My experience describing how I lost weight with probiotics, and the theories behind it. "Normal" gut bacteria appear to metabolise fat, and extract calories from food, in a “historically correct” fashion, with the result that the vast majority of people with normal gut bacteria would be a healthy weight without having to diet or engage in any real food intake control. Historically, weight gain and obesity have only been a problem for a small minority of people. Since antibiotics - and possibly the contraceptive pill - started being widely used, being overweight has become a problem for the vast majority of most populations. Antibiotics, and potentially the contraceptive pill, both result in damaged gut flora. Abnormal gut bacteria process fats and extract calories from food in an inappropriate way, that makes slow but eventual obesity more-or-less just a matter of time. Unless of course these people work hard to restrict their food intake. Or unless they correct their gut flora to that which the human race has grown-up with, probably since life on earth began. Which is where some probiotic bacteria, mainly it seems Lactobacillus types, come in. All of the theories and potential techniques around the use of probiotics - and prebiotics in weight-loss are still essentially experimental and unproven. And you should read everything I post with that in mind. I have experimented with quite a few different probiotic bacteria for weight-loss effects, and have found that there are some that actually result in weight-gain: Streptococcus Thermophilus is the most common - it is found in many shop-bought yogurts.
Getting back to your Correct Weight with Correct Gut Microbes This document describes a method of weight loss that is essentially experimental, the science and experience are just not there to “prove” if it is effective or not. It is based on the latest bleeding-edge scientific research, but that does not guarantee that it will work for everyone. I developed this theory after losing weight inadvertently, when food intake and exercise levels were effectively unchanged. The weight loss was gradual over about 18 months, when I went for noticeably overweight to noticeably slim. This method worked for me but I have absolutely no idea if it will work for you. This document has unfortunately grown very large, and there is a lot more scientific evidence that I have come across that I could add to it. Therefore I have provided a summary, near the bottom of the document, that gives a brief idea of the theory behind this weight loss method. Skip to it if you do not want to wade through 40+ pages! Note that this document is not intended to be contemporaneous. This is version 4.2 of the document (30th August 2008). I am probably not going to update this document any further. Introduction The 1980‟s were when overweight and obesity rates started rising significantly. I mostly quote statistics for America as they are more readily available. “Seven out of 10 U.S. adults are overweight or obese.”i “Obesity rates that have risen three-fold or more since 1980 in some areas of North America, the United Kingdom, Eastern Europe, the Middle East, the Pacific Islands, Australasia and China.”ii The causes of increasing obesity, according to the experts. “Dr. Ercel Eppright, Iowa State's top nutritionist, suggested that weight control should begin during childhood. Thanks to TV and the automobile, children are getting less exercise, spending playtime indoors gobbling high-calorie snacks and soda pop.”iii That sounds a bit like a quote from yesterdays newspaper, but is in fact from Time Magazine in 1955, long before the obesity epidemic really started, which was around 1980… Everyone is now eating more of course. Well not according to the few statistics available: “In the adult US population the prevalence of overweight rose from 25.4% from 1976 to 1980 to 33.3% from 1988 to 1991, a 31% increase. During the same period, average fat intake, adjusted for total calories, dropped from 41.0% to 36.6%, an 11% decrease. Average total daily calorie intake also tended to decrease, from 1,854 kcal to 1,785 kcal (-4%). Men and women had similar trends. Concurrently, there was a dramatic rise in the percentage of the US population consuming low-calorie products, from 19% of the population in 1978 to 76% in 1991.”iv So it must be exercise. But exercise isn‟t really quite as efficient a fat-burner as you might think: “to take off one pound, said Dr. Ralph E. De Forest, a fat man would have to walk 36 miles, or do 2,400 pushups, or climb the Washington Monument 48 times”v Increasing weight is not necessarily a consequence of “the modern world”, as a country like the US has been living in the modern world for a pretty long time now. There are many theories of how, since the 1980‟s, obesity has become epidemic. When you look at each suggested cause, you need to consider the following: does that cause also affect cats? That may sound ridiculous, but the obesity epidemic in the human population since around 1980 has been mirrored in the pet population (both cats and dogs): “Obesity is a serious problem in cats which can lead to premature death. Sadly it is the most common nutritional disorder seen in cats. Approximately 40% of cats in the USA are obese… A cat is considered to be obese if it's weight is around 20% over the ideal weight.”vi “Britain's vast population of lethargic and over-fed cats is facing a diabetes epidemic as soaring rates of feline obesity take their toll on the animals' health, veterinarians warned yesterday…. “Researchers believe the numbers mirror dramatic rises in feline diabetes recorded elsewhere, including a fivefold increase in the US over the past 30 years.”vii Cat and dog obesity is explained with the usual reasons given for human obesity: cats are not getting enough exercise, and eating too much… But doesn‟t a cat exercise itself? And don‟t most cats generally just leave food when they have had enough? And why did this pet obesity issue all start around the 1980‟s, at essentially the same time as the human obesity problem emerged? The cat link I find interesting, as it rules out many of the common theories about the causes of obesity, including: McDonald‟s, KFC, Coca-Cola, Monosodium Glutamate, artificial sweeteners, high fructose corn syrup, sweets, biscuits, playing computer games all day long, TV, snacking, “grazing”, laziness, greed, fatty diets, high/low carbohydrate diets, "couch-potato" lifestyles, the motor car, affluence, and most of the other theories. Cats are mainly meat eaters, so the theory that growth hormones used in farm animals could affect both humans and cats sounds plausible - until you consider that growth hormones have been banned in the European Union for many years, and should not have been present in any meat eaten within the EU since 1989. But despite the ban, both the British and their cats have still become overweight. If cats and dogs aren‟t enough, try pet birds: BirdChannel.com has the article “Birds can develop weight problems too” “… Most veterinarians cite obesity as the No. 1 health problem in pet birds. Gregory Burkett, DVM, for one, who has a private practice in North Carolina, said approximately 50 percent of his avian patients are overweight — meaning they are 5 to 20 percent above their ideal body weight. He is seeing an increased number of birds that are obese as well — meaning they are more than 20 percent above their ideal body weight.”viii Or look at horses, eating only grass, as this Virginia Tech study from 2007 reported: “Fifty-one percent of the horses in the study were found to be overweight and 19 percent were found to be obese. … The study also suggests that equine obesity may result from natural grazing behavior instead