Disease Archives

Probiotics Aid in Preventing Female Urinary Tract Infections

Disease, Women’s Health / By Staff Writer

Dear EndoMune Subscribers,

Appropriately, May’s newsletter is directed to women. May was named for the Greek goddess Maia…and men, don’t forget that Sunday, May 13th, is Mother’s Day.

Let’s start this month’s newsletter with a case report:

CASE REPORT

Susan is a 48 year-old woman who has suffered with recurrent urinary tract infections. She was aware that the symptoms of urgency, frequency and burning are typical warnings signs of an impending urinary tract infection. Her doctor would likely prescribe an antibiotic to treat the infection.

Unfortunately, two years ago, Karen ended up in the emergency room with fever to 1030, generalized aches and hypotension. She was hospitalized and given IV antibiotics for a serious bout of an E. coli bacterial kidney infection.

Susan read about the benefits of taking a probiotic to lessen the risk of recurrent urinary tract infections. She emailed me to say that since starting EndoMune two years ago, she has not had another infection!!

BACKGROUND

The female urinary tract is composed of the kidneys, ureters, bladder and urethra.

The short female urethra places women at increased risk for urinary infections. A urinary tract infection or UTI is a bacterial infection that occurs when bacteria invade the urinary tract system. Nearly 1 in 3 women will have had at least 1 episode of UTI requiring antimicrobial therapy by the age of 24 years. Almost half of all women will experience 1 UTI during their lifetimes. Financially, the estimated annual cost of community-acquired UTI is significant, at approximately $1.6 billion1.

DEFINITIONS

A urinary tract infection limited to the bladder can be painful and annoying. However, serious consequences can occur if a urinary tract infection spreads to the kidneys.

Susan’s recurrent infections occurred in the urinary bladder, or the cystitis. She was hospitalized because the bacteria were able to travel from the bladder to the kidneys and cause pyelonephritis, a serious kidney infection.

CAUSE

The urine is normally sterile. An infection occurs when bacteria are able to invade the lining cells of the urinary tract. The infection usually starts at the opening of the urethra and migrates into the urinary bladder and at times, up into the kidneys.

The culprit in at least 90% of uncomplicated infections is a type of bacteria called Escherichia coli, better know as E. coli. These bacteria normally live in the bowel (colon) and around the rectum.

These bacteria can accidentally contaminate the opening of the urethra and invade the lining cells of the urinary tract. Two common causes are limited fluid intake and sexual intercourse.

BENEFITS OF PROBIOTICS

There have been many studies2,3 that have evaluated the benefits of probiotic bacteria like the Lactobacillus species in preventing recurrent UTI’s. Different strains have been used in clinical trials. Trials have included oral probiotics and vaginal suppositories. Not all the trials have shown benefit, but no study has found that probiotics cause any adverse effects.

The theory has been that the Lactobacillus bacteria that normally inhabit the vaginal mucosa produce different protective products that destroy or inhibit the invasion of harmful bacteria like E. coli.

Taking probiotics that contain Lactobacillus strains will increase the stool concentration of these protective bacteria. The Lactobacillus bacteria can then migrate from the intestinal tract to the urethra area, stimulating the lining cells to activate an immune response against pathogens like E. coli and producing a biofilm that acts as a barrier against harmful bacteria.

PREVENTIVE MEASURES

For women who suffer with recurrent infections, physicians recommend several preventive measures such as voiding after intercourse, wiping from front to back, and drinking plenty of water.

Physicians will prescribe an antibiotic for UTI’s and sometimes will recommend use of antibiotics as a preventative.

TAKE HOME MESSAGE

While there is no perfect regimen to prevent recurrent UTI’s, may assist with prevention. If you or a loved one suffers from recurrent UTI’s, consider trying a probiotic like EndoMune.

Remember, Mother’s Day is May 13th! Men, consider giving the mothers in your life a bottle of EndoMune.

Eat healthy, exercise, take EndoMune and live well!!

