Methods for preparating / sterilisation of gut prior to HPI

Discussion started by mrhazard 9 years ago

This area is for discussing the pros and cons of different methods of sterilising the gut prior to HPI. This can include antibiotics, antifungals, biofilm breakers, etc.....

 

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Tracy Mac
Tracy Mac
I may have misunderstood the conversation I had with the CDD nurse. We were talking about being desparate enough to drink the HPI, so maybe its the method rather than the top down approach they don't recommend.
9 years ago
Maff
Maff
Thanks for passing that on Tracy. Strange of them to say that as it clearly states on their website that they use a top-down method - naso-jejunal tube! Yes, my own experience and the scientific literature clearly points to SIBO (and I think we can infer yeast overgrowth) affecting the lower section of the small intestine (ileum) only. As you say this has a lot to do with gastric acid and bile sterilising the duodenum and jejunum. Also, colonic microbes may migrate upwards into the ileum through a faulty ileo-caecal valve.

In my case I have been tested for gastric acid production and have no deficiency at all. In fact, using a Heidelberg pH probe I was found to be producing (around) 103% of "normal". So lack of gastric acid is not the problem, I suspect my problems are down to poor gut ecology from birth compounded by far too many courses of antibiotics through childhood. Dysfunctional GI immunity either as a result of this or independent of it would also be a likely factor.
9 years ago
Tracy Mac
Tracy Mac
I have spoken to CDD re the top down method and they are actually against it. Not sure why but they did say that the new bacteria will spread from the lower gut. From what I have read it is only the lower end of the small intenstine that has bacteria in it as the upper end is sterilised by stomach acid? This would suggest that if you have SIBO then it is the stomach acid not doing its job properly?
9 years ago
Maff
Maff
Following my bowel prep (rifaximin + nystatin) and HPI experience I am inclined to conclude that top-down HPI is not the potent treatment I was hoping it would be for upper gut microbial overgrowth. I have noticed no change in the level of upper gut fermentation (attributed by blood alcohol testing to yeast) following meals since the treatment. I was hoping the HPI would act as a potent antimicrobial and take out the yeast.

In general if upper gut microbial overgrowth is the issue (as I believe you feel is the case for you Redo) perhaps top-down HPI is not advisable since it may simply undo the prep with antimicrobials and stimulate new overgrowth.

My feeling is that perhaps SCD/GAPS/PAleo type diets and long-term antimicrobial treatment is a better way to go. I know most of us have come to HPI because this approach has failed to bring significant benefit but in my experience at least it is itself not a "silver bullet".

Sorry to put a downer on things. It could of course be that my treatment methodology was inadequate e.g. capsule method of introducing donor faecal matter, amount of faecal matter, duration of treatment etc.

For colon-only issues I believe HPI has a much greater chance of success. The colon is supposed to be full of microbes...the small intestine is not.
9 years ago
Redozipous
Redozipous
About sterilization of the gut. If/when I give the NG tube HPI another go, I'd like to do more of that. Perhaps rifaximin first, and most likely do more of bowel emptying before I go.
9 years ago
Tracy Mac
Tracy Mac
I tried metrionodozole and erythromaycin again and was able to tolerate. The combo of these two antibiotics has reduced the symptoms by about a third. I think tolerance all depends how well you support your liver to handle these toxic drugs. For me this takes large amounts of Sam-e and Vitamin B. I have the Ondamed/Rife practitioner tomorrow. My donor has finally tested clear and I start HPI on Saturday.
9 years ago
Tracy Mac
Tracy Mac
My gut ecology should probably be called a mono-culture as streptococcus seems to be the last bug standing. The CDD don't know anything about strep. Their interest seems to lie with UC, Crohns & C. Diff. The best advice I have received has come from the clinic linked to the Bioscreen lab at University of Melbourne. First drug of choice for strep is Erythromyacin, then Amoxicillin, then Bactricyn as a last resort but it's a really nasty drug and I don't think I have a chance of tolerating it.

The only good thing about my situation, which I have come to appreciate reading everyone else's stories, is that it is very clear to me that 100% of my problems come from my gut, particularly as it occurred as a result of anti-biotic over use in the first place. This is supported by the very encouraging results I had from my first two HPIs. Now all I have to do is get enough of it into me for long enough.

