# Treatment Protocol emphasizing Probiotics and prebiotic substrate



## karoe (Sep 22, 1999)

I know this post is long, but I think it's very good information and it took me a while to put it together. It includes an excerpt from Dr. Galland's monograph, an appendix called the 4R Program (Remove, Replace, Reinoculate and Repair). This is important information about the critical activity of bacteria which produce short chain fatty acids from indigestible starches in the large intestine. Making sure that this process is working seems basic to good health and to ending digestive problems&#8230;.it appears to be important that the right starches are eaten or all the expensive probiotics in the world aren't going to make a lasting improvement&#8230;. My take on this, anyway. I found Dr. Leo Galland's website (http://www.mdheal.org/) one day while I was doing a search on Metagenics, a company that makes supplements. I spent a lot of time reading his articles and looking at his slide presentations. He is very generous with his material. A lot of the stuff on his site has to do with gastrointestinal health and its connection to chronic disease. (not just IBS, Chrons, IBD) Recently (6/08) I found his monograph "Gastrointestinal Dysregulation: Connections to Chronic Disease" on the Integrative Medicine site, and I purchased it. (119 pages, softbound, $60) It is meant for physicians, but I read it and got a lot out of it. I think this approach was preferable to a phone consultation with him ($400 for 30 min). I am working with Dr. Galland's recommendations for probiotics (and pre-biotics), because that is where I am with my healing journey. I 'only' have IBS. I did a two week Elemental Diet (using AbsorbPlus) for two weeks in the Spring, and now I am able to eat fruit (& got rid of lots of gas). I have had good but unfortunately temporary results from various probiotic sources, including raw milk (which I still cosume, a glass at bedtime), and I can't take large quanities of the Natren products without getting constipated, so I thought I would do more research and try other probiotics. I am currently taking one capsule of Natren's Bifido factor and one capsule of the Megadopholis in the am on an empty stomach and again just before bed with the raw milk. I feel better than I have in several years, but I have to be very careful about what I eat, and I continue to have extreme fatigue and gut pain every afternoon from about 2-6. I am often having a formed stool, finally, and I'm grateful and very excited about that. I take no other supplements at this time, but eat lots of whole fresh food (org.meats, vegetables, no sugar or simple carbs-- over 3 years now) and drink triple-filtered water to the exclusion of all other beverages.The information on providing a substrate, or prebiotic, in the form of vegetable or fruit fiber that is digested by gut bacteria in the large intestine is something I wish I'd found out about before now. I feel that I might have been able to get the probiotics to "implant" after the Elemental Diet, had I thought earlier about the substrate issue. I am actively eating foods that will be a good substrate. Again, I am now able to eat apples, after the elemental diet experience, and this helps (pectin).Next up I will be adding fermented foods to my diet, as it seems more logical to me than popping capsules over the long term. Here is a long interesting quote from the monograph. I don't know which to try first, as the research makes them all sound great (!).[brackets are mine]From the Appendix -- 4R Program (Remove, Replace, Reinoculate, Repair)"'Reinoculate' is the third step in the 4R gastrointestinal support program Reinoculate refers to the reintroduction of desirable bacteria, or "probiotics," into the intestine to reestablish micro flora balance. Bacterial balance in the intestine is critical for proper intestinal permeability. Over 400 different species of microorganisms reside in the human gastrointestinal tract and the overall balance of these organisms can profoundly influence gut ecology and health.Probiotics serve a variety of functions in the gastrointestinal tract. Perhaps the most important function of probiotics is antagonistic activity toward pathogens, which they perform in a variety of complimentary ways. First, probiotics assist in colonization resistance-- the ability of normal flora to protect against the unwanted establishment of pathogens. Second, probiotics may produce various antimicrobial substances. For instance, lactobacillus casei GG has been shown to produce substances inhibitory toward a broad spectrum of gram-positive and gram-negative pathogens. Competition for nutrients is a third mechanism. By competing for available nutrient substrate, beneficial bacteria can inhibit the growth of other less favorable flora. Competitive inhibition for bacteria adhesion sites is a fourth mechanism of probiotics. For instance, lactobacillus acidophilus inhibits the adhesion of several enteric pathogens to human intestinal cells. A final mechanism involves systemic host response. For instance, L. casei GG may decrease the likelihood that pathogens will develop resistance against probiotic agents. Thus, probiotics may be viewed as a vehicle to neutralize on inhibit pathogen activities, or increase or stimulate host immune stimulant activities to the intestinal tract, or both.A variety of supplemental sources may be considered helpful in reinoculation. These include cultured and fermented foods containing live bacteria, refrigerated liquid supplements containing live bacteria, or freeze-dried bacteria packaged in powder, tablet, or capsule form. Frequently supplemented species include Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillus thermophilus, Lactobacillus sporogenes, Lactobaccillus casei GG, Lactobacillus NCFM, Saccharomyces boulardii, Bifobacterium bifidus, Bifidobacterium longum, Bifidobacterium breve.In addition to directly reintroducing the bacteria, the reinoculate step may also involve indirectly bolstering the healthy microflora with prebiotics, which selectively promote beneficial synergistic flora without silmultaneously supporting pathogenic bacterial growth. When prebiotics are included in the diet, increased levels of fecal fermentation and intraluminal concentrations of SCFAs [short chain fatty acids], such as proprionate, acetate, and butyrate, are produced from fermentation of the fibers by the colonic microflora. SCFAs are thought to supply up to 70% of the energy used by colonic epithelial cells; therefore, prebiotics support improved intestinal integrity and promote intestinal cell regeneration. Prebiotics include fructans [jerusalem artichokes, chicory root, belgian endive are rich sources, supplements are made out of the chicory root], inulin [asparagus, artichoke, onion, banana, chicory root] and fructooligo- saccharides [jicama, jerusalem artichoke], arabinogalactans [radishes, leek seeds, reiki, mushroom. Food sources are said to provide minimum amounts. Supplements are made of the wood of the larch tree. Should we really be eating that?] and some soy fibers. The incorporation of soluble fiber [pectin as in apples, oatmeal (not instant) numerous supplements exist for this ] another important nutrient substrate for probiotics, may also help the reinoculation process."From Gastrointestinal Dysregulation: Connections to Chronic Disease, a monograph, 2008, available from the Institute for Functional Medicinewww.functionalmedicine.orgauthor: Leo Galland, M.D. with Helen LaffertyAdapted from Lukaczer D. The "4R Program" in Jones DS, ed. Textbook of Functional Medicine, Gig Harbor, WA: The Institute for Functional Medicine


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