Tributyrin: Benefits and Drawbacks of Supplemental Butyrate in IBS/SIBO and a New Option on the Market

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'm going to be talking all about butyrate and tributarin, which is the best absorbed form of butyrate. This is a supplement that I recommend frequently to my clients and which some of my favorite gut health mentors like Dr. Daniel Kalish and Grace Liu PharmD also recommend for certain gut issues. It's particularly indicated for people with diarrhea, loose stool, IBS-D, and hydrogen or hydrogen sulfide SIBO because it slows motility and leads to firmer stool. But before I launch in, I want to make the disclaimer that this should not be construed as medical advice and that you should see your own healthcare practitioner and make decisions about your own care. And this podcast will also be heavily documented in the show notes with the studies that I'm mentioning. But before I launch in, if you haven't yet followed or subscribed to the show, be sure to do so. And if you want to get transcripts of the podcast pop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter. You'll also get my free ebook, Finding Your Root Cause Through Stool and Organic Acids Testing, when you sign up. And if you haven't yet done my quiz on which stool test would help you get to your root cause, you can find a link in the show notes and take that. Now onto the show. So let's start with the basics. Butyrate is a short-chain fatty acid, which is primarily produced by bacteria fermenting fiber in your colon. The other primary short-chain fatty acids, which are often abbreviated SCFAs, are acetate and propionate. Butyrate is also present in butter and cheese and human breast milk. In fact, a breastfed infant could receive a daily dose of butyrate of approximately 30 milligrams per kilogram of body weight due to its high concentration of breast milk. So obviously nature is signaling that this is an important substance for health. To some extent, you can find out about how well your gut is producing butyrate and other short-chain fatty acids with many direct consumer gut microbiome sequencing tests, as well as through advanced stool tests like the Genova GI Effects Comprehensive Profile or the Doctor's Data GI 360, although the methodology may not be that accurate. Some of butyrate's known health benefits are providing the primary energy source for the cells that line the colon, or colonocytes, improving the integrity of the gut barrier, also known as reducing leaky gut or a leaky colon in particular, and therefore reducing inflammation and preventing the leakage of toxins into the bloodstream. It has also been shown to enhance insulin sensitivity, which can reduce the risk of type 2 diabetes. It also has all-over-body anti-inflammatory properties. And if that wasn't enough, if you're short on butyrate-producing microbes, which is associated with an increase in metabolic disease, type 2 diabetes, and obesity, butyrate may also be helpful. Supplemental butyrate has been shown to lower hemoglobin A1c and reduce blood glucose spikes in type 2 diabetics. Reduce insulin resistance, and reduce obesity-associated inflammation. In addition, in animal models, when they purposely fed the mice high-fat diets, which aren't great for mice, butyrate prevented them from becoming obese and having the accompanying metabolic issues that accompany obesity. It was also shown to bring about weight loss in a randomized clinical trial of obesity in children. But in one study, it did increase the weight of rats born to mothers fed butyrate, so I don't generally recommend it for pregnant women, although Lucy Maling Lindsey Parsons, who is a gut health expert and my guest from episode 25 of the podcast, made a good argument for using it even during pregnancy in one of her office hours calls and took it herself while pregnant. And I'll include the study she cited in the show notes about that. Butyrate has also been found to have neuroprotective effects in animal models of Alzheimer's and Parkinson's disease, and therefore may help to improve cognitive function and reduce the risk of neurodegenerative diseases. Butyrate is also great to use in autoimmunity because it supports the formation of regulatory T cells. Which quells inflammation and suppresses autoimmune-type responses. Because the more your T-cells are being differentiated into regulatory T-cells and not the other types, the better, because the other types are the ones that can exacerbate autoimmune symptoms. Then tributarin, which is formed of 3 molecules of butyric acid combined with 1 molecule of glycerol, is a form of butyrate that is found in newer supplements as opposed to sodium butyrate, potassium butyrate, magnesium butyrate, or calcium butyrate forms, and has been found to be preferable to other forms of butyrate because it has a low odor and chemical stability, meaning it's resistant to breakdown by gastric and pancreatic enzymes. This means that it can reach the large intestine intact. Tributyrin is also superior to other forms of butyrate for its ability to diffuse