Possible Paths to healing the Gut

A reader posted on Facebook:

Ken Lassesen Hi Ken, maybe you can explain this: based on my latest biomesight test, one suggestions recurs in most of the suggestions on MicrobiomePerscripitons.com: Sucralose.
Sucralose is not regarded as particularly beneficial for the gut or overall health, actually it is associated with leaky gut and can decrease the diversity of bacteria. But I guess it comes up as it can modulate certain bacteria short term in a way that can potentially be beneficial for me? 🤔

Common Paths Starting Points

I have seen the following being very common:

  • [A] You complain about symptoms and a friend speculate that you have X, for example “Acid Stomach”
  • [B] You see a medical professional, often a naturopath, and the say “You appear to have T” example, “Gluten Issues”
  • [C] You see a medical professional, who perform an extensive list of tests. These tests results precisely match a known condition. example: Heliobacter pylori causing peptic ulcer.
  • [D] You go the “self-serve” approach using microbiome tests and ‘heal thyself’. Borrowing from Hippocrates:  ‘First do no harm‘, ‘Let food be thy medicine and medicine be thy food’, ‘Walking is the best medicine’ and ‘All diseases begin in the gut‘.
    • Often this is the result of disappointment or non-availability of [A],[B] and [C].

Typical Treatment Path for [A]

This is usually done by following friends suggestions or random searching of the internet for solutions. In short, it is an influencer treatment plan. Sometimes these treatment will work; the majority of people will get short term relief at best, if any,

Typical Treatment Path for [B]

This is usually done by the medical professionals working off their clinical experience and suggesting what they perceived to work. This is rarely objective, rather subjective. Their decisions are based on their view through rose-color glasses.

A simple example: “Jill Muller came to see me and said she would follow my advice. She did not come for a follow-up appointment –hence my treatment advice worked!” Reality, Jill followed the advice and became much worse, she concluded that this medical practitioner does not know what they are talking about and went elsewhere. To the practitioner, the lack of more appointments is proof that their treatment plan worked very well.

Sometimes these treatment will work; the majority of people will get short term relief at best, if any,

Typical Treatment Path for [C]

This is usually done by the medical professionals working off their clinical experience influenced by clinical studies and pharmaceutical sales representatives. For many conditions, these treatment will work to either cure or slow progression. These practitioner knows exactly what their target is. There can often be failure or less than desired progress because the current body of approved treatments is insufficient.

Two examples that I am personally familiar with are Mast Cell Activation Syndrome and Crohn’s Disease. Many other conditions like Autism, Depression, Anxiety, Alzheimer’s Disease, etc.

As with all of the above, when the treatment fails or is insufficient, path [D] is often taken

Typical Treatment Path for [D]

Following Hippocrates, All diseases begin in the gut. The problem is that despite having microbiome test results, we do not have clarity on what the target is.

From personal experience, I took a uBiome test and downloaded their FASTQ file and then processed it through:

  • Thryve/Ombre
  • BiomeSight
  • Sequentia Biotech 

I got 4 sets of interpretations of this digital microbiome sample. This was not taking 4 samples and sending it to these labs (hence differences could be ascribed to where the sample was taken in the stool), but one sample, processed into a single digital description and then processed.

There was less than 5% agreement on which bacteria were out of range. In one case, a bacteria was too high according to one lab and too log according to another lab. For more information see: The taxonomy nightmare before Christmas…

Influencer versus Single Study of Single Bacteria versus Holistic

I view an influencer as a person who looks at a single microbiome test (from random lab) and say “It looks like …. and you should take ….”. The basis of the recommendation is often internet legend. When an influencer is asked to provide studies supporting their recommendation, there is typically no answer. IMHO, quod erat demonstrandum on this being internet legend.

A medical professional, often a naturopath, or a well-educated self-learner may provide a study supporting their suggestions. Often this study will show that one and only one bacteria is changed by their suggestions. If you ask these people for a study showing that the same suggestions will help a different bacteria that is out of reference ranges, it is very unlikely that they can provide one.

I term this as the “bacteria tunnel vision” version.

The Holistic or Microbiome Prescription approach is to accept two things:

  • Reference Ranges are usually suspect from labs (see Using Ranges based on Averages is BOGUS) and compute ranges in a more valid way.
  • Decisions should be based on all available studies (at present 98,841direct citations generating 2,301,058 expert system rules)
    • This volume of data to consider require software and not brain-ware

The suggestions generated should always be reviewed by a knowledgeable and experienced medical professional before doing. Dosages are often a critical factor (more is not better always). There can be significant medical conditions that would exclude some suggestions. The suggestions are not “this is a protocol”, rather this is a list of things that are more likley to help than hurt — do whatever you feel comfortable with.

Returning to the question

To speed an accurate response, I used Perplexity and ask for studies.