Dr. Hoberman

1) Epidemiology of urinary tract infections: incidence, morbidity, and economic costsBetsy Foxman, PhD, Am J Med. 2002 Jul 8;113 Suppl 1A:5S-13S

2) Prevention and treatment of urinary tract infection with probiotics: Review and research perspective.Borchert D, Sheridan L, Papatsoris A, Faruquz Z, Barua JM, Junaid I, Pati Y, Chinegwundoh F, Buchholz N.Indian J Urol. 2008 Apr;24(2):139-44

3) Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Stapleton AE,

Au-Yeung M, Hooton TM, Fredricks DN, Roberts PL, Czaja CA, Yarova-Yarovaya Y, Fiedler T, Cox M, Stamm WE.Clin Infect Dis. 2011 May;52(10):1212-7

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The Gut-Brain-Skin Connection and the Benefits of Probiotics

Diet, Disease, Healthy Aging / By Staff Writer

Greetings EndoMune Subscribers!

March is the month we shake off the winter blues and start thinking about spring flowers and beautiful days. On the flip side, it is also the time we must complete taxes; or for students, prepare for midterm exams. Basically, March is a happy month mixed with some stress.

This month I want to discuss two common chronic skin conditions affected by stress: Acne vulgarus and Acne Roseaca.

Emotional Stress Leads To Bodily Stress

A well-respected medical journal, Gut Pathogens, published an interesting article last year that outlined how emotional stress has an impact upon common skin conditions like acne and rosacea.

Consider these four cases:

1.) Emotional stress can disturb the healthy balance of intestinal bacteria.
2.) Overgrowth of harmful bacteria break down the intestinal barrier and stimulates the immune system
3.) The immune system can contribute to the skin inflammation that causes acne and rosacea.
4.) Re-establishing the healthy balance of intestinal bacteria helps to improve these skin conditions.

Where There’s A Probiotic, There’s A Cure

Acne or pimples occur when hair follicles become infected. The exact cause is still unknown, but the hair follicles become blocked which allows the bacteria, Probionibacterium acnes, to proliferate and cause inflammation resulting in pimples. A very common form of therapy is to prescribe antibiotics either topically or orally to clear the infection and control flares of acne. Unfortunately, this form of therapy is also associated with intestinal side effects and doesn’t always work. Scientific studies have shown that adding probiotics to standard acne treatment therapy can improve the inflammation and also lessen GI symptoms.

Acne Rosacea or rosacea is a common chronic skin condition that occurs in adults. It causes redness of the face and nose and pimples. In advanced cases, the nose becomes bulbous. President Bill Clinton and Prince Charles are among the millions of people who suffer from this condition.

Stress is a factor that can aggravate rosacea. Excess build up of bacteria in the intestines also plays a role. Taking antibiotics can help to control the skin inflammation. There are several scientific reports that also adding probiotics can help.

Over the years, a number of readers have written in, letting us know how much EndoMune has helped them manage teenage acne and adult rosacea…especially during stressful times!

Take Home Message

Bottom line: If you or your loved ones have these skin conditions, consider taking EndoMune to lessen skin flares – especially if March brings you stress.

Eat healthy, exercise, take EndoMune and live well!

Best Wishes,
Lawrence Hoberman MD

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Otitis Media: Probiotics Should be Given Alongside Antibiotics

Disease, Drug interactions / By Staff Writer

We are in the full swing of cold and flu season. I’m hopeful everyone got their flu shot and is staying healthy. However, if you’re not so fortunate and your kids are suffering with symptoms, then this is a very timely newsletter for you to read.

This month we will explore two important clinical studies published in the January 13th issue of the New England Journal of Medicine ^(1,2). These studies provide evidence that prescribing antibiotics is beneficial for infants and young children who are suffering with a very common disorder called otitis media. This is an infection of the middle ear, usually due to bacteria.

For a number of years, the pediatric medical organizations recommended watchful waiting for some children with evidence of acute otitis media. This is primarily because some children with mild infections may improve without the use of antibiotics. Unfortunately, the problem is the identification of which children will do well without antibiotics.

While many physicians do not like to prescribe antibiotics, and often only do so if no other solutions are available, otitis media can become a very serious condition. In some children it can progress to the point of a perforation of the eardrum or even lead to the development of mastoiditis. Clearly, waiting to treat a child can be a risk.

