Intractable Chronic Bowel Disorders: Alternative Therapeutic Approaches

 

 

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

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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