The Sprenkle Anti-CDiff Protocol

[rsprenkle]

Finally, some good news – I hope this works for others – it worked for me…

I suffered several reoccurrences of CDiff after an appendectomy (ruptured) which required me to go on IV and later a cocktail of various antibiotics. I came down with CDiff about 6 weeks after surgery. First two infections treated with Flagyl (10 day) , and third with Vanco (18 day). In all cases, reinfection occurred within a week after completing antibiotics.

After I finished the Vanco, I was taking a probiotic (Primal Defense) as recommended (1/3 teaspoon three times a day with juice) for five days, but missed two days due to travel and CDiff came back although less severe than the previous infection. During my previous infections, I had experiemented with different food types and combos, and I decided to combine these lessons learned with a very aggressive probiotic approach and had excellent results -- I was symptom free after 4 days

Before Protocol –
Cramping, frequent pure mucus stools (about every hour on average – more often during the day). Discomfort and pain due to gas and intestinal ‘rearranging’

After first day –
Loose stool, some gas. Bathroom visits about every two hours

After second day
Loose stool but firming, less gas. Bathroom visits about every 3 – 4 hours.

After third day
Normal Stool, some gas. Normal Bathroom visits (about 90% of full health)

After 1 week

Daily bowel movements – close to pre-infection behavior.

Currently...
So far so good – I'm now on my second week without symptoms (June 20 2006)

Disclaimer - Some aspects of the protocol may be ineffective or down right counterproductive, but I don’t want to experiment much further because it is working for me.

Theory behind the protocol:

On an earlier infection, I noticed that I could minimize symptom severity by going with very acidic liquids (V8 / Vinegar / Soda / Coffee).
Eating cookies seemed to make things worse, so I avoid sweets.

I read that you want to avoid drugs like Imodium or other drugs which slow the rate of material through the colon, so I lean toward the opposite approach: eat bran and other high fiber products.

Probiotics provide good bacteria to compete with CDiff. There are mechanical issues which make it hard for these good bacteria to gain a foothold in the gut, so you have to keep supplying fresh ‘soldiers’ for some extended period (not sure how long, but certainly more than 2 weeks). Perhaps the magic 70 day number is reasonable.

Each probiotics product I looked at supplied a different subset of bacteria, so I picked several that I rotate to provide better coverage.

I normally have a pretty healthy immune system related to significant aerobic exercise – I have been keeping that up, despite the difficulty with CDiff.

I take a standard multivitamin and a fish oil supplement prior to CDiff, and have been keeping it up since.

Products Used:

Probiotics

Lifeway Kefir – $3.79 per quart (good for a day or two)
http://www.lifeway.net/product/kefir_lowfat.php

Garden of Life - Primal Defense – $40 / 81 grams – good for a month
http://www.netnutri.com/browse.cfm/4,1713.htm

Dannon Activia Yogurt -- $4.99 for 8
http://www.dannon.com/dn/dnstore/cgi-bi ... 796954.htm


Standard food Products
V8 (normal sodium), Apple Cider Vinegar, Fiber One Cereal, Oatmeal (Quick Oats)



Breakfast – 7am


Mix Fiber One (about 1 cup) with 1/3-1/2 teaspoon of Primal Defense dry. Make sure bran is coated well before adding milk. I use substitute sugar

For a beverage, ¾ Cup of Kefir Lowfat Blueberry


Brunch 10am

V-8 with Cider Vinegar (I used normal sodium level). I use about 1 cup V-8 and a few tablespoons of vinegar. Hypothesis – Highly acidic combo should inhibit growth of CDiff, but not Acidophilous.

Activia Yogurt – 1 serving


Lunch – 12 noon

Quaker Oats Oatmeal (Quick Oats) mixed with hot water. Add 1/3 tsp primal defense after it has cooled a little and mix thouroughly

Kefir – 1 Cup

Noon Workout – Heavy Aerobic Activity (bowels permitting)

I alternate running 7 miles MWF, and 30 minutes of orbital / weight lifting TuTh Hypothesis - keep the immune system in good shape, raise body temperature and heart rate. I tend to relax on the weekend…

Midday Snack – 3pm

V-8 with Cider Vinegar


Dinner – 7pm

Normal Dinner, but with a preference toward spicy or acidic foods. Thai, Mexican, etc. Kefir as a beverage (cools the hot Thai nicely!). I sprinkle some Primal defense on the main course – probably about ¼ - 1/2 teaspoon – enough to get the job done but not taste the effect. I avoid 'too hot' or 'too spicy' for obvious reasons...