Perplexity on sucralose consumption and leaky gut

From perplexity:

Recent studies have shown a potential association between sucralose consumption and leaky gut syndrome, although the evidence is not yet conclusive from clinical studies in humans.

Laboratory and Animal Studies

Several laboratory and animal studies have demonstrated concerning effects of sucralose on gut health:

  1. A study led by North Carolina State University found that sucralose and its metabolite sucralose-6-acetate damaged the junctions between intestinal cells, potentially causing leaky gut17.
  2. In mice, sucralose administration for 6 months altered gut microbiome composition and increased pro-inflammatory gene expression in the liver, which could contribute to inflammation and gut permeability4.
  3. Another mouse study showed that even low doses of sucralose altered gut microbiome composition, affecting intestinal barrier function8.

Human Studies

While direct clinical evidence in humans is limited, some studies suggest potential effects:

  1. A randomized, placebo-controlled study found that acute intake of sucrose, but not sucralose, resulted in post-prandial endotoxemia (increased blood endotoxin levels). However, this study did not directly measure gut permeability5.
  2. Researchers have called for revisiting the safety and regulatory status of sucralose based on its potential genotoxicity and effects on gut health7.

It’s important to note that more comprehensive clinical studies in humans are needed to definitively establish the link between sucralose consumption and leaky gut syndrome. The current evidence, while concerning, is primarily based on laboratory and animal studies, which may not directly translate to human health outcomes.

Look at “acute intake of sucrose, but not sucralose” above. Microbiome Prescription does not give dosages except for a few items, and those are references to clinical studies only. My take would be moderate intake, not excessive dosages. The appropriate dosage should be coming from your knowledgeable and experienced medical professional

Can sucralose decrease the diversity of bacteria, with studies

From perplexity:

Yes, studies have shown that sucralose can decrease the diversity of gut bacteria:

  1. A 2022 study on mice found that sucralose administration altered gut microbiome diversity. The number of bacterial features and Shannon index (a measure of diversity) showed a downward trend in groups given higher doses of sucralose compared to the control group1.
  2. Research on rats demonstrated that a 1.5 mg/mL concentration of sucralose led to the lowest α-diversity in gut microbiota, indicating a reduction in bacterial diversity1.
  3. A human study conducted over 10 weeks showed that sucralose consumption altered the abundance of certain bacterial phyla, specifically increasing Firmicutes while not affecting Actinobacteria or Bacteroidetes. It also led to a 3-fold increase in Blautia coccoides and a 0.66-fold decrease in Lactobacillus acidophilus2.
  4. A 6-month study on mice revealed that sucralose altered the gut microbiome composition, affecting 14 different bacterial genera over time compared to the control group5.

While these studies provide evidence for sucralose’s impact on gut bacterial diversity, it’s important to note that more comprehensive clinical studies in humans are needed to fully understand the long-term effects of sucralose on gut microbiota diversity.

I agree that it changes bacteria — that is what the goal is. Again note “higher doses of sucralose“. The bacteria changed are listed here.

What is the appropriate dosage

Again from perplexity with reference. If you keep to these limits, you should be fine.

The healthy daily amount of Splenda (sucralose) is determined by regulatory bodies based on extensive safety studies. Here are the key points regarding the recommended daily intake:

  1. The U.S. Food and Drug Administration (FDA) has established an Acceptable Daily Intake (ADI) for sucralose of 5 mg per kilogram of body weight per day37.
  2. The European Food Safety Authority (EFSA) and the Joint FAO/WHO Expert Committee on Food Additives (JECFA) have set a higher ADI of 15 mg per kilogram of body weight per day12.
  3. These ADI levels are considered conservative, representing an amount 100 times less than the quantity found to have no observed adverse effects in toxicology studies3.

To put this into perspective:

  • For a 150-pound (68 kg) person, the FDA’s ADI would be equivalent to consuming about 340 mg of sucralose daily3.
  • This translates to approximately 23 individual packets of Splenda per day, well above typical consumption levels37.

It’s important to note that:

  • Current estimated intake levels are well below these ADIs. A conservative mean estimate of sucralose intake from beverages among adults in the U.S. is about 1.6 mg/kg of body weight per day3.
  • The ADI applies to all population groups, including children, pregnant women, and individuals with medical conditions1.

While these guidelines suggest that Splenda is safe when consumed within these limits, recent recommendations from the World Health Organization (WHO) advise against the use of non-sugar sweeteners for weight control4. As with any dietary component, moderation is key, and individuals should consider their overall diet and health goals when consuming artificial sweeteners.

Bottom Line

A lot of the answers came from https://www.perplexity.ai/. I use this resource heavily to get summaries with references to data sources and then always check the source to make sure that this AI did not misread the study.

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