Gut Bacteria As Possible Cause/contributor To Pots?

[bruc]

"Thanks for that info; very interesting. It's always eye-opening to see a new perspective and it helps to know where it's coming from. I think it's safe to say that Dr. Pimental's advice re. probiotics is new (unorthodox)- hence my questions."

His advice isnt new or unorthodox. In my case, think about the function of the small bowel. It makes perfect sense. If the peristaltic waves are not functioning right the bacteria has no place to go but accumulate in the small bowel. What is new is the mass promotion of probiotics marketing by many. Im not saying probiotics are wrong for everyone just please evaluate your condition are they appropriate?

"There's lots of medical literature that touts the advantages of probiotics for SIBO's. I think it's a commonly held belief.... which doesn't necessarily make it right."

Did you overlook or miss the conclusion(s) on pgs85 of the article I posted?

"Guidelines for the routine clinical use of probiotics are confounded by insufficient data to guide optimum strain selection,dose, mode of delivery, and methods for monitoring efficacy."

The article references several experimental studies.

"Probiotics appear, therefore, to possess a number of properties that could be of benefit in bacterial over-growth and intestinal failure; their introduction into the therapeutic armamentarium, however, must await the results of well-conducted clinical trials as are performed for poorly absorbed antibiotics"

In other words, nothing is definitive. Medicine is an inexact science.

"BTW, the article I cited earlier was written/edited by a couple of gastroenterologists who also had ties to Cedar Sinai."

Could you post literature references instead of websites?

"Dr. Pimental agrees that there ARE bacteria in the small bowel, just fewer numbers. The Zaidel & Lin article is the first I've ever seen that state that 33% of biopsies (in healthy patients) show NO bacteria in the small bowel.

Interesting, but most likely not representative of the truth."

What's your basis for that conclusion?

Yes, they are there but if the small bowel and its waves working optimally, bacteria shouldnt be there.

"I'm guessing that Dr. Pimental is surmising that in your case, due to your myopathy, ingested probiotics could become entrapped in your small bowel and wreak havoc. Out of curiosity, how do you know that your dysmotility is due to myopathy and not a neuropathy?"

My current GI motility specialist is at the University of Iowa.

Antroduodenal manometry revealed patterns suggestive of myopathy.

A second manometry indicated myopathy in the esophagus.

Myopathy secondary to autonomic dysfunction, although not very common.

"He also takes a GI prokinetic that helps to normalize the contractions throughout his GI tract."

I would suggest the prokinetic is just as important to no SIBO as the probiotics.

If you can somehow normalize the waves in the small bowel and clear it out then chances for it to repeat lessen.

Im not sure what the difference is in the waves when comparing the dysmotility to a myopathy or neuropathy.

"NOT whether or not probiotics can be helpful."

Since the studies are lacking, and those they cite are experimental, the question on there helpfullness is remains unresolved.

Being proactive, getting the word out, educating yourself and anyone else willing to learn is the only way to solve our conditions.

[bruc]

My neurologist is the one who has stated that a biopsy would be only way for definitive neuropathy or myopathy but there are limitations.

From all my readings its beyond me to understand how an autonomic neuropathy could cause a suggestive myopathy; a startling find.

My neurologist did point me to an article where a Myotonic Dystrophy patient with GI dysmotilites was thought to result from a myopathy. However, upon full thickness biopsy the pathology results yielded neuropathic finds no sign of myopathy.

[cmruls]

Thanks.

[bruc]

I cant imagine doing the TTT with an ADM at the same time.

Must been awful.

Is Hopkins only place to offer this combo?

Havent come across any other.

[Rachel]

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[Dizzysillyak]

I haven't read this whole thread so I don't know if this has been discussed yet. FWIW... Dr. Myhill is typically ahead of the pack when it comes to health care. I only copied in one section but IMHO, the whole article is interesting ...

http://www.drmyhill.co.uk/wiki/Fermentation_in_the_gut_and_CFS

Change the bugs in the gut

Probiotics have not lived up to their therapeutic potential. I suspect this is because the single most important probiotic is bacteroides and this cannot exist outside the human gut. Oxygen kills it within minutes. There is no probiotic on the market which contains bacteroides. We acquire bacteroides at birth and retain those bacteria for life.

Kefir is useful because it contains a combination of bacteria that produces a toxin that kills yeast.

