Adapted from episode 90 of The Perfect Stool podcast and edited for readability.
Today’s post is all about butyrate and tributyrin, which is the best absorbed form of butyrate. This is a supplement 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, hydrogen or hydrogen sulfide SIBO because it slows motility and leads to firmer stool. But before I launch in, I was to make a disclaimer that this should not be construed as medical advice and that you should see you own health care practitioner to make decisions about your own care.
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, aka 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 generally don’t recommend it for pregnant women, although Lucy Mailing, gut health expert and my guest from episode 25 of the podcast, made a good argument for using it even in during pregnancy in one of her office hour calls, and took it herself while pregnant. (See Episode 90 Show Notes for links to those studies).
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 other types the better, because the other types are the ones that can exacerbate autoimmune symptoms.
Then tributyrin, which is formed of three molecules of butyric acid combined with one 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 tributyrin, 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 prescence 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 Faecalibacterium, Roseburia, Eubacterium, Anaerostipes 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 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 Mailing 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. Tributyrin 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’re dealt with loose stool, when you have a good one, it just puts you in a great mood. The trick with using tributyrin 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 have found that I’d typically need something in the range of 900-1500 mg and at times even as much at 2000 mg/day to 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, with even higher doses up to 2,000 mg/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 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 result, and because the available supplements in capsule or gel cap format were typically 300 to 500 mg each, I always felt bad telling clients about it and then telling them that in addition to the other 10 things they were taking they might likely need 3-4 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’m announcing publicly that I have this new supplement available for sale called Tributyrin-Max, a 750 mg/capsule tributyrin supplement in a hydroxypropyl methyl cellulose capsule, which is an enteric coated capsule so that it makes it through the stomach acid and to the intestines. It is available on tributyrinmax.com (free shipping for 1-3 bottles and low cost after that) and on Amazon.
This is pretty exciting for me but I also do it with a little bit of trepidation. Up until now I have been very agnostic about supplements, meaning I don’t have loyalty to any particular brand and 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 that it has made me question their integrity. The dilemma is that it’s really hard to make a living seeing clients the way I do, because I give them like 1-3 additional hours of prep and follow-up time for every hour they spend with me. So that only allows me to see 3 gut health clients per week in addition to all my other duties with the podcast and newsletter and answering client emails. But I spent a really long time thinking about what if anything I might sell as a supplement, and I only wanted to sell something I felt I could unequivocally recommend, that didn’t have really contradictory evidence, like probiotics, for instance, and for which there actually was a legitimate need in the marketplace.
So rest assured I wrestle with the ethical dimensions of selling my own supplements, I won’t unequivocally recommend them to anyone. Like even on the bottle I put that people with constipation or with a history of polyps in the colon shouldn’t take it, which no one else selling it warns against, 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 is 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 Mailing article called “SCFAs Part 2: The benefits of butyrate” that cites all that 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 a following blog “SCFAs Part 3: Decrypting the butyrate paradox: can excess butyrate be toxic?” she talks about 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 600-1200 mg/day of tributyrin.
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 carboxymethyl cellulose as a food additive, not hydroxypropyl methyl cellulose, which is actually used as a coating for capsules of IBD-targeted pharmaceuticals, but if you want to exercise an abundance of caution, there is one powdered tributyrin supplement called AuRx* that’s available in my Fullscript Dispensary instead, 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 Mailing’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 benefitted from it.
But if that’s not your concern, the capsule is a plant-based capsule and okay for vegans or vegetarians. I would actually have used a gelatin capsule but the manufacturer told me there was a 1-year wait for those.
So to sum 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, tributyrin is a good supplement for helping slow motility and firm up stool and reverse the cycle of an oxygenated gut. And of course, trying to bring more fiber into your regular diet so that the bacteria can ferment the fiber and produce butyrate naturally. So I’m talking about beans and lentils and psyllium husk fiber. Those things are all great for producing butyrate naturally. And if you have SIBO or other dysbiosis, you need to see an appropriate health care 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.
And if you’re interested in trying my new butyrate supplement, Tributyrin-Max, I’m offering a 15% off discount code for your first order, which is INTRO15.