of the overfeeding of grains and other feed supplements, which defies conventional thinking on equine weight matters. The majority of horses examined in the study were fed primarily pasture and hay with very little grain and concentrate.”ix The idea that humans, and more-or-less every domesticated animal, have all suddenly started to eat more and exercise less, is not really credible. Weight used to be a fairly stable thing, as can be seen from this quote from Time magazine in 1955: “Since 1912, the average white man's weight has gone up five Ibs.; white women have actually lost the same amount, evidently doing their best to keep up with fashion designers.”x The diet Industry Thousands of sites on the internet want to sell you a diet, or a weight-loss “secret”. And weight-loss guru‟s tell you their simple program is the only effective way to get slim, while displaying muscle-bound pictures of themselves that seem to imply they must be spending countless hours in the gym in order to keep their own weight down. None of the weight loss organizations, or diet book writers, want to tell the basic truth: loosing weight permanently is a very slow process: “People who participated in Weight Watchers kept off an average of 6 pounds after two years, while people who tried to lose weight on their own were back at their starting weights, according to a study in today's Journal of the American Medical Association… Weight Watchers participants lost an average of an inch around their waist after two years; the others [not attending Weight Watchers] were at their starting waist circumference.”xi A 2008 study in Israel followed dieters on three different diets for a total of two years. Among the 272 participants who completed the diets, the mean weight loss after two years for the low-fat diet was 3.3 kg (7.275 lb), the Mediterranean diet was 4.6 kg (10.141 lb), and those on the low-carbohydrate diet lost an average of 5.5 kg (12.125 lb).xii This implies that maximum realistic weight loss long-term is about half a pound (0.226 kg) per month. For your weekly weigh-in, that‟s about 60 grams (2 ounces). A small apple is about 100 grams. Losing weight without keeping it off permanently is pointless, but also absolutely normal: “5 percent of dieters actually keep the weight off [over the long term]”xiii Weight loss drugs, like Xenical (orlistat), Meridia (sibutramine), phentermine, and Rimonabant (Acomplia) have been developed that appear to offer a solution, provided you are prepared to run risks like “inability to control bowel movements”, depression and suicidal tendencies. But even these are not quite as effective as you might think: "Weight loss medications can be modestly effective, and enhance weight loss by 8%-10%, but medication does not work for everyone," says Robert Kushner, MD, a professor of medicine at Northwest University. Kushner estimates that about a third of his patients respond well to medication”.xiv And people do still die from that other solution, weight-loss surgery. The 1980’s: A little detour The spike in obesity that started around 1980 is in fact quite interesting. If you keep your eyes open you will see many spikes in illnesses that started around the late 1970‟s and 1980‟s. These include allergies, asthma, eczema, autism, adhd, and add. Just one example is below: Obesity and Autism both took off in the 1980‟s: xv Obesity in the USA since 1960: xvi Rates of autism in California (long curve) and in U.K. (short curve). This document is concerned with experimental weight loss only, but just bear the 1980‟s in mind when you hear of increasing prevalence, epidemics, plagues and explosions in a given illness. The ideas in this document Basically, obesity and weight loss “solutions” are pathetically bad. So although this little experiment in weight loss might only work for a small fraction of people who try it, it would not really be any worse than the solutions already out there. For our sources we have to cast the net wide: there is very little research into weight-loss that is of interest. Most research, into any medical matter, is paid for by pharmaceutical companies, who not unnaturally want to research drugs and treatments that they can patent and sell. They are not really interested in anything that is not profitable. Universities used to be rather better, but nowadays they tend to want to “increase links with industry” – essentially looking at research from the point of view of spin-off companies and collaborative ventures, which again need a product or technology that can be patented and sold. So we take our research and ideas for here, there and everywhere. Accepted theory of weight gain “Your body uses food for energy. It stores any excess energy as fat. This means if you eat more food than your body needs for daily activities and cell maintenance, you will gain weight. “To lose weight, you need to get your body to use up these stores of fat. The most effective way to do this is to: reduce the amount of calories you eat increase your levels of activity. “This is why experts talk about weight loss in terms of diet and exercise”xvii. Weight is thus basically a matter of intake and energy used: calories in less energy expended are either in balance, or out of balance. If out of balance, one side will lead to weight gain, the other to weight less. According to the accepted theory, it is all down to Inputs (food) and Outputs (energy). But could it actually be down to Inputs, “Processing” and Outputs? Take two identical car bodies, and fit then with two different engines. Say a BMW engine and an old Lada engine. Put a gallon of fuel in the tank of each car, and drive 25 miles. The Lada engine will probably leave an empty fuel tank, and will almost certainly have produced significant environmental emissions. The BMW engine will probably leave at least a quarter of a gallon of fuel left, and have produced significantly less emissions. This is obviously because the two engines are different: different parts, different technology, whatever: they are using fuel at different efficiencies. Different results from the same fuel, although both engines are based on exactly the same principle: the internal combustion engine. The Processing of the Inputs (petrol) is different. Are there any differences in the human digestive system that can cause it to behave like different internal combustion engines? Is it possible that people can take in the same amount and type of fuel, expend the same amount of physical energy, but get different results on their weight? Processing inside the engine So what inside the human engine can alter the processing of fuel? The quotes below are adapted from Gut and Psychology Syndrome by Dr Natasha Campbell-McBride: 85% of the body's immune system can be found in the gut Not many people know that an adult on average carries 2 kg of bacteria in the gut. There are more cells in that microbial mass than there are cells in an entire human body. It is a highly organized micro-world, where certain species of bacteria have to predominate to keep us healthy physically and mentally. Their role in our health is so monumental that we simply cannot afford to ignore them. One of the major functions of the good bacteria in the gut flora is controlling about 500 different species of pathogenic (bad) and opportunistic microbes known to science. Gut flora is something we do not think much about. And yet the number of functions the gut flora fulfills is so vital for us that if some day our digestive tract got sterilized we probably would not survive. The first and very important function of gut bacteria is appropriate digestion and absorption of food. But there are “good” gut bacteria, and “bad” gut bacteria. Having too many bad bacteria in the