Fighting fire with fire!

A recent study examined the efficacy of a probiotic mix of 8 strains of Clostridium difficile (C. diff) administered orally as a probiotic in people who had recurrent C. diff infections or were at high-risk for recurrences (e.g., >65 years old). Spurred on by the success of fecal transplantation (as high as 92% success) in eradicating C. diff, this group identified 8 strains of non-pathogenic C. diff from healthy volunteers that, when given to participants with prior C. diff infection, slashed recurrence rates significantly.

For those of you unfamiliar, C. diff enterocolitis is a devastating complication of antibiotic use. Take an antibiotic, for instance, for an upper respiratory or urinary infection, and approximately 1% of people experience proliferation of C. diff that causes severe colon inflammation and bleeding. Take a course of antibiotics for C. diff and about 1 in 4 people will experience recurrence, some do not respond at all, about 5% die of the infection. Multiply recurrent infection is becoming more common, also, meaning multiple recurrences, need for multiple courses of increasingly toxic antibiotics. The success of fecal transplant has therefore created interest in microbial solutions to C. diff. Infection from C. diff, by the way, is also occurring “spontaneously,” i.e., in people without a prior recent course of antibiotics—this is almost certainly a consequence of SIBO and abnormal proliferation of Proteobacteria, i.e., fecal microbes.

In this study, 8 C. diff strains, 8 billion CFUs per day (“high dose”) was compared to a dose of 1.6 billion CFUs (“low dose”) vs. placebo over 14 days. While the low-dose was relatively ineffective, the high-dose proved effective in preventing recurrence. Now, those of us around here recognize that what they labeled “high-dose” to us is actually a small dose. Recall that, thanks to the bacterial count-amplification we achieve with our yogurts and other fermentation vehicles, our notion of “high-dose” is more towards 300 billion, a 3700% higher intake than the 8 billion in this C. diff formulation. (It reflects the enormous lack of dose-response evidence in the world of the microbiome due to the costs of performing such studies. This will improve over time but, preliminarily, it is looking to me that tens of billions of CFUs are required for optimal biological effects.) Nonetheless, 8 billion CFUs of live commensal (normal inhabitants) of C. diff was more effective than antibiotics in preventing recurrence, a major finding.

Another observation from this study: Participants who had greater species diversity, i.e., a greater number of microbial species, were more likely to avoid recurrence, those with lower species diversity were more likely to have recurrent infection. This suggests that efforts to increase species diversity, restoring species lost from the GI microbiome, would stack the odds even more heavily towards successful eradication of C. diff. In my programs, we accomplish this with consumption of Saccharomyces boulardii sparkling juices, frequent consumption of fermented foods, our yogurts fermented with specific keystone species such as L. reuteri and L. gasseri, and probiotics. Just administering several strains of C. diff is, no surprise, insufficient to rebuild a diminished gastrointestinal microbiome.

Also, unlike antibiotics that are used to eradicate pathogenic C. diff, the strains of C. diff used in this biotherapeutic formulation have been found to persist for up to one year after administration, an effect that suggests that long-term inhibition of recurrence is likely, unlike antibiotics that come and go over hours. Be aware that they declared this a “phase 2” study, meaning it is part of commercializing this combination of C. diff strains as a drug, not a probiotic supplement.

Step back for a moment. Do you see what is happening here? Fecal transplant, microbial consortia, microbial species with bacteriocin-producing capacity, microbes that bind heavy metals and metabolize glyphosate, reduce uric acid and oxalates—the power of emerging microbiome strategies is becoming extremely powerful. And, unlike pharmaceuticals, we don’t have to be concerned with weight gain, liver damage, diarrhea, or all the other awful side-effects that plague the use of pharmaceuticals. Microbiome strategies are rapidly eclipsing the world of pharmaceuticals. We are not that far away from saying, for instance, if you have a urinary tract infection, restore these microbes. If you are concerned about the potential for miscarriage, eclampsia, or premature delivery during pregnancy, restore these microbes. If you are concerned about your risk for coronary heart disease or are struggling with losing weight, get these microbes. We are witnessing the birth of a revolution in health. Too bad your doctor doesn’t recognize it.