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BTD Forums  /  Supp Right For Your Type  /  Polyflora and Mesalamine
Posted by: yvonneb, Saturday, June 16, 2012, 7:51am
Here is a tricky one for you...

Currently I am taking a drug called 'Salofalk enema' which contains the active ingredient 'mesalamine' - details here:

Prompted by Dr.D's Crohn's and IBS lecture in May in Williamsburg where he mentioned that Sulfadrugs (mesalamine is the isolated, working part of a sulfadrug) kill gut bacteria (good and bad), I found this study:

So my question is...when should I start taking the Polyflora?
Should I take it now alongside or will the Mesalamine kill it off or wait until the drug is reduced?

I don't know if I can stay in remission without taking any mesalamine  :-/
This day could be a couple of months away and I was hoping to benefit from Polyflora earlier.

Your thoughts?
Posted by: Conor, Saturday, June 16, 2012, 9:01am; Reply: 1
On another thread we were recently discussing, amongst other things, S. thermophilus' possible drug resistance to certain antibiotics (S. thermophilus is one of the two bacteria included in Polyflora O). Here's a study that seems to support S. thermophilus' ability to withstand antibiotic activity and prevent diarrhea:

There was another study which indicated a similar outcome.

Are you taking the mesalamine delayed-release tablet (t.i.d.) or the controlled-release capsule (q.i.d.)? Are you taking the mesalamine with food, i.e., at mealtimes, regardless of which form it is? If so, my suggestion is to time the taking of the Polyflora as far opposite the mesalamine dose(s) each day as possible. For example, take the first Polyflora O immediately upon arising with 10-16 ounces of water. Then, do the same again 30 minutes or so before bedtime. In this manner, you're effectively book-ending the mesalamine every day.
Posted by: yvonneb, Saturday, June 16, 2012, 3:08pm; Reply: 2
Am taking stomach acid resistant coated tablets one hour before food three times daily and an enema at night that is supposed to stay in, but doesn't- I wake up to pass it about 3-4 hours later.

So, taking your advice I'd be taking the Polyflora after that, hours away from food.
Would it be better to take it with food to help it reach the intestine quicker? Three o'clock in the morning snack sounds just fine to me  ;D

Today was the first 'good stool' day, so I am hoping not having to take the full course of the enemas, but I will still be stuck with the oral doses for the time being... I could split those into two rather than three doses per day...

Hmm- must think on that some more...(think)
Posted by: Conor, Saturday, June 16, 2012, 7:25pm; Reply: 3
Quoted from yvonneb
So, taking your advice I'd be taking the Polyflora after that, hours away from food. Would it be better to take it with food to help it reach the intestine quicker? ...

In addition to the links you provided, I checked Medline Plus, the Lancet and a couple of other sites I trust to be certain I understand the enema protocol in question. It seems there are a number of Mesalamine Rectal Suspension products going by different trade names (e.g., Asacol, Canasa, Canasa Pac, Rowasa, Salofalk, et al), but all have mesalamine as their primary active ingredient.
Quoted Text
Mesalamine Rectal Suspension is an enema containing 5-aminosalicylic acid (5–ASA) that is effective in treating inflammation in the rectum. However, the enema solution cannot reach high enough to treat inflammation in the upper colon and the small intestine. Therefore, for most patients involving the ileum (distal small intestine) and/or colon, 5–ASA must be taken orally.

Also, as I understand it, mesalamine is an aminosalicylate anti-inflammatory with 5-ASA as its active ingredient and, thus, may co-exist less antagonistically with existing beneficial intestinal bacteria (flora), and with probiotic supplementation, than older sulfa drugs.
Quoted Text
[T]he newer 5-ASA compounds (e.g., Asacol, Pentasa or Salofalk) do not have the sulfapyridine component and have fewer side effects than sulfasalazine ... [Adam Schoenfeld, MD, George Y. Wu, MD, PhD]

Here's a study on PubMed that may be of interest to you:

Also, are you familiar with Mutaflor?

Even in consideration of the combination of oral and rectal doses, I'd still divide my Polyflora supplementation into two doses; taking the first one upon arising and the second one 30 minutes before bedtime. Taking them at these times (expecting that your stomach will be somewhat empty at these times), and with a full glass of water, should help to expedite the capsules' contents past the gastric acid and bile salts so that the greatest number of probiotic organisms possible have a chance to compete for mucosal adhesion sites. Plus, taking them with plain water should help to dilute acid within the stomach and stabilize pH levels (the stomach has a mechanism for releasing water pretty quickly, so that less of your probiotic supplementation is subjected to the stomach's gastric acid). Hope this helps. (:
Posted by: yvonneb, Saturday, June 16, 2012, 9:38pm; Reply: 4
Wow, Conor!

That is great stuff!! Thank you for putting in the time for me  :)

All makes a lot of sense, taking the Polyflora with water is brilliant!!

Didn't know that the new formulations (5 ASA) can co-exist with gutbacteria- I had only been going on Dr.D's lecture and couldn't find a precise study that unravelled all the new data for me- but you have done it- THANK YOU!!

Yes, I know Mutaflor- I took it in the past, but I had to get it from Germany (not available in Ireland) and it was doubtful how viable it was by the time the postman brought it 4 days later. Mutaflor is alive and has to be kept cool- my mum used to include a tiny coolpack when she posted it- made it more expensive and I had to post the little cooler back every time  :)

But is Polyflora not superior now to Mutaflor?
Posted by: Conor, Saturday, June 16, 2012, 9:58pm; Reply: 5
Quoted from yvonneb
But is Polyflora not superior now to Mutaflor? ...

Right now I'd have to say yes, especially as I don't have any data on E. coli strain Nissle 1917's blood type specificity. Empirically, though, if Mutaflor really worked well for you, i.e., was quite successful in helping to manage symptoms, I think you'd be more motivated to continue its use despite any associated inconvenience (however, correct me if I'm wrong). Too, Polyflora O is formulated specifically with our blood type in mind.

Please post your experience with it back to this thread after you've used it for a period of time. All the best. (:
Posted by: yvonneb, Saturday, June 16, 2012, 11:14pm; Reply: 6
Will do!

Thanks again!

PS: I'll search the german google tomorrow to find out about Mutaflor strain 'Nissle' & Bloodtype. I'll post if I find anything.
Otherwise, I think I'll try the Polyflora- I don't recall the Mutaflor being earthshattering  ;D

I am contemplating to continue the Polyflora indefinitely as a means to stay in remission together with ARA 6...
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