gut is know as dysbiosis. Leaky gut is a related syndrome of an overrun of bad gut bacteria. If person does not have normal balanced gut flora, then they will not digest and absorb foods properly, developing multiple nutritional deficiencies. Testing of people with abnormal gut flora reveals some typical nutritional deficiencies in many important minerals, vitamins, essential fats, many amino- acids and other nutrients. The most common deficiencies, are in magnesium, zinc, selenium, copper, calcium, manganese, sulphur, phosphorus, iron, potassium, vanadium, boron, vitamins B1, B2, B3, B6, B12, C, A, D, folic acid, pantothenic acid, omega-3, 6, 9 fatty acids, taurine, alpha-ketoglutaric acid, glutathione and many other amino-acids. In addition to promoting normal digestion and absorption of food, healthy gut flora actively synthesize various nutrients: vitamin K, pantothenic acid, folic acid, thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), pyridoxine (vitamin B6), ciancobalamine (vitamin B12), various amino-acids, and proteins. When tested, people with gut dysbiosis always present with deficiencies of these nutrients. What's more, people with damaged gut flora often have particular groups of pathogenic bacteria growing in their gut, including iron-loving bacteria (Actinomyces spp., Mycobacterium spp., pathogenic strains of E.Coli, Corynebacterium spp. and many others). These bacteria consume whatever iron the diet provides, leaving that person deficient in iron. Gut flora protect and nourish the digestive tract In addition to taking a direct part in nourishing the body, beneficial bacteria in the gut act as the housekeepers for the digestive tract. They coat the entire surface of the gut, protecting it from invaders and toxins by providing a natural barrier and producing a lot of antibacterial, anti-viral and anti-fungal substances. At the same time, they provide the gut lining with nourishment. It is estimated that 60-70% of the energy that the gut lining derives is from the activity of bacteria which live on its surface. Without control of the beneficial bacteria, different opportunistic and pathogenic bacteria, viruses, and fungi have a good chance to occupy large territories in the digestive tract and grow large colonies. Two particular groups which are most commonly found on testing are yeasts (including Candida species) and Clostridia family. These pathogenic microbes start digesting food in their own way, producing large amounts of various toxic substances which get absorbed into the blood stream and are carried to the brain, where they cross the blood-brain barrier. The number and mixture of toxins can be very individual, causing a variety of neurological and psychological symptoms. Due to the absence or greatly reduced numbers of beneficial bacteria in the gut flora, instead of being a source of nourishment the digestive system becomes a major source of toxicity in the body. What kind of toxins are we talking about? There are many toxins which have not been studied very well yet. But some toxins have received a considerable amount of research. Let us have a look at them. Acetaldehyde and alcohol. The most common pathogenic microbes shown to overgrow in the digestive systems ofpeople with neuropsychological conditions and allergies are yeasts, particularly Candida species. Yeasts ferment dietary carbohydrates, producing alcohol and its by-product, acetaldehyde. Let us see what a constant exposure to alcohol and acetaldehyde does to the body. The effects include: Liver damage with reduced ability to detoxify drugs, pollutants, and other toxins. Inability of the liver to dispose of old neurotransmitters, hormones, and other byproducts of normal metabolism. As a result, these substances accumulate in the body, causing behavioral abnormalities and many other problems. Degeneration of the pancreas with reduced ability to produce pancreatic enzymes, which impairs digestion. Reduced ability of the stomach wall to produce stomach acid. Damage to immune system. Peripheral nerve damage with altered senses and muscle weakness. Direct muscle tissue damage with altered ability to contract and relax plus muscle weakness. Nutritional deficiencies from damaging effect on digestion and absorption of most vitamins, minerals and amino acids. Deficiencies in vitamins B and A are particularly common. Alteration of metabolism of proteins, carbohydrates, and lipids in the body. Alcohol has an ability to enhance the toxicity of most common drugs, pollutants, and other toxins. Acetaldehyde is considered to be the most toxic of alcohol by- products. It is the chemical which gives us the feeling of having a hangover. Acetaldehyde has a large variety of toxic influences on the body. One of the most devastating influences of this chemical is its ability to alter the structure of proteins. Acetaldehyde-altered proteins are thought to be responsible for many autoimmune reactions. People with neuropsychological problems are commonly found to have antibodies against their own tissues. Other toxins include: Clostridia neurotoxins. There are about 100 different Clostridia species known so far. Many Clostridia species are normal inhabitants of a human gut. For example, Clostridium tetani is routinely found in the gut of healthy humans and animals. Everybody knows that tetanus is a deadly disease, due to an extremely powerful neurotoxin Clostridium tetani produces. Clostridium tetani, which lives in the gut, is normally controlled by the beneficial bacteria and does us no harm, because its toxin can not get through the healthy gut wall. In gut dysbiosis this powerful neurotoxin may well get absorbed through the damaged gut lining and then cross the blood-brain barrier affecting mental development. Many other species of Clostridia (perfringens, novyi, septicum, histolyticum, sordelli, aerofoetidum, tertium, sporogenes, etc) produce toxins similar to tetanus toxin as well as many other toxins. Gluteomorphins and casomorphins or opiates from gluten and casein. Opiates are drugs — such as opium, morphine and heroin — which are commonly used by drug addicts. Gluten is a protein present in grains — mainly wheat, rye, oats, and barley. Casein is a milk protein, present in cow, goat, sheep, human, and all other milk and milk products…. As a result of misdigestion, gluten and casein turn into substances with chemical structure similar to opiates such as morphine and heroin. These opiates from wheat and milk get through the blood-brain barrier and block certain areas of the brain, just like morphine or heroin would do, causing various neurological and psychological symptoms.” How can the gut bacteria affect weight? Ok, so the gut flora are heavily involved in digestion. And if you are overgrown with the wrong type of bacteria, they are capable of producing some nasty substances, and these can have quite a profound effect on the body. Although this weight loss document is aimed at people who do have digestive problems of one kind or another, and therefore are almost certainly overloaded with bad gut bacteria, there is evidence that the gut bacteria of obese people in general is different: The Daily Telegraph of 29/05/2007xviii published an article entitled “Fat? Blame the bugs in your guts”. It describes some of the research of Professor Jeffrey Gordon at Washington University School of Medicine: "He has shown that the intestines of obese people are swimming with a slightly different medley of microbes compared with slim people - obese people have more Firmicutes and fewer Bacteroidetes than the lean ones.” Some psychological aspects of over-eating Acetaldehyde, the hangover chemical produced by some bacteria, is certainly not going to make you feel good. Feeling bad is definitely