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Antibiotics Stopping The Symptoms - Have You Experienced This?

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I have been gluten free now since January - 3 full months - but still have ongoing diarrhea and malabsorbtion symptoms. I have had my endoscopy which visually showed no damage at all as well as a colonoscopy that was clean. I am still awaiting some biopsies from both areas testing for microscopic colitis and celiac disease.

But here is the funny thing. I have been suffering from a sinus infection and was given amoxicillin for it. While taking the amoxcillin, I had no diarrhea at all, no food intolerances and no malabsorbtion. I and could eat anything (although I did not eat anything that was with gluten). But, once I stopped the antibiotics - the symptoms came back again :(

This leads me to believe that this might be SIBO? Have any of you experienced this?

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very very interesting! i was thinking SIBO too- before i finished your post- and now i think i may go back on the GSE (grapefruit seed extract) to see if it works for me too- cause this bloating and crap is getting really really old

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I had a c.diff overgrowth, and it was a b*tch - I couldn't digest anything. I was treated by an alternative M.D. practitioner with all different kinds of supplements, one of which was Deglycyrrhizinatedl licorice, and it worked miracles.

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I had a c.diff overgrowth, and it was a b*tch - I couldn't digest anything. I was treated by an alternative M.D. practitioner with all different kinds of supplements, one of which was Deglycyrrhizinatedl licorice, and it worked miracles.

How long did you take this and did it clear up the condition for good?

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I noticed this same thing when I took an antibiotic after diagnosis. A few blissful days of near normalcy. Ironically, though, I tan also trace the trigger episode of my major event that sent things into a tailspin several years before to a course of antibiotics. Brings to the forefront the whole issue of the gut flora and how we brutally assault it with so much antibiotic overuse. I heard recently that it (the flora) is actually now considered one of our vital organs. Yet, there are very few physicians who take the necessary steps of proactive probiotic maintenance in conjunction with antibiotic prescriptions. Once the flora is disrupted it seems that opens the door for SIBO.

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gut bacteria study

I don't have access to the full article but the extract looks interesting in light of this discussion.

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How long did you take this and did it clear up the condition for good?

As I said, it was taken in conjunction with a bunch of other stuff I can recall - one was evening primrose oil - and yes, it worked. I took them all for at least a couple of months, maybe three. And the condition was brought on by a six-month course of ever stronger antibiotics to treat a resistant sinus infection. I also ended up with candida which was treated at the same time. Wait, I am thinking more clearly now, the licorice was for the candida. The lab that analyzed my stool sample (now known as Genova) said that the c.diff. was susceptible to treatment by another (different) antibiotic or by a gentian formula, so naturally since antibiotics got me there in the first place I chose the gentian formula. I had the two conditions simultaneously. This was all about 20 years ago. :o

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gut bacteria study

I don't have access to the full article but the extract looks interesting in light of this discussion.

Very interesting indeed!

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I have been gluten free now since January - 3 full months - but still have ongoing diarrhea and malabsorbtion symptoms. I have had my endoscopy which visually showed no damage at all as well as a colonoscopy that was clean. I am still awaiting some biopsies from both areas testing for microscopic colitis and celiac disease.

But here is the funny thing. I have been suffering from a sinus infection and was given amoxicillin for it. While taking the amoxcillin, I had no diarrhea at all, no food intolerances and no malabsorbtion. I and could eat anything (although I did not eat anything that was with gluten). But, once I stopped the antibiotics - the symptoms came back again :(

This leads me to believe that this might be SIBO? Have any of you experienced this?

