My favorite probiotic: E.Coli Nissle 1917 (Mutaflor)

I thought it was time to revisit what is on PubMed for Mutaflor (the probiotic E.Coli Nissle 1917). There are 213 studies at the moment.

  • “Probiotics as E. coli Nissle could be used as alternative to mesalazine for maintenance of remission in patients with ulcerative colitis. “[2014]
  •  The probiotic E. coli strain Nissle 1917 (EcN) is known to be effective in the treatment of several gastro-intestinal disorders. While both in vitro and in vivo studies have described strong inhibitory effects of EcN on enteropathogenic bacteria including pathogenic E. coli, the underlying molecular mechanisms remain largely unknown.” [2014]
  • Our results indicate that EcN can inhibit many of the pathological effects of C. perfringens in vitro conditions.”[2014]
  • “Its beneficial effects in the treatment of UC have been demonstrated in several controlled clinical studies” [2014]
  • The data can be explained according to our “restaurant” hypothesis for commensal E. coli strains, i.e., that they colonize the intestine as sessile members of mixed biofilms, obtaining the sugars they need for growth locally, but compete for sugars with invading E. coli pathogens planktonically.“[2014]
  • “Our results show that coseasonal treatment with EcN in grass pollen-allergic subjects was not superior to placebo” [2014] – i.e. does not cure allergies – no big deal
  • “By administering Escherichia coli strain Nissle 1917, which assimilates iron by similar mechanisms, we show that this nonpathogenic bacterium can outcompete and reduce S. Typhimurium colonization“[2013]
  • Intestinal bacteria compete for the essential nutrient iron, leading to replacement of pathogenic Salmonella by the probiotic Escherichia coli Nissle, which is better equipped with iron acquisition systems, and resolution of infectious colitis.” [2013]
  • The combination of Lactobacillus, Bifidobacterium, Saccharomyces boulardi and the treatment with Escherichia coli Nissle were found beneficial in inducing and maintaining remission of disease activity of gut inflammation and moderately severe ulcerative colitis.” [2014]
  • EcN “ consumed on average 65% glucoiberin and 78% glucoraphanin, transforming them into glucoiberverin and glucoerucin, respectively, and small amounts of iberverin nitrile and erucin nitrile. The lactic acid bacteria did not accumulate reduced glucosinolates, consuming all at 30-33% and transforming these into iberverin nitrile, erucin nitrile, sulforaphane nitrile, and further unidentified metabolites. ” [2013]
  • Probiotic EcN shows effects in irritable bowel syndrome, especially in patients with altered enteric microflora, e.g. after gastroenterocolitis or administration of antibiotics.”[2012]
  • In conclusion, EcN supplementation to minocycline treatment improves the recovery of the intestinal damage and prevents the reactivation of experimental colitis.” [2011]
  • In the mouse model E. coli Nissle can not be used alone to eradicate IBD associated E. coli; rather, 3 days of ciprofloxacin are apparently efficient in eradicating these strains, but surprisingly, after ciprofloxacin treatment (3 or 7 days), the introduction of E. coli Nissle may support re-colonization with IBD associated E. coli.” [2011] – interesting but some distinct study issue.
  •  oral administration of EcN might be an effective strategy in prevention and potentially therapy of allergic inflammatory skin diseases.” [2011]

Iodine, Microbiome and Chronic Fatigue Syndrome

Many of us more ancient folks remember when if we got a cut, we dreaded the treatment worst then the cut. Iodine tincture was applied to the cut to kill bacteria. It is a very very effective antimicrobial. It’s use has stopped in our society. A reader, who like me, from a location where his ancestors likely had a very high iodine intake due to fish being a stable of the diet, asked about iodine as a supplement. Excellent question because the level of it would likely impact inherited microbiome significantly.

What is inherited microbiome? It is two parts: bacteria obtained from babies putting their fingers into their parent’s mouth, as well as inherited DNA cooperation with certain species-strains.  Conceptually it is easy to understand, but it’s impact on treatment protocols is a lot of complexity.

