Digestive Health Archives

What Came First – The Chicken or The Infection

8 million – that’s the number of women currently at risk for difficult-to-treat bladder infections brought on by superbugs, transmitted to humans through E.coli.

But what makes these intestinal superbugs so super?

According to a recent report by the ABC News Medical Blog, superbugs are resistant to antibiotics. This can lead to a bladder infection that many bladder infection sufferers say just won’t go away.

The reason why?

“[Chickens] in many cases, are getting drugs from the time that they were in an egg all the way up to the time they are slaughtered….”

That means are gastrointestinal bacteria chickens transmit post-slaughter has already survived a lifetime of antibiotic treatment before it gets to a human host.

This could have implications for your own digestive health, particularly if you are a woman. Read the full blog here and see what doctors are doing to identify the full extent of intestinal superbugs’ digestive effects.

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More And More Research Affirms The Benefits Of Healthy Gut Bacteria

Digestive Health, Drug interactions, Healthy Aging / By Staff Writer

Dear EndoMune subscribers,

This month’s newsletter looks at some of the recent research on the positive effects healthy bacteria can have on the digestive system.

When I went into medicine, we spent a long time studying how bacteria caused serious infectious diseases. We learned about the importance of antibiotics and when to use them.

We never had a lecture on how certain bacteria (microflora) have co-evolved with us and how they help maintain our health.

No one really knew much about these healthy bacteria. But it turns out that they are essential for human life. We need them in our gut to digest food, synthesize certain vitamins and form a barricade against disease-causing bacteria.

But what do they look like in healthy people, and how much do they vary from person to person?

“Studies have found that the healthy bacteria can inhibit intestinal immune system from producing immune reactions against food protein lessening the risk of asthma, eczema and other allergies.”

Human Microbiome Project

The National Institute of Medicine launched the Human Microbiome Project¹ (HMP) in 2008. It’s a five-year program to better understand how the bacterial communities (microbiome) that live on and in the human body protect our health.

The HMP involves 200 scientists at 80 institutions. Using the latest genetic techniques, they collect samples of bacterial genetic material from 242 healthy people.

The samples have been collected from five areas of the body: the digestive tract, the mouth, the skin, the nose and the vagina.

The projects reveal some of the ways in which invisible or microscopic bacteria shape our lives from birth to death. The ultimate goal is to test whether changes in the human microbiome are associated with human health or disease.

Benefits of a Healthy Microbiome

For example, researchers² at Baylor College of Medicine have found that the vaginal bacterial flora or microbiomes change during pregnancy. Particular species, like Lactobacillus johnsonii, become dominant. This bacteria is usually found in the human intestinal tract where it produces enzymes that promote digestion of milk and substances that destroy harmful bacteria.

These findings have implications for the newborn. Before birth, the infant is in a sterile environment. The initial exposure to the world of bacteria is during the passage through the birth canal. It has been speculated that the baby will ingest some of the Lactobacillus johnsonii which will aid in digesting breast milk.

Babies born by Caesarean section start out with different microbiomes, but it is not yet known whether their microbiomes remain different after they mature.

During infancy, the baby’s intestinal microbiome expands and is impacted by breastfeeding. A study of 16 lactating women³ found that human breast milk had up to 600 bacterial species and resistant starches. Breast milk helps to promote the healthy intestinal bacteria which aid in digestion, immune function and protection from harmful bacteria.

Studies have found that the healthy bacteria can inhibit intestinal immune systems from producing immune reactions against food protein lessening the risk of asthma, eczema and other allergies.

Future Research Projects

In addition to the above studies, the HMP is doing research on the how the skin microbiome may play a role in skin disorders like psoriasis and eczema.

Other research projects are evaluating the intestinal microbiome in obese versus normal weight individuals. Previous studies have found that there is a difference in the bacterial flora in obese and thin animals and humans. Hopefully, the flora can be manipulated to lessen obesity and the associated disorders of diabetes, hypertension and heart disease.

