and species that reside in the human gut.
this means that prebiotics ( foods that feed bacteria may be the only current way to increase many of the bacteria that we would like to grow there ) but as above these are often not tolerated by people with Lyme and digestive issues.
but this leads to the question of what exactly those should be - and this is I'm afraid a field of science at a very early stage.
they can tell us some general rules for instance - diversity is associated with good health outcomes and there are a few patterns that are associated with specific diseases - but it seems likely these patterns themselves are related to changes in the gut environment due to other factors more than caused by the bacteria themselves.
it is likely therefore that it is changes to this environment that are the best options for treatment approaches - per above - as probiotic species will simply not flourish in an unsuitable environment - as demonstrated by numerous PCR stool tests.
also what works as a supplemental probiotic for one person may not be tolerated or even helpful in the next - so there is a lot of trial and error needed.
so my summary would be:
- consider probiotics as one element in a complex system - where other factors may in fact be more important in terms of health outcomes.
- address diet and other macro lifestyle factors before probiotics to manage symptoms
- Carbs and Fiber, in particular, are likely to aggravate gut/SIBO/IBS symptoms in Lyme
- try a Ketogenic diet for 3-4weeks if you think you have SIBO/IBS/Dysbiosis. the improvements are often dramatic.
- go slow with any probiotics ( or prebiotics) to begin with - and be prepared for lots of trial and error - as everyone is different
Post Edited (Garzie) : 10/20/2020 4:20:15 AM (GMT-6)