Late night snack – 9pm

Dannon Activia yogurt and V8 (1-1/2 cups)


Before Bed– 11pm

Kefir – about 1 cup
Multivitamin and Fish Oil

NOTES – This protocol is a bit expensive, so I will try to finish or taper off after a month or two. So far, I’ve been repeating the protocol each day, and eat normal food in addition. Beverages I use tend to stick to acidic -- Coffee and Diet Coke (Phosphoric acid)

Good luck to everyone - I'd love to hear from anyone who tries this approach or has better luck with some modifications.

[rsprenkle]

So far so good - I've gone another week and I'm currently asymptomatic at this point.

I've made some minor modifications, and am considering switching to just Kefir in order to reduce cost ( I found one quart of Kefir at Trader Joes for only $2.49). If you want to give this a try, you might try starting with Kefir first, and skipping the other probiotics listed.

MODIFICATION

After obtaining more information from various sources, I’m modifying the protocol as follows:

1. Consume probiotics 1 hour prior to meals using milk, kefir or yogurt to improve the number of bacteria that make it past the stomach acid.
2. Keep meals on the highly acidic side – Cdiff does not like acid environment. I noticed the benefit from trial and error before I knew I even had CDiff…
3. I’m trying the Primal Defense Caplet at work because it is more convenient and may actually do a better job getting through the stomach acid. I'm looking for feedback from anyone who has done research on enteric coated or other brand specific methodologies for optimizing delivery to small intestine.

-----

7am - Pre meal Probiotic

1 cup Kefir with ½ teaspoon of Primal Defense or one Primal Defense Caplet.

8am – Breakfast

High fiber breakfast cereal with Skim Milk (Fiber One, raisin bran, etc.).
V-8 with Cider Vinegar (I used normal sodium level


Brunch 11am

Activia Yogurt – 1 serving
Primal Defense Caplet.


Lunch – 12 noon

Quaker Oats Oatmeal (Quick Oats) mixed with hot water
Diet Coke or other beverage with Phosphoric Acid but no sugar

12:30 Workout – Heavy Aerobic Activity (bowels permitting)


1:30 pm Post workout snack

V8 with Cider Vinegar

4:00 pm Pre Dinner Probiotic

1 Cup Kefir with Primal Defense Caplet


Dinner – 7pm
Normal Dinner, but with a preference toward spicy or acidic foods. Thai, Mexican, etc. V-8 with Cider Vinegar, or some equivalent acidic beverage (phosphoric acid drink, decaf coffee, etc.)


Before Bed– 11pm

Kefir with Primal Defense – about 1 cup
Multivitamin and Fish Oil

[jennie]

rsprenkle -- Your protocols are great, and that you are so well on this plan. To add, however, that for many of us, spicy foods are a no-no, until the real inflammed bits have settled down again completely. Many of us tend to stick to bland and boring for months; guess it is trial and error.

Am very interested in acidic environment -- I also use apple cider vinegar (in salad dressing), but had not thought it could do good work v. c-diff. What else is acidic but not spicy? (Chilis, for instance, in a curry, once set me back weeks, not tried it again in a hurry!)

Agree with you that kefir is very good. We take it in goat's milk, and together they have wonderful anti-inflamm properties. Kefir is an ancient culture, been traded for centuries, from old Ottomans and old Russians. We think that maybe even Oprah uses it, it was once on her web site - Marcia found it, perhaps she still has the link?

[Marcia]

Finally found it again, i did a key search but nothing came up so went looking for it

http://www.oprah.com/presents/2005/youn ... ir_b.jhtml

http://www.dairyfoods.com/CDA/Archives/ ... 32a8c0____

[rsprenkle]

Thanks for the links -- I understand the need to avoid spicy. In retrospect, it isn't important. For my experience, the V8 / vinegar is sufficient in conjunction with continual probiotics. I am fortunate that I can eat a normal dinner - spicy or not - now that I am asymptomatic.

I talked with someone today who makes there own Kefir -- he put me onto a link I have to follow up on that provides the initial culture. Ideally, this would be sufficient and displace the need for some of these more expensive probiotics. I'm still a bit lazy at this point, and prefer to just buy it at the local store (they were kind enough to order some for me, and keep it supplied).

The acid diet part is interesting. When I first came down with CDiff, I just assumed I had a virus, or some bug that would pass with time. As you know, this stuff is severe, and I was soon experimenting with foods to determine what would minimize the pain. I do know that early on, it was easy to determine that sugar and alkaline were killing me, so I tried to go acid. V8 was acid, and the only other thing I could find to make it more acidic was some vinegar. It didn't cure anything, but it really reduced the symptoms to where I could at least go to work. I finally gave in and went to the doctor, and he suspected CDiff. I was tested and on Flagyl in two days, and thought -- whew, that was the end of that... boy was I wrong.