The point of this newsletter is that the scientific community now recognizes the importance of maintaining a healthy microbiome. The concern is that antibiotics can upset the healthy microbiome and can contribute to chronic disorders like Crohn’s disease, ulcerative colitis and allergies.

Take Home Message

Consider taking a high quality probiotic like EndoMune to maintain a healthy microbiome balance.

Remember, EndoMune contains 10 strains of bacteria, and it is the only probiotic on the market developed by a board certified gastroenterologist.

Eat healthy, exercise and live well!!!
Best Wishes,
Dr. Hoberman

1) Structure, function and diversity of the healthy human microbiome. Human Microbiome Project Consortium.Nature. 2012 Jun 13;486(7402):207-14. doi: 10.1038/nature11234.

2) A metagenomic approach to characterization of the vaginal microbiome signature in pregnancy. Aagaard K, Riehle K, Ma J, Segata N, Mistretta TA, Coarfa C, Raza S, Rosenbaum S, Van den Veyver I, Milosavljevic A, Gevers D, Huttenhower C, Petrosino J, Versalovic J. PLoS One. 2012;7(6):e36466. Epub 2012 Jun 13.

3) Characterization of the diversity and temporal stability of bacterial communities in human milk.Hunt KM, Foster JA, Forney LJ, Schütte UM, Beck DL, Abdo Z, Fox LK, Williams JE, McGuire MK, McGuire MA.PLoS One. 2011;6(6):e21313. Epub 2011 Jun 17.

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How To Avoid Traveler’s Diarrhea

Diet, Digestive Health, Disease / By Staff Writer

Dear EndoMune subscribers,

It is summertime and that often means going on a vacation. This newsletter will give you some tips on how to avoid a common gastrointestinal illness while traveling.

During the peak travel seasons, we are bombarded by the Internet and television with all kinds of travel offers. Some trips are just a state or two away, but some journeys extend out of the United States to less developed countries.

This month’s newsletter is on traveler’s diarrhea (TD), a common problem encountered by vacationers visiting Latin America, the Middle East, India and South Asia.

I want to begin with a case report.

Case report

Recently back from her honeymoon at a Playa del Carmen resort in Mexico, Lisa visited her physician complaining of crampy abdominal pain, low-grade fever and diarrhea.

The first 4 days of the trip were terrific. The beaches and activities were wonderful and so was the food. In addition to the fresh fruits and seafood, Lisa particularly enjoyed the salad bar.

Unfortunately, on the fifth day she woke experiencing abdominal cramps and then diarrhea. What a way to end the honeymoon!!

Was there anything that Lisa could have done to prevent developing TD? (See answer at end of this month’s newsletter).

Overview

Diarrhea is the most common medical complaint for Americans visiting developing countries. It is estimated that for Americans traveling internationally, 9.5 to 15.9 million will experience TD. Most episodes last 3-4 days without therapy, but some infections can cause severe diarrhea and dehydration requiring hospitalization, IV fluids and antibiotics.

TD is due to consuming food or water that has been contaminated with fecal matter resulting from poor personal sanitary and public health conditions.

The organisms that cause the diarrhea are bacteria, viruses and parasites. Bacteria like E. coli, Shigella, Salmonella and Campylobacter account for 80% of the episodes of TD. The type of bacterial pathogen depends on the region travelled.

In the medical journal, Current Gastroenterology Report, an article entitled Advances in the Treatment of Traveler’s Diarrhea¹ discusses recent recommendations on how to prevent and treat TD.

Prevention

Diet: Food and water are the most common sources of infection. Reduce your risk of TD by ordering all of your foods well-cooked. Avoid raw vegetables and the skin of unpeeled fruits. Tap water and ice also present a high risk. That includes ice in sodas. The general recommendation to avoid TD is to “boil it, cook it, peel it, or forget it”. Even if it smells and looks great…don’t eat food from street vendors!!