Yes, I have experienced exactly the same. Before I knew about my gluten sensitivity, I experienced several uti's that were treated with antibiotics. During each treatment, I was free from diarrhea and bloating, and every time I stopped the treatment, my gastrointestinal symptoms and my food intolerances came back. My GI specialist suspected SIBO and we did a hydrogen breath test and an endoscopy

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Microbiome article

NIH Microbiome project

wiki gut flora

More links related to this. I think, in light of the numbers of people who also cited a link with antibiotic use in a former discussion, there may be much more to this than anyone realizes. I have been hypothesizing in recent weeks that my gut is still broken. When you read about all the functions and symbioses of the gut flora with mediating and facilitating things like epithelial tissue healing, etc and put this in context of antibiotics disrupting this.. especially broad spectrum administered orally, it makes me curious about the potential repopulation of the flora post treatment as a possible way to heal the gut. No matter what accelerating pharmaceuticals are attempted in refractory situations if the environment is not prepped to sustain the healing the drugs won't be effective. I have a ton of research ideas related to this as well as some potential treatment strategies related to this as well. Unfortunately I am not a research scientist.

I think the fact that this essentially functions as a complex organ has very huge potential impact on recovery and also makes treatment with antibiotics something that should be approached with greater care. Think of all the antibiotics that are taken with no follow up for re-establishing proper flora. I wonder if IV administration would be more sparing than oral dosing. I do not know enough to understand this, though.

Anyway. Lots more to think about.

I would be interested in studying modern paleolithic equivalents as to gut flora make up.. populations isolated from western influence and still dietarily relatively intact.

I will calm down now.

CS

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tirgger discussion

Here's the discussion I was talking about as well.

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another piece of the puzzle?

Now this may not make sense to some as to why I am posting this link relative to the discussion but... If you decide to look at this and have the stomach for it just take a look at the stomach contents picture of the two calves. One had the benefit of a healthy gut environment whereas the other didn't. The profound effect on the function of the gut relative to the overall health of the two animals is absolutely astounding. Why is it that the unhealthy one reminds me of what my stomach and gut seems to be doing? I apologize if this is disturbing to anyone not accustomed to biology 101 and dissections but it has been a part of my "Aha" moment in all of this to this point.

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Thank you for posting that Chas, as gut churning as it may be :o I left a comment on the site. I grew into adulthood telling my husband that my body felt toxic. And to a certain extent it still does :unsure: I do still consume dairy products (in New Zealand where are animals are primarily grass raised (although big ag practices are intruding more and more :angry: )). I quit drinking milk when we moved to the city and stopped milking our own cows. I could not tolerate pasteurized milk. :huh:

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My head is still spinning with all the implications of the Microbiome project. The thing that worries me is that they will try to reduce it down to a few key essentials. Over 3000 potential microbes and they may be able to identify 900 by the time they are done? We take probiotics with only 8 strains of bacteria? I begin to understand how woefully inadequate all this is. If I look at the gut flora as a sort of rolled up cheesecloth overlapping matrix that supports an overwhelming number of microbes and see how the contents of the digestive tract pass through this with the microbes helping to prepare the content for digestion and absorption I marvel at the whole process. Lets say you get too many holes in this matrix through the catastrophic injury of physical trauma, some illness or chronic antibiotic assault. I can see this as a prelude to so many of the autoimmune symptoms we are dealing with. In fact, I can see this as ground zero for so many health maladies I can't absorb it all. The information on the early gut flora development in infants has me intrigued as well as I was born by C-section. When I think of the potential impact of formula feeding to a possible lack of proper gut flora development and see the rise in so many potentially gut mediated complications over the last several decades.. well, there I go again. I think of the rise in autism in relation to this. Honestly, before I was finally dx'ed with celiac I had stretches where I thought I was getting adult onset autism. I needed to be in quiet rooms with subdued lighting and couldn't handle interaction well. I know this may sound ridiculous but I cannot convey just how debilitating this was becoming. I am sure my scientific naivete in this will amuse some but I operate under a few rules. The first is not to fix the problem by treating the end result but rather to trace, like a detective, as far back the process and preparation as possible. the second is related to Occam.. simple versus complicated.. go with the simple.. and seek to understand the obvious at a depth most are unwilling to examine because, well, it seems too obvious. I want to know why it is obvious.

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Just another random thought that struck me while thinking about all this. If a person is serum negative but biopsy positive for celiac and then displays a tendency towards being refractory it may be because the disease is mediated by gut flora destruction.