To determine the efficacy of antibiotics on acute otitis media, the researchers in these recent studies prescribed a very effective antibiotic to one group of children and the other group received a placebo. The children were followed closely for 7-10 days to determine the treatment outcome. If the children receiving the placebo developed worsening infections, they would be given “rescue therapy.”

The results were of the treatment were as follows:

Children on antibiotics: 18.6% treatment failure
Childen on placebo: 44.9% treatment failure

The authors concluded that otitis media in this age group is a treatable disease with the use of antibiotics: “More young children with a certain diagnosis of acute otits media recover more quickly when they are treated with an appropriate antimicrobial agent.” ⁽²⁾

The next step in these research studies is to determine how to identify the children who may get better without the use of antibiotics.

Unwanted Side Effects of Antibiotics

It’s worth noting that two of the most frequent adverse events occurring in the children receiving antibiotics were diarrhea and diaper area dermatitis. More than 50% of the children in the antibiotic group developed diarrhea and/or diaper rash. Among the children who received a placebo, only 25% experienced these side effects.

So how can these effects be mitigated if your child needs to take an antibiotic? There are several published studies ⁽³⁾ that have found that taking a probiotic when antibiotics are prescribed can reduce the risk of developing diarrhea by roughly 50%. While very few medications or treatments are 100% effective, taking a probiotic for a 50% chance to reduce the risk of antibiotic related diarrhea and diaper rash is a worthwhile effort.

Take Home Message

If your child is prescribed an antibiotic, consider adding a probiotic that will lessen the risk of diarrhea and diaper rash. Remember to separate the timing of the antibiotic and probiotic by two hours to insure the probiotic bacteria are not destroyed by the antibiotic.

Finally, to be successful, the probiotic serving size should be greater than 10 billion bacteria and consist of multistrain, multispecies organisms like those in EndoMune Jr.

Wishing you and your children a very healthy winter season!

Eat healthy, exercise and live well!
Dr. Hoberman

References:

(1) A placebo-controlled trial of antimicrobial treatment for acute otitis media. Tähtinen PA, Laine MK, Huovinen P, Jalava J, Ruuskanen O, Ruohola A. N Engl J Med. 2011 Jan 13;364(2):116-26.

(2) Treatment of acute otitis media in children under 2 years of age. Hoberman A, Paradise JL, Rockette HE, Shaikh N, Wald ER, Kearney DH, Colborn DK, Kurs-Lasky M, Bhatnagar S, Haralam MA, Zoffel LM, Jenkins C, Pope MA, Balentine TL, Barbadora KA.N Engl J Med. 2011 Jan 13;364(2):105-15.

(3) Probiotics for prevention of antibiotic-associated diarrhea. Doron SI, Hibberd PL, Gorbach SL. J Clin Gastroenterol. 2008 Jul;42 Suppl 2:S58-63.

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Probiotics, Leaky Gut and Autoimmune Diseases

Disease, Drug interactions, Probiotics / By Staff Writer

I am hopeful you all had a wonderful holiday season and will enjoy a healthy and successful New Year.

January is the month in which we make resolutions to exercise, eat healthy and maybe lose a few of those unwanted pounds.

This month’s newsletter discusses another reason why you should consider adding EndoMune to your list of healthy things to do.

Leaky Gut Makes Way for Harmful Toxins

I want to begin 2012 by sharing with you an important probiotic benefit that I haven’t previously mentioned. The term “leaky gut” has been around for a long time. It has been used more in the alternative medicine sector to explain a variety of health issues⁽²⁾.

Conventional medicine now recognizes the importance of a healthy intestinal barrier against toxins and harmful intestinal organisms. When there is a breakdown in this barrier, the disorder is decsribed as “increased intestinal permeability”⁽³⁾ – or, in other words, leaky gut.

In the November issue of the medical journal, Clinical Reviews in Allergy and Immunology, Dr. Alessio Fasano (Director of the University of Maryland Center for Celiac Research) published an article on “Leaky Gut and Autoimmune Diseases”⁽⁴⁾.