I am very concerned however that I have run out of options to 'prep' the gut pre HPI. That's why I was asking about Rife Machines. I have an appointment with an Ondamed Practiotioner next Thursday to try and kill off the strep that way. Just dreading telling my story to another practitioner though. If it works I think I will buy my own machine and use it in conjunction with the HPI. Any idea where I can get a reputable affordable Rike machine?
9 years ago
Bushi
Bushi
Maff, you're right the Cedars Sinai is where Dr Pimental works out of. I'm sure that very soon the FDA in the U.S. will approve Rifaximin as a treatment for SIBO and IBS.
9 years ago
Maff
Maff
Sounds like you are in a bad way with your gut ecology Tracy so good to hear your donor has passed the stool testing. Fingers crossed for the bloods. You've been through a lot of antibiotics there! Based on your current testing it seems you need highly targeted treatment for Streptococcus sp. Have you researched or discussed with the CDD what the best antibiotics would be?

Thanks for the links Bushi, very interesting. Cedars Sinai are doing a lot of research in this area. I believe this is where Mark Pimentel does his work? Looks like combination antibiotic therapy is the way many researchers are now thinking for SIBO.

N.B. to view the first link posted by Bushi you'll need to copy and paste the link into your browser address bar and delete the "reduce" from the end so it finishes with .asp
9 years ago
Tracy Mac
Tracy Mac
Bioscreen fecal ecology report said 'undetectable' ecoli , lactobacilli or bifido bacterium. Some of the latter two appeared after HPI but will be gone now that I'm back on amoxicillin. Bacteriodes low but better after HPI. Both tests this year have shown 80-98% streptococcus. Mild overgrowth of other bad bugs. So no surprises why this is so hard to beat. Normal range for Ecoli is 70-90% and I have none. My instinct says that the strep has an anti-microbial effect on the Ecoli.

I've tried erythromyacin (no effect) amoxicillin (limiting but not reducing effect) metronidazole (worked then became resistant) rifaximum (no effect) vancomyacin (couldn't tolerate) The only thing that worked was combination of metronidazole and erythromyacin but I can no longer tolerate the metrionadozole even if I wanted to.

Donor has now passed both poo tests (parasitology and ecology) with only blood tests to go. Donor has 90+% ecoli (unusual) and never gets travellers diareoh. Bioscreen lab were fascinated with his profile and thought we would be a good match!
9 years ago
Bushi
Bushi
Just thought I'd share two articles I came across. The first relates to a study done with Rifaximin test for differential diagnosis between small intestinal bacterial overgrowth and irritable bowel disease:

www.wjgnet.com/1007-9327/13/… SIBO with IBS symptoms.

I also recently read somewhere recently that at Cedars Sinai Hospital in LA are currently testing with the following treatment for SIBO:
Rifaximin 1600 mg per day + Metronidazole (which i think is used to treat Helicobacter pylori) 750mg per day x 10 days . Supposedly the prelim results are quite promising.

The second link relates to enteric coated peppermint capsules and how they can help reducing SIBO. It also mentions CFS

www.altmedrev.com/publications/7/5/…]
9 years ago
Maff
Maff
Of course we can't sterilise the gut completely but antibiotic drugs DO kill bacteria. I am not sure the context in which the doctors you spoke to were explaining the action of antibiotics and I am not a microbiologist but I do know that they kill bacteria via a variety of mechanisms e.g. inhibiting enzymes vital to their survival, "digesting" their cell membranes etc. Also, many bacteria do not produce endospores (or "spores". Unfortunately for you Tracy I believe cocci are one group that do, so this is probably an issue for you with your Streptococcus growth. You might want to check this for yourself though.

Are your Bifidobacteria sp., Lactobaclli sp., and E.coli reported as non-existant or just low but within reference range on your faecal ecology test and was this Metametrix?

I hope your donor results come back soon so you can get moving with things!
9 years ago
Tracy Mac
Tracy Mac
We need to be clear that nothing 'kills' or 'sterilises' everything in our gut - although wouldn't we all love to achieve that! I have had two doctors explain that anti-biotics only slow down the reproductive cycle of the bugs. Even if you find one that works well, the problem bugs are still buried in the bowel wall and the spores of the bugs are still there waiting to 'hatch' in the next phase of the reproducive cycle.