If a person goes gluten free before testing who has a reasonably functioning flora they might, in fact, be able to heal so quickly that a biopsy would be inconclusive.

I am sure I am not conveying the gist of what I am thinking here but I will try to clarify if I figure it out better.

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I am having a hard time letting this go. The little girl they cited in the Microbiome article had, for all intents and purposes, a gut flora transplant. It seems they inadvertently cleared the way, much like a bone marrow transplant is prepped by destroying or sterilizing the bone of the faulty marrow. In this case the antibiotics they were using may have created a clean slate. The human fecal matter they used was really a gut flora transplant. Since this can be considered to work like an independent organ it was like she received an organ transplant of sorts. I would be curious if the prepping would be necessary in all cases or if the gut flora could be re-established to a healthy functional level without needing the antibiotics. Antibiotics very much triggered my episode that began the real downhill slide and later on a course of antibiotics gave me relief for a few days. Since there was no follow up with probiotics (of limited effectiveness now that I am taking them anyway) I was back to square one or worse once the antibiotic was done and the damaged gut flora was just that much more out of whack. I would be willing to have them try a gut flora transplant on me. I am looking into other methods as well. I have been trying to add in foods that naturally promote this to little success and wonder. It seems to me that an intact gut flora should, in the healthy individual, be self sustaining. I wonder how much a role the damage to this plays in a myriad of conditions that are becoming more prevalent.

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After posting this question, I have been doing some research on SIBO (Small Intestine Bacteria Overgrowth) and came up with three very interesting links I am going to share.

If you think you may have SIBO, you should see a doctor who can prescribe the correct antibioics for you. SIBO is confirmed by a hydrogen breath test. I have an appointment with my doctor in two weeks and hopefully he can help me with this. But, in the meantime, I have done my research and this is what I found:

Symptoms:

•excess gas,

•abdominal bloating and distension,

•diarrhea, and

•abdominal pain

A small number of patients with SIBO have chronic constipation rather than diarrhea. When the overgrowth is severe and prolonged, the bacteria may interfere with the digestion and/or absorption of food and deficiencies of vitamins and minerals may develop. Weight loss also may occur. Patients with SIBO sometimes also report symptoms that are unrelated to the gastrointestinal tract, symptoms such as body aches or fatigue. The symptoms of SIBO tend to be chronic. A typical patient with SIBO can experience symptoms that fluctuate in intensity over months, years, or even decades before the diagnosis is made.

The interesting part of this is the dietary approach to what foods to avoid and what foods are good to eat.

This is where we get into the Low-Fodmap Diet. On this diet, gluten free cereals and gluten free bread are advocated. Also limiting dairy and fruits with excess fructose is part of this diet as well. And most artificial sweetners are a no no.

The links describing the diet are here:

http://thefoodielist.co.uk/wp/the-low-fodmap-diet-for-ibs-sufferers/

http://www.gidoctor.net/diet-ibs-sibo.php

And a great little chart outlining the foods to avoid and those to eat can be found here:

http://www.healthyfood.co.nz/articles/2010/march/are-you-intolerant-to-common-foods/fodmap-intolerances-0310.pdf

There does seem to be a definite link with gluten free diet and eliminating the symptoms of SIBO.

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WOW is all I can say,,, it may take me awhile to digest (pun intended :) ) all of this ., seems the more I learn the less I know :unsure:

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I have been reading up on the specific carbohydrate diet approach to all of this and recommend the book "Breaking the Vicious Cycle: Intestinal Health through Diet" by Elaine Gottschall. There was a link in another thread to some video of her being interviewed. Interesting stuff. Basically a proponent of reestablishing a healthy gut flora through dietary means. I was close with my paleo approach and really don't have to change much in order to switch to the SCD diet. I do need to add yog(h)urt in order to accomplish full compliance but am waiting until I have a source for yogurt made from raw milk as I have some real concerns about pasteurized milk. Gottschall addresses the whole issue of SIBO as well in this but takes diet only approach to it instead of antibiotics. I am wanting to avoid them as I have had nothing but trouble over the last thirty years when taking any of them.

