The Resistant Starch Challenge: Is It The Key We've Been Looking For?

[Hip]

@Ripley
I am trying to find these David A. Relman studies at Stanford that show SBOs are more numerous in the gut than lactic acid bacteria, but cannot find them. Would you have any references?

There are 178 studies by David A. Relman on PubMed, but I cannot find any that refer to SBOs.

And a Google search on David Relman and SBOs also finds nothing about SBOs in the gut.

Chris Kresser does not provide any reference to his statement that "SBOs are more numerous in the gut than lactic acid microflora".


I have ordered a packet of Bob's Red Mill Unmodified Potato Starch, by the way, and look forward to testing this. Thanks very much for posting all this very useful info on resistant starch.

 

[Ripley]

Hip, I believe Kresser is referring to most of the studies on this page. At the bottom of that list of publications, you'll find this study:

Diversity of the Human Intestinal Microbial Flora Paul B. Eckburg1,*, Elisabeth M. Bik2, Charles N. Bernstein3, Elizabeth Purdom4, Les Dethlefsen2, Michael Sargent3, Steven R. Gill5, Karen E. Nelson5, David A. Relman1,2,6,*

...which showed the difference between the mucosal and commonly referred to fecal populations. The stark differences between mucosal and fecal populations were also summarized in this article:

http://forms.asm.org/microbe/index.asp?bid=35617

David Relman of Stanford University in Stanford, Calif., and his collaborators are using genomics to look at commensal species diversity along the mammalian GI tract and, indeed, have worked with several human volunteers to probe diversity at particular sites along the GI mucosal layer and in feces. With some 11,000 microbial genomic sequences in hand, at least 7 phyla are represented with substantial diversity within each, although most of the sequences come from three main types of bacteria, he says. In addition, other types of microbes are found in minority representation, including sequence evidence for cyanobacteria species. Big differences in microbial populations are seen between specimens obtained from different individuals, and there is very distinct clustering per individual host, he adds. “We also see big differences between species found in mucosa versus in feces, but the [microbes found at] different sites along the mucosa are not that different.”

Though, I don't think Relman comes right out and says what are "SBOs" and what aren't (I can't read the full text of the study). But, my guess is that if you take the time to read what species are found in the mucosa, you'll find what Kresser is referring to.

I also found this one, but I don't see Relman's name on it:

http://aem.asm.org/content/68/7/3401

Of course, washing vegetables is probably a new phenomenon in the human diet, so it wouldn't surprise me if dirt was commonly ingested by our ancestors with every meal and the first place it would probably stick was the mucosal layer of the gut! So, I think it's fair to say that dirt — and the bacteria it harbors — was probably a key part of our gut's evolution.

In any case, I don't see good evidence to support Trevnev's fear-mongering statements, and the results from SBOs speak for themselves quite well.

 

[Hip]

@Ripley
Thanks for those links. Certainly there is nothing in the Relman paper you cited to back up Chris Kresser's statement that the "Relman-Stanford group studies have shown that SBOs are more numerous in the gut than lactic acid microflora."

I guess you would need a list of microbes commonly found in the gut, and also a list of HSO organisms (I could not find a list of the latter), and then you could work out how many human gut organisms are HSOs.


According to the info in this article and its comments (I cited this earlier), Garden of Life have taken out all the HSOs from their Primal Defense probiotic, except Bacillus subtilis, which is now the only HSO remaining in Primal Defense.

Why would they remove this HSOs if they were safe and effective? But in any case, that makes the present version of Primal Defense safer, as Bacillus subtilis has been used for 1000s of years in Japan.

However, if you look at Dr Ohhira's HSO probiotics, these contain the bacterium Enterococcus faecalis, which has been linked to colorectal cancer in susceptible individuals. Probiotic-3 from Advanced Orthomolecular Research and Threelac also contain Enterococcus faecalis. So it would seem like a good idea to steer clear of these, and any other HSO probiotics that contain Enterococcus faecalis. Prescript-Assist does not appear to contain this bacterium.

The reason they put Enterococcus faecalis in these probiotics is because this bacterium inhibits Candida.ᐞ So it's a useful bacterium, and this bacterium also is part of the normal gut flora — it says here that "Enterococcus faecalis is the most frequent species isolated from human intestine samples (80-90%)."

But apart from its benefits in eating up Candida, Enterococcus faecalis can be considered a pathogenic bacterium rather than a beneficial bacterium, and given the cancer question mark associated with Enterococcus faecalis, perhaps you should think twice before supplementing with it.

I have IBS-D myself, so I am always tempted to try a HSO probiotic (though one that does not contain Enterococcus faecalis), given that HSO probiotics can help irritable bowel syndrome. Though so far I have shied away from doing so.