Medications

Antibiotics can prevent TD, but it is not generally recommended to prescribe antibiotics as a prophylaxis due to the potential for adverse drug reactions and the development of drug resistant organisms.
Bismuth subsalicylate (Pepto Bismol) provides a protection rate of 60% against TD when two tablets are taken four times daily. It does cause the tongue and stool to turn black and can induce ringing in the ears.
Probiotic clinical trials using a probiotic or a placebo to prevent TD found that 85% of episodes were prevented by probiotics. The dosage of probiotic bacteria given and the type of organisms varied. The analysis found that probiotics containing Lactobacillus and Bifidobacteria strains were effective and so was the yeast, Saccharomyces boulardii. However, at this point it is still difficult to generalize that all probiotics are effective since the amount and strains of probiotic bacteria utilized varied in the different trials.

Treatment

Fluids: Fluids and electrolytes are major concerns during an episode of TD. Drinking fluids like water and rehydration packets are very important, as is eating salty soups and saltine crackers.

Antimotility Agents: Bismuth subsalicylate (Pepto Bismol) and loperimide (Imodium) taken at the onset of diarrhea can lessen the severity and duration of the episode. They do not cure the infection, and they often are taken in combination with an antibiotic.

Antibiotics: Based on established guidelines, antibiotics are generally recommended if there are 3 or more loose stools in eight hours. Fever and blood in stools are other symptoms indicating the need for antibiotics. Most physicians are comfortable prescribing an antibiotic for their patients to have in case they do develop TD.

The most commonly prescribed antibiotic is a quinolone like Cipro. However, there are regions like Thailand where the bacteria are resistant to Cipro, and azithromycin (Zithromax) is recommended.

Probiotics: Probiotic organisms may help in preventing and treating TD in a number of ways.

They produce antibacterial substances that kill invading pathogens.
They adhere to the intestinal lining cells and act as a shield against invading harmful bacteria.
They stimulate the immune system to produce a response against the pathogens.
Recommendations To Prevent TD:

1) Start taking a good probiotic like EndoMune on a daily basis. Begin at least 2-3 days before starting the trip. When traveling, EndoMune will do fine at room temperature. It is best not to store probiotics at temperatures greater than 85 degrees for prolonged periods.

2) Buy a bottle of Pepto Bismol and a box of Imodium to bring with you just in case you develop TD.

3) Check with your physician about getting a prescription for the appropriate antibiotic for TD.

Final Comments

I hope your travels are safe, joyful and healthy. I think Lisa would have been able to enjoy her entire honeymoon if she had avoided the salad bar and the skin of unpeeled fruits, and if she had taken a daily dose of EndoMune.

Eat healthy, exercise and live well!!!
Best Wishes,
Dr. Hoberman

1) Advances in the treatment of travelers’ diarrhea. Paredes-Paredes M, Flores-Figueroa J, Dupont HL. Curr Gastroenterol Rep. 2011 Oct;13(5):402-7. Review.

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Pain Medications and Gastrointestinal Injury

Digestive Health, Drug interactions, Healthy Aging / By Staff Writer

Every day we are bombarded with ads for medications to ease the pain of arthritis. The majority of these ads are for a common class of drugs called nonsteroidal anti-inflammatory drugs or NSAIDs. These are very commonly used drugs – more than 30 million Americans take these medications on a daily basis.

NSAIDs include aspirin, over the counter medications like Advil, Motrin, Aleve, Nuprin and the generic version, ibuprofen. A few of the well-known brand name prescription medications within this same class include Naprosyn, Mobic, Indocin, Relafen and Clinoril.

These drugs are also combined with antihistamines and marketed as a sleep aid such as Advil PM. Additionally, NSAIDs are combined with a decongestant and marketed as Motrin Cold and Sinus.

While NSAIDs are very effective medications for lessening inflammation and fever and easing the pain of arthritis, they can also cause serious side effects, mainly in the gastrointestinal (GI) tract.

Both limited and chronic use of NSAIDs can lead to stomach ulcers and may also cause damage to the lining of the small intestines and colon. These injuries are referred to as NSAID-induced gastropathy, enteropathy and colopathy.

The general public is aware of the risk of stomach ulcers, but lesser known is the risk of NSAID-induced intestinal ulcers, strictures, perforation and colitis. Studies in humans taking chronic NSAIDs have shown 50-70% of the individuals have evidence of damage to the small intestines^(1,2).