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If you are interested in Elaine Gottschall's diet - here is a link to a web site that tells you something about her book including a list of legal and illegal foods. Her diet does require you to give up a lot, though.

http://www.breakingtheviciouscycle.info/legal/legal_illegal_a-c.htm

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Antibiotic mediated gut flora dysbiosis:

A hypothesis based on anecdotal observation.

Texts influential in formative thought in this matter:

"Nutrition and Physical Degeneration" Weston Price

"Breaking the Vicious Cycle: Intestinal Health through Diet" Elaine Gottschall

"Good Calories/Bad Calories" Gary Taubes

Synopsis of the Human Microbiome Project by NIH

Study of two calves done in 2010

Key facts:

Serum negative for celiac disease

reactive to soy

multiple autoimmune issues including rheumatoid arthritis, sjogren's syndrome, high lupus indicators, episodes of Reynaud's, positive response to a celiac gluten free diet in remediation of all above autoimmune disorders.

Notable trigger events all linked to episodes of antibiotic use

I started to have my first rheumatic symptoms when I was in pre-school at approximately age 5. I had a number of reactions to antibiotics. First were sulfa based antibiotics then came some penicillin antibiotics and eventually reactions to biaxin and other broad spectrum antibiotics.

I had a series of chronic bronchial infections starting in the 1980's with a respite until into the 1990's. By the time my ear nose and throat doctor was able to come up with an effective strategy to break the dependence on antibiotics his observation was that I had many symptoms of antibiotic overuse. This is when I began to have problems with Sjogren's Syndrome as well as what appeared to be thrush. His opinion was that my immune system was really out of balance due to the number of courses of antibiotics used in a relatively short time.

At no time did any doctor ever recommend prophylactic use of probiotics or yogurt to go along with antibiotic use.

My ear nose and throat doctor did put me on a very strict yeast free diet which, as it turns out, was gluten and soy light. When I followed the diet strictly I had an unprecedented stretch of good vocal function for nearly ten years where I had no respiratory ailments or missed performances. I did have the occasional arthritic flare (although I didn't know that's what it was until 2004.)

I had a history of digestive problems as well as blood sugar regulation dating back to my middle school years in the early/mid 1970's and went through a whole host of diagnostic imaging at that time although nothing was conclusive. I also had orthopedic and neurological evaluations due to neuropathic pain and was told there was nothing physically wrong and to consider counseling.

In fall of 2004 I took my first course of antibiotic in many years and immediately went into a severe rheumatic flare that led to my diagnosis of rheumatoid arthritis. This flare failed to let up, even with typical medications of methatrexate and Enbrel. As these two medications only marginally reduced my gel time while causing severe dysphonia and hearing loss issues, I elected to stop taking them altogether. I did continue to get worse even with dietary measures aimed at reducing inflammatory trigger foods such as night shade vegetables such as potatoes and tomatoes.

By 2008 I was having severe mobility issues as well as difficulty with sustaining mental effort. I was developing dental complications that necessitated having a tooth extracted in an emergency. Four other teeth were causing problems and my oral surgeon was prepared to extract them as well.

In the course of our researching what might be causing all the complications my wife came across an article on celiac disease and suggested that we look into this in light of my symptoms.

I had to find a new general practitioner as my doctor had tragically passed away recently. I was calling around with a great sense of urgency but no one was taking new patients or the waiting list was months and I sensed I had little time left to find a solution to my rapidly declining health.

I met the local facilitator of the celiac support group at a local health foods market and she made a recommendation of a physician who was knowledgeable in celiac disease. I called his office immediately and they were able to see me two days later.

Initial consultations followed by testing led to endoscopic biopsy and referral to a gastroenterologist who diagnosed celiac based on villus atrophy and response to diet.

I stayed rigorously gluten free but was not successful initially as we tried to maintain a near equivalent standard western diet with gluten free replacement food. I stopped deteriorating on a daily basis but really didn't get much in the way of relief from present symptoms.