However, I am keeping a close eye on the development in fecal transplants (fecal bacteriotherapy). So far, the only way to do this is via a fecal transplant from a healthy donor. But there are human probiotic products under development (see "RePOOPulate") that will do away with the messy process of getting a fecal transplant from a donor, and are safer.

 

[adreno]

This figure from a recent study referenced at the PA website shows: "Relative abundance of 57 frequent microbial genomes among individuals of the cohort."
It should then be possible to compare this list with the ingredients of PA.

http://www.nature.com/nature/journal/v464/n7285/full/nature08821.html

 

[Ripley]

This figure from a recent study referenced at the PA website shows: "Relative abundance of 57 frequent microbial genomes among individuals of the cohort."
It should then be possible to compare this list with the ingredients of PA.

I wish it were that simple. Unfortunately, that list was sequenced from fecal samples. We were talking about gut mucosal samples testing high for SBOs. The Relman research we were referencing, above, specifically stated that there is a big difference between fecal and mucosal populations.

EDIT: @Hip, My guess is this is one of the key mucosal biogeopgraphic maps Kresser is referring to from the Relman lab:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1334644/pdf/pnas-0506655103.pdf

In fact, it's the same map that appears on the front of Relman's research page. As you will notice, Lactobacillus or Bifidobacterium species aren't really found in the mucosa, just as Kresser stated. The section of the map labeled "Actinobacteria" are your basic Soil Based Organisms. Therefore, we can conclude that Relman's research does show that there are more SBOs (Actinobacteria) than lactic acid microflora in the mucosa.

So, it appears that Kresser was correct after all.

 

[Lou]

@Hip Uh, oh, just finishing up a bottle of Prescript Assist. From assessment given it would take a cannon ball to the stomach to rid those hearty spore formers. Ugh, the side effects, though. But thanks, gives me something to chew on before reordering.

@Ripley Whew! Thanks for this information, perhaps sbo's are safe, after all.

Is it just me, or do other ME's wish for once there wasn't a flip side to every friggin thing we try?

@anne_likes_red Thanks, please keep us informed, hope you have good news to report in upcoming weeks. Happy camping!

@Crux Thanks, that's good news. For me, my big wish is it will help problem regarding mal-absorption of vital nutrients. That it will further help us to rebuild and repair.

@Gestalt Thanks, please let us know.

 

[adreno]

@Ripley Yeah, I missed that was a fecal sample. Still, interesting to see that the bacteroides dominate, as opposed lactobacillus and bifido.

 

[Ripley]

@Ripley Whew! Thanks for this information, perhaps sbo's are safe, after all.

Is it just me, or do other ME's wish for once there wasn't a flip side to every friggin thing we try?

I honestly believe that the concern over SBOs is unfounded and nothing but fear-mongering from the dairy-based probiotic industry. If someone comes along and says these are dangerous, they are going to need better proof because people have been using SBOs with overwhelming success and safety, for over a decade, and I'm not aware of a single problem reported from them.

We aren't talking about something that came out yesterday. We are talking about millions of years of humans consuming dirt, with food, and a decade of very safe use in the forms of SBOs.

 

[Ripley]

Thought I would post this so that people don't get the idea that the encapsulation ability of RS to shuttle bacteria safely through the stomach, to the colon, was some random theory. It's been well established through scientific research:

Encapsulation Technology to Protect Probiotic Bacteria
By María Chávarri, Izaskun Marañón and María Carmen Villarán
DOI: 10.5772/50046

Starch granule is an ideal surface for the adherence of the probiotics cells and the resistant starch (the starch which is not digested by pancreatic enzymes in the small intestine) can reach the colon where it is fermented [172]. Therefore, the resistant starch provides good enteric delivery characteristic that is a better release of the bacterial cells in the large intestine. Moreover, by its prebiotic functionality, resistant starch can be used by probiotic bacteria in the large intestine [173, 174]. [LINK]

It's pretty simple. You take your resistant starch with your probiotic and/or fermented food and that's all there is to it. Of course, the "starch granule" would no longer exist after heating (it bursts like popcorn), so that's why we consume it raw. Once the granule reaches the colon, it becomes a fermentable food for bacteria.

 

[Gestalt]

I wonder if taking probiotics with RS is wise....might the wrong bacteria like bifido begin blooming prematurely along their 20-30 foot journey to the large intestine?

 

[Ripley]

I wonder if taking probiotics with RS is wise....might the wrong bacteria like bifido begin blooming prematurely along their 20-30 foot journey to the large intestine?

