I am on a microbial mystery tour but I am not entirely sure where it is leading. Whenever I waver or feel a little directionless, something unexpected and quite wonderful happens to shove me in the back and keep me travelling along this path.

The most recent shove in the back came in the shape of Kate Robinson and her black Labrador, Islay. We first met out walking when Islay was a puppy – just a few months younger than our own dog Nella (also a black Labrador). We exclaimed about how similar they looked and wondered if they shared a father (they do not).

Months later, I bumped into Kate and Islay in the woods in a characteristically Somersetesque downpour (never-ending). As the rain dripped down my glasses, Kate told me that, in February, Islay had nearly died due to a sudden and severe problem with her gut. Despite the inclement weather, I was all ears. It turned out that this was just the sub-plot to an incredible human gut story.

Kate could you tell The Colonic what happened to Islay?

We were away for the weekend and our daughter was looking after Islay. On the evening of our last night away, we got a phone call from the vet to say that Islay was on the operating table with such a devastatingly twisted gut that they were not expecting her to wake up. Another vet was on the way to see if there was anything that he could do. Thankfully, the second vet managed to remove 2 feet of Islay’s small intestine and, in so doing, saved her life.

Could you tell The Colonic how Islay was affected by the operation?

Obviously, we were extremely relieved to see her still alive the next day but she was a quivering, terrified wreck. She came straight to my lap, panting and shaking. She let me stroke her all over but snapped at the nurses when they tried to touch her. Islay stayed in the vets that night but came home the next day as they thought she would be calmer at home. Islay had had quite a range of antibiotics during her stay at the vets.

The first few months after the operation were tough. Her digestive system was a mess. Islay needed to poo every couple of hours – day and night. Her poos were yellow and very watery. She was nervous and miserable. The vet put her on special hypoallergenic food and she was on 4 different types of medication – Omeprazole,[1] Questran,[2] Nutra Bio,[3] and Vitamin B12 injections.[4]

We were told it would take about 6 months for things to get back to normal – and this was not an exaggeration.

In the woods, I suggested you feed Islay water kefir grains – communities of beneficial bacteria and yeast to try to support the recovery of her gut microbiome. What was your initial reaction to this suggestion?

I was keen to try anything! When we met in the woods, we were around 3 months on from the operation and Islay was still suffering both physically and emotionally – her poos were still basically yellow water and the lack of health of her coat and her levels of anxiety were still an issue.

I liked the idea of a naturally-occurring remedy that could do no harm. I’ve always quite fancied the idea of being a witch doctor! I really enjoy the whole process of brewing the water kefir and so does Islay. She comes running in from the garden and sits at my feet watching everything that I do – always hoping for some sort of water kefir explosion[5] that might mean a quicker delivery of grains to the floor…

Within 7 days of having the grains in May, she did the best poo since her operation in February and her coat has rapidly returned to its shiny condition. Not only that, but her energy levels and her joie de vivre have returned. We have our Islay back. Of course, we can’t know for sure that it is the grains that have made her turn the corner, but it happened so soon after taking them, my husband and I are convinced we have them to thank.

We are now reducing her medication and she continues to improve. She eats her water kefir grains daily.

When I delivered the water kefir grains to you, you shared your own gut story with me. Could you tell The Colonic what happened to you when you were 19?

I was at Euston station heading to Stafford to see a friend for the weekend. I had felt unwell that day with stomach cramps but I put it down to something I had eaten. The cramps got worse and I collapsed at the station, spilling the contents of my basket. No-one stopped to help me. Through the haze of pain, I remember a nun stepping on and breaking my lip salve. And a policeman muttered something about drugs. Neither of them helped me. I realised that I was on my own and I somehow managed to get on to my train.

I spent the journey in the loo in the worst pain imaginable – being sick and with diarrhoea that soon turned to blood. I remember looking at the emergency cord but deciding that, even if it worked, we would probably stop in the middle of a field.

