I have a very heavy bug burden - the MRSA is always there ready to cause me a fever and an infection if I'm not on antibiotics all the time. I really tried to stay off the antibiotics (both oral and IV) for long periods of time. I tried a month, then two months, then three months. I felt like crap, but I convinced myself that I was benefitting my microbiome by trying to regrow the beneficial bacteria in my guts by taking a break from the antibiotics. But without the antibiotics, my MRSA infections kept getting slowly worse. My regimes of eating well, exercising diligently, taking herbs and supplements, and experimenting with enzymatic biofilm inhibitors certainly helped - they've helped A LOT. But I've just got too much MRSA down there, and the bacterial biofilm issue is something that no one has yet helped me address in any significant way. So while I am going to continue with my dietary, herbal, and supplementary regimes, I am also going to try being more aggressive with antibiotics this next year to see if this will help my lung function and my quality of life improve. Part of my willingness to be more aggressive with antibiotics is my new discovery that IV vancomycin has no impact on the gut flora, and therefore will not disrupt all of the hard work I've been doing to restore my intestinal microbiome to a healthy ecosystem.
I do believe that if my MRSA wasn't such a nuisance, the GAPS diet would have had a greater impact on improving my lung health. That is why I think it is so important to rebalance one's gut flora at an earlier age, possibly before big bugs like MRSA and pseudomonas have taken hold. The healthier the gut microbiome, the healthier the lung microbiome, and the more resilient the entire body becomes to resisting infections by these nasty pathogens. More and more studies are showing that if our microbiome is dominated by a healthy and diverse ecosystem of beneficial bacteria, we become better protected from infection and colonization by all pathogens (colds and flus included), but especially the typical big bad CF bugs, pseudomonas and MRSA. Remember that Germ Theory is only a piece of the puzzle - we must also keep in mind the Hygiene Hypothesis. Just because a germ (e.g. MRSA) is in your environment does not guarantee you are going to catch it and become colonized with it. That depends heavily on the strength of your immune system, your diet, the species that make up your microbiome, and a number of other factors. There is an often-told story of a famous scientist who wanted to challenge the wildly popular Germ Theory in a public way, so in front of a lecture hall of students he chugged a glass of water laced with cholera. He claimed that his microbiome was healthy enough that he would not be susceptible to infection by the cholera in the water he just drank. And sure enough, he was right. He did not develop a cholera infection, proving that there is more to the equation than exposure = infection. So in my mind, a lot of CF medicine should be focused on infection prevention, but not just with good hygiene and contagion control. Infection prevention can be much improved by optimizing the health of one's microbiome, and this is where the most exciting new research is headed. This is what is going to revolutionize medicine.
Tending the Garden
Although I am going to be willing to use antibiotics, including oral antibiotics, more often in the next year as part of my new experiment, I am also going to be focusing more closely on tending to my gut microbiome. By becoming more diligent and regular about eating and taking in more probiotics and well as prebiotic foods, I am hoping that I can rebalance my gut microbiome even when I am on oral antibiotics. I will do this in 3 ways: 1) by making sure to eat lots of probiotic and fermented foods, especially saurkraut and kimchi, 2) by taking particularly well-studied strains of probiotics like Lactobacillus rhamnonsus GG (i.e. Culturelle) as well as an effective multi-strain probiotic everyday, and 3) by including a number of prebiotic foods in my diet.
In the last month I've slowly added back in a little bit of grains (rice, quinoa, and millet in some seed crackers I buy) and added potatoes back in. I've discovered that my I still cannot control my blood sugar when I eat straight-up grains (i.e. a side of rice), plus my guts don't like it, so I only eat grains if they're mixed in with something else, like a bunch of seed in my Mary's Gone Crackers (I'm addicted to those things). For some reason my blood sugar is much more controllable (using insulin) with potatoes than grains, so I've started to eat some of those when I want to eat a carby meal. And I've also added in unmodified potato starch (Bob's Red Mill brand) as a prebiotic supplement in all of my smoothies. Unmodified (meaning unheated, unprocessed, and raw) potato starch contains a huge amount of resistant starch, a kind of carbohydrate that is completely unabsorbable and unusable by us, but is fantastic food for probiotic bacteria living in the colon, particularly bifidobacteria which are very important for our digestive health and regulating the immune system. Supplementing with raw potato starch to help boost the probiotic populations in our colon is becoming a really popular topic right now in the Paleo and Ancestral Health communities right now, so I thought I'd just on the bandwagon and try it. Check out this article if you want to read more about this topic in the Paleo blogosphere.
Since starting this change in my diet I have actually noticed a big difference in my energy levels. I have a lot more energy and get tired less often, even when I feel "sick". I feel more robust, and even when I get a fever my temperature is higher than it used to be a few months ago, which I see as a good sign because it may be that I have more energy now to really get a good, high fever going. I am gaining weight again. My stools are phenomenally regular and beautiful, and I have no adverse G.I. symptoms at all, not even a little gas. In the beginning when I started using the potato starch in my smoothies, I did see a little uptick in the amount of gas I had, but that subsided in a week or two.
Anyway, as part of my new experiment I am focusing more on prebiotics. But be aware that in the beginning stages of the GAPS diet, prebiotics are significantly reduced and it is advised to avoid them as much as possible. This is because in someone with severe gut dysbiosis, eating prebiotics can actually feed those populations of pathogenic bacteria that are causing the person such digestive problems. However, as the theory goes, once these pathogenic bacteria have been "starved out" by adhering to a strict GAPS diet for many months, it may then be a good idea to begin to add in prebiotic foods alongside probiotic supplements to repopulate the guts with beneficial bacteria and to provide those bacteria with the fodder they need to rebuild a healthy and stable microbiome. In fact, eating prebiotic foods like fibrous veggies or potato starch has actually been proven to be more effective at building populations of probiotic bacteria like bifidobacteria in the colon than taking supplemental probiotics in pill form alone. However, I think the most effective strategy is to eat prebiotic foods and probiotic foods and supplements together, once the beginning stages of the GAPS diet have been completed. Again, every body is different, so the length of time one needs to stay on the strict GAPS diet and the way one begins to transition off the GAPS diet will look different for everyone.
So far I have liked the results of my new strategy, and I will continue to keep you updated on any changes or improvements I experience.