associated with overeating: One relevant study was “To test the hypotheses that induction of negative mood in obese binge eaters would increase food intake.” The result was “Those in the negative mood condition ate significantly more food.”xix The opiate-type substances the bad bacteria can produce may, in particular, be responsible for once aspect of weight: comfort eating and cravings for certain foods. The opiates are typically formed in response to eating certain foods. These opiates will reach the brain, making a pleasant association with that food. When the withdrawal from the opiates sets in, the person may crave for more of that type of food, or even feel bad from drug withdrawal, so the food is eaten again – as a source of “comfort” but in fact to re-gain the opioid-induced sensation and/or stop the withdrawal feeling. In effect, they may be addicted to certain foods.xx Meanwhile candida, a form of unhealthy yeast that can overrun the digestive system, has always been strongly associated by natural-health practitioners with “craving for breads and sugars (yeast eats sugar)”.xxi An article in the Daily Telegraph of 12/11/2007, in relation to chocolate, hints at a link between food cravings and the gut bacteria: “Chocoholics have been handed a useful new excuse for their craving after a scientific study suggests it may be determined by the bacteria in their stomach. While everyone has a vast number of microbes in their gut, people who have a daily craving for chocolate show signs of having different colonies of bacteria than people who are immune to the food's allure, according to the research. Sunil Kochhar, the co-author of the study published in the American Journal of Proteome Research, said the same may hold true for other foods, allowing some types of obesity to be treated by changing the bacteria in the intestines and stomach.” xxii But is there any evidence that gut bacteria have a physical effect on weight? From this same article, “Fat? Blame the bugs in your guts” quoted above: Prof Gordon: "This raises the question of whether differences in the mix of bacteria in our guts predispose some of us to obesity: the number of calories harvested from a serving of cereal may not be the same for everyone - some people may extract slightly more than others and over time this will add up." Animal experiments have suggested that the bacteria in an obese gut can directly affect calorie extraction: “The ecology of guts in lean and obese rodents is dominated by different bacteria, the Washington University researchers reported in 2006 in Nature. The same holds for people. “After collectively identifying all of the microbial genes present in the guts of the naturally lean and obese mice, "we found that genes involved in breaking down otherwise indigestible complex carbohydrates were much better represented in the obese animals' gut communities," Gordon says. “His group then transplanted gut flora from a lean or obese mouse into a germfree animal and fed all treated rodents the same amounts. Animals that had received the gut microbes from obese animals gained more fat than did the animals given flora from a lean mouse. “Such experiments "show that differences in gut ecology influence the efficiency with which the bugs extract energy from foods," Gordon says. However, his team's data also show that gut microbes can alter what share of consumed energy will be stored as body fat.” From another source: Gordon's hypothesis is that this variation between individuals might mean that some people are significantly better than others at extracting energy from food and routing it for storage in the fat bank. In other words, your individual gut flora could predispose you to obesity. "For one shopper a 170-kilocalorie serving of Cheerios could actually have significantly fewer calories," says Gordon, "whereas another shopper could be getting the full caloric load depending on the type of bacteria in their gut." And it doesn't take a lot of excess calories to make you gain weight. Just 20 more a day than you need - about the amount in four pistachio nuts - will add about a kilogram of fat over a year.xxiii Professor Jeremy Nicholson of Imperial College, London, is another researcher into gut microbes: “Where obesity is a problem, the same bugs might help people limit weight gain by diminishing their absorption of fats. "You only need to take in 20 to 30 more calories a day than you expend to make you fat in 2 or 3 years," observes Nicholson.” It can be concluded from this research that obese and overweight people actually do have “engines” operating at a different efficiency from their slim counterparts. How you get the gut dysbiosis (bad bacteria) Starting at the beginning: Babies get their gut flora from the mother. “A baby is born with a sterile gut and as the baby goes throughout the birth canal at birth, it swallows its first batches of bacteria. So a major part of the gut flora which would populate the virgin gut of the baby, comes from the mother.” “After the baby is born the breast milk promotes the process of populating the gut wall with appropriate bacteria. Formula milk does not fulfill this function.” How a baby born by cesarean section, whose mother does not breast feed, can hope to populate its gut with healthy bacteria is a mystery. But if the mother of any baby does not have healthy digestive flora, then the baby will not have it either. This is particularly relevant to the current childhood obesity explosion. “A typical modern mother was probably not breast fed when she was a baby, because she was born in 60s or 70s when breast-feeding went out of fashion. Why is it important? Because it is well known now that not breast fed babies develop completely different flora to the breast fed babies. This compromised gut flora in a bottle fed baby later on predisposes her to many health problems. Having acquired compromised gut flora from the start, a typical modern mum had quite a few courses of antibiotics in her childhood and youth for various infections. It is a well known fact that antibiotics have a serious damaging effect on gut flora, because they wipe out the beneficial strains of bacteria in the gut. At the age of 16 and sometimes even earlier the modern mum was put on a contraceptive pill, which she took for quite a few years before starting a family. Contraceptive pills have a devastating effect on the beneficial (good) bacteria in the gut. One of the major functions of the good bacteria in the gut flora is controlling about 500 different known to science species of pathogenic (bad) and opportunistic microbes. When the beneficial bacteria get destroyed the opportunists get a special opportunity to grow into large colonies and occupy large areas of the digestive tract. A modern diet of processed and fast foods provide perfect nourishment for these pathogens and that is a typical diet a modern mum had as a child and a young adult. As a result of all these factors a modern mum has seriously compromised gut flora by the time she is ready to have children. “ Research published in March 2008 directly implicates the baby‟s gut flora in weight gain: “The mix of bacteria in a baby's gut may predict whether that infant will become overweight or obese later in life, a new study suggests. “Babies with high numbers of bifidobacteria and low numbers of Staphylococcus aureus may be protected from excess weight gain, according to a team of researchers from the University of Turku in Finland. “Their study was published in the March issue of The American Journal of Clinical Nutrition. “The researchers suggested their findings may help explain why breast-fed babies are at lower risk for later obesity, since bifidobacteria are prevalent in the guts of breast-fed