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Dealing with the gut: just a bit more complicated than we thought
We’re confusing you this month. Ben Brown is highlighting the potential dark side of probiotics. Dividing gut microbes in the gut into “good” and “bad” is a dangerous over-generalisation, he says, and assessing “who’s there” in the gut is fraught with
But then we also present something of an alternative view. Dr Derek Butler, PhD, and Dr Tom van den Bogert, PhD, make the case that microbial assays are not only accurate, but can lead to useful clinical interventions and help the cause of truly personalised nutrition. The argument for the use of probiotics seems a no-brainer, but as one of my favourite book titles of all
time has it: “I think you’ll find it’s a bit more complicated than that” (Ben Goldacre, 2014).
Meanwhile, in this gut special issue, we’re also delving into SIBO (small-intestinal bacterial overgrowth). In 1980-ish, when I was editor of Here’s Health, Brian Butler and his muscle-testing Touch for Health crew were annoying the heck out of me because they wouldn’t stop banging on about the ileocaecal valve and how important it was. “Everyone” had an ileocaecal valve that was “out”. It turns out that the alternative therapists of the day were on to something (as usual). The ileocaecal
valve is the gateway to SIBO. Bear in mind that back in the day, neither SIBO nor the microbiome had been “invented”. And we had no probiotics – the word hadn’t even been coined – that was a few years off, when Monica Bryant imported the first-ever bacterial supplement into the UK and came up with the description in an article she wrote for the Journal of Alternative Medicine.
Now here we are. Ileocaecal valve expert Dr David Jockers, DNM, DC, confirms that the once batty idea that the ileocecal valve can get “stuck” open is now a clinical fact – thanks to SIBO research. It’s this that allows bacteria to proliferate up into the small intestine. Dr Jockers says: “One study that was designed to find out if a malfunctioning ileocecal valve is related to small intestinal bacterial overgrowth, evaluated ileocecal valve pressures and lactulose breath readings. They also noticed correlations with patient symptoms that they were not expecting. “They used a colonoscopy procedure to evaluate pressures and found that patients with a lower pressure and open valve had positive lactulose breath readings and symptoms of fullness during meals, gas, and bloating. Patients with higher pressure had negative lactulose readings and denied having gastrointestinal symptoms. “These results show us that an open ileocecal valve is highly related to small intestinal bacterial overgrowth (“Ileocecal valve dysfunction in small intestinal bacterial overgrowth: A pilot study”). “Another very similar study…replicated the results…The researchers concluded that malfunction of the ileocecal valve is a ‘prominent player in intestinal disorders’ and should be considered in patients struggling with gastrointestinal complaints” (“Low ileocecal valve pressure is significantly associated with small intestinal bacterial overgrowth (SIBO)”
And finally…the latest report from the DiRECT study (see page 40) confirms that Type 2 diabetes can be reversed – and pancreatic beta cells can recover and regenerate. And it’s being done with diet, not drugs. “Proper” academic medicine is saying this, so this just might be the clichéd “paradigm shift” we need. Co-leader of the DIabetes REmission Clinical Trial study, Prof Roy Taylor of Newcastle University certainly thinks so (as does Diabetes UK, who are advocating the very-low calorie diet approach). Prof Taylor says: “This study demonstrates that beta-cell ability to recover long-term function persists after diagnosis, changing the previous paradigm of irreversible loss of beta-cell function in type 2 diabetes”. Diabetes is a huge problem and around 90% of diabetics have Type 2. It is becoming hard to think of it as a disease anymore; it is really a lifestyle choice.
Simon Martin, Editor
Keep up with Simon on Twitter @simonCAMedit
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