As a pediatric gastroenterologist and research scientist, he has developed a theory on how a leaky gut can contribute to autoimmune disorders such as:

Celiac disease
Inflammatory bowel disease
Type 1 diabetes
Multiple sclerosis
Rheumatoid arthritis

Evolution of a Healthy Intestinal Barrier

As man evolved, it was critical to develop a mechanism that would allow humans to coexist with intestinal organisms like bacteria and parasites. Some of the organisms were beneficial but others could invade and cause serious infections and death.

Fortunately, the intestinal lining cells acts as an effective barrier between the internal and external environment. From a physical standpoint, the lining is similar to a brick wall. The bricks are the intestinal cells and the mortar is the “tight junction” between the cells. The tight junction is made up of secreted proteins that make the lining impermeable to some of the gut contents. The healthy intestinal bacteria – like those in probiotics – help maintain the intestinal barrier by stimulating the production of tight junction proteins.

One of the major proteins in the tight junction is called zonulin. “Zonulin works like the traffic conductor or the gatekeeper of our body’s tissues. Zonulin opens the spaces between cells allowing some substances to pass through while keeping harmful bacteria and toxins out⁽⁵⁾,” explains Dr. Fasano. “It has a major effect on intestinal permeability.

Zonulin: A Contributor to Autoimmune Diseases

Studies suggest that increased levels of zonulin are a contributing factor to the development of autoimmune diseases. Zonulin weakens the other proteins making up the tight junction resulting in increased intestinal permeability.

In individuals with a genetic predisposition to autoimmune disorders, a leaky gut exposes their immune cells to proteins in bacteria, viruses and other environmental agents. They then develop antibodies which cross react to their own cells resulting in a variety of autoimmune diseases.

Dr. Fasano performed a clinical trial in patients with celiac disease. This disorder is due to an immune reaction against gluten proteins in grains. The studies found that when individuals with a genetic predisposition to celiac disease were challenged with gluten, there was a 70% increase in intestinal permeability and an increase in zonulin. By giving a drug that blocks the activity of zonulin, however, there was no increase in permeability when exposed to gluten. Additionally, the patients didn’t develop diarrhea or symptoms associated with celiac disease.

When the healthy intestinal balance is disturbed by such diverse things as repeated antibiotic exposure, stress or alcohol misuse, the harmful bacteria are then able to penetrate the tight junctions and invade the wall of the intestines. The result is increased permeability and immune inflammation.

There are a number of studies on how probiotic bacteria stimulate the production of tight junction proteins and prevent increased intestinal permeability^(6,7,8).

This is a very exciting time in intestinal permeability research and understanding how to lessen the risk of developing an autoimmune disease.

I am amazed how intestinal bacteria and specifically probiotic bacteria have such an impact on our overall health!

Take Home Message

If you or any of your family members suffer with an autoimmune disorder, check with your doctor about the benefits of taking a probiotic like EndoMune.

Eat healthy, exercise, take EndoMune and live well!

Best Wishes,
Dr. Hoberman

References

(1) Developmental biology of gut-probiotic interaction Ravi Mangal Patel, Patricia W Lin Gut Microbes. 2010 May-Jun; 1(3): 186–195. Published online 2010 May 26. doi:

(2) A brief evidence-based review of two gastrointestinal illnesses: irritable bowel and leaky gut syndromes. Kiefer D, Ali-Akbarian L. Altern Ther Health Med. 2004 May-Jun; 10(3):22-30; quiz 31, 92.

(3) Intestinal permeability, leaky gut, and intestinal disorders. Hollander D. Curr Gastroenterol Rep. 1999 Oct; 1(5):410-6.

(4) Leaky Gut and Autoimmune Diseases. Fasano A.Clin Rev Allergy Immunol. 2011 Nov 23.

(5) Physiological, Pathological, and Therapeutic Implications of Zonulin-Mediated Intestinal Barrier Modulation : Living Life on the Edge of the WallAlessio Fasano Am J Pathol. 2008 November; 173(5): 1243–1252

(6) Therapeutic manipulation of the enteric microflora in inflammatory bowel diseases: antibiotics, probiotics, and prebiotics.Sartor RB Gastroenterology. 2004 May ;126(6):1620

(7) VSL#3 probiotics regulate the intestinal epithelial barrier in vivo and in vitro via the p38 and ERK signaling pathways.Dai C, Zhao DH, Jiang M.Int J Mol Med. 2012 Feb;29(2):202-8. doi: 10.3892/ijmm.2011.839. Epub 2011 Nov 15.