through biological membranes, releasing butyrate over time directly into cells, as opposed to other forms of butyrate which are metabolized rapidly as soon as they enter the cells lining the colon. Tributyrin has also been found to be more effective than other forms of butyrate in uses with animals, such as improving gut health in livestock and modulating immune function. So now I'm going to focus in on the gut health benefits I've seen in myself and others of supplemental tributarin, which are supported by the research. So when you take antibiotics, your body's ability to produce butyrate likely drops significantly. In animal models, the use of 3 days of oral antibiotics decimated the gut's ability to produce butyrate from fiber and increased oxygen levels in the colon. Now, the colon is supposed to be oxygen-free, also known as hypoxic, And a healthy hypoxic colon supports both anaerobic bacteria, which can't live in the presence of oxygen, and facultative anaerobes, which can live with or without oxygen. But importantly, the anaerobes are the ones who produce butyrate to feed the colonocytes. Most butyrate producers belong to the Clostridium cluster of the phylum Firmicutes, such as Fecalibacterium, Roseburia, Eubacterium, Anerostipes, and Coprococcus, among others. So post-antibiotics, when your gut becomes unable to produce butyrate, it will pull in oxygen as an alternate fuel source. This promotes the growth of those facultative anaerobic bacteria, typically proteobacteria. In my experience, this leads to messy, loose stool, a poor mucus lining, and an inflamed and leaky colon. So supplementing with butyrate during and after antibiotics can reverse this cycle and help restore the healthy balance between anaerobic and facultative anaerobic bacteria. Lucy Milling described this process in a great blog called The Oxygen-Gut Dysbiosis Connection and also spoke about it when she was on my podcast. In my personal experience, because I have post-infectious IBS leading to frequent hydrogen-dominant SIBO, or small intestine bacterial overgrowth, I often have periods of bloating and accompanying loose stool and sometimes diarrhea. Trebuterin has been my savior in these periods so that while I'm working on reducing the quantity of bacteria in my small intestine, I can still have firm stool and maintain a healthy mucus lining. I don't know about you, but if you dealt with loose stool, when you have a good one, it just puts you in a good mood for the whole day. The trick with using Tributarin, in my experience, is getting the dosing right, and that happens most easily by increasing the dose until you get firm stool, and then when it gets too firm, like rabbit pellets, decreasing the dose until it's just right. Personally, I've found that I typically need something in the range of 900 to 1500 milligrams, and at times even as much as 2000 milligrams a day or more to start to achieve firm stool, but then I can decrease my dose after that. The nice thing about butyrate is it has very few known side effects, and even with higher doses of up to 2,000 milligrams a day, no short-term adverse reactions have been observed in studies. Of course, I don't recommend it to my clients with constipation because it does slow motility and firm the stool, and constipation does increase your short-term risk of GI and other cancers. And since I found that I needed such high doses to achieve the desired results of butyrate or Trebuterin, and because the available supplements in capsule or gel cap format were typically 300 to 500 milligrams each. I always felt bad telling clients about it and then telling them that in addition to the 10 other supplements they were taking, they might likely need 3 to 4 additional pills of Tributyrin once or twice a day to get the desired effect. So this is probably a good moment to mention that because I saw this obvious hole in the marketplace, I set out to solve the problem by making a higher dose Tributyrin supplement. So this is actually the first time I am announcing publicly that I have this new supplement for sale called Tributyrin Max. Which is a 750 mg capsule of Tributarin in a hydroxypropyl methylcellulose capsule, which is an enteric-coated capsule so that it makes it through the stomach acid into the intestines intact. As of now, it's available on tributarinmax.com, which I'll link to in the show notes, and it will be available on Amazon in, I'd say, about a week. I put the shipment in the mail to Amazon on February 7th, 2023, so it should be available for preorder soon. And I will add the link in the show notes when it is, but it's free shipping from my site for 1 to 3 bottles in any case. This is pretty exciting for me, but I also announce it with a little bit of trepidation because up until now I have been very agnostic about supplements, meaning I don't have loyalty to any particular brand and I choose what I think is best for my clients. And because I'm a pretty skeptical person myself, when I see health celebrities promoting their own products, I have to admit it has made me question their integrity. And the