No. This has been very well studied. The transit time to the colon is very quick and significant fermentation doesn't take place until the colon, with adhesion remaining constant the entire way. For instance:

Absorption of starch by healthy ileostomates: effect of transit time and of carbohydrate load.
R W Chapman, J K Sillery, M M Graham, and D R Saunders

Adhesion of Bifidobacteria to Granular Starch and Its Implications in Probiotic Technologies
R. Crittenden,* A. Laitila, P. Forssell, J. Mättö, M. Saarela, T. Mattila-Sandholm, and P. Myllärinen

So, what happens is that bacteria jump on the RS bus and it shuttles them rapidly to the colon, where the fermentation takes place. RS literally attracts bacteria and pathogens like a magnet, and the magnet stays intact until it reaches the colon.

 

[Hip]

I honestly believe that the concern over SBOs is unfounded

You are probably right: these HSO/SBO probiotics are likely safe. But it is interesting to consider the safety issues anyway.

Though I think it might be wise to avoid HSO/SBO probiotics that contain Enterococcus faecalis, as this bacterium has been linked to tumor initiation. Refs: 1, 2, 3. This is just a theoretical consideration, rather than any proven link between Enterococcus faecalis-containing probiotics and cancer.

The Prescript-Assist probiotic you recommended does not contain Enterococcus faecalis, so this is not a concern regarding this issue.


I did come across this interesting study of Prescript-Assist, which found benefits for IBS:

Prescript-assist probiotic-prebiotic treatment for irritable bowel syndrome: an open-label, partially controlled, 1-year extension of a previously published controlled clinical

It's not quite clear from the study abstract just how much improvement in IBS symptoms Prescript-Assist was able to achieve.

Though the regular probiotic Bifidobacterium infantis also shows benefit for IBS:

Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome

Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles

that list was sequenced from fecal samples. We were talking about gut mucosal samples testing high for SBOs. The Relman research we were referencing, above, specifically stated that there is a big difference between fecal and mucosal populations.

I find this a very interesting concept: that the bacterial populations on the intestinal mucous membranes are different in constitution to the bacterial populations found in the stool. It certainly makes you look at the whole bowel picture in a new way.

Any idea how mucosal bacterial populations are measured in a lab? Presumably you would need to use a endoscope to collect a mucosal sample of bacteria.

It would be very interesting to get an idea of one's own mucosal membrane bacterial species in the intestine. Are there any commercially available tests for this? I had an intestinal bacterial analysis performed by Genova Diagnostics, but that of course was the standard test via stool sample.

Of course, washing vegetables is probably a new phenomenon in the human diet, so it wouldn't surprise me if dirt was commonly ingested by our ancestors with every meal and the first place it would probably stick was the mucosal layer of the gut! So, I think it's fair to say that dirt — and the bacteria it harbors — was probably a key part of our gut's evolution.

That is debatable: Wikipedia says "most anthropologists believe that cooking fires first developed around 250,000 years ago "

Cooking with fire of course will sterilize any bacteria in any soil that may be clinging to root vegetables (presumably the only sort of vegetables that are likely to have some soil clinging to them).

 

[Ripley]

That is debatable: Wikipedia says "most anthropologists believe that cooking fires first developed around 250,000 years ago "

Cooking with fire of course will sterilize any bacteria in any soil that may be clinging to root vegetables (presumably the only sort of vegetables that are likely to have some soil clinging to them).

@Hip. Great post and great questions. But, in terms of fire, cooking wasn't for all foods. There's plenty of documented evidence of indigenous cultures who ate raw tubers/roots/bulbs/corms. Some in Africa still do this today. Sometimes they were dried in the sun. Sometimes they were eaten raw. Sometimes they were cooked.

Jeff Leach recently documented the microbe-laden food consumption by the Hadza. Let's just say that it's far less sanitary than you might imagine.

Additionally, ever notice that toddlers have this undeniable instinct to constantly their hands in their mouth, no matter how many times they are told not to? I suspect children have been putting soil into their mouths, for eons. Mine certainly likes to.

 

[Ripley]

Chris Kresser and Robb Wolf discuss all the ins and outs of taking Resistant Starch in Episode Episode 211 of The Paleo Solution Podcast. Definitely worth listening to if you're taking RS or thinking about it. Lots of good info and explanations.

Episode 211: The Paleo Solution Podcast: Guest Host — Chris Kresser

They cover FODMAP/SIBO issues and how to use RS in such situations. The importance of SBOs are covered as well. Kresser also explains how clinicians can incorporate RS into their practice.