After the third setback (last one was 6 days off Vanco), I decided to go back to the acidic diet. My wife, a biologist, picked up some probiotics for me and insisted I start taking them -- good call honey! She then put me on to this site, and it helped me to get a better understanding of this awful disease.

I just ordered some other probiotics that are supposed to have some success at killing the spores. For now, I'm just happy to not be in pain. I'm going to ask to be tested again in a few weeks to see if I test negative -- are there ways to test to see if you have rid yourself of the spores?

[Marcia]

Hello
For some reason i thought you was a women. We don't get that many male posters so it's great to hear their side.
To be honest i think the kind of diet you have been on would of nearly killed me already, specially the spicy part. Like we always say here what works for one does not work for the other, it is interesting about the acidic diet.
Walmart sells the probiotic Culturelle, i didn't know that and i was ordering online paying for S&H.
I had a friend who grew her bulgarious (that thing in yogurt) and she would make me shakes but back in the day i thought what a waste of time. I wish i knew where she was now.
It would be more productive to grow your own i think than to drink the ones at the store.
Thanks for letting us know your plan of attack for c diff. Keep posting and wish you health!

[dgervase]

What probiotic are you getting that is supposed to kill the spores. I really would like to know so I can get some. Thanks

[Bobbie]

rsprenkle,
Your protocol is interesting & makes a lot of sense. Glad it is working for you. Acid helps kill "bad" bacteria that enter the stomach. However, anyone who also has acid reflux/hiatal hernia (I do) couldn't tolerate the acid in your diet or some of the spicy foods.

I agree with your exercise routine -- might not "cure" C. diff. but makes you feel better -- both mentally & physically.

I don't believe any probiotics will kill the spores. Read Dr. Borody's article & some of the other articles listed in FAQ under Medical Articles Written by C. diff. Experts. Some times (if the "Bacteriodes" aren't wiped out), probiotics can "crowd out" the bad bacteria including C. diff. Check out the info. on Kelly Karpa. She is a pharmacologist/pharmacist/professor & knows a lot about probiotics. Info. on her & her book is in FAQ.

How did you wife find out about this site? Continued good luck on your protocol.

[rsprenkle]

Hi Bobbie,


Thanks for the tips. I have read all the FAQs on this site as well as starting to explore scholarly articles / research papers. Concur with the crowding out.. I think the acid impact is post stomach - in the intestine. The body tends to neutralize acid as it goes through, so the higher the acidity to start, perhaps leads to higher acidity in the small intestine / colon. Unfortunately, this competes in the stomach with probiotics, helping to kill of larger populations of the good stuff. That is why I have basic / alkaline probiotic ingestion 1 hour before my acid / roughage meals.

Argh! I cannot find the link amongst all my articles and links -- I'll keep looking. It was an article that said that one of the toxins / acids (butyl?) released from a healthy bacteria was thought to help kill of CDiff spores -- sounded circumstantial, but worth a try -- I believe I was originally turned onto it from Google Scholar.

While I try to track down the document, check out the link below. It discusses a few named strains of CDiff, and there is a short discussion toward the bottom that talks about some interesting new therapies in development. One uses a toxin binding chemical that removes symptoms. Another is a 'good' strain of CDiff which apparently displaces the 'bad' strain. My wife thinks it is a genetically modified CDiff which does not produce the toxins.

http://www.paete.org/forums/viewtopic.php?t=1381

I've found plenty of information supporting the pro acid approach. In fact, many anti-acids are thought to cause CDiff outbreaks, because it does well in less acid environment.

What I would like to do know is convince my primary care physician to allow a test for both the toxins and the spores. While I feel pretty well these days, I don't know if there are any toxins / spores present.

My wife found out about the site via Google.

[Allison]

Hi rsprenkle,

To test for spores, a lab has to try for culture of the bacteria. This test does not impart any useful information so is not routinely used.
A culture cannot differentiate cdiff strain, (there are over 100), and many folks harbor non-toxin producing strains of cdiff. These are common commensal bacterias.
Testing positive for the bacteria and negative for toxins is not a recommendation for treatment because it does not indicate cdiff disease, even if you previously tested positive for one or both toxins.

Some of the cdiff experts in the U.S. don't even recommend toxin testing after treatment as long as there is no obvious relapse and signs point to continued improvement.
Testing positive for toxins may not be at all clinically important if you're doing well and see no return of acute symptoms.
There have been some folks on the boards who continued to test + for residual toxins, yet are asymptomatic and for the most part, recovered from acute cdiff.
For these reasons, the thinking now is to go by clinical symptoms alone when deciding if re-testing is necessary.
So.....your doc may be smart in not wanting to order any further testing.
I wouldn't worry about it at all if you continue to do well.