babies. “Other studies repeatedly have found that being breast-fed is associated with a reduced risk of excess weight or obesity in childhood, with the risk lowered from 13 percent to 22 percent.”xxiv But for those who were born with healthy gut flora, the most common ways of destroying the healthy flora, and being overrun with bad bacteria, are: Antibiotic use Antibiotic use is the most common and significant cause of major alterations in normal gastro-intestinal microbiota. The dosage and length of administration of an antibiotic will also determine the magnitude of impact on the intestinal flora. In general, the greater the dosage and length of administration, the larger the impact on the microflora. … In general, trials conducted on healthy humans and involved only a single course of antibiotics. It is possible microfloral alterations induced by a particular antibiotic might be more severe in individuals with compromised health or who have been subjected to multiple courses of antibiotics. xxv Diet The composition of the diet has been shown to have a significant impact on the content and metabolic activities of the human fecal flora. Some diets promote the growth of beneficial microorganisms, while others promote microfloral activity that can be harmful to the host. Use of the contraceptive pill Stress, to some extent. Antibiotic use is the main cause of alterations to the composition of the gut flora. Professor Jeremy Nicholson of Imperial College London in the Daily Telegraph article already quoted has this to say: “Prof Nicholson believes that obesity could be linked to antibiotic use and misuse. "We speculate that this might be a consequence of the widespread use of antibiotics that reselect the gut microflora (that we have evolved with over aeons) to cultivate a much less friendly set of bugs in our general population […] But mapping the change in population obesity in the US over the last 20 years looks rather like the spread of an infectious disease."xxvi Do antibiotics make people fat? 1952 Research by Pennsylvania State University into AGP‟sxxvii This is not central to our weight loss method but it is interesting. If antibiotics are the main cause of bad bacteria being overactive in the gut, and the bad bacteria have weight-gaining effects, then this would suggest that they could be a prime cause of increasing obesity. A link between antibiotics and weight gain has never really been investigated by the medical profession. However, farmers have known about a link for years. They have used "Antibiotic Growth Promoters" (AGP‟s) since the 1950‟s. These are antibiotics that are given to farm animals and poultry, in low doses, not to treat any infection, but because it has been found that the animals put on weight faster when given them. They are thought to work by “depress(ing) microbial growth in the gastro-intestinal tract”xxviii – ie they are altering the gut flora. If antibiotics make animals fat, they are probably going to have the same effect in the human body. As Antibiotic Growth Promoters are/were used on animals that grow very rapidly, the weight gain is noticeable. In humans, growth in childhood is much slower, so weight gain would probably be very slow, so no association with antibiotic use is likely to be noticed. In adults weight increase is likely to be slower still. Note that there is no real difference between the antibiotics that have been/are used as growth promoters, and the antibiotics that doctors have been giving out to treat practically any and every illness. Dr Natasha Campbell-McBride: “We really started prescribing antibiotics for everything and anything in the „70s and „80s“, she says. “That‟s when we started to get generations of people with compromised gut flora. Antibiotics wipe out the beneficial bacteria as well as the pathogenic bacteria. Remember, our beneficial bacteria are very vulnerable to antibiotics and get wiped out very quickly.” If as suggested, weight gain from antibiotics in humans is likely to be a slow process, then it can be speculated that the 1980‟s surge in obesity is related to the over-prescribing of antibiotics that begin in 1970‟s. One researcher from Hungary has already suggested this connection, in 2005: “The growth promoting effects of antibiotics were first discovered in the 1940s. Since then, many antimicrobials have been found to improve average daily weight gain and feed efficiency. The total production of antibiotics can be estimated between 100,000-200,000 tons annually and the human population is being influenced, directly or indirectly (from the environment) by this amount of drug. The twentieth-century increase in human height and the obesity of the population is roughly observed since the mass consumption of antibiotics 40-50 years ago. The association between antibiotic consumption and the increase of human growth/obesity is suspected.”xxix More recently a French researcher has been looking at antibiotics and obesity. “Obesity pandemics and the modification of digestive bacterial floraxxx “The gut microbial flora (microbiota) plays a role in converting nutrients into calories. Variations in microbiota composition are found in obese humans and mice. The microbiota from an obese mouse confers an obese phenotype when transferred to an axenic mouse. There is a large body of experimental evidence and empirical data in the food industry showing that both antibiotics and probiotics, which modify the gut microbiota, can act as growth promoters, increasing the size and weight of animals. The current obesity pandemic may be caused, in part, by antibiotic treatments or colonization by probiotic bacteria. Using metagenomics and microarray analysis, studies of microbiota modifications after antibiotic and probiotic intake may identify the modifications associated with increased size and weight. Epidemiological studies recording these factors in an obese population may be able to link obesity with the absorption of microbiota modifiers.” Unfortunately, proving from statistics whether or not there is a link between antibiotics and the obesity epidemic conclusively is not likely to be possible. Dr Campbell-McBride, in her Gut and Psychology (GAPS) theory, attributes rises in Autism, ADD, ADHD, dyspraxia, dyslexia, allergy, and asthma to gut dysbiosis. This document suggests that the rise in obesity is also probably related to gut bacterial changes. Professor Jeremy Nicholson of Imperial College again: “Nicholson also believes the rise of many big killer modern diseases, such as diabetes and obesity, are influenced by our gut flora. "We've done lots of things over the last 50 years that have really messed up the symbiotic relationship we have with our gut bacteria, for example our antibiotic use." Of course, antibiotics not only kill the nasty bacteria for which they're prescribed, but also kill friendly gut bacteria. As Nicholson puts it: "We have done an experiment on the human population that we didn't know we were doing, we can't go back to the bugs we had 50 years ago." Although no conclusive link has been shown, at least so far, Nicholson notes that these diseases, and others such as autism, schizophrenia and motor neurone disease, are all modern diseases which are associated with countries that have high antibiotic use. There is also evidence that colon cancer associated with the presence of carcinogen producing microbes in the gut.”xxxi What adults, children, cats, dogs, birds, horses and every domesticated animal affected by obesity have in common is the wide spread use of antibiotics, which alter the gut flora. Normalizing processing: correcting the gut bacteria So that‟s the theory: your gut bacteria are inappropriate, and have helped to create and maintain a body weight that is