(8) Molecular regulation of the intestinal epithelial barrier: implication in human diseases.Liu Z, Shi C, Yang J, Zhang P, Ma Y, Wang F, Qin H.Front Biosci. 2011 Jun 1;17:2903-9. Review.

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Study Links Crohn’s and Ulcerative Colitis to Antibiotic Use

Disease, Healthy Aging, Mental Health / By Staff Writer

Many physicians are hesitant to prescribe antibiotics for many reasons. In fact, it’s not uncommon for physicians to use antibiotics as a last option for treatment. Those who are hesitant to prescribe antibiotics now have one more reason – Crohn’s Disease and Ulcerative Colitis (Here is more information on “What Is Colitis?“).

A new study published in the American Journal of Gastroenterology has found that people who are prescribed larger amounts of antibiotics have a higher risk for inflammatory bowel diseases (IBD). Crohn’s Diease and Colitis are the most common forms of IBD and can cause inflammation in the intestines, which then can cause abdominal pain, diarrhea and weight loss.

The article can be found at length at the American College of Gastroenterology website.

Study Links Crohn’s and Ulcerative Colitis to Antibiotic Use Read More »

IBS Sufferers Not at Greater Risk for Colon Cancer

Disease, Drug interactions, Probiotics / By Staff Writer

Some very reassuring news was just released from a recent research study. The study, published in the American Journal of Gastroenterology found Irritable Bowel Syndrome (IBS) patients to be at no greater risk than healthy patients for polyps, colon cancer or inflammatory bowel disease.

According to the article:

This research shows that it is unnecessary to order colonoscopies for patients with IBS, unless they show alarming symptoms like unexplained weight loss or anaemia, bleeding from the GI tract, or have a family history of colon cancer, inflammatory bowel disease, or celiac disease, says Dr. Chey.

If you’re interested in reading the article in its entirety on DocGuide.com, visit:
http://www.docguide.com/news/content.nsf/news/852576140048867C852576E20000C862

IBS Sufferers Not at Greater Risk for Colon Cancer Read More »

Probiotics Benefits for IBS, Cancer and Chemotherapy

Disease, Healthy Aging / By Staff Writer

Generally, the monthly newsletter is on a specific topic related to probiotics. This month I thought I would present a potpourri of recent scientific articles on probiotic benefits.

1) Post Infectious Irritable Bowel Syndrome

There have been a number of studies published on the relationship between acute infectious gastroenteritis (diarrhea) and the subsequent development of ongoing symptoms of Irritable Bowel Syndrome (IBS). IBS is characterized by intermittent abdominal pain, altered bowel habits and other gastrointestinal symptoms such as bloating and flatulence in the absence of structural abnormalities in the intestine.

When healthy individuals develop gastroenteritis due to food and water contamination, studies have found up to 30% of the infected population will have chronic ongoing gastrointestinal symptoms of IBS. The general opinion is that the infecting bacteria or parasite stimulated the immune system, leading to chronic inflammation^(1,2,3).

Probiotics can suppress the inflammatory process and may alleviate symptoms. No study has been specifically done in post infectious IBS, but the safety and potential anti-inflammatory properties of probiotics make them an intriguing option for management of these patients ^(4,5,6).

Commentary
This can be a real concern for our military troops. A recent study reported that “infectious diarrhea is one of the most common medical problems associated with military deployments” ⁽⁷⁾. Overall, diarrhea was reported in 76.8% of the troops in Iraq and 54.4% in Afghanistan ⁽⁸⁾. There have been no published reports on the use of probiotics in our troops, but it seems a reasonable to consider the use of probiotics to lessen the risk of gastroenteritis and post infectious IBS.

