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Hey everyone,

I thought I would give the scientific papers a rest this week. Instead, I want to focus on answering some questions posed to me over the last several months from folks who have emailed me.

The first question I want to tackle was from someone who asked if it was OK to take a probiotic everyday. They had read that I wasn’t taking one daily in a reply I made to a reader comment.

Yes, it’s OK to take a daily probiotic, and I’m now consistently doing so. I tried an experiment for a week or so where I stopped taking a probiotic every day to see if I felt any different. While I didn’t notice any changes to GI function, my insomnia came roaring back with a vengeance.

I do the cooking at home so I knew nothing had changed there, nor was I under any more stress than usual. Not taking a probiotic every day affected my sleep for the worse. After resuming the daily probiotic, I’m sleeping like a baby again.

God only knows what we’re exposed to from our environment that is harmful to gut flora. Those who read the glyphosate or Roundup® paper I posted about know how environmental toxins are capable of disrupting gut flora populations and liver health.

So, yes, I do believe probiotics or fermented foods should be taken daily. However, there is a situation where the latter option may be counterproductive. I’ll get to that at the end of this post.

Another user wrote in asking if the skin rashes she was experiencing could be related to taking a probiotic. The answer is yes.

When you begin taking an effective probiotic, and you suffer from gut dysbiosis, it is not in the least bit uncommon to experience various skin outbreaks. The reason for this is due to the Jarisch-Herxheimer reaction. This reaction is named after the two early 20th-century European dermatologists who discovered it: Adolf Jarisch and Karl Herxheimer.

The rapid death of pathogens like bacteria and fungus due to probiotic or antibiotic use can result in a variety of symptoms. These symptoms can include fevers, muscle aches, exacerbation of GI symptoms, coated tongue, feeling very tired and skin outbreaks.

Whether or not you get these reactions depends on a number of factors:

  • the extent of small or large bowel dysbiosis
  • the specific type of bacterial or fungal toxins that are dying off
  • the “leakiness” of the gut
  • whether a person is currently eating or drinking foods that increase intestinal permeability, i.e. gluten, polyunsaturated fats, binge drinking, large quantities of fructose, and for some, nightshades
  • whether the person is also taking an antibiotic, pharmaceutical or herbal
  • the state of the liver at the start of the healing process

This last point is of immense importance. The intensity of skin eruptions is a good sign of how stressed your liver is. Now is not the time to go into the intricacies of phase I and phase II liver detox. That would require its own blog post. Suffice it say that it is not uncommon for many people who experience die-off issues to have what I would call a sluggish liver.

For those of you who are young and spry, chances are your livers are better able to deal with a more aggressive course of probiotic and prebiotic treatment in contrast to someone who is older and may have already sustained liver damage after decades of chronic endotoxemia. Because of this, there is no way for me to give you general recommendations on dosage.

What I can tell you is that if you are experiencing die-off reactions that are uncomfortable, dial back, but don’t stop, your intake of probiotics and prebiotics. Same with a prebiotic. If a teaspoon causes you too many die-off issues or makes you too gassy, take half a teaspoon. The key is to continue with both and only increase your intake when you feel up to it.

Now let me share some of the die-off reactions I had when I started taking probiotics and prebiotics. These may or may not mimic what some of you are going through, but it gives you an idea of what can happen.

The biggest change I noticed were skin outbreaks that appeared mainly on my arms or chest. These looked like pimples, but never came to a head. Many could be lightly scratched, oozing a clear fluid when done so. They typically lasted only a day or two before fading.

This went on for weeks, appearing sometimes on the left-side of my body, then shifting to the right and then shifting back again. Once they resolved, I increased my intake to two probiotics a day and promptly elicited a new crop of skin bumps. These too resolved after several weeks. After those went away, I went back to my once daily dose and have, with the exception noted above, been on this regimen ever since.

Apart from skin outbreaks, all of my other die-off symptoms involved my sinuses and nostrils. For two weeks, I developed very dry, itchy skin on my upper lip and nasal openings. It became quite maddening, and necessitated using an entire container of Carmex® to keep the skin lubricated and me from going batty. Then, out of the blue, that symptom just went away never to return again.

I’ve always suffered from sinus problems as far back as I can remember. I dreaded catching a cold because inevitably I had to visit a doctor for antibiotics to clear out the infection. I can only imagine how those numerous courses of antibiotics ravaged my gut flora.

I noticed a worsening of sinus congestion when I began taking the prebiotics/probiotics. This would typically affect only one side of my nasal passages. On rare occasions, I would experience a slight sinus headache. All of those symptoms eventually went away, and I can now breathe freely through both nostrils. My nasal irrigation machine is now collecting dust under my sink.

Some of you recall that I went to the East Coast in November to celebrate my dad’s 85th birthday. I was going to be staying with my sister who owns a cat. I’ve had cats in the past, but suffered terribly for the privilege. I was a bit nervous about this visit as the cat has long-hair.

Much to my surprise, I experienced no issues during my stay. The cat and I became good friends.  Fixing my gut dysbiosis resolved a long-standing cat allergy, and I couldn’t be happier.

Now as I said, my die-off experiences are very likely to be different from yours for all the reasons listed above. Some people experience no die-off issues at all because they are great at phase II liver detox, and don’t need to do anything other than drink plenty of water while their guts heal.

For those with a more sluggish liver, and I most definitely fall into that category, there are a number of supplements you can take to help things along. Phase II detox is enhanced by vitamin B6, vitamin C, folic acid, vitamin E and magnesium. One other thing phase II detox is extremely reliant on is glutathione status. Glutathione is the body’s master antioxidant.