Decreased Intestinal Inflammation: Yet Another Benefit of Probiotics

NSAIDs prevent the production of a protective mucus barrier in the small intestines. Without this protective barrier, bile acids, enzymes and harmful intestinal bacteria are able to damage the intestinal lining cells. However, experimental studies in mice have shown that the NSAIDs cannot cause this injury to the small intestines if the intestinal tract is sterile⁽⁴⁾.

Since our intestines and GI tracts are not sterile, a study was undertaken to determine if probiotic bacteria given to individuals taking NSAIDs could protect against small intestinal damage⁽³⁾. They studied 20 healthy volunteers who took either a placebo or a probiotic. All volunteers received indomethacin, and their stools were collected to measure for a protein called calprotectin. This protein is increased in stools if there is damage to the intestines⁽⁴⁾.

The study found that the volunteers receiving the placebo had a statistically significant increase in calprotectin concentration in their stools beginning on the second day of taking indomethacin compared to the group that received the probiotic. The authors concluded that the results of this study suggest that a probiotic given before and during indomethacin therapy could be useful in decreasing intestinal inflammation. They recommended that further studies be performed to confirm their results.

Take Home Message

Each year scientific studies are discovering new health benefits of probiotics. Based on the current study, I would suggest if individuals need to be on NSAID drugs, they should consider taking a probiotic with a mixture of bacteria in a dose of greater than 10 billon per serving – like EndoMune Advanced.

Finally, I think it is important for the general population to understand that taking NSAIDs in any form has potential adverse effects and the risks versus benefits should be considered.

Thank you for your interest in EndoMune.

Eat healthy, exercise and live well!

Dr. Lawrence Hoberman

(1) Is non-steroidal anti-inflammatory drug (NSAID) enteropathy clinically more important than NSAID gastropathy? Adebayo D, Bjarnason I.Postgrad Med J. 2006 Mar;82(965):186-91

(2) Present status and strategy of NSAIDs-induced small bowel injury. Higuchi K, Umegaki E, Watanabe T, Yoda Y, Morita E, Murano M, Tokioka S, Arakawa T.J Gastroenterol. 2009;44(9):879-88. Epub 2009 Jul 1

(3) The effects of a probiotic mixture on NSAID enteropathy: a randomized, double-blind, cross-over, placebo-controlled study.Montalto M, Gallo A, Curigliano V, D’Onofrio F, Santoro L, Covino M, Dalvai S, Gasbarrini A, Gasbarrini G.Aliment Pharmacol Ther. 2010 Apr 7

(4) Fecal calprotectin as a promising marker of inflammatory diseases. Paduchova Z, Durackova Z.Bratisl Lek Listy. 2009;110(10):598-602.

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To Go or Not To Go… that is the problem

Digestive Health, Disease, Women’s Health / By Staff Writer

Dear EndoMune subscribers,

Now that we are enjoying the beauty of the spring days, we really don’t want to be slowed down by any GI issues. The following real case report describes how EndoMune can make a positive difference in your health this season:

Case Study: Constrained By Constipation

Karen, a 34-year old corporate executive, saw her primary care physician due to a problem of constipation. Karen had a longstanding history of difficulty with normal stool habits. She had tried a variety of diets and laxatives with no real improvement.

A comprehensive gastroenterological evaluation did not reveal any abnormality. She was told that her problem was due to “irritable bowel syndrome.”

The physician recommended a high fiber diet, stool softeners and exercise.

Karen continued to have problems with bloating, distention and constipation. Her GI issues made it hard for her to function at work. Enjoying outdoor activities like hiking and biking with her family were difficult.

Karen read about probiotics and decided to try EndoMune.

After one week of therapy, Karen’s constipation markedly improved. She was so delighted with the results that she emailed to let me know how EndoMune had made such a difference in her life.

The Discomfort of Constipation

After reading the case report, it is apparent that this month’s newsletter is about how probiotics can ease the problem of constipation.