2) Anticancer Effect of Probiotics

Evidence that probiotics have anticancer activity has been emerging from laboratory studies. A recent study investigated the effect of a probiotic on the growth of colon cancer cells in a test tube and the development of colon cancer in mice ⁽⁹⁾. The probiotic suppressed the activity of a cell receptor called ErbB2 which has to do with cell division and growth. There is an anticancer drug called Herceptin that acts as an antibody to inhibit this receptor in breast cancer cells.

Commentary
There have been a number of studies on probiotics protective effect against colon cancer ⁽¹⁰⁾. There are no direct experimental investigations for cancer suppression in human subjects using probiotics. However, there are a wealth of studies indicating indirect evidence for cancer suppression in human subjects. This study helps to identify one of the mechanisms how probiotics can prevent cancer development. Bottom line, it doesn’t hurt to take a probiotic.

3) Chemotherapy-Induced Diarrhea

Diarrhea is a common side effect induced by anticancer treatments such as chemotherapy and radiation. A recent case study reported on a patient receiving chemotherapy for breast cancer who developed severe diarrhea requiring discontinuation of the medication and hospitalization for 2 weeks⁽¹¹⁾. The patient was prescribed a probiotic to be taken twice daily. The probiotic controlled the intestinal symptoms and diarrhea, and no adverse effects were noticed. The patient reported that if she stopped taking the probiotics, the diarrhea returned immediately. The patient was discharged from the hospital and was able to continue the scheduled chemotherapy medications while taking the probiotic.

Commentary
Chemotherapy agents cause diarrhea by damaging the intestinal mucosa. In addition, the normal intestinal bacterial flora can be disrupted. A study published in 2007 on the frequency of severe diarrhea in patients receiving chemotherapy for colon cancer was reduced with the supplementation of a probiotic ⁽¹²⁾. In addition, there was less abdominal discomfort, need for hospital care and fewer chemotherapy dose reductions due to bowel toxicity. No probiotic related toxicity was detected. Hopefully these reports will stimulate further clinical studies to determine whether probioitcs are an effective treatment for controlling diarrhea in patients receiving chemotherapy agents.

Take Home Message

Probiotics are entering a new era in clinical medicine. No longer are they just considered complimentary and alternative therapies. Each month, there are new published reports on the therapeutic benefits of probiotics.

When you consider taking a probiotic, think EndoMune Advanced for adults and EndoMune Kidsfor children. These are high quality, potent probiotics!

Thank you for your interest in EndoMune.

Eat healthy, exercise and live well!
Dr. Lawrence Hoberman

(1) Travel and travelers’ diarrhea in patients with irritable bowel syndrome. DuPont HL, Galler G, Garcia-Torres F, Dupont AW, Greisinger A, Jiang ZD. Am J Trop Med Hyg. 2010 Feb;82(2):301-5.

(2) Bugs and irritable bowel syndrome: The good, the bad and the ugly. Ghoshal UC, Park H, Gwee KA.J Gastroenterol Hepatol. 2010 Feb;25(2):244-51. Epub 2010 Jan 14.

(3) Post-infectious irritable bowel syndrome.Thabane M, Marshall JK. World JGastroenterol. 2009 Aug 7;15(29):3591-6.Review

(4) Immunosuppressive effects via human intestinal dendritic cells of probiotic bacteria and steroids in the treatment of acute ulcerative colitis. Ng SC, Plamondon S, Kamm MA, Hart AL, Al-Hassi HO, Guenther T, Stagg AJ, Knight SC.Inflamm Bowel Dis. 2010 Feb 12.

(5) Probiotics have clinical, microbiologic, and immunologic efficacy in acute infectious diarrhea.Chen CC, Kong MS, Lai MW, Chao HC, Chang KW, Chen SY, Huang YC, Chiu CH, Li WC, Lin PY, Chen CJ, Li TY.Pediatr Infect Dis J. 2010 Feb;29(2):135-8.

(6) Probiotics: their role in the treatment and prevention of disease. Doron S, Gorbach SL.Expert Rev Anti Infect Ther. 2006 Apr;4(2):261-75. Review.

(7) Military importance of diarrhea: lessons from the Middle East.Sanders JW, Putnam SD