This is the rationale of pulsed anti-bioitic therapy, 2 weeks on 2 weeks off. The two weeks off allows the bowel to recover from the anti-bioitics while you pump pro-bioitics, mutaflor etc into it - then you hit it again for two weeks to tackle the next reproductive cycle.

I am 'lucky' because my problem bugs are acid producing. This means that I can monitor objectively how well the anti-biotics are working by measuring my PH level. So I don't have to solely rely on 'do I feel better today' which can be influenced by so many things. (How many shades of 'bad' are there!)

I've tried a mind-boggling array of both pro-biotics (which I can no longer tolerate) and anti-biotics (which either no longer work or my liver can no longer tolerate). I've had two HPI treatments at the CDD in Australia which created a phenomenal turnaround but ultimately failed. So sustained HPI is my last option. I'm waiting for donor tests so that I can pursue this strategy for as long as it takes.

My fecal ecology tests show I have no ecoli, lactobacillus or bifido left in my gut and most of the 'bad' bugs are overgrown somewhat. However streptococcus is the stand-out culprit. Last test it was 80% of my aerobes (should be under 5%) and I am twice as bad since then so I reckon I've cracked the jackpot at 100% by now! Does anyone else have trouble with streptococcus overgrowth?
9 years ago
Maff
Maff
Good discussion guys. I agree with the jist of what mrhazard and Tracy have said - that stool testing is next to useless to determine what is going on in the upper gut (small intestine). Much better off with breath testing, urinary organic acids, or testing the blood for alcohols following glucose challenge (only aware of Biolab in London, UK offering this).

As for bowel prep prior to HPI I went with nystatin for Candida/yeast and rifaximin for bacteria. The sole reason for these choices was that both drugs are non-systemic i.e. not absorbed in an appreciable amount through the small intestinal wall. I have history of developing toxic hepatitis with systemic antimicrobials.

In a modest attempt to tackle biofilms I used a product called Interfase Plus by Klaire Labs which is primarily an enzyme formula (cellulase, hemicellulase etc) designed to digest the biofilm material. No way of telling whether this product was successful or not but it did not cause any adverse reactions despite also containing EDTA for metal chelation.
9 years ago
True
True
I am doing three parasite cleanses at the same time. No parasites detected on any tests and small bowel overgrowth test was negative...but I have this horrible bloating after almost every meal. Thought I would start with a parasite cleanse then a liver cleanse and heavy metal chelation.
9 years ago
Tracy Mac
Tracy Mac
The other problem with the fecal ecology tests is that they only show a handful of the bacteria in the gut, allbeit the known offenders.
As I understand it, the breath tests are more reliable for the small/upper intestine bacterial overgrowth and the fecal tests for the large/lower intestine eg. my breath tests were clear as my problem is in the lower gut.
Which bacteria are methane producing?
9 years ago
mrhazard
mrhazard
True, are you treating a particular parasite based on testing, or just doing a full cleanse?
9 years ago
mrhazard
mrhazard
Stool samples aren't fool proof though either. I've had multiple Metametrix tests and Bioscreen tests over the last 2 years and neither showed any bacteria capable of producing methane, despite elevated methane levels on breath testing.
9 years ago
Tracy Mac
Tracy Mac
Not all IBS is diareoh or constipation predominant. The important thing is to get a comprehensive gut ecology test (Metametrix or Bioscreen) before you even consider embarking on an anti-biotic regime. The rules of war apply. You must 'know your enemy'. A targeted strategy is better than going in all guns blazing. Too much collateral damage otherwise.
9 years ago
True
True
I am currently embarking upon a antiparasite regimen before trying another transplant. Has anyone else tried this?

Also would like opinions on whether or not a heavy metal cleanse would make any difference on the success of a transplant. Blood tests have shown very high levels of lead and semi high levels of mercury.
9 years ago
mrhazard
mrhazard
Rifaximin alone is not overly effective at erradicating methane producing bacteria for those suffering IBS-C without a clostridium overgrowth.

www.ncbi.nlm.nih.gov/pubmed/… seems to be the drug of choice for methane producing bacteria, although not as safe as rifaximin. The combination works wonders for constipation though!
9 years ago

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