 

[Hip]

@Ripley
What do you think of the suggestion in this article that it is even more beneficial to add psyllium husk, a soluble fiber, to the resistant starch?

I personally had a lot of success with soluble fiber prebiotics for my IBS and the anxiety, depression and brain fog symptoms that I think arose from my gut issues. I started this thread on the benefits of prebiotics. This is why I am quite excited to try resistant starch.

 

[Ripley]

@Ripley
What do you think of the suggestion in this article that it is even more beneficial to add psyllium husk, a soluble fiber, to the resistant starch?

I personally had a lot of success with soluble fiber prebiotics for my IBS and the anxiety, depression and brain fog symptoms that I think arose from my gut issues. I started this thread on the benefits of prebiotics. This is why I am quite excited to try resistant starch.

I think Grace/Dr. BG is great. She's been giving RS a lot of thought (and I linked to her articles in my original post). She's the one that really figured out that SBOs are probably an excellent combination with RS.

I think people — who are willing — need to experiment with RS as much as possible. Taking RS at different times of the day. Taking RS with different kinds of fermented foods and fiber, etc. Grace/Dr. BG's blog is a great resource and Tim Steele (the guy who started this RS movement) and her have been collaborating on a lot of the recent RS research.

So, yes... if people can tolerate it, I say go for it. Tim Steele has said that most average people will do really well on RS alone. But, it certainly seems like you can take RS to another level with things like SBOs, fermented foods and some other fibers that are tolerable.

I can't say this enough, but most people with severe issues need to start slow with whatever regimen they decide on. Eating more RS-rich foods and adding some fibers are things that people will want to work up to over time.

 

[Ripley]

I started this thread on the benefits of prebiotics. This is why I am quite excited to try resistant starch.

Great thread. You were really on the right track. Everything you were noticing about prebiotics is confirmed by this study on the "prebiotic effect":

http://pmid.us/20920376

It comes to the conclusion that prebiotics are way more powerful for repopulating the gut than probiotics. If you think about it, probiotics are just useful for introducing some new diversity to the gut — and diversity is believed to be crucial for health (of both minority flora and majority flora). But, prebiotics are what feed and grow that diversity.

So, probiotic foods and supplements can certainly be useful when you are missing certain "keystone" flora (and that's another thing I learned from Grace/Dr. BG). But, prebiotic foods are the ultimate end-goal once keystones are in place. The good news is that "safe starches" are extremely easy to tolerate, and are a great way to start introducing RS and fermentable carbs into a damaged gut.

 

[SickOfSickness]

I started RS2 and plan to keep updating here: http://forums.phoenixrising.me/index.php?entries/resistant-starch.1539/

 

[Lou]

Great thread. You were really on the right track. Everything you were noticing about prebiotics is confirmed by this study on the "prebiotic effect":

http://pmid.us/20920376

It comes to the conclusion that prebiotics are way more powerful for repopulating the gut than probiotics. If you think about it, probiotics are just useful for introducing some new diversity to the gut — and diversity is believed to be crucial for health (of both minority flora and majority flora). But, prebiotics are what feed and grow that diversity.

So, probiotic foods and supplements can certainly be useful when you are missing certain "keystone" flora (and that's another thing I learned from Grace/Dr. BG). But, prebiotic foods are the ultimate end-goal once keystones are in place. The good news is that "safe starches" are extremely easy to tolerate, and are a great way to start introducing RS and fermentable carbs into a damaged gut.

Hi Ripley,

Not that you didn't start this thread with a bang, but the probing questions and issues brought up by Hip and addressed thoroughly by you have made it one of par excellence in my opinion.

I think you've brought us something that possibly will make a tangible difference (so often not the case), and you had your ducks in order, there seems to be no obvious trap doors as we get further along in our understanding of resistant starch and what works best with its use. Once again, thank you.

 

[Hip]

I'd really like to find out if there are specifically targeted probiotic species.

From my Genova Diagnostics stool analysis, I found that I have two potentially pathogenic species in my gut: Proteus mirabilis, and Staphylococcus aureus. Potentially pathogenic means that they become problematic when they multiply to larger numbers.

Thus "crowding out" these potential pathogens with probiotics and prebiotics is one very good strategy; but it would also be interesting if there were probiotic bacterial species that have a particular anti-Staphylococcus or anti-Proteus effects. Just as Enterococcus faecalis bacterium specifically inhibits Candida ᐞ (but unfortunately has a cancer question mark associated with it), are there any probiotic species that target Staphylococcus or Proteus?


I also at some point would like to try bacteriophage therapy: which involves swallowing bacteriophages that kill Staphylococcus or Proteus. Bacteriophages are bacterial viruses that attack only bacteria.