above ideal. The obvious route to go down is to attempt to normalize the bacteria into that of a healthy slim person, and see if this results, over time, in a healthier weight being achieved. The easiest way to do this is to take a Probiotic – a substance that is made up of “live microbial organisms which favors the beneficial bacteria in the body while inhibiting harmful microbes”. Dr Campbell-McBride: “When an efficient probiotic is introduced to the gut, over time it clears out the "bad" microbes together with old putrefaction and re-establishes the normal Gut Flora. Once the normal flora is established, the healing process starts and the person starts digesting and absorbing foods appropriately. The immune system gets the right stimulation and the whole digestive tract changes from being a major source of toxicity to a source of nourishment.”xxxii That probiotics can have the weight-reducing effect we want is suggested in these quotes from Professor Jeremy Nicholson: „What we found is that probiotics seem to physically reduce fat absorption in the upper gut,‟ says Professor Jeremy Nicholson, co-author of the study which appears in the journal Molecular Systems Biology. „It is too early to say for sure but in future we may be able to design probiotic treatments which improve health and control weight gain.‟xxxiii “Jeremy Nicholson of Imperial College London and his collegues fed strains of "probiotic" Lactobacillusxxxiv to mice whose gut microbes had been replaced by those that usually live in the human gut. These mice had different bile acids from the norm - favouring enzymes that reduce the amount of fat digested. "More fat is available for the microbes…" says Nicholson. “The changes may only reduce fat absorption by a little, but this could have an impact on obesity if sustained over several yearsxxxv Just recently, a surgeon has tested this probiotic – weight loss theory for us, in patients undergoing bariatric surgery (surgery for weight loss, usually involving reducing stomach size). I have quoted a report on this in full as it is so relevant: “Gut bacteria on the frontline in obesity fightxxxvi Probiotics help body use calories more efficiently Sharon Kirkey, The Ottawa Citizen Published: Monday, May 26, 2008 Probiotics, the good bacteria in yogurt, may help people lose weight, according to new research that adds to emerging evidence that part of the obesity problem might be an imbalance of bacteria in the gut. Stanford University School of Medicine researchers who gave a probiotic supplement to weight loss surgery patients to treat a potential complication of surgery -- an overgrowth of harmful bacteria in the gastrointestinal tract (GI tract) -- stumbled on some unexpected results: the patients lost significantly more weight. "We know that the type of bacteria that we have in our intestine does determine how many calories you actually take in. So you could easily imagine that if you changed the composition of that bacteria, you'll change how many calories you absorb," says lead author Dr. John Morton, an associate professor and director of bariatric surgery at Stanford University. "It may be minimal, it may be a difference of a calorie or two per 100 calories ingested, but over time, that adds up." The finding builds on recent studies showing lean mice have different kinds of bacteria than fat ones, and that the type of bacteria in humans changes, before and after weight loss. In the future, Dr. Morton says it may be possible to come up with the ideal "microbial profile," and essentially give people a bacterial transplant "to re- populate the bacteria in the intestine to give it the very best profile possible." Bacteria act like a furnace to our GI tract, he says. "They're what allow us to consume and burn calories. "If you have a set of very, very efficient bacteria it's going to extract every last bit of energy from what you eat, versus maybe a lean (person) where they don't extract everything and they don't end up absorbing quite as many calories." Obesity is "by far" the leading cause of preventable death in the U.S., Dr. Morton says. In Canada, 35 per cent of adults are overweight; 24 per cent are obese. About the only treatment today that works for the severely obese is gastric bypass, or stomach-shrinking surgery. But it isn't without its complications. "On occasion, because we do some rearranging of the intestine, some patients will have a small amount of bacterial overgrowth," Dr. Morton says. He noticed that some patients complained of abdominal pain or bloating, even though there appeared to be nothing anatomical going on to explain the discomfort. Dr. Morton's team wondered whether probiotics might help. They randomly divided 44 gastric bypass surgery patients into two groups. One group got the good bacteria, the other did not. Researchers measured the level of hydrogen in the breath to diagnose conditions that cause GI symptoms. After six months, the patients in the probiotic group not only did better on the breath tests as well as GI "quality of life" scores, but they lost 70 per cent of their excess body weight, versus 63 per cent of excess weight in the control group. Weight loss after bypass surgery is fairly consistent, Dr. Morton says, so "any sort of difference would have been unusual." Slim Engine: what is the normal gut bacteria of a slim person? The reality is that not much is currently know about bacteria in the gut, let alone what is “normal” or ideal: “The human gut is the natural habitat for a large and dynamic bacterial community, but a substantial part of these bacterial populations are still to be described.xxxvii "Somewhere between 300 and 1000 different species live in the gut"…"However, it is probable that 99% of the bacteria come from about 30 or 40 species"xxxviii There is actually no product currently available that comes near to having all or even most of the “normal” bacteria in it. The vast majority of probiotics available contain one or a few strains of bacteria, not 30 or 40. So using a probiotic to get a completely “normal” gut flora is not currently an option. That means we have to make the best of what is actually available at the moment. Effectiveness The next thing we have to do is make sure that the probiotic is effective. The Daily Mail of 7th August 2006xxxix says: "Glenn Gibson, a professor of food microbiology, cautioned that up to half the probiotic drinks, yoghurts, powders and capsules on the market do not work “The Reading University scientist said: 'There is research showing that half of the products you can buy in the UK don't match up. They've got the wrong bacteria or the wrong numbers. 'Some have pathogens in them and some are completely sterile, which is quite an achievement for any food product.' “He stressed, however, that the best-known brands of probiotic drinks, yoghurts and supplements, including Yakult, Actimel and Multibionta, do work. Supermarket own-brands are also effective.” Additives There is another slight fly in the ointment. This one is obvious to anyone who has ever looked at the labels on many of the proven-to-work probiotics that are listed above: The Sunday Times October 23, 2005xl: "SOME leading probiotic drinks contain up to 80% more sugar than cola."