BTW. Those of us familiar with o.forminges knew this ... tc ... dizzy

[sue1234]

Thanks for posting this. I really got some useful info out of the part that breaks down what things are produced by the bacteria and how they affect the body. I have told my husband for years that I "feel" drunk. And, I haven't drank alcohol in about 15 years! And then the days where I just cannot think! So, that's what I was really interested in--how the different bad bacteria can affect us in different ways in the body.

[sue1234]

Now when I think of it, I am trying to find out this week if an allergist will work with me regarding the MCAD possibility. As a side-effect of taking the H1 and H2 blockers, that is going to make my stomach more alkaline, right? That is going to apparently not help regarding killing off the bacteria in the upper gut area. What's a person to do?

[juliegee]

Hi Sue-

Forgive me if this has already been covered, but have you done a course of xifaxcin? That anti-B has been a godsend for Mack when he gets a SIBO. He does a relatively short course, 7-10 days and he feels better from day one. This is a much improved anti-B over the older ones that were used, like Flagyll. There are essentially no negative side effects. I've been researching Dr. Mark Pimental, whom Bruc has quoted, and this is his beginning strategy as well.

I'm really trying hard to wrap my head around the idea that probiotics worsen SIBO's. I'm not quite getting that even from the articles that Bruc and Dizzy posted. Dr. Myhill says that probiotics haven't lived up to their therapeutic potential (and I understand his reasons), but he still strategically recommends them and kefir, which is essentially lactobacillus. (Lactobacillus is the one my son's motility docs insist upon.)

Bruc's article listed all of the benefits of probiotics, but warned that it is difficult to get the correct type, dosage, delivery methods, and to monitor efficacy. That doesn't tell me that they worsen SIBO's. I think you are on the right track to figure this out with a doc so that you can specifically target a treatment plan for you.

Do you know if you have a motility issue? If so, a GI prokinetic may also be a godsend- something to help the GI tract contract more effectively. Have you experimented with any of them?

I'm open to learning more about all of this. Dr. Pimental's book is available on Amazon and I plan to download it to learn more. I suspect that you are right- bacterial imbalances may play a part in more than GI woes.

BTW, I have an interesting observation regarding MCAD and GI stuff. My whole adult life, I had horrible crampy, uncontrollable "D." My docs called it IBS-D. Since I've been on the MCAD meds, it is much improved. No more "D." BUT, the pendulum has swung to the opposite direction and I now have intractable "C." I control it very well with Miralax, lots of it- about 40 grams or more a day. I am far from "normal." Hard to tell if it's from an imbalance of bacteria OR from too many/highly reactive mast cells in my GI tract...

Share what you learn with us. When's your appt?

Julie

[HopeSprings]

Sue - I am unable to read through all of this - too foggy. But what caught my eye is where you say you feel "drunk." THAT is how I feel and have felt for years. If you discover something in the gut (or anywhere else LOL) that might cause this, please let us know.

Naomi

[ramakentesh]

There is consistent evidence - although not widely accepted - that ankylosing spondylitis is related to the Klebsiella bacteria. So who knows what other nasties cause this or that.

There is a doctor in Melb that tells his patienst that CFS and its related illnesses are all caused by hydrogen sulfide and its neurotoxic effects. Couple of problems with that are the fact that its effects would normally result in the opposite of what are described in POTS and maybe CFS. While NO controls large artery vasodilation, HS controls small artery vasodilation.

And low levels of hydrogen sulfide were found in POTS who fainted in:

http://en.cnki.com.cn/Article_en/CJFDTOTAL-SYQK200715022.htm

[DoozlyGirl]

This is a very interesting discussion. I have wondered how to string my many diagnosis and odd symptoms together and always felt each contributed to the next. Chronic infections leading to antibiotic overuse-->IBS-->migraines--> allergies-->candidiasis-->endocrine issues--> autonomic dysfunction. Since 80+ percent of the immune system is located in the gut, I always felt my issues picked up speed with the IBS.

In the past three years, my PMD has ordered xifaxcin several times, which helped me control my colon issues. She is more comfortable ordering this than 200 mg daily diflucan, which I had taken for about 6 months to treat candidiasis. Recently, I found digestive enzymes helpful. Anyone else taking enzymes?

Lastly, Florinef and corticosteroids can promote candidiasis and I was wondering if anyone has had issues with that?

Thanks, Lyn

[sue1234]

Another good abstract on gut bacteria linked to the brain:

http://gut.bmj.com/content/60/3/288.extract

I found it interesting that halfway down, they mention a finding of infection with Campylobacter causes a vagal reaction by the body.