It was not until I switched to a Paleolithic based diet informed by the writing of Loren Cordain that I had true relief from the symptoms. In fact, the whole host of autoimmune complications began to clear up as I followed the paleo diet. I had a stretch of six weeks where I lived almost exclusively on meat and a few vegetables with no fruit or dairy and felt better than I ever remember.

I had a slight setback due to a family crisis and never did get back to the level of health I felt when eating such a limited diet.

Follow up testing showed I still had villus atrophy even though I only had one other known episode of gluten exposure over the course of two plus years of eating strictly gluten free.

That brings me to this point.

I was reading Elaine Gottschall's book and was struck by two comments in particular. One was her contention that there are many possible causes of villus atrophy including reactions to soy. The other was that celiac needs to be more rigorously diagnosed and not just based on response to diet restrictions.

I was curious as to her recommendation to avoid liquid milk. In light of the two calves experiment I wondered whether this might be rooted in the fact that pasteurized homogenized milk used to make yogurt and kefir is necessarily a dead food relative to the bioactivity to be found in raw milk.

Further reading of the details of the human microbiome project made me curious about the effect of antibiotic insult to the normal state of healthy gut flora. Gut flora serves to facilitate the digestion of many nutrients and vitamins. While it is true that you can digest food with a sterile gut environment it is shown that you also need thirty percent more caloric intake in the state.

I encountered a number of situations where antibiotic use triggered severe digestive problems over the years. There were episodes where this would be reversed for a short time when taking yet another course of antibiotics only to become worse when I finished the prescription.

The catastrophic reaction I had in 2004 that resulted in a cascading onslaught of more and more autoimmune complications seems to be directly coincident with taking a broad spectrum antibiotic. It was as if this was the final insult to any sense of normal gut flora function.

I have been working from the premise that I do, indeed, have celiac so it was surprising to read that Elaine Gottschall seems to think celiac is, perhaps, over diagnosed. She notes cases where celiac was cured. My guess is that what the subject actually had was not celiac. This has made me curious as to the response I have to soy. It also makes me curious as to the function, or lack thereof, of my gut flora.

When I read about the treatment of the two year old who had suffered from severe diarrhea only to be complicated by stronger and stronger antibiotics and resolved by placing healthy human fecal material (in essence, a gut flora transplant) in the digestive tract I was intrigued. In comparing the digestive tract health of the two calves a light went on. Would raw milk be a way of re-establishing proper gut flora balance and function?

Here in Ohio you cannot purchase raw milk from a farmer due to restrictions. Ultra low temperature pasteurization is a possibility but still, the process kills active microbes that might be essential for proper establishment of and support of gut flora function.

I was able to find a source for raw milk and have begun an experiment. I was concerned about the need to make it into either yogurt or kefir and was looking for suitable cultures to accomplish this with the raw milk so that I wasn't having any liquid milk per Elaine Gottschall's recommendation. The more I thought about this, though, thinking it might have more to do with the deleterious effects on the biovitality of milk as nature intended, I decided to just go with the raw milk.

Now in day four I have several observations:

Milk never tasted this good.

I have absolutely no digestive complications indicating lactose intolerance.

I am willing to attribute this to psychological factors even though I had some apprehension when starting this but.. I feel great.

My hair has gone from being chronically straw like for the last several years to being silky smooth in just four days.

Things have been healing on me that I thought never would.

My Sjogren's Syndrome has been far less problematic and my eyes are much less dry upon waking.

My response to working out has been palpable, rapid and strength is noticeably increasing.

I am have been able to put on a few pounds in the last four days.

I have not had near the hunger problems and feel satiation after meals.

I drink the milk at room temperature.

I realize that this is not scientific in any useful way but I am beginning to wonder as to whether I actually have celiac. I suppose I would need genetic testing to see whether I have the genes for celiac. I also know that I will not be inclined to ever test by gluten exposure as I have made a conscious decision to be grain free from now on anyway.

I am curious, in light of the growth of the pharmaceutical manufacture of and therefore greater exposure to antibiotics, as to whether much of what we see in deterioration of health has its initial source in insult, injury and deterioration of the gut flora to a much greater degree than most would think. I can start seeing how this could ultimately be a source/point of departure for many disease processes.