dilemma, however, is that it's really hard to make a living seeing clients the way I do because I put in, in addition to the hour I spend with them, I put in 1 to 3 additional hours of prep and follow-up time for every hour. So that really only allows me the time to see 3 gut health clients per week in addition to all my other duties with the podcast and the newsletter and answering client emails. And I spent a really long time thinking about what, if anything, I might sell as a supplement. And I only wanted something I felt I could unequivocally recommend to certain people, that didn't really have big contradictory evidence, like probiotics for instance, and for which there was actually a legitimate need in the marketplace. So rest assured that while I do wrestle with the ethical dimensions of selling my own supplements, I won't unequivocally recommend them to anyone. Like even on the bottle, I decided to put that people with constipation or with a history of polyps in the colon shouldn't take it. And no one else warns against that because there is a little bit of evidence that because butyrate is a food for the colonocytes, It could be cancer-promoting for those with a history of polyps, although there's a much greater body of literature showing it's preventative for colon cancer, prostate cancer, tongue cancer, breast cancer, lung cancer, and neuroblastoma. I'll link to the Lucy Maling article called SCFAs Part 2: The Benefits of Butyrate that cites all the literature as well as the studies that show its potentially negative impact on colon cancer. In her article, she also cites additional benefits to the brain of butyrate, including increased neurogenesis. Reduced oxidative stress, and improved recovery following ischemic brain injury, as well as potential benefits for skin and bone health. And then in the following blog, SCFA's Part 3: Decrypting the Butyrate Paradox— Can Excess Butyrate Be Toxic?— she talks about the potential drawbacks, especially in the case of active and flaring ulcerative colitis, and about the importance of only taking physiologic doses, which she describes as 600 to 1,200 milligrams a day of tributarin. Also, because of the capsule ingredients, because emulsifiers and other food additives have been shown to be harmful for people with inflammatory bowel disease, I might advise caution on that front as well. The studies I've seen are only on mice and concern something called carboxymethylcellulose as a food additive, not hydroxypropylmethylcellulose, which is actually used as a coating for capsules of IBD-targeted pharmaceuticals, ironically. But if you want to exercise an abundance of caution, there is one powdered tributerin supplement called Aurix, that's A-U-R-I-X, that's available in my full script dispensary instead, then that has a delivery mechanism that makes it not gross to eat as a powder. It was actually designed for kids with autism in mind because butyrate has been shown to be beneficial in autism. But reading through one of Lucy Meiling's other blogs on butyrate, which is linked in the show notes, I think that butyrate may not be advisable in higher dose format for people with active and flaring ulcerative colitis, although I do have one client who has definitely benefited from it. But if that's not your concern, the capsule is a plant-based capsule and it's okay for vegans or vegetarians. I actually would have used a gelatin capsule, but the manufacturer told me there was a 1-year wait for those. So to sum it up, if you have loose stool, diarrhea, etc., and it's from SIBO or dysbiosis that involves a likely dominance of proteobacteria, which is often the case in post-infectious IBS that causes SIBO, and following heavy antibiotic usage, tributarin is a good supplement for helping slow motility and firm up the stool and reverse the cycle of an oxygenated gut. And of course, trying to bring in more fiber into your regular diet so that the bacteria can ferment the fiber and produce butyrate naturally. So I'm talking about things like beans and lentils, psyllium husk fiber, things like that are all great for producing butyrate naturally. And if you have SIBO or other dysbiosis, of course you need to see an appropriate healthcare practitioner to deal with that and determine the reasons for it and address it as well, which as you know, is something I do with my clients. And you're welcome to set up a free 30-minute conversation with me to find out if I can help you. So if you're interested in trying my new butyrate supplement, it's called Tributerin Max. You can find it at tributerinmax.com. That's T-R-I-B-U-T-Y-R-I-N-M-A-X dot com. And I'm offering a 15% off discount code for your first order, which is INTRO15, all caps INTRO15. And of course, I'll link to that in the show notes. And if you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my gut healing Facebook group, or join my newsletter list at highdeserthealthcoaching.com. .com, as well as Twitter, Instagram, and Pinterest. Links for those are in the show notes. Thanks for joining me today, and here's wishing you all the perfect stool.