Unfortunately, taking glutathione supplements is worthless as they aren’t easily absorbed in the digestive tract. However, cysteine, a precursor sulfur amino acid, is easily digested and has been shown effective in increasing levels of glutathione in the body, especially in the liver. So for those of you having issues with liver detox, I highly recommend supplementing with at least 600 mg of N-acetyl cysteine (NAC) daily.

There are a number of supplements on the market, but I’ve had good experiences with Jarrow Formulas Nac Sustain 600mg. Regardless of which NAC supplement you use, you’ll find it helps mitigate some of the die-off reactions you’ve experienced.

Please don’t skimp on water during this whole process. I also recommend you cut back on alcohol intake as your liver is already straining to clear gut pathogens and doesn’t need another toxin to deal with. If you do drink, I highly recommend red wine as it appears to improve gallbladder function in those who consistently drink it.

Some people have luck improving liver detox with either dandelion root or milk thistle. Sorry to say, I wasn’t one of them. However, that doesn’t mean it won’t work for you. At the risk of stating the obvious, we’re all different in how we developed gut dysbiosis and how we eventually resolve it.

Third question I want to answer today was a curious one. This person wanted to know if taking prebiotics could increase the urge to urinate. The answer to that is maybe and here’s why.

Any fiber, whether soluble or insoluble, will be fermented in the colon by gut bacteria. That is, after all, the reason I recommend prebiotics, to feed and increase your colonies of bifidobacteria. All fermentation causes some level of gas production. It’s for this reason I recommend cutting back on other fibrous veggies, fruits and whole grains when taking prebiotics if gas and bloating are already an issue for you.

Our “plumbing”, so to speak, is in close proximity to our bladders. Any gas or feces that expands your intestines can press against your bladder making you feel the need to urinate. In fact, constipation is the number-one reason children wet their beds while sleeping.

So yes, prebiotics may cause an increase in this sensation. For that reason I recommend you take your prebiotic drink in the morning when this is less likely to be an issue. If you take it right before going to bed, it may cause you to get up in the middle of the night to visit the little boy’s or girl’s room.

But there might be something else going on here. As I wrote in my post on blood pressure, propionate, one of the short-chain fatty acids produced by bifidobacteria fermentation, consistently causes decreases in blood pressure. One way blood pressure goes down is because less water is being retained by the body. It is quite conceivable that increases in propionate can, like any diuretic, cause a person to retain less water by increasing urinary frequency.

Another question I received was from someone who hasn’t noted any improvement in gut issues after taking garlic. They wanted to know if I thought they should continue.

My answer was no. If nothing is resolving after taking garlic, chances are your problems lie elsewhere. What makes tackling gut issues so vexing is that the same symptoms oftentimes are the result of very different causes. I suspect this person never had a bacterial or yeast overgrowth, so the garlic wasn’t doing them any good. In fact, it may have exacerbated the problem as garlic is rich in prebiotic fiber, and as you know that can increase colonic gas if you are not careful about the dosage.

In cases like these, the problem may be due to too much fiber in the diet or fructose or sugar alcohols or gluten or dairy. I once again refer you to my post on FODMAPs. Eliminating or cutting back these foods may be all that’s needed for symptom relief. Other problem foods were covered in this post.

Fiber is a huge issue for many. Yes, fruits and vegetables are good for you, but not if they make you bloat or keep you up at night from gas pain. Whole grains, especially wheat, are some of the biggest offenders.

Beans cause people a lot of problems because of the fiber they contain. High-fiber meals delay stomach emptying predisposing to GERD, and will create lots of gas.

When trying to deal with gas and bloating, keep the fiber to a minimum. Any added fiber should be from prebiotics to increase the levels of bifidobacteria in the colon. If you eat an apple, and assuming you have no issues with fructose malabsorption, peel it first to avoid gas later. Yes, yes I know there are lots of great phytonutrients in the skin, but you don’t need to eat them right this minute do you? When you get your gut issues resolved, you can always go back to eating apples with the skin on to get those trace nutrients.

Same goes for vegetables. Many of you love your salads, but eating raw veggies can cause a lot of gastrointestinal discomfort for some. I like salads too, but if they contain a lot of bell pepper or raw onion I’ll be tooting Dixie for the next six hours. And if you eat a baked potato, don’t eat the skin, or it may also end up causing you issues in a couple of hours.

The reality is that some of us are extremely sensitive to any pressure exerted against the gastrointestinal wall, and this will probably never change. At best, all you can hope for is that you are able to eat a nutritious meal containing fruits and vegetables without feeling like a stuffed sausage afterwards.

While my gut problems are now gone, to this day I can’t handle lots of fermented foods like sauerkraut, which is ironic, as I used to make it from scratch at home. Problem was, I couldn’t handle those foods then, and I still can’t handle very many of them now. I doubt I ever will and that’s OK.

This brings me to the last question. A couple of my readers wanted to know if they should continue drinking kefir if it keeps causing them gastrointestinal distress. My answer is no.

Kefir is a wonderful fermented food full of beneficial bacteria. However, not everyone can handle drinking it. I know I couldn’t when I had gut dysbiosis even though I made kefir using the best milk available to me. I’m far better able to handle it now, but still find myself getting a bit gassy if I drink too much.

Some of you may not be able to handle dairy until you get your dysbiosis under control, or ever. Again, just because you know someone who healed their dysbiosis with kefir, doesn’t mean it will work for you. Same goes for other fermented foods like kombucha, fermented vegetables, water kefir and yogurt.

So if you are finding your symptoms becoming worse on fermented foods, cut them out of your diet and see how you feel. If better, then get your beneficial bacteria from a probiotic, at least until you get a handle on your gut issues.

And that, ladies and germs, is that.


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