Thursday, March 17, 2016

Pre, Pro and Anti - Biotics

Antibiotics are a normal part of post lung transplant life.  I take two different antibiotics daily, prophylactic antibiotics anytime I see the dentist, and high dose antibiotics anytime I get sick.

My daily antibiotics are Bactrim and Valcyte.  I take the Bactrim to help prevent a certain type of pneumonia that lung transplant recipients are prone to contracting.  I take the Valcyte because my lungs and I are a CMV mismatch.  CMV is Cytomegalovirus, a virus that somewhere around 70% of all Americans have contracted at one time or another.  Most people won't even know if they catch CMV as it rarely causes symptoms in healthy people.  The only problem is that once infected, the body retains CMV for life.  CMV is a very aggressive virus for those of us with a suppressed immune system, especially those of us with new lungs.  My donor lungs are CMV+, I am CMV-, hence the CMV mismatch.  The first few months following my transplant included an aggressive treatment protocol to help prevent the spread of CMV from my new lungs to the rest of my body.  Taking Valcyte is what keeps the CMV at bay today.

Taking all of these antibiotics is a necessary part of post-transplant life. They keep me healthy and out of the hospital.  Routine and heavy antibiotic use does have issues, especially with the gut flora, what I call my 'Gut Bugs', and others refer to as the gut biome or other similar names.

Not only is a healthy variety of gut bugs necessary for proper digestion of food, they are an important tool in your defense against disease and infection.  Trying to maintain healthy gut flora was important before my transplant, and doing so is even more important now that I have a compromised immune system and take all of these antibiotics.

I use a three tiered approach to maintain a healthy gut.  Probiotics, prebiotics, and fermented foods.

Probiotics - The only over the counter probiotic authorized for my use by the Team is Culturelle.  Culturelle has plenty of clinical evaluations to prove it is safe for use by folks with compromised immune systems.  I would very much like to take a supplement that includes soil based probiotics to help with increasing the variety of beneficial gut bugs in my system, but the Team rejected my request.  They had one patient who had a leaky gut take an off label probiotic, acquire an infection, and lose their life. The team did take my request seriously and dig into the recent studies on the importance of soil based probiotics to good gut health, but they still recommended against their use due to the lack of studies using folks with a compromised immune system and/or lung transplants.  So I will occasionally do a cycle of Culturelle after heavy antibiotic use.

Prebiotics - Prebiotics are basically foods for your gut bugs.  Wikipedia provides "In diet, prebiotics are typically non-digestible, fiber compounds that pass undigested through the upper part of the gastrointestinal tract and stimulate the growth or activity of advantageous bacteria that colonize the large bowel by acting as substrate for them."

Foods that are a good source of prebiotic fiber include Dandelion Greens, Garlic, Onions, Green Bananas, Plantains, Chicory, cooked then chilled Potatoes, and cooked then chilled Rice. Recent studies have shown that leafy green veggies are also an important energy source for beneficial gut bugs.

One way to add "non-digestible fiber compounds", also known as resistant starches, to your diet is to supplement with raw potato starch.  There are about 8 gr of RS per tablespoon of Bob's Red Mill Unmodified Raw Potato Starch.  Plantain chips are another good source of RS.

I eat leafy greens, garlic and onion pretty much every day.  I also have a couple tablespoons of potato starch or a half ounce of plantain chips daily to help feed my gut bugs.  After this last bout of high dose antibiotics, I decided to add a cycle or two of Natural Stacks Prebiotic +. to my routine to help my gut bugs recover.  This is the first time I've used this particular product and haven't decided if it is something I'm going to use often or not, but I am happy with it so far.

Fermented Foods - Fermented foods are probably the largest part of my gut health protocol.  The Transplant Team has approved all commercially produced fermented foods that are not otherwise restricted.  I have to be careful when selecting a Kombucha.  Most Kombucha is made with green tea, and great tea has an interaction with one of my anti-rejection medications so is off limits.  I eat some form of fermented food every day.  I include kefir, yogurt, sauerkraut, kimchi, and various live fermented pickles in my daily diet.  I even have a bottle of sauerkraut juice in the fridge.

I really like kimchi, my Sweetie has pretty much banned it from the house.  Good kimchi is a bit odoriferous.  Farmhouse Culture has a kimchi that much easier on the noses of folks who don't like the odor of more traditional fare and is OK for use at my house.

I also drink Good Belly Super and Straight Shots for a week or so after antibiotic use.

So, for a quick recap, I eat plenty of leafy green vegetables and other foods high in prebiotic fiber.  I take a little extra resistant starch to feed my gut bugs, and eat a wide variety of fermented foods.  I do all of this to help maintain a health gut biome.  Gut bugs are a very important part of your immune system and one of your first lines of defense against illness.

Now for the big question... what has all of this attention and care for my gut bugs done for me?

Building a healthy gut is only one part of my health plan.  I have also pretty much eliminated eating grains and processed sugars (the Primal Blueprint) and exercise regularly.  These all work together to help with my post-transplant success.

There are a few things I can attribute to my healthy gut bugs.  First is my digestion.  I rarely have gas and my bowels move regularly and easily.  I do not have a sense of urgency when it is time to go and everything flows smoothly.

I never get heartburn and no longer have any acid reflux.  I do take Pantoprazole as a prophylactic to protect my lungs and the transplant graft.  All lung recipients at this center do.  I am on the lightest dose of any of the other transplants performed by this team.  I really don't think I need it at all, but the danger of stomach acid in the new lungs is not worth stopping the medication at this time.

I am very healthy and have only been sick twice since my transplant.  This is in spite of the fact that we often care for our granddaughter after school and I do go out and mingle with the public (taking proper precautions of course).  I have had zero issues with food borne pathogens.  My last colonoscopy was very clear.  Looked even better than the previous one

If you want a healthy gut, I would recommend that you eat plenty of green vegetables, add a fermented food or two into your diet, and start to minimize the amount of processed sugar and artificial sweeteners you consume.  Just doing these three things for a few weeks could make all the difference in the world for your gut bugs.


  1. Could not wait to get over here. Looks like I am missing a few things I should be doing daily. Thanks for this post!

  2. Awesome info John! Now I have written plan of what to do on my own. I'm missing a few things too. :) NM

  3. Thanks Pam and Sue, I appreciate your stopping by.