… Yakult contains 18g of sugar per 100g, Flora pro.activ raspberry 12.3g, Müller Vitality strawberry 12.6g and Danone Actimel multifruit 14.2g.” ... Coca-Cola contains 10g of sugar per 100g." This narrows our search for a suitable probiotic down a fair bit: we just don‟t want one that contains sugar. Sugar is something that unhealthy yeast-type bacteria thrive on. The product used The probiotic I used, and the only one I would endorse at this time, was Multibiontaxli by Seven Seasxlii. This is a probiotic multi-vitamin in tablet form. All the studies cited in this document have used some form of Lactobacillus bacteria to produce weight loss. Lactobacillus Gasseri and Lactobacillus Salivarius are the predominant strains of bacteria in the digestive systems of infantsxliii, so these seem like a good place to start. There appears to be no proven-effective probiotic that contains both of these strains, but Multibionta contains one of them: Lactobacillus Gasseri. A type of Lactobacillus gasseri has been noted to have an effect on fat tissue in rats.xliv Multibionta as such has a number of advantages over other products: it has a long shelf-life, it does not need to be kept in the fridge, and it has three different bacteria strains rather than the normal one. It is also quite cheap, and widely available.xlv The experiment Staring in August 2006, I took standard Multibionta tablets at the recommended dose of one tablet per day. No changes to diet or exercise levels were made. Diet at that time was not incredibly healthy by the thinking of modern nutritionists, featuring quite a few supermarket ready-meals, but was not outrageously unhealthy. Exercise levels were actually minimal to non-existent. I also avoided all artificial sweeteners, as these are associated with weight gain.xlvi The result I have never actually weighed myself in living memory, so cannot give precise figures over different times for weight loss – but at the start I was obviously overweight, and after 18 months I was not. Fortunately, my GP had a record of my weight in 2006: 70kg (about 11.02 stone). At a height of 165 cm (about 5‟ 6”) my Body Mass Index (BMI) was 25.7. That is technically overweight (BMI > 25). Today (start of July 2008) my weight is 64.3 kg (about 10.12 stone). BMI is 23.6, which is classed as normal. Total weight loss over the period (23 months) was 5.7kg (about 12.5 lb). Total cost of using this weight loss technique was around £65 (about $130). This compares favorably with Weight-Watchers, where 6lb (2.72 kg) was lost on average after 2 years. Cost unknown to me, but probably not trivial. Unlike the vast majority diets, the excess weight has not returned. So that‟s it. It worked for me. I do not know if it will work for anyone else, but if you try it you are extremely unlikely to come to any harm, even if it does not work. And there are also many other suspected health benefits of taking a probiotic. If you do try it, don‟t expect fast results, and try it for at least 12 months. You will actually be breaking new ground scientifically, going well beyond what is now currently accepted nutritional science. GT. July 2008. Some Pictures I am rather camera averse, but as they (wrongly) say a picture is worth a thousand words, I have dug out some of the very few that were taken while trying this method. Before starting (started August 2006) 10 Months in (May 2007) 18 Months in (April 2008) And just the other day (29th June 2008) Other Material Some other research that I have not quoted from. ScienceDaily (Apr 2, 2008) “Could Changing The Bacteria In Your Digestive System Be An Obesity Treatment?” http://www.sciencedaily.com/releases/2008/04/080401165014.htm Nestlé Research Center (Apr 12, 2008) “Nestle Researchers Discover a New Link between Gut Microbiota and Glucose Control” http://www.flex-news-food.com/pages/16367/Nestle/nestle-researchers-discover- new-link-gut-microbiota-glucose-control.html Research: “Yogurt Consumption Linked to Healthier Body Weights for Women”. Live yogurt contains lacto-bacteria, which is what links all the research that associates weight with gut flora. You could probably use live yogurt – in its American form of Streptococcus Thermophilus and Lactobacillus Bulgaricus, as an alternative to using Multibionta. I have not tried it, so I am not certain it will work. Note that the yogurt used in most research is this US definition of yogurt – “yogurt” in many counties, including the UK, is now rarely made with Lactobacillus Bulgaricus. http://cw11.empowereddoctor.com/story_1323.html Research for the more scientifically-minded: July 2007: “Metabolic endotoxemia initiates obesity and insulin resistance.” http://www.ncbi.nlm.nih.gov/pubmed/17456850 June 2008: “Changes in gut microbiota control metabolic endotoxemia-induced inflammation in high-fat diet-induced obesity and diabetes in mice.” http://www.ncbi.nlm.nih.gov/pubmed/18305141 Oct 2007: “Gut microbes and obesity in adolescents” Quote from this research: “Overall, the present preliminary study shows that modifications in the gut microecology are associated with corporal weight in adolescents under a similar energy-restricted diet.” http://journals.cambridge.org/download.php?file=%2FPNS%2FPNS67_OCE%2F S0029665108006290a.pdf&code=40b7bcac5ef188a2e4a6c55bf429b91c Feb 2007: Article: “Yeast and the Weight Connection” by Dr. Carolyn Dean. Although I talk about “bad bacteria”, I would of course include yeast in this definition (and also related concepts such as leaky gut). This article is very interesting, and well worth looking at. I have never seen a quote like this from a medical doctor: “What does belly fat have in common with beef cattle? Antibiotics! These drugs are liberally used in the beef industry for the specific purpose of “beefing up” cattle. It is little recognized that antibiotics can do the same to humans!” This quote, in my experience with other overweight people, definitely rings true: “Belly fat is more than just fat. Yeast causes abdominal bloating that can add an extra 5-7 inches that seems to appear out of nowhere. “ http://drhotzeblog.netymology.com/2007/02/19/yeast-and-the-weight-connection- 2/ Prebiotics Prebiotics provide some of the food that Probiotic bacteria feed on. Using a prebiotic will in effect boost the number of probiotic bacteria in the body. There is some research on using prebiotics in weight control: NutraIngredients.com on a paper in the Journal of Pediatrics (Oct 02, 2007) “Prebiotics may prevent excessive teenage weight gain” "BMI [Body Mass Index] normally increases during puberty at a yearly rate of about 0.6 to 0.8 kg per sq. m. We found that the prebiotic group had an increase in BMI of about 0.7 kg per sq. m during the supplementation year, consistent with expected increases during puberty and that the control group had an increase of 1.2 kg per sq. m," explained the authors. "Thus the overall greater increase in BMI during the year in the control group was likely not ideal."xlvii I have not yet done much exploration into the use of prebiotics in weight control. However, if you want to take an inexpensive prebiotic in addition to the suggested probiotic, then Apple Cider Vinegar is interesting for a number of reasons: It contains Pectin, which has prebiotic properties, so is exactly what we want.xlviii It also has some other interesting properties: A study found: “As pectin induces satiety and delays gastric emptying in obese patients, it may be a useful adjuvant in the treatment of disorders of overeating.”xlix A more recent study arrived at the same conclusion.l Also, research has shown that vinegar itself increases satiety (feeling fuller for longer after eating).li Carol Johnston at Arizona State University has also been researching the uses of vinegar (mainly in diabetes), and found that it does affect weight: “After her initial experiment, Johnston conducted a longer study in which subjects consumed vinegar twice a day for four weeks. She wanted to see if vinegar would lower cholesterol levels. Unfortunately, it didn‟t, but it did make subjects drop pounds.”lii Therefore, Apple Cider Vinegar appears to be a perfect prebiotic companion to this probiotic weight loss method. I have just recently being experimenting with Apple Cider Vinegar, and would say that it does seem to reduce your appetite. SUMMARY I have provided this summary mainly for those who do not want to read the whole document. The human digestive tract cannot digest food entirely by itself. It is reliant on bacteria that live in the tract to process food. In a slim person, the bacteria in the digestive system are mainly “good” bacteria, in particular lactobacillus species. “Bad” bacteria can overrun the gut, usually when the “good” ones have been killed of, typically by taking antibiotics or the contraceptive pill. Overweight people generally have far more “bad” bacteria than slim people. There is increasing evidence that the “good” bacteria, in particular lactobacillus bacteria, affect the number of calories extracted from food, and how fats in the food are metabolized. A person with “good” bacteria is likely to be extracting fewer calories from the same food than a person with more “bad” bacteria. The amount of additional calories extracted by the “bad” bacteria may only be a small amount on a daily basis, but over the course of a few years it adds up significant, leading to the person slowly becoming overweight or obese. Historically, societies where obesity was very rare, for example China and Korea, had a tradition of eating foods containing “good” bacteria, such as lacto- fermented foods, yogurt, kefir, etc. As they have recently moved away from ingesting these types of “good” bacteria, and have begun using antibiotics widely, their digestive systems are operating differently, leading to obesity now becoming essentially a universal phenomena. Killing off “good” digestive bacteria, primarily with antibiotics, started in the west, and has now spread around the world, closely followed by the obesity “epidemic”. Re-populating the gut with “good” bacteria, again in particular lactobacillus species reverses the extra calorie extraction. With fewer calories being extracted, gradual and sustainable weight loss should take place, without any dietary or exercise changes. The method I used to repopulate the gut with “good” bacteria was to take a widely available and proven-effective probiotic called Multibionta. With this, I lost all my excess weight very gradually over an 18-month period. There may be other probiotics that have this effect (in particular the type of bacteria in live yogurt as sold in the US), but the only one I know works is Multibionta tablets. I do not make any money from recommending these, or have any association with the manufacturers, I just know they worked for me, and I have observed it in others. Gary Tivendale Gary.Tivendale @ gmail.com This document is Public Domain References [Note some links may be messed up after this last revision of the document] i http://www.webmd.com/parenting/news/20060404/obesity-epidemic-balloons-to-new- girth ii http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/ iii http://www.time.com/time/magazine/article/0,9171,866056,00.html iv http://www.ncbi.nlm.nih.gov/pubmed/9217594 v http://www.time.com/time/magazine/article/0,9171,859822,00.html vi http://www.cat-world.com.au/ObesityInCats.htm vii http://www.guardian.co.uk/science/2007/aug/07/2 viii http://www.birdchannel.com/bird-diet-and-health/bird-care/bird-obesity.aspx ix http://www.vtnews.vt.edu/story.php?relyear=2007&itemno=390 x http://www.time.com/time/magazine/article/0,9171,866056,00.html xi http://www.usatoday.com/news/health/2003-04-08-weight-watchers_x.htm xii http://www.ncbi.nlm.nih.gov/pubmed/18635428 xiii http://www.drwoolard.com/peinnews/fat_chance.htm xiv http://www.medicinenet.com/script/main/art.asp?articlekey=56559 xv http://blogs.discovermagazine.com/discoblog/2007/12/12/what-cdc-actually-found-no- evidence-of-a-slowdown-in-national-fattening/ xvi http://www.autism.com/ari/editorials/ed_explosion.htm xvii http://www.netdoctor.co.uk/health_advice/facts/loseweight.htm xviii http://www.telegraph.co.uk/earth/main.jhtml?xml=/earth/2007/05/29/scibugs129.xml xix http://www.ncbi.nlm.nih.gov/pubmed/14968127 xx This document has some references to opioids derived from food: http://www.newscientist.com/article/mg12316734.600-another-mans-poison-how-can-common-foods-such- as-wheat-ormilk-cause-anything-from-migraine-to-a-runny-nose-we-are-beginning-to-seewhy-some- people-cannot-tolerate-some-foods-.html xxi http://www.thinforlife.info/sugar_cravings.html xxii http://www.telegraph.co.uk/earth/main.jhtml?xml=/earth/2007/10/12/scichoc112.xml xxiii http://www.newscientist.com/article.ns?id=mg18825191.900 xxiv Article: http://news.yahoo.com/s/hsn/20080308/hl_hsn/bacteriamixingutsofbabiespredictsobesity Original research: http://www.ajcn.org/cgi/content/abstract/87/3/534 xxv http://findarticles.com/p/articles/mi_m0FDN/is_2_9/ai_n6112781/pg_1?tag=artBody;col1 xxvi Daily Telegraph article “Fat? Blame the bugs in your guts” 29/05/2007. Article seems to be unreachable from the Telegraph site, but I do have the source text . xxvii Daily Collegian (Pennsylvania State University magazine), February 7, 1952 Page Number: 2 http://digitalnewspapers.libraries.psu.edu/Default/Skins/collegian/Client.asp?skin=collegian&AW=12144 03893621&AppName=2 xxviii http://www.jsr.co.uk/conferences/1/16th-annual-jsr-technical-conference/2/agp-ban-an-opportunity- for-profit-or-loss xxix Antibiotics may act as growth/obesity promoters in humans as an inadvertent result of antibiotic pollution? http://www.ncbi.nlm.nih.gov/pubmed/15533603 xxx Obesity pandemics and the modification of digestive bacterial flora http://www.springerlink.com/content/17p22x858ph26q4x/ xxxi http://www.union.ic.ac.uk/media/iscience/article_template_typ.php?articleid=3 xxxiiDr. Natasha Campbell - McBride http://www.bedrokcommunity.org/id88.html xxxiii http://www.saga.co.uk/health/healthyliving/medicinesandsupplements/probiotics-may-fight-weight- gain.asp xxxiv Multibionta contains a different variant of Lactobacillus than the one used in this experiment. Multibionta contains Lactobacillus gasseri PA 16/8, as well as Bifidobacterium bifidum MF 20/5 and Bifidobacterium longum SP 07/3. xxxv http://www.newscientist.com/channel/health/mg19726395.000-probiotic-bacteria-could-keep-us- slim.html xxxvi http://www.canada.com/ottawacitizen/news/story.html?id=9c58c55c-7d03-4d73-982b- 8d30419acf03 xxxvii http://www.ncbi.nlm.nih.gov/pubmed/12583961 xxxviii http://en.wikipedia.org/wiki/Gut_flora xxxixhttp://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=39949 0&in_page_id=1770 xl http://www.timesonline.co.uk/tol/newspapers/sunday_times/scotland/article581810.ece This article now seems to have been deleted from the Sunday Times database. xli The “standard” (and cheapest) Multibionta tablets, known as “Advanced Formula Multibionta”, not the premium-priced varieties. The premium varieties appear to offer no advantages over the standard product. xlii I have no association with the company that makes this probiotic, or any other company/organization involved in nutrition or weigh loss. xliii http://www.ncbi.nlm.nih.gov/pubmed/16978242 xliv http://www.ncbi.nlm.nih.gov/pubmed/18684338 xlv All the major British supermarkets sell them, for around £3 for 30 days supply. xlvi http://www.webmd.com/diet/news/20050613/drink-more-diet-soda-gain-more-weight xlvii http://www.nutraingredients.com/news/ng.asp?n=80224-orafti-prebiotics-inulin-bmi xlviii http://www.dairyreporter.com/news/ng.asp?id=12789-prebiotic-pectin-properties xlix Pectin delays gastric emptying and increases satiety in obese subjects. http://www.ncbi.nlm.nih.gov/pubmed/3169489 l Effect of pectin on satiety in healthy US Army adults http://www.jacn.org/cgi/content/abstract/16/5/423 li http://www.ncbi.nlm.nih.gov/pubmed/16015276 li http://researchmag.asu.edu/stories/vinegar.html Gary Tivendale 2008. 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