UC flare w/probiotics - Q

UC flare w/probiotics - Q


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gagliardi_colleen
Message 1 of 6 , Apr 9 7:58 AM
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Hello,
I've been working successfully with a 46 yo woman with ulcerative colitis (lower descending colon) since 2/14.  She started care with me having daily bloody stools, gas, bloating and stomach pain.  She was started on GI caps by wise woman, and we did CPx3 (negative except for a little Candida, treated with 1 capsule grapefruit seed extract and she also had low lactobacillus), SIBO (negative) and food sensitivity testing  (some foods eliminated).

She has been taking Lialda (mesalamine) all the time too.

Her symptoms improved greatly with the GI caps, butyrex, multivitamin, glutamine powder and digestive enzymes.  She has for the most part not had any digestive symptoms x 10 months.  We started her on a probiotic 2 weeks ago that had lactobacillus rhamnosus and lactobacillus reuteri in it.  After 2 capsules of the probiotic, she has had 3-12 bloody stools daily with abdominal pain for the past 1 1/2 weeks.  She just contacted me 2 days ago to let me know.  She is getting daily acupuncture and GI doc ran stool test that was normal (no WBC in stool).  She had stopped the GI caps with the flare.  I had her try 2 GI caps yesterday, and she reported that her symptoms worsened with them.

Any ideas if/why the lactobacillus probiotics could have flared her UC?

Thanks,
Dr. Colleen Gagliardi, ND LAc
Westminster, CO


Mona Morstein
Message 2 of 6 , Apr 10 7:28 AM
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I have not seen probiotics do that, Colleen, and I give them to every IBD patient.

Many, if not most or all, patients flare now and then.  Was there anything else going on in her life?  Even though her SIBO was (-), in general even UC patients should avoid all grains, as well as their food sensitivities, if you are not doing the SCD diet as a whole with them.  I've seen brown rice cause a flare in a UC patient.

You should follow IBD patients with calprotectin and lactoferrin, stool tests done by typical labs.  Those tests for IBD are like the A1C in diabetes--it is the best non-invasive way to measure how inflamed their gut is.  Not having symptoms is one thing; but ensuring the inflammation is under control is another.


Mona Morstein, ND, DHANP
Tempe, AZ
www.diamend.info
Official Sponsor of NatChat--Doctors Data Lab


Anne Van Couvering
Message 3 of 6 , Apr 10 11:11 PM
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Hi Colleen -

I have no idea whether this is an actuality or not, but I have heard some docs speculating about people who are allergic to their gut flora; I suppose someone could be allergic to a probiotic, or have it trigger autoimmunity.

My thoughts at the time were "how horrible" and "what could you possibly do if that were the case?" Anyway, one possible mechanism. I still don't have a clue as to what you could do about it, unless it would be fecal transplant or rectal ozone

Anne

Anne Van Couvering, ND, LMT, CNS
Sag Harbor, NY


Eric Yarnell
Message 4 of 6 , Apr 11 11:19 AM
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I have encountered this with one patient with UC, interestingly also a woman in her 40s. She had two flares associated with taking two different probiotics. So we just had her stop those completely.

There is some preliminary evidence that at least some people with UC have immune reactions against Lactobacillus. PMID 24991549





Eric Yarnell, ND, RH(AHG)
Seattle, WA
Natural Approach to Gastroenterology 2nd ed (healingmtn.com)
Northwest Naturopathic Urology (urologynd.com)


Eric Yarnell
Message 5 of 6 , Apr 11 1:46 PM
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Presumably the treatment when this is the case is to reduce gut permeability so that the immune system can no longer see the bacteria it is upset about. Also it raises the specter that not all strains of aerophilic microorganisms in the gut are necessarily healthy/helpful in all people, and therefore on to your theory about fecal transplant. However, it is proving quite difficult to shift multiple strains of organisms around involved in IBD, fecal transplant so far in my limited experience has been anything but a panacea for IBD or complex situations. It practically is for much simpler single-organism issues like C. diff.



Eric Yarnell, ND, RH(AHG)
Seattle, WA
Natural Approach to Gastroenterology 2nd ed (healingmtn.com)
Northwest Naturopathic Urology (urologynd.com)


markdavisnd
Message 6 of 6 , Apr 13 9:17 PM
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I have seen people with IBD who are aggravated by certain strains of probiotics. It's in the literature as well, don't have the reference handy but it looks like Culturelle leads to higher relapse rates than placebo in folks with Crohn's.

Mark Davis, ND
PDX OR