[sue1234]

Julie,

I posted a long post to answer some of your questions, hit "add reply" and POOF! I was disconnected. So, moral of the story here is, next time I have a long post, I will write it on Word and copy it over to here.

Just quickly, I am leaving for my allergist/immunologist appt. right now. I have my POTS/MCAD article in hand.

[green]

I'm going to have to dig to find it, but a few weeks ago I ran across a place that mentioned an NIH-backed study in California(forgot which institution) that is looking at the possible connection between the endotoxins from gut bacteria and ALZHEIMERS! When I stopped and really thought about it, I could understand. I hate to keep repeating myself, but 3 days without food lifted the brain fog! So, I can see where the by-products could damage(?) or definitely alter the brain. I have sometimes equated my thinking brain to pre-Alzheimers. It seems like I can't remember anything, and I don't mean it in a funny, usual way. I mean I have a bachelor of science degree, and I can't THINK anymore. I know what my abilities used to be, and they're not there anymore.

You have to be careful about using anecdotal experiences to validate theories (even your own anecdotal experiences)

Fasting has effects on the brain that are independent of digestion. For example, after 24 hours of fasting the body shifts into an altered metabolic state called ketosis. In ketosis, the blood is filled with ketone bodies - which are dissolved bits of fat. Ketone bodies are thought to have the potential to significantly improve cognitive function.

That's just one way diet can change the brain without the intervention of bacteria in the gut.

[bruc]

Ann Neurol. 2011 Feb;69(2):240-7. doi: 10.1002/ana.22344.

Gut, bugs, and brain: role of commensal bacteria in the control of central nervous system disease.

Ochoa-Repáraz J, Mielcarz DW, Begum-Haque S, Kasper LH.

Source

Department of Neurology, Dartmouth Medical School, Lebanon, NH, USA.

Abstract

The mammalian gastrointestinal track harbors a highly heterogeneous population of microbial organisms that are essential for the complete development of the immune system. The gut microbes or "microbiota," coupled with host genetics, determine the development of both local microbial populations and the immune system to create a complex balance recently termed the "microbiome." Alterations of the gut microbiome may lead to dysregulation of immune responses both in the gut and in distal effector immune sites such as the central nervous system (CNS). Recent findings in experimental autoimmune encephalomyelitis, an animal model of human multiple sclerosis, suggest that altering certain bacterial populations present in the gut can lead to a proinflammatory condition that may result in the development of autoimmune diseases, in particular human multiple sclerosis. In contrast, other commensal bacteria and their antigenic products, when presented in the correct context, can protect against inflammation within the CNS.

Copyright © 2011 American Neurological Association.

PMID:

21387369

[PubMed - in process]

[bruc]

Mutat Res. 2007 Sep 1;622(1-2):58-69. Epub 2007 Apr 6.

Importance of microbial colonization of the gut in early life to the development of immunity.

Kelly D, King T, Aminov R.

Source

Rowett Research Institute, Aberdeen, Scotland.

Abstract

The mammalian gastrointestinal tract harbors a complex microbiota consisting of between 500 and 1000 distinct microbial species. Comparative studies based on the germ-free gut have provided clear evidence that the gut microbiota is instrumental in promoting the development of both the gut and systemic immune systems. Early microbial exposure of the gut is thought to dramatically reduce the incidence of inflammatory, autoimmune and atopic diseases further fuelling the scientific viewpoint, that microbial colonization plays an important role in regulating and fine-tuning the immune system throughout life. Recent molecular diversity studies have provided additional evidence that the human gut microbiota is compositionally altered in individuals suffering from inflammatory bowel disorders, suggesting that specific bacterial species are important to maintaining immunological balance and health. New and exciting insights into how gut bacteria modulate the mammalian immune system are emerging. However, much remains to be elucidated about how commensal bacteria influence the function of cells of both the innate and adaptive immune systems in health and disease.