So what do we know:

  • Nothing on CFS and Iodine on pubmed.  We do know that iodine is essential for thyroid, “Iodine’s main role in animal biology is as a constituent of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). “[Wiki], and there is a lot on thyroid and CFS. Why have there been no published studies on iodine supplementation for CFS?
  • Looking for Iodine and Bacteria results in thousands of hits where iodine was used for staining bacteria… ugh.

Looking at various sites, there is a feeling of dejavu with Vitamin D3.  The official healthy level for Vitamin D3 was defined to be that which stopped rickets from happening. (about 200 IU/day)  and only recently has a level of 5000 -1000 IU/day has been found to be needed to reduce cancer and MS risk as well as decrease in symptoms for CFS and FM. Iodine is not tested for usually. There are procedures for dealing with iodine poisoning.

There is a privately published study Effect of Daily Ingestion of 100 mg Iodine Combined with High Doses of Vitamins B2 and B3 (ATP Cofactors) in Five Subjects with Fibromyalgia that is worth the read. Note that the dosage was 100 mg/day and Vitamin D is strongly recommended with it.


A [2008] study found “In conclusion, median urinary iodine 100~200 mug/l may reflect the safe range of iodine intake levels. Serum thyrotropin/thyroglobulin ratio might be a better index of evaluating iodine status.” A [2006, full text] study found “Mild and moderate iodine deficiency was associated with a decrease in serum TSH with age.”, the full text went on to state “Until recently, the iodine intake of many European populations including the Danish (1) was below the level recommended by the international organizations (2)“. For CFS patients there is a tendency to eat too-healthy for their own good. This includes avoiding salt (especially  iodine salt) or use special salts not containing equivalent iodine levels (Himalayan salts, etc).

Further more, “Even if there is consensus on the importance of avoiding iodine deficiency, there are many unanswered questions concerning optimal iodine fortification of food, and optimal iodine nutrition of a population (6).”  One of my favorite CFS MD’s, Dr. Myhill writes “Interest in iodine was re-awoken in 1993, when Gent demonstrated that 5mg a day of iodine is highly effective in the treatment of fibrocystic disease of the breast. A study in Japan showed that the average daily intake of iodine was 13.8mg (because of their high intake of seafood) and the Japanese have the lowest incidence of breast cancer in developed nations.”   Hmmm Iodine and Cancer… sounds like Vitamin D and cancer is echoing! She goes on to describe a protocol using about 50mg/day which resulted in less brain fog and major increase in the level of toxins being excreted by CFS patients.

Bottom Line

There is more that we do not know then what we do know :-( . There is the appearance that individual generics may play a significant role in determining the appropriate level. The inferred safe range of supplementation seems to be 14mg – 50mg of iodine/day. This is well above the official RDA (Minimal) levels, to quote MyHill “.Furthermore, the recommended daily amount of iodine is 150 μg – that is to say a thousand fold less than the sort of doses that were used in the 19th century.”  The typical iodine supplement is ~5  - 12 mg/tablet and Kelp around 150mcg (0.15mg) each. Myhill recommends:  Iodoral.

As always, consult your knowledgeable medical professional before changing or adding supplements (if you can find said).



Chemotheraphy induced CFS Remission

Twice in my life I have sat down and spoke with CFSers that went into remission from cancer treatment. This has also been reported from Norway (“Cancer Drug May Also Treat Chronic Fatigue Syndrome“) and pubmed [2009] and after 3 years, the clinical studies or confirmation of the suspected drug agent has not materialized [Blog 2013]. So it seems that it may not be a single drug doing it, but chemotheraphy as a whole.

Does this fit in with the microbiome model… surprisingly — there was a recent publication that ties the pieces together!

“We observed a steep reduction in alpha diversity and significant differences in the composition of the intestinal microbiota in response to chemotherapy. Chemotherapy was associated with a drastic drop in Faecalibacterium and accompanied by an increase of Escherichia. The chemotherapy-induced shift in the intestinal microbiota could induce severe side effects in immunocompromised cancer patients. “

Very low E.Coli is the dominant microbiome shift seen in CFS.  Chemotheraphy is not a recommended treatment for CFS — however, if you need it and have CFS — you may have a pleasant side-effect!



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