I tumbled out of the train at Stafford and was rushed to 4 different hospitals as the medics tried to identify the problem. I ended up in Newcastle-under-Lyme hospital, where they operated and discovered an intussusception.[6] The doctors had never seen this condition in an adult. It is more common in babies and very young children. I was told that some of the lymph glands inside my intestine had swollen, perhaps due to a minor infection and the intestine had picked them up thinking they were food and the whole thing had turned in on itself. The blood supply had been cut off to almost half of my large intestine and it had turned gangrenous. They cut out 2.5 feet of my large intestine (and took my gut microbes with it) and concluded that I had been minutes away from dying.

My recovery was painfully slow. Physically and emotionally, I had taken a real hit. But, having been brought up to think that there is always someone worse off than myself, I went back to running my Montessori nursery far too early, despite grappling desperately with the physical and emotional fall-out of the whole episode.

There were many trips to the doctor with symptoms which would now be diagnosed as Irritable Bowel Syndrome. I had to undergo hideous investigations to check whether there was anything else more sinister going on. I lost all my confidence in myself and the world around me.

How unusual for both you and Islay to suffer such a similar and rare health issue. Was the vet at all surprised when you told her of the coincidence?

So, you can imagine the thunderbolt that hit me as we were sitting on the floor at the vets with Islay shaking in my lap and hearing that she had experienced such a similar episode.

I expected the vet to be surprised when I told her of my similar experience. Not at all. She said it’s a ‘thing’ that vets see regularly. The vet said that she sees an unusually high number of patients whose conditions mirror their owner’s experiences or at least their perception of their experiences.[7] This happens mainly with diabetes and cancers but also with gastrointestinal disorders at a level that seems unlikely to be explained by coincidence. The vet did acknowledge though, that she had never seen anything like Islay’s condition with my history! Of course, owners and pets share an environment and often similar healthy or unhealthy dietary habits. Who knows whether our microbes are somehow involved in all this too!

[1] Omeprazole: a medication to reduce stomach acid (e.g for acid reflux). Over-production of stomach acid can be an issue after small intestine re-section and can be problematic. However, these types of medication, through reducing stomach acidity, can also upset the bacterial balance in the small and large intestine and the ability to absorb various important vitamins and minerals, particularly vitamin B12. They can be a double-edged sword.

[2] Questran: helps to bind bile acids which can be poorly reabsorbed into the blood-stream after partial small intestine removal. If these bile acids make it into the large intestine (ordinarily, they should be reabsorbed before then), they can cause diarrhoea.

[3] NutraBio: a prebiotic and probiotic to help support the gut microbiome and to help restore normal digestive function.

[4] Vitamin B12: an essential vitamin – neither humans nor dogs can make it themselves and need to absorb it from certain animal-based or fermented foods via the small intestine. This is an issue if part of the small intestine has been removed, and especially so if other medication prescribed exacerbates poor uptake of vitamin B12. B12 is crucial for nerve and blood cell health and helps to make DNA.

[5] A by-product of water kefir fermenting is carbon dioxide that can, if the kefir is not “burped” regularly, result in an impressive explosion of water kefir, kefir grains and the kefir bottle. Here is the link to my water kefir fermenting foray

[6] This is an abdominal emergency whereby one part of the bowel slides into the next, a little like the pieces of a telescope. In Kate’s case, it had occurred in the large intestine.

[7] A fascinating topic for Wondergut/The Colonic, which I am investigating further.

What fall-out did you suffer after the intussusception Kate?

I crashed my way through the next few years eating lots of All Bran and drinking disgusting Fibogel (I was given no other dietary advice). I struggled with post-traumatic stress (although I didn’t know at the time that that was what it was) and I certainly suffered from anxiety, depression and panic attacks.

Looking back now, I think the episodes of depression I have suffered since really took hold then.

I experienced ‘dark times’ from about the age of 8, but we were taught that any sign of emotion was a sign of weakness so I internalised it all. I am the youngest of four by quite a long way, so I spent much of my childhood alone. I had several imaginary friends I remember vividly to this day – their names were Fig, Lung, Ping, Person, Lady and Boy – they lived in the corner of the tennis court.

My siblings and I were all sent to boarding school. I was sent at the age of 9. I am dyslexic so I never did well in lessons. It did not help that I was left handed – I have seen cine film of me when I was small playing with bats and balls and I always have the bat in my left hand but at home and at school, I was told to use my right hand for my pencil. I have two left-handed children. Luckily, I had great friends at school and found it easy to make people laugh although unfortunately, the teachers did not find me funny at all!

After the trauma of the operation, as when I was at school, my friends and my sense of humour kept me going.

And as if that wasn’t enough to cope with, 5 years later, just before a scuba diving holiday, you found yourself at the doctors again. What did you discover?

I went to the doctor feeling very thirsty, my eye sight was wonky and I had cramp in my legs at night. She just looked at me and asked if I knew much about diabetes.

That night in St George’s hospital in Tooting, I had the first of my life-saving injections of insulin. Type 1 Diabetes is a very different beast to Type 2. It is an autoimmune condition where my own immune system attacks and kills the insulin-producing cells in my pancreas so that I can no longer produce insulin.

How has this affected you?

Type 1 Diabetes affects every aspect of my life. I am tuned into my body 24 hours a day. I have to constantly balance three things –  carbohydrate intake, insulin and the exercise I do. Every time I leave the house, I make sure I carry glucose tablets and blood testing equipment with me.

It is very hard work and impossible to get right all the time. The low blood sugars make me feel very low in myself (which is challenging when I have a tendency towards this anyway) and I know the high blood sugars are doing long term damage to my body. I do suffer from low self-esteem.

I keep fit though and run a small salad growing business in my garden with 9 adults with learning difficulties. I had three very successful diabetic pregnancies and have 3 beautiful children (now all grown up).

Having said all that, within 6 months of being diagnosed, I took up a teaching post in the South Pacific that I had committed to before my diagnosis and whilst there, I was part of a women’s Polynesian Canoeing race. The diabetic nurse at St George’s agreed that I should not give up this opportunity. After everything that had happened, to do so would have been devastating for me.

They sent me off with a suitcase full of 2 years’ worth of insulin, syringes and blood testing kit. The customs officer on the Samoan island of Tutuila just shrugged his shoulders and hurried me through! I had a few interesting hypos on the canoe out in the open ocean, but I always carried waterproof glucose gel. It was an amazing year and helped me come to terms with my condition and face a lifetime of insulin injections.

Then in 2004, a friend and I climbed Mount Kilimanjaro with a group of diabetic people. It took 6 days to get up and a day and a half to descend. I had trained for a year but nothing could have prepared me for the final push for the summit. Due to the high altitude (5,895m 19,340ft) we could not stop for long at the summit so we had to walk for 12 hours continuously. I reduced my insulin, thinking I would be burning off the carbohydrates. My blood monitor froze, so it was impossible to tell whether the sick feeling was due to high or low blood sugar or high altitude sickness! Eventually, I realised that I had very high blood sugar because of the stress the altitude had put on my body. I managed to find some tummy skin under all the thermal layers to inject more insulin. Sadly, we missed the sunrise, but the views were astonishing and I will never forget the incredible feeling of achievement.

Do you think that the loss of part of your large intestine, along with it, a substantial percentage of your gut microbes and then struggling with Irritable Bowel Syndrome could have contributed to you developing Type 1 Diabetes?

This is difficult for me to answer but there is certainly some persuasive evidence to suggest that it might be true.[8] No one else in my family has Type 1 Diabetes and there is no doubt that my whole system suffered a huge shock as a result of the intussusception and ensuing operation. I have suffered with IBS since (which I know to involve microbiome and immune upset and inflammation.) But maybe this whole episode was just one of many straws on the camel’s back?

You raised another interesting theory as to what may have contributed to you developing Diabetes Kate – could you share it with The Colonic?

A group of 5 of us, who were all childhood friends get together occasionally. We all grew up on dairy farms in Somerset and drank a large amount of cow’s milk as children. We all developed Type 1 Diabetes in our mid-twenties. I have always thought that there must be a connection.[9] I also know that I was not breast fed and was most likely fed cow’s milk formula as a baby. So maybe this was another straw?

It is possible that the trauma I suffered from the intussusception and removal of part of my large intestine (and all those precious bacteria along with it) affected the conversation between my gut microbiome and my immune system. It certainly caused sufficient immune dysregulation, inflammation and leaky gut to induce Irritable Bowel Syndrome instantly and I am not sure copious amounts of Fybogel and All Bran helped.

If I think, too, that my system may have already been primed against bovine insulin, having consumed large amounts as a child, it seems a possibility that, in the wake of the operation and resulting IBS, my immune system may have gone a bit doolally, attacked the bovine insulin in the milk products I consumed and then gone on to attack the insulin-producing cells in my pancreas.

Another possible “straw” of course, is that my system had to deal with a fair amount of stress at a young age. I was separated from my mother at a few weeks old and sent to a family friend for at least a month due to my mother suffering from viral pneumonia after my birth. I had to deal with high levels of anxiety and stress as a left handed dyslexic child made to be right handed and sent to boarding school against my wishes at the age of 9.[10] I suffered bouts of depression, loneliness and a sense of isolation from a young age and I know that depression is strongly linked with an upset gut microbiome. Maybe all this caused sufficiently persistent gut inflammation to induce the intussusception. Gut inflammation is recognised as one of the possible causes of intussusception.

I guess I will never know the cause of it all. The human body is so inordinately complicated. Looking back, there were so many possible straws on the camel’s back! I am where I am now and all that I have experienced has taught me that it is very important for me to look after my gut health. Doing so helps with my mental and emotional health. And of course, caring for my mental and emotional health supports my gut health. It is all one intricately connected system.

Having seen Islay respond well to the water kefir grains, have you considered dabbling with it yourself?

I tried the water kefir – the drink that is produced by the activity of the water kefir grains (Islay is eating the grains themselves) – which is based on sugar as the food substrate for the bacteria and yeasts. It must be true that the bacteria consume all the sugar if you get the proportions and timings right as drinking it didn’t affect my glucose readings at all, which was reassuring. However, it doesn’t seem to have had any real beneficial effect on me so I have just started trying milk kefir now.[11] You will not be surprised to hear that I am using goat’s milk, not cow’s milk for that!  I will see whether the benefits of consuming all those beneficial bacteria fermenting away in the milk kefir outweigh the possible irritant effect of the milk on my immune system!

I would like to think that it is the milk kefir grains that are generally raising my spirits, but who knows? I did wake up the other morning with a song in my head rather than the more usual feeling of heavy black rocks, so maybe the goat’s milk kefir is beginning to help!

[8] E.g Duodenal mucosa of patients with type 1 diabetes show distinctive inflammatory profile and microbiota – Lorenzo Piemonti et al January 2017 Journal of Clinical Endocrinology and metabolism – showed that diabetics have significantly more inflammation of the gut mucous membrane and a more leaky gut than non-diabetics as well as a different and distinct combination of gut bacteria. We can’t say whether inflammation is the cause or effect of the illness, but inflammation is one of the underlying processes and we know that inflammation is modulated by our gut microbes talking to our immune system. It appears that Type 1 Diabetes has an influence on or is influenced by a peculiar relationship between inflammation (our immune system) and our microbes.

[9] Removal of Bovine Insulin From Cow’s Milk Formula and Early Initiation of Beta-Cell Autoimmunity in the FINDIA Pilot Study – Outi Vaarlala et al Arch Pediatr Adolesc Med. 2012;166(7):608-614. There is a respected theory linking cow’s milk consumption (especially as a baby) to an increased risk of developing Type 1 Diabetes. This appears to be due to our immune system responding to the bovine insulin, getting confused and then attacking our own insulin-producing cells in the pancreas.

[10] Stress results in the release of cortisol which induces inflammation which, in turn, affects the balance of our gut microbiome and its conversation with our immune and nervous system.

[11] Milk kefir contains 30-50 strains of beneficial bacteria and yeasts whereas water kefir contains only 5-10 strains. Here is the link to my milk kefir fermenting foray.

© July 2017 Jo Webster

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