PMID:

17612575

[PubMed - indexed for MEDLINE]

Publication Types, MeSH Terms

[firewatcher]

Hot off the medical presses:

Bacteria, intestinal injury and reactive oxygen species

Enteric commensal bacteria potentiate epithelial restitution via reactive oxygen species-mediated inactivation of focal adhesion kinase phosphatases

Phillip A. Swanson IIa,1,

Amrita Kumara,1,

Stanislav Samarina,

Matam Vijay-Kumara,

Kousik Kundub,

Niren Murthyb,

Jason Hansenc,

Asma Nusrata, and

Andrew S. Neisha,2

+ Author Affiliations

Departments of aPathology and

cPediatrics, Emory University School of Medicine, Atlanta, GA 30322; and

bDepartment of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332

Edited by Ralph R. Isberg, Tufts University School of Medicine, Boston, MA, and approved April 15, 2011 (received for review July 14, 2010)

Abstract

The mechanisms by which enteric commensal microbiota influence maturation and repair of the epithelial barrier are relatively unknown. Epithelial restitution requires active cell migration, a process dependent on dynamic turnover of focal cell-matrix adhesions (FAs). Here, we demonstrate that natural, commensal bacteria stimulate generation of reactive oxygen species (ROS) in intestinal epithelia. Bacteria-mediated ROS generation induces oxidation of target cysteines in the redox-sensitive tyrosine phosphatases, LMW-PTP and SHP-2, which in turn results in increased phosphorylation of focal adhesion kinase (FAK), a key protein regulating the turnover of FAs. Accordingly, phosphorylation of FAK substrate proteins, focal adhesion formation, and cell migration are all significantly enhanced by bacterial contact in both in vitro and in vivo models of wound closure. These results suggest that commensal bacteria regulate cell migration via induced generation of ROS in epithelial cells.

Edited May 11, 2011 by firewatcher

[juliegee]

Tell us about your appt., Sue. Did you make any headway?

[sue1234]

Bruc and Firewatcher, thanks for the articles!

Julie, I made NO headway. The doctor said she didn't know anything about POTS and that "mastocytosis" needs to be checked by a bone marrow biopsy. In fact, she said something about the only way to check for mast cells is by BMB. I didn't want to begin "arguing" with her. She never brought up a tryptase or methylhistamine. She looked for the typical rash, which I don't have. She said that what I have sounds like something the cardio should be addressing, that it was "vascular". I did tell her, no matter what and because it can't hurt, I was going to start the H1 and H2 blockers to see if they helped or not. She recommended a few, and said that IF it did help, that I really should let my cardio know and get the BMB.

I would order my own methylhistamine, but it costs $200 out of pocket. I was hoping a doctor was going to order it, as my deductible is fulfilled right now.

I took a half of an Allegra so far, and will try the Zantac tomorrow. Then I'll combine them in a couple of days.

Do you ever just go to an appt. and know right away that there is no use bringing in this information?? Right away I knew it. She was nice and polite, but apparently not willing to fully look at the article or try and think about it.

[juliegee]

Oh yeah- I've wasted lots of appointments Sorry, it was such a bust. You're in LA? Dr. Lawrence Afrin in SC is the closest guy I can recommend for a masto work-up. Note your response to the meds and see if this really seems like a possibility.

An allergist that doesn't know to test for serum tryptase??? You should ask for your money back, really. A BMB is often necessary, after you get a high reading with either serum tryptase, methylhistamines, prostaglandin D-2, or too many cells via a biopsy anywhere on your body or in your body. Starting with a BMB is unheard of and incredibly invasive w/o some good evidence that it's necessary. You are asking to be worked up for mastocytosis, MCAD is a DX that's given after that is excluded.

Sorry. I know we've all been there

Julie

[sue1234]

Yea, if she would have at least read just the abstract of the article, she would have seen that it talked of mast cell activation disorder, and not mastocytosis. When she started saying BMB was what would be needed, I was shaking my head NO, to let her know I was not asking for that, nor was I going to do anything that invasive.

Yes, I'm in LA. If I would happen to find the meds helpful, I will keep Afrin in mind.

[ramakentesh]

totally unrelated but still interesting:

In Chrons disease they now believe that rather there being T cell related autoimmunity there is actually a poorly functioning inate immune system that cant kill certain bacteria properly, thus attacked the whole area vainly trying to destroy the bacteria - like a scatter gun approach.

What if all autoimmune illnesses are the same - rather than overactive, perhaps they aer disfunctional. ??

[Guest tearose]

I'm starting to wonder if the cumulative effects of all ( meaning all people not just pots people) our exposure to things like: chemicals, additives, preservatives...has somehow altered ALL of human ability to fight new strains of disease and dysfunction. J

Then, with us just keeping our body in balance is even more work if we are sensitive to thing already.

We may have over exposed ourselves to technological and chemical improvements with what we thought was helping us all along.

[cmruls]

We may have over exposed ourselves to technological and chemical improvements with what we thought was helping us all along.

"chemicals, additives, preservatives"

This is what has changed over the last 30 years. We are a product of what we eat and do.