I can speculate as to the possible mechanics for how improper gut function could make someone prone to many hypersensitivities that would cause autoimmune response and a lack of homeostatic balance in the body.

I will be curious to see how this affects my blood work next month as well as bone density testing.

I hope this would make someone curious about the research possibilities as to gut flora restoration.

Another note, I wonder what impact the prepping for various imaging procedures has on the viability and sustainability of a healthy gut flora. I know that I never received any follow up care that would attend to this matter whenever I have had to take antibiotics or after prepping for and receiving various GI tests over the years. It seems rational and even logical to me that any time the gut flora is disturbed as severely as it is in all these cases that there should be a regimen to follow that is every bit as important as any other to restore/re-establish the proper functioning of the gut flora.

Funny, I was talking to a farmer about the care of pastured herds and milk production. We got to talking about probiotics. I was taking one with eight different strains of bacteria. He laughed and said his cows get at least twenty three! And they just chew on grass. Further, the Human Microbiome Project is hoping to eventually be able to identify the genetic code for as many as nine hundred of the possibly three thousand different microbial organism existent in the human gut flora. Eight starts looking like a very small number. Not only that but, who's to say that out of three thousand, those are the ones that are out of balance? What if they are actually the ones that are already overgrown? I stopped my probiotics several days before starting this experiment. Things got seemingly worse while actually feeling a bit better. I know, hard to understand but that's what was going on. Poor function is no substitute for correct function.

I am not sure how long I will be carrying this experiment on but I intend to do so for several months if at all possible. It is expensive at present but I think it will be well worth it.

Makes me want to move to Texas, though. That's one state where you can actually drive to the farm and by raw milk without having to jump through all sorts of legal loopholes.

I guess I have now officially joined the lunatic fringe. Sorry for the long read..

CS

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A small number of patients with SIBO have chronic constipation rather than diarrhea. When the overgrowth is severe and prolonged, the bacteria may interfere with the digestion and/or absorption of food and deficiencies of vitamins and minerals may develop. Weight loss also may occur. Patients with SIBO sometimes also report symptoms that are unrelated to the gastrointestinal tract, symptoms such as body aches or fatigue. The symptoms of SIBO tend to be chronic. A typical patient with SIBO can experience symptoms that fluctuate in intensity over months, years, or even decades before the diagnosis is made.

I am so glad you posted. This whole thread is answering or at least giving clues to my brothers life. All the antibiotics...

I am going to have to reread everything you wrote many times to digest it all.. not meant to be punny. Thanks again for taking the time to share all of this.

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I am now in the third week of my whole milk/raw milk experiment. It has been quite a ride thus far. I have also been eating a quantity of coconut oil for the capryllic acid to knock down any yeast overgrowth as well. I went into a flare last week of what seems to be reminiscent of a severe viral infection I had twenty five years ago complete with rash and several other symptoms. The last time I had a flare it put me in the hospital for a week and took me the better part of six months to recover from. I didn't panic this time around because, although the physical signs were there, I felt weirdly like this was more like it was going through its death throes. I was actually feeling better while I was feeling worse if that makes any sense. It was cleared up in a matter of days and I was measurably stronger after the episode. I feel as if I have been going through this massive detox of sorts. I make sure I let the milk I drink reach room temperature and I have no digestive problems at all with it. In fact, my gut flora must be working much better. This is a better probiotic than any pills I have ever taken. My eyes just keep getting better as well as far as dryness goes. Is it all coincidence? I don't know. Is it a result of drinking full fat milk with the extra calories? I don't know. I do know that it has helped tremendously.

