Comment by fpgaminer | Hacker News Reader

Comment by fpgaminer | Hacker News Reader

I can only wish these researchers good luck; we don't even understand the gut's microbial ecosystem as it relates to gut diseases.

I, unfortunately, have first hand experience here. The short version of my story is that I started out 2020 with an acid reflux diagnosis and ended 2020 laid out in bed 24/7 eating nothing but rice and potatoes with doctors shrugging over a mystery GI issue.

They finally gave me a specially designed, brand name, and expensive as hell antibiotic that specifically targets the gut microbiota. The drug and its effect is the medical equivalent of the old IT adage: "Have you tried turning it off and on again?" The idea is to rain hell down upon your gut and hope it resets to a better balanced microbiota.

So yeah, that's the current state of modern medicine when it comes to GI issues; bludgeon it to death and hope for the best. So God have mercy on this researcher attempting to identify links between the GI microbiota and other illnesses.

P.S. I was somewhat inclined to go into more details on my journey, cause finding information on GI issues is so hard, but it would be a stupidly long comment. Suffice it to say, I learned a lot about the gut, but mostly about what we don't know. For all those people with IBS-*, SIBO, and NCGI out there, you have my deepest commiserations. Science can take the FODMAP diet and shove it up its poorly understood rectum.

EDIT: I think in my revisions of this comment I forgot an important bit: the treatment seems to have worked. My symptoms are continuing to improve after the round of antibiotics. So as crude as the science may be, at least it worked.

I've being suffering IBS for the past ten years. I also had that nuke all treatment and then try to colonize the gut.

It was antibiotics for x days, I don't remember how many, and then pre and probiotics for x days. Rinse and repeat.

It didn't work.

I only can speak for myself but the FODMAP diet is the only relief I've had experienced in ten years, and for the first time (pardon my french) my shit is not watery.

P.S. I agree science has a lot to learn about this topic.

> for the first time (pardon my french) my shit is not watery

Yeah. If I could impart advice on anyone, it's that if your shit isn't "good" (a nice, clean Type 3 or Type 4), you need to sort your shit out. In retrospect, my BMs were never "great" in the past couple years and ... I clearly should have done something about that a long time ago. It's likely whatever was wrong with me was brewing for awhile, and just triggered into something severe when something pushed it over the edge.

Right, the Bristol Stool chart. What a fun when doctors ask you to keep a stool record.

> It's likely whatever was wrong with me was brewing for awhile, and just triggered into something severe when something pushed it over the edge.

I can't back it up with any evidence but my feeling is that a combo of stress and too healthy food (for me) triggered my gut crisis.

What I mean is that I started to eat food that was too rich in GOS, and also fructose, just before my problems started.

> I can't back it up with any evidence but my feeling is that a combo of stress and too healthy food (for me) triggered my gut crisis.

Similar. I'd been trying to eat healthier for the past couple years, slowly cutting back on dessert/sweet foods, eating more vegetables and fruits. Even started doing green and fruit smoothies this year. But yeah, under the FODMAP theory a lot of fruits could ferment in the gut, some vegetables too, and beans, a staple of a healthy diet, are probably the prototypical high-FODMAP food.

I'm not sure what the moral of that is ... I guess ... don't eat healthier because it might kill you? shrug The gut is a weird beast.

Was there a re-colonization process? If so what kind/brand/bacteria types?

The treatment is just 14-days of the antibiotic, there's nothing specifically done to recolonize your gut. The "off-and-on" again thing is really just a theory, if you can even call it that. Like a lot of medicine, it's something a drug they developed with an idea in mind, found that it worked and that's about the extent of our understanding of it. It may or may not do what we think it does, because all the manufacturer cared about is whether it works.

I did do my own research on whether taking probiotics would be helpful, to recolonize my gut as you say. Of all the studies I read, none found any benefit. Both during treatment and after. So it's unlikely that a manual recolonization process is even needed.

My personal pet theory is that the antibiotic doesn't wipe everything out, but instead works by making the gut a much, much more competitive environment. Beneficial flora tend to be better survivors in our guts (for various reasons), so they are more likely to survive the assault and the bad bugs are less likely. Once the good bugs have the advantage again they can outcompete and take over. There's also your gut's immune system which, based on my reading, has the potential to "farm" the flora in your gut. It too will be working to rid the bad bugs and promote the good ones. It seems like in the case of GI issues a bad bug gets a beachhead for one reason or the other and then your immune system can't naturally correct. The antibiotic gives it the chance to do that.

Hence why probiotics are unlikely to do anything. It isn't a total elimination, so there's nothing to reseed. And your immune system is going to favor the same microbiota it grew accustomed to when you were born. Not to mention the appendix which is suspected as being a safe-harbor for your natural gut flora.

I did take probiotics myself, since they don't seem to do any harm. I took them during and after treatment. Probiotic pills, Yakult, and yogurt. But there's no science backing that action.

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