Constipation is a common condition affecting children and adults. In the vast majority of cases, no underlying natural cause is found and functional constipation or “irritable bowel syndrome” is diagnosed.

Did you know that:

Constipation is medically defined as less than 3 stools per week and associated with straining1

Constipation is one of the most common GI disorders in clinical practice

Approximately 20% of the general population suffers from chronic constipation during their lifetime

Childhood constipation accounts for 3-5% of all visits to pediatricians2

Approximately 70-80% of nursing home residents have constipation3

Finding Relief

In the last 5-6 years, there have been a number of medical studies evaluating whether probiotics can improve constipation and associated symptoms. Not all of them have shown benefit.

I have listed the results of some of the most well done studies:

In 2011, Guerra et al4 reported the results of a study involving 59 children suffering with constipation. Over a 10-week period, the group receiving probiotics had significant improvement in stool frequency, consistency and less abdominal pain.

In 2011, Waller et al5 published a study done on 100 adults with chronic constipation. The group receiving probiotics for 14 days had significantly improved stool frequency and decreased abdominal symptoms compared to the control group.

In 2010, Hyang et al6 reported the results of a clinical study using probiotics in a group of nursing home patients. After 2 weeks of therapy, there was a significant improvement in frequency and consistency of the stools.

In addition to improving GI function, there were no adverse side effects associated with the use of probiotics in these medical studies. This is a very important and unique benefit of probiotic use when compared to other constipation therapies.

How probiotics improve intestinal function is being actively researched by medical experts. Studies7 have found that the bacterial flora in constipated individuals is different than in individuals with regular bowel movements in that they lack the ability to produce beneficial fermented products that enhance intestinal function. Adding probiotics reestablishes a healthy intestinal flora resulting in improved intestinal activity.

Take Home Message

If you struggle with GI issues, consider adding EndoMune to your daily regimen and enjoy these beautiful spring days comfortably!

Eat healthy, exercise and take EndoMune!

Best Wishes,

Lawrence Hoberman MD

1) Epidemiology of constipation in North America: a systematic review.Higgins PD, Johanson JF.Am J Gastroenterol. 2004 Apr;99(4):750-9. Review

2) Epidemiology of childhood constipation: a systematic review.van den Berg MM, Benninga MA, Di Lorenzo C.Am J Gastroenterol. 2006 Oct;101(10):2401-9. Review.

3) Chronic Constipation in the Elderly free Juan F Gallegos-Orozco, Amy E Foxx-Orenstein, Susan M Sterler & Jean M StoaThe American Journal of Gastroenterology 107, 18-25
doi:10.1038/ajg.2011.349

4) Pediatric functional constipation treatment with Bifidobacterium-containing yogurt: a crossover, double-blind,controlled trial.Guerra PV, Lima LN, Souza TC, Mazochi V, Penna FJ, Silva AM, Nicoli JR, Guimarães EV.World J Gastroenterol. 2011 Sep 14;17(34):3916-21.

5) Dose-response effect of Bifidobacterium lactis HN019 on whole gut transit time and functional gastrointestinal symptoms in adults.Waller PA, Gopal PK, Leyer GJ, Ouwehand AC, Reifer C, Stewart ME, Miller LE.Scand J Gastroenterol. 2011 Sep;46(9):1057-64. Epub 2011 Jun 13.

6) Efficacy of Lactic Acid Bacteria (LAB) supplement in management of constipation among nursing home residents.An HM, Baek EH, Jang S, Lee do K, Kim MJ, Kim JR, Lee KO, Park JG, Ha NJ.Nutr J. 2010 Feb 5;9:5.

7) Functional dysbiosis within the gut microbiota of patients with constipated-irritable bowel syndrome (pages 828–838) C. Chassard, M. Dapoigny, K. P. Scott, L. Crouzet, C. Del’homme, P. Marquet, J. C. Martin, G. Pickering, D. Ardid, A. Eschalier, C. Dubray, H. J. Flint and A. Bernalier-DonadilleAlimentary Pharmacology and Therapeutics, 03/19/2012

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