[rsprenkle]

Thanks Allison -- that is great information

I guess I was concerned for two reasons:

1. If you still produce the toxins but are asymptomatic, does your colon still mount a toxin defense with the 'plaques' -- if so, is it bad? Do plques go away if the toxin level drops?

2. If you harbor spores, are you likely to transmit to someone on antibiotics?

I'd love to know if I pose no further risks to anyone, but perhaps we just must assume we always will be...

[Bobbie]

I can't answer your questions as well as Allison can as she is better at research. I believe the plaques "go away" when you are over active C. diff.

I wouldn't be too concerned about transmitting disease to someone on antibiotics (or anyone else) as long as you practice good hygiene -- wash hands frequently esp. after visits to bathroom. See FAQ-Hygiene. Be careful to use separate towel (or paper towels in public restroom) to turn off water tap & open outside door. If there isn't a wastebasket by the door in public restroom, throw the paper towel on the floor. You'll notice there are more wastebaskets by the door now so restaurants, etc. are getting the message.

My son & I both had C. diff. (many years apart) & never transmitted it to each other.

I posted your hyperlink in FAQ- Articles Re. C. diff. Lots of good info.

[WV Mom]

I'd love to know if I pose no further risks to anyone, but perhaps we just must assume we always will be...

I know I'm a newbie, but IMHO . . . until c-diff is airborne, your responsibility begins and ends with good hygiene. The people you meet also bear responsibility for protecting themselves from c-diff -- and a host of other bugs -- through handwashing and keeping their unwashed hands away from their mouths.

If one of my mom's aides picks up c-diff, I'm not going to feel responsible in the least. Harsh? I don't think so. I've told them my mom has c-diff and explained that they'll only pick it up if they get my mom's poop in their mouth -- and, as caregivers, if they can't practice better hygiene than that, they've got bigger problems than my mom's c-diff.

[Bobbie]

WV Mom,
I agree. The only people I would be concerned about infecting are family, friends, & co-workers & if you practice good hygiene, this should minimize the risks. One poster did infect others, but this was before she realized she had C. diff., and there are always exceptions. Family members & people in nursing facilities are most at risk.

All healthcare workers (& everyone) should wash their hands (and with soap & water & not just the alcohol foams available in most hospitals) for both their patients' protection & their own. Soap & water are more effective against bacteria; alcohol will "do it" for most viruses. Special care should be used to disinfect bathrooms -- especially if they are shared with others.

When I visit a doc., I say , "I hope you've washed your hands between patients as I'm at high risk of infection." Some are offended -- most are not. It took me years to "speak up." It's up to us to protect ourselves & our loved ones. We are our own best advocates.

[rsprenkle]

WV Mom,

I think the pathology is a bit nastier than 'poop to mouth' -- because the bacteria can sporify, like anthrax, it is very resistant to drying, antibiotics and dysinfectant in this state. The link below discusses the difficulties related to killing off the bacteria, and then only in a 'log' way (if each time you clean you only kill of some portion of the bacteria, you will never totally kill all of them).

http://www.bioquell.com/news.asp?id=167

The problem is that the spores travel from surface to surface, living on metal for up to 2 years. My wife, a biologist, indicated that bacterial endospores (similar to C Diff) have been found in salt crystals / mummies still viable after thousands of years.

Now, according to my wife, we all have C Diff, it just doesn't take over until good competing bacteria are removed. However, there are several strains, including both a non-toxin producing as well as a binary toxin (very nasty) variant that is spreading through the US (goto the CDC site to see a map).

Avoiding contact with the super strain spores is important, so hospitals that have been outbreak sites (McGill / Canada) have developed rigorous isolation protocols so that other patients that are immune compromised or on antibiotics do not get infected.

Now the part I wonder about is, not that a healthy person would come down with CDiff, but that they would get exposed to spores that may flourish the next time you go on antibiotics. If these spores were obtained from one of the hospital-born superstrains, that would be bad. I don't know what strain I had: I tested positive for toxin A, but they didn't test for toxin B. I'd like to know if I harbor any bad spores...

I found these more recent articles good on the topic:

http://nursingassistants.net/2005/12/06/c-diff-spreading/

http://www.washingtonpost.com/wp-dyn/content/article/2005/12/29/AR2005122901575_pf.html

http://www.sciencenews.org/articles/20060218/bob8.asp


I'm still doing well on the probiotics -- added Acidophillous Plus and Lactobacillus GG as a lower cost alternative to the Primal Defense, which will run out soon. My evening diet is still varied including all the stuff that would normally bother IBS / Lactose Int. sufferers. I drink kefir all the time now -- its yummy, but a bit pricy and definitely high cal (160 per glass). Coming up on three weeks since the last symptoms...