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I am now in the third week of my whole milk/raw milk experiment. It has been quite a ride thus far. I have also been eating a quantity of coconut oil for the capryllic acid to knock down any yeast overgrowth as well. I went into a flare last week of what seems to be reminiscent of a severe viral infection I had twenty five years ago complete with rash and several other symptoms. The last time I had a flare it put me in the hospital for a week and took me the better part of six months to recover from. I didn't panic this time around because, although the physical signs were there, I felt weirdly like this was more like it was going through its death throes. I was actually feeling better while I was feeling worse if that makes any sense. It was cleared up in a matter of days and I was measurably stronger after the episode. I feel as if I have been going through this massive detox of sorts. I make sure I let the milk I drink reach room temperature and I have no digestive problems at all with it. In fact, my gut flora must be working much better. This is a better probiotic than any pills I have ever taken. My eyes just keep getting better as well as far as dryness goes. Is it all coincidence? I don't know. Is it a result of drinking full fat milk with the extra calories? I don't know. I do know that it has helped tremendously.

there's capryllic acid in coconut oil?????? good God- no wonder people are finding the coconut oil to be beneficial- i love capryliic acid

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    So how, you may ask, is all this related to gluten? As a starting point, one report from the medical literature identifies a patient who developed aphasia after admission for severe diarrhea. By the time celiac disease was diagnosed, he had completely lost his faculty of speech. However, his speech and normal bowel function gradually returned after beginning a gluten free diet (8). This finding was so controversial at the time of publication (1988) that the authors chose to remain anonymous. Nonetheless, it is a valuable clue that suggests gluten as a factor in compromised speech production. At about the same time (late 1980’s) reports of connections between untreated celiac disease and seizures/epilepsy were emerging in the medical literature (9).
    With the advent of the Internet a whole new field of anecdotal information was emerging, connecting a variety of neurological symptoms to celiac disease. While many medical practitioners and researchers were casting aspersions on these assertions, a select few chose to explore such claims using scientific research designs and methods. While connections between stuttering and gluten consumption seem to have been overlooked by the medical research community, there is a rich literature on the Internet that cries out for more structured investigation of this connection. Conversely, perhaps a publication bias of the peer review process excludes work that explores this connection.
    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics

    Jefferson Adams
    Celiac.com 06/12/2018 - A life-long gluten-free diet is the only proven treatment for celiac disease. However, current methods for assessing gluten-free diet compliance are lack the sensitivity to detect occasional dietary transgressions that may cause gut mucosal damage. So, basically, there’s currently no good way to tell if celiac patients are suffering gut damage from low-level gluten contamination.
    A team of researchers recently set out to develop a method to determine gluten intake and monitor gluten-free dietary compliance in patients with celiac disease, and to determine its correlation with mucosal damage. The research team included ML Moreno, Á Cebolla, A Muñoz-Suano, C Carrillo-Carrion, I Comino, Á Pizarro, F León, A Rodríguez-Herrera, and C Sousa. They are variously affiliated with Facultad de Farmacia, Departamento de Microbiología y Parasitología, Universidad de Sevilla, Sevilla, Spain; Biomedal S.L., Sevilla, Spain; Unidad Clínica de Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Celimmune, Bethesda, Maryland, USA; and the Unidad de Gastroenterología y Nutrición, Instituto Hispalense de Pediatría, Sevilla, Spain.
    For their study, the team collected urine samples from 76 healthy subjects and 58 patients with celiac disease subjected to different gluten dietary conditions. To quantify gluten immunogenic peptides in solid-phase extracted urines, the team used a lateral flow test (LFT) with the highly sensitive and specific G12 monoclonal antibody for the most dominant GIPs and an LFT reader. 
    They detected GIPs in concentrated urines from healthy individuals previously subjected to gluten-free diet as early as 4-6 h after single gluten intake, and for 1-2 days afterward. The urine test showed gluten ingestion in about 50% of patients. Biopsy analysis showed that nearly 9 out of 10 celiac patients with no villous atrophy had no detectable GIP in urine, while all patients with quantifiable GIP in urine showed signs of gut damage.
    The ability to use GIP in urine to reveal gluten consumption will likely help lead to new and non-invasive methods for monitoring gluten-free diet compliance. The test is sensitive, specific and simple enough for clinical monitoring of celiac patients, as well as for basic and clinical research applications including drug development.
    Source:
    Gut. 2017 Feb;66(2):250-257.  doi: 10.1136/gutjnl-2015-310148.