Recently ran a Doctor’s Data CSAP on a client. Everything was normal except no growth or Lactobacillus. All other beneficial flora were 4+. Symptoms include constipation, sometimes only one bowel movement a week, but she can also swing over to the diarrhea extreme as well. She has years of these symptoms but also gained between 30 and 40 pounds in the past year or two with no identifiable cause. Also has a history of seriously long fasting periods of up to 30 days where she has only juices. I would think that these extended fasts would have really starved her good gut bacteria, but her results would indicate otherwise given only the low Lactobacillus. Any thoughts on this? I want to run a SIBO test on her ASAP, but she’s saving up for that. In the meantime, I suggested she try adding in HCl, Iberogast, Prescript-Assist. I’m curious as to what probiotic or prebiotic you would suggest specifically for increasing her Lactobacillus. I suggested Lactobacillus plantarum to help with her symptoms and also fermented foods, but would you have any other specific suggestions?

Chris Kresser:  Okay. Great. Let’s go back. The Doctor’s Data stool test with the proteomics can be helpful in quantifying some of the more well-known genre of beneficial bacteria, but, as you know, there are over 1,000 species in the average gut. I don’t believe we’re at the level where we can look at the Doctor’s Data test and unequivocally know what the state of a patient’s gut flora is. We can get an idea, but it’s possible that in addition to Lactobacillus there is another less commonly known genre of bacteria that is still important that was not adequately fed with that history of really extended fasts where she was only juicing.

The fact that she is really constipated is probably a better indicator of that than anything else. Constipation is almost always, at least in part, related to a lack of beneficial gut bacteria. How do we know that? Because about 80 percent of the dry weight of stool is dead bacteria, or live bacteria in some cases, or in every case. There is a lot of bacteria in stool. If the patient is not having normal bowel movements, then that is a sign that she probably doesn’t have beneficial bacteria. There is a lot of research on this, going back to the famous Stokes and Pillsbury studies that I’ve written and spoken about before. So, that’s that question.

As for the probiotics, yes, I would actually have suggested exactly the same thing. Fermented foods, if you look at—I think we talked about this during the probiotic presentation—if you look at the content of the amount of microbes, beneficial microbes, in a glass of kefir, for example, it’s far higher than any commercial probiotic you can get, so when Lactobacillus is low, I definitely like the fermented foods approach if the patient tolerates them. Then Lactobacillus plantarum can be especially helpful for constipation. I suggest that you try some of the other interventions for constipation that I mentioned. Of course, with the SIBO test, we might very well see high methane, and you might have to treat that in order to deal with it.