HSO’s Part 6 – What About Enterococcus faecalis?

HSO's Part 6 - What About Enterococcus faecalis?

Everyone believes I have a vendetta against HSO’s.

Maybe I do, maybe I do not. Honestly, I am just tired of everyone saying that HSO’s or that probiotics in general have no side effects whatsoever and that they are perfectly safe.

Probiotics are our friends everyone loves to claim. People need to learn that bacteria are out for themselves, just like most humans! Bacteria are in a commensal relationship with us. This commensal relationship does not mean however that they will not stab us in the back if it is in their favor. Bacteria will help us as long as we make it worth their while and do not ever give them the chance to turn on us.

Enterococcus faecalis is a prime example of this commensal relationship. Enterococcus faecalis lives in our intestines. It helps to properly colonize our gut flora when we are infants. 1 As long as it stays in our intestines and is kept in check through healthy gut flora competition, it works with us. If Enterococcus faecalis ever gets the chance, though it turns on us in a heartbeat.

Enterococcus faecalis can become opportunistic and has been known to cause life-threatening sepsis in humans. Enterococcus faecalis infections have been known to cause endocarditis, 2 UTI’s, 3 sepsis, root canal infections, 4 and meningitis. 5Enterococcus faecalis is also known to be highly antibiotic resistant, 6 7 suppress immune function by suppressing lymphocytes, 8 infect your stomach, make stomach cancer worse, 9 and form biofilms. 10 Since Enterococcus faecalis has been shown in multiple clinical studies as being opportunistic bacteria and has multiple resistances to eradication, I cannot recommend this probiotic for supplementation currently.

Enterococcus faecalis is the main probiotic found in doctor Ohhira’s probiotic. Doctor Ohhira’s probiotic strain of Enterococcus faecalis is a specific strain known as TH10. Enterococcus faecalis TH10 may be a safer strain of Enterococcus faecalis, but there are not enough studies or evidence to show that this strain would not cause severe opportunistic infections like those that the other strains of the same bacteria are known for. In defense of Dr. Ohhira’s probiotic, many people have taken the probiotic, and it has helped their digestive woes. There are, however, anecdotal reviews of people who have taken the probiotic and have had UTI’s and other infections that might have been caused by the probiotic. For this very reason, I do not recommend Dr. Ohhira’s probiotic anymore in any of my protocols (the probiotic also contains carrageenan, which is inflammatory to the gut. 11)

I believe that there are safer probiotics available that people can supplement to help their digestive system. Not using established safer probiotics is my main grievance with the use of Enterococcus faecalis as a “probiotic.” There is very little evidence of its use as a probiotic and a lot of evidence of its virulence.

Instead, other probiotics like Bifidobacterium could be supplemented with a lot less chance of issues and would benefit more people in the end.

20 Comments
  1. Hey there,
    you got me a bit worried now. I’m from europe and my doc (a very good one I might say) just prescriped me enterococcus faecalis because I have too little of them in my stool. I am 23 yrs old and have brain fog and fatigue for 3 years now, gut problems as well which improved a lot. She prescribed this product:
    http://www.symbiopharm.de/en/products/symbioflor-1.html

    I also took the e.coli product months ago and I managed to get my low e coli count to high normal again with no adverse effects.
    I also looked the enterococcus up and it has been used for decades without problems. Do you really think it is that dangerous?

    A CFS blogger wrote an article about the bacteria and this specific brand: https://cfsremission.com/2016/03/01/symbioflor-2-another-e-coli-probiotic/

    ” Enterococcus faecalis Symbioflor 1 clone DSM 16431, included in a commercial probiotic product used for more than 50 years without any reports of infection”

    Please tell me what you think about it as you got me very worried right now. I don’t really want to argue with my doc about this since she always reads the newest science.

    Thank you so much for your articles, a lot of them helped me tremendously!

    Regards

    • It would appear that the specific strain in the probiotic would be safer: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569346/. It does not appear to have any virulent genes currently. That being said the actual probiotic that has it would have to be free from any contamination, so it is still a roll of the dice, albeit not as dangerous.

      • Thank you for answering ;) This probiotic can be beneficial in upper respiratory infections and sinusitis, so I’ll give it a shot. Keep on the good work, Mr. Brisson!

  2. Hi John what about faecalis’s brother faecium?

  3. Hi John,
    Excellent series of articles on probiotics! There are way too many comments in internet extolling the benefits (not just probiotics but supplements in general), too few in voicing cautions. You are one of the rare few. Your systematic and open minded approach in discussion is a joy to read. I took Prescript Assist before and after reading your article, I decided not to continue with it. Always better to err on the side of caution.

    May I have your “opinion” on 2 probiotics related issues:
    1. Is it safe to take probiotics during pregnancy? My wife is taking:
    a. MegaFlora for Baby & Me for Lactobacillus rhamnosus (HN001) and
    b. Nature’s Way, Primadophilus Reuteri, Superior Probiotic for Lactobacillus reuteri

    We read that these 2 strains could be beneficial for babies and safe to take one a day during pregnancy

    2. What is your opinion of this product – http://www.amazon.com/gp/product/B00X4U2NDK
    It doesn’t seem to have the few dubious strains that you have highlighted.

    Plan to take it occasionally for general health purposes – perhaps once or twice a week, now that I read your articles!

    Thanks in advance and hope you continue the good work!

    • 1. Depends on the probiotic and the woman.

      First off, why is she taking probiotics? It is best to control the microbiome through food intake if she has no digestive issues than taking probiotics.

      Both probiotics may be ok, again it is best for her to follow a diet like the Perfect Health Diet to optimize her microbiome diversity.

      2. It is ok, but it all depends on the state of ones gut. If you are having histamine or d-lactate issues this probiotic would make you feel ill.

      • Thanks John. I’m quite new to all these. First learned about Omega 3 and fish oil via OmegaVia blog and from there I learn about Chris Kresser, Chris Masterjohn and Weston Price. Discover your excellent blog while trying to find out on which brand of supplement that are trustworthy (a very good article by the way) and then discover a whole new world on the gut. Best I found so far! Still reading and learning more about the gut. I’m suffering from heartburn since I’m a teenager. Hopefully I can fix it for once and for all.

        And thanks for the tip on perfect health diet. I’m now reading their articles too.

  4. Issues with the gut are more complex than we think. For people who have gut issues, I suggest work with a good functional medicine or a naturopathic doctor. Let’s not put the blame on probiotics. There is a proper time in your healing process when to introduce probiotics in your gut for them to work their job in shifting your microbiome.

    • You are correct I agree with you. The blame is not always on the bacteria, but we should still use caution when supplementing with them.

  5. Based on a stool test I have close to nothing of enterococcus species. I have tried to find information about this. So it can be dangerous to have too much but what about too little?

    I have let myself understand that enterococcus is responsible for producing/handling vitamin B. Well I am deficient to b12.

    How can I feed this bacteria? If it as a supplement might be dangerous?

    I am also low on e.coli and lactobacillus and am histamine intolerant. Currently taking strong probiotic by solgar which I seem to tolerate very well. Any cheap vague brand can make me awfully sick.

    Been ill for 15 years and so fed up. Nausea/fatigue/weak/hives/low temp/no appotite etc etc currently also having low t3 and possibly hashimoto.

    It all started 20 years ago after years of using antibiotics. No one told me I could end up like this.

    • Maybe try a Maybe try GOS (Galactooligosaccharide) supplement to see if it can culture some of your microbiome back? Have you been tested for H. pylori, it can cause B12 deficiencies?

  6. It is my understanding that the genus Enterococcus neither has GRAS (Generally Regarded as Safe status in the U.S. nor has it been added QPS list (Qualified Presumption of Safety) in the E.U. However, Enterococcus faecalis is the main probiotic found in Dr. Ohhira’s probiotic. Despite the lack of GRAS and QPS status (primarily because of the genus’ association with disease development) this probiotic product still received FDA approval for release for sale in the marketplace. Can anyone shed some light as to how it received FDA approval considering the main probiotic in the product i.e. E. faecalis is not considered ‘safe’?

  7. Hi.

    I got the probiotics AOR probiotic 3 and was taking it for 2 weeks. I got severe bloating , pan and diarrhea. after two weeks of giving it uo im still feeling miserable. This pobiotic contains Enterococcus faecalis and it has waken up my leaky gut again ( who had been cured with 0 symptoms before this probiotic). I strongly recomend not to take this probiotic.

  8. Hey John can you she’d some light on the whys and how’s HSO supplementation could be dangerous in immune compromised individuals. I have been using primal defense and I’ve been fine until I recently went a week with horrible sleep. Immune compromised via lack of sleep I suppose. I got severely sick for a week, but I got better probably because I was in the middle of a SIBO protocol (still am), yet it still lingers slightly. I recently tried Prescript assist and the symptoms came back overnight. I just pieced it together that my probiotics with lack of sleep got me I’ll. I’m also supplementing with Lacto and Bifido strains. I’m going to stop all HSO until I feel I have fully recovered. What’s your input?

    • Most HSO’s are protected by endospores which are very difficult to deal with if they cause an infection. Any bacteria can cause an infection if the conditions are right at any time. “Probiotic” bacteria can become opportunistic and become infectious. I would not use the PA, it is a possibility that it is eliminating bacteria and yeast causing a herx reaction and that is why you feel bad.

  9. Kresser of course goes on to say: “If I had to rank additives, I’d say carrageenan is a bit more concerning than the other two additives we’ve discussed so far because of its association with gut issues. Remember, in cases involving modern ingredients, the burden of proof should be on manufacturers to prove that they’re safe, rather than on consumers to prove that they’re harmful. Because the evidence isn’t conclusive either way, I recommend avoiding carrageenan, especially if you have a history of digestive problems.”

    I know through my own personal digestive health and the clients that I have coached that carrageenan can cause gastritis.

    As far as it causing cancer you are correct, it is more unknown.

    And of course my blog is full of “shit” it is a blog about digestive health after all.

  10. The dicussion of carageenan seems a little bit out of context. here is what the great Chris Kresser states on his podcast:

    “However, carrageenan has produced intestinal damage in some animal studies. Observed effects in rats include epithelial cell loss, increased intestinal permeability, and diarrhea. (6) In guinea pigs, carrageenan at a 5% concentration in the diet caused ulcers in the colon, although a similar concentration in the diets of rats and hamsters resulted in no difference from controls. (7) In pigs, concentrations of carrageenan between .05 and .5% administered for 83 days resulted in abnormalities in the intestinal lining, but no ulcerations or tumors. (8) Still, a more recent rat study found no ulcerations or lesions in the colon after 90 days of carrageenan administration. (9) These studies suggest that the effects of carrageenan are highly species-dependent, which makes it more difficult to extrapolate these results to humans.”

    I think it would be important to point out that a person taking Dr. Ohira’s probiotic supplement would not be ingesting anywhere near these concentrations of carageenan. I imagine they would need to eat at least ten cases of the 60ct size to get even up to the .05% concentration in a typical 2000 calorie diet.

    And of course Kresser recommends HSO’s. and he’s right. they’re great. This blog is full of shit. and sloppily cited.

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