I received a request
from a friend through my WhatsApp chat group that reads:
“Dear Professor Lim
Ju Boo
A friend of mine
whose relatives heard so much about you and they wish to consult you about one
of them who has problems with her intestines passing a lot of gas and loose
motion for years. She consulted a lot of gastroenterologists already, did a lot
of scopes and took a lot of antibiotics and other medicines the specialists prescribed,
but no avail
Now someone else
told her to take yoghurt and probiotics tablets to solve her problems
But she wants to
consult your expert opinion first if taking yogurt and cultured drinks solve
her problems
Your expertise in
all fields is highly appreciated
Thanks”
Silva
------------------------------------------------
I thought I should
share this very interesting this very interesting question and topic in this
blog as well so that other readers outside our chat group may also benefit.
Below here’s my reply:
Thank you for your
question soliciting my help
It is okay if your friend’s relative wishes to try yogurt or any probiotics as
the last resort
But i have to tell you there are only a few strains of natural milk
bacteria in yoghurt or in any commercial cultured drinks vs the vast numbers of
over 1,000 or much more species of natural human gut bacteria called “microbiota”
such as Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus,
Enterococcus, Escherichia, and other bacillus that inhabit our gut, just
to name a few.
The bacterial flora
of the gastrointestinal tract varies longitudinally; the oral cavity contains
about 200 different species, the stomach is almost sterile, and the bacterial
content increases distally, with approximately 108 bacteria per
g (dry weight) of ileal contents and up to 1012 bacteria per g
(dry weight) of colonic contents.
The main types of bacteria in the colon are obligate
anaerobes, and the most abundant bacteria are members of the genus Bacteroides,
anaerobic gram-positive cocci, such as Peptostreptococcus sp., Eubacterium
sp., Lactobacillus sp., and Clostridium sp.
The bacteria Escherichia
coli (E. coli) for instance are also found in and intestines of people and
animals as well as in the contaminated water, environment, and contaminated
foods. They are a large and diverse group of bacteria used as faecal
indicators to indicate contaminated sewage water containing human and animal
excreta. Most strains of E. coli found in the human intestines are
harmless, others are highly pathogenic, and they can cause diarrhoea, urinary tract,
and respiratory illnesses such as pneumonia, and other illnesses. The
importance of the pathogenic strain of E. coli is shown by the fact that diarrhoea
remains one of the leading causes of mortality in children in developing
countries. Enteropathogenic E. coli (EPEC) is an important
cause of severe diarrheal illness associated with high infant mortality
However, the main types of bacteria in the colon are obligate anaerobes, and
the most abundant bacteria are members of the genus Bacteroides, anaerobic
gram-positive cocci, such as Peptostreptococcus sp., Eubacterium sp.,
Lactobacillus sp., and Clostridium sp.
The principal
pathogens in this group are Salmonella, Shigella, Campylobacter, invasive E
coli, and Yersinia. The enteric viruses also invade the intestines
More than 99% of the
bacteria in the gut are anaerobes, but in the cecum, aerobic
bacteria reach high densities. It is estimated that the human gut
microbiota has around a hundred times as many genes as there are in
the human genome.
There is some
evidence that treatment with some probiotic strains of bacteria may be
effective in irritable bowel syndrome and chronic idiopathic constipation.
Those organisms most likely to result in a decrease of symptoms have included:
- Bifidobacterium breve
- Bifidobacterium infantis
- Enterococcus faecium
- Lactobacillus plantarum
- Lactobacillus reuteri
- Lactobacillus rhamnosus
- Lactobacillus salivarius
- Propionibacterium freudenreichii
- Streptococcus thermophilus
Yogurt as you
mentioned, specifically contains main just two types of milk bacteria,
namely, Lactobacillus bulgaricus and Streptococcus thermophilus although some
manufacturers may add in additional types of lactobacilli and bifidobacterial
species
Bifidobacteria
are a group of probiotics bacteria that normally thrive in intestines.
They support the body undertake essential functions such as digestion and fends
off harmful bacteria. One species in this group is Bifidobacterium bifidum as
an example.
Given the limited types
of bacteria found in yogurt vs the tens of hundreds if not thousands of mixed
intestinal bacterial flora found in the human intestines, it would be just a
drop in the ocean if you were to swallow even 20 tablets of commercially-made probiotics
and eat 20 cups of yoghurt a day containing just 2 or 3 species of milk flora
in them. I do not think yogurt could help much as it would be round and round
in the same cycle with the same bacteria being ingested vs the tens of hundreds
of microbiotas inhabiting the human gastrointestinal tract (GI tract).
I do not think this
is going to solve her chronic bowel problem as she has already seen so many
gastroenterologists with all their scans plus so many antibiotics given to her.
The amount of antibiotics and other chemical drugs prescribed for her by so
many gastroenterologists may have made her problem worse by sterilising her
entire GI tract free from these highly beneficial human gut microbiotas.
TCM and FMT Options:
However, there was a Traditional Chinese Medicine (TCM) approach the TCM doctors
in China used to treat diarrhoea and a variety of colon disorders very
effectively. This treatment in TCM is over 1,700 years ago.
It was first described by Ge Hong using human faeces called "yellow
soup" or "golden soup" to successfully treat all these
intractable bowel diseases that conventional drug and surgical based medicines
have failed miserably like in your friend's relative case.
This method of using
the faeces of a healthy individual to give it to another patient with all sorts
of chronic bowel problems ranging from irritable bowel syndrome, chronic
colitis, ulcerative colitis, all the way down to appendicitis, Crohn's disease
to colorectal cancers, just to name a few, were very successful for nearly two
thousand years.
This “yellow soup" prescription in Traditional Chinese Medicine was so
successful that now Western mainstream drug-based doctors too have copied the
TCM approach in the management of all these wide ranges of bowel disorders but
in a modified way.
We now call the modified therapeutic approach as “Faecal Microbiota
Transplantation” (FMT) where they take healthy donors, screen them thoroughly
and transplant their faeces into the colon via colonoscopy or via pills taken orally
Faecal microbiota
transplantation (FMT) is now used in conventional allopathic medicine that aims
at treating these wide ranges of colonic diseases by copying the TCM therapeutic
modality. It is a recommended treatment
option for patients with recurrent or
refractory Clostridioides
difficile as it has a cure rate of over 90%.
There are numerous
research papers already published where western drug medicine has copied
Traditional Chinese Medicine approach in managing many of these intractable chronic
bowel disorders.
There is also evidence
that faecal microbiota transplantation can induce remission in ulcerative
colitis, however maintenance of remission data is lacking. We shall
explain this shortly.
In FMT, stool donors
must be healthy and are screened for a range of diseases. As faecal material is
usually transplanted during colonoscopy, the recipient must have bowel
preparation before the procedure. Adverse effects are mainly
gastrointestinal and usually resolve in the week
following transplantation. There are limited data on long-term safety.
Here's just one among 35 studies I managed to pick up already been done using
FMT.
“Faecal microbiota
transplantation: Historical review and current perspective”:
https://www.wjgnet.com/2308-3840/full/v7/i9/423.htm
Readers can search and read other literatures for themselves. It is not possible for me to search and show
all of them for readers to spoon feed as I am already long retired from active
medical research.
(I was then a Senior
Medical Research Officer and a Deputy Head of one the Divisions at the
Institute for Medical Research Malaysia).
However, the use of
pills containing these microbiotas via oral route, in my opinion may not be as
effective as direct infusing microbiota into the colon because of the very
powerful gastric juice in the stomach and other proteolytic enzymes in the GI
tract that may kill off most of these microorganisms before they can even reach
the colon.
In the stomach where
the hydrochloride acid is secreted, it is virtually devoid of bacteria except Helicobacter
pylori (H. pylori), a spiral shaped bacterium that inhabits in or on the
lining of the stomach. It causes more than 90 percent of ulcers in the lining
of the stomach or the duodenum (the first part of the small intestine).
However, the use of FMT may not last long as the transplanted bacteria may not stay long enough in the colon and may also be excreted out in the faeces
Diet and Nutrition:
One way out from
this problem is the consumption of foods rich in probiotics. The most common
fermented foods that naturally contain probiotics, or have probiotics added to
them, include yogurt, kefir, kombucha, sauerkraut, pickles, miso, tempeh,
kimchi, sourdough bread and some cheeses. But even then, these bacteria may not
stay long in the colon unless probiotic-rich foods are regularly consumed to
replace those excreted out.
But I have another
way to circumnavigate this problem. Instead of consuming foods rich in probiotics,
better still, consume foods on which these bacteria depend on to survive and to
remain in the intestine.
These are called
prebiotics, meaning they may not contain beneficial gut bacteria, but because
of their high fibre content on which these bacteria feeds such as in the
intestines of cows, horses, and herbivores, they promote the growth of these
bacteria to remain there once FMT is done. These prebiotic foods are garlic,
onions, leeks, asparagus, bananas, etc containing soluble fibres,
oligosaccharides, and sugars consumed by gut bacteria that encourages these
beneficial microbiotas to remain and proliferate the colon
In short, it looks to me your friend's relative problem is dietary and nutritional in orgin since he or she had already seen so many gastroentrologists, and has already have so many investigations, scopes done, and were on antibiotics and all kinds of medication without response
His or her doctors should have look into the patient's dietary history and suggest a change in diet rather than giving all kind of antibiotics that made the patient's problem worse. A sterile colon due to antibiotics without competition by a huge hosts of healthy and beneficial gut microflora will give opportunistic infections by other pathogenic organisms to invade. That may have made her presented with chronic diarrhoea as his or her body was trying to get rid of them.
I suggest he or she goes into a vegetarian or vegan diet due to their higher fibre content for colon natural bacteria to feed, grow and inhabit his / her bowels.
Merely taking yogurt may not help as I have already explained above.
What I suggest here may be the final and most clinically effective prescription I can give for
your friend's relative.
If this FMT is not
available in Malaysia, I think Singapore has this therapeutic approach and service.
I hope I managed to answer and has been of help to your friend and his loved
ones.
Good luck.
Lim jb
