Should we always be taking probiotics when we are doing a pathogen cleanse? Addressing intestinal dysbiosis involves reducing the populations of unfavorable flora and increasing the populations of favorable flora. You pull the weeds, plant new grass seed, and condition the soil. In this blog post, I want to go into some detail on the T cell polarizing effects of probiotics and their contemporaneous use with anti-pathogenic supplements.
We know that not all probiotics have the same effect and that some can tip you toward Th1, Th2 or Th17 dominance depending on the type of strain. Recent Research condifrmed that “Different strains of probiotics possess the ability to finely regulate dendritic cell (DC) activation, polarizing the subsequent T cell activity toward Th1 (e.g. Lactobacillus (Lb) acidophilus), Th2 (Lb.reuteri and Bifidobacterium bifidum) or, as more recently demonstrated, Th17 responses induced by specific strains” (Curr Allergy Asthma Rep, 2013). Adding in certain strains such as L. Reuteri and B. longum will decrease IL-12.
To get technical for a moment
As Dr. Yanuck states: “When you are working to eradicate dysbiotic organisms, remember that the immune system recognizes pathogen associated molecular patterns (PAMPs) on organisms using pattern recognition receptors (PRRs) such as Toll like receptors (TLRs) and NOD-like receptors (NLRs). There are about 1,000 different PRRs. They’re on dendritic cells, macrophages, monocytes, neutrophils, and epithelial cells. Stimulation of a PRR gives the macrophage or dendritic cell information about the organism that it will use to signal T and B cells to polarize appropriately.”
Crucially, this PRR recognition of PAMPs takes place whether the organism is alive or dead. This means that, when you’re killing pathogens in the gut, your process of doing so will yield a transient, and potentially substantial, increase in PAMPs, as organisms disintegrate, going from intact cells to debris of cells. This is a likely driver of the Herxheimer reaction that people get when starting a pathogen cleanse.
So what does all this mean in regards to probiotics and pathogen cleansing? It is a good idea to take probiotics during a intestinal cleanse but understanding you will need to have things in place to limit the Herx reaction and remove PAMPS (explained below).
We can use probiotics strategically, while working on dysbiosis, to signal for T cell polarization effects that would be useful to us during the pathogen cleanse. You would take the probiotics at the same time as the substances you’re using to eradicate the dysbiosis (black walnut, oil of oregano, caprylic acid, artemisia, etc.), with the expectation that most of the probiotic would also be killed by the substances you’re using. This is the intended effect, with the PAMP debris from the probiotic working as signaling agents that influence PRR-mediated influences that instruct macrophages and dendritic cells to drive the T cell polarization pattern we want. Once you are no longer Th2 dominant and pathogens have been mostly cleared, you can start flooding with probiotics afterwards to replenish what has been lost and the body would tolerate it a lot more.
Whenever doing a pathogen cleanse, consider using a binder to remove PAMPs that are released when you kill dysbiotic organisms. This will limit PRR-mediated upregulation of inflammatory activation inherent in pathogen killing and therefor help with the Herx reaction too. It’s often useful to give the binder 60 to 90 minutes after giving the anti-pathogenic substances. This gives those substances time to act, producing the PAMP field. It also ensures that the binder isn’t interfering with the effectiveness of the anti-dysbiotic substances.
It’s typically useful to accompany efforts to eradicate dysbiosis with substances like curcumin and resveratrol. This will improve control of the inflammation that is already being driven by the dysbiosis itself and will also improve control of the incremental inflammatory activation driven by the increased PAMP burden that occurs as a consequence of killing pathogens. Curcumin lowers inflammation in the gut directly so it is not necessary to use a form that is very absorbable as we want it staying in the gut anyway to dampen inflammation there.
Most the time, the overgrowth in the gut is also characterized by Th2 dominance so taking lactobacillus acidophilus would be expected to generate PAMPs that drive the production of IL-12 by macrophages and dendritic cells involved in intestinal APC functions. This would influence the intestinal immunological environment away from Th2 dominance and toward a more neutral T cell polarization pattern that includes enough Th1 family responses to provide a balanced immune environment. My go to probiotic during dysbiotic protocols is the HMF intensive 500 from Genestra, I have clients do 1/2 sachet every other day at the start and then slowly increase the dosage as we decrease the antifungals over time. This contains the best strains to minimize elevating inflammatory cytokines, PAMPs and the Herx reaction.
The Research
Mucosal Immunology and Probiotics
Curr Allergy Asthma Rep (2013) 13:19–26. Dongarra ML, Rizzello V, Muccio L, et al.
Human antigen-presenting cells respond differently to gut-derived probiotic bacteria but mediate similar strain-dependent NK and T cell activation
FEMS Immunol Med Microbiol 51 (2007) 535–546. Fink LN, Zeuthen LH, Ferlazzo G, Frokiaer H.
Lactic acid bacteria inducing a weak interleukin-12 and tumor necrosis factor alpha response in human dendritic cells inhibit strongly stimulating lactic acid bacteria but act synergistically with gram-negative bacteria
Clin Vaccine Immunol. 2006 Mar;13(3):365-75. Zeuthen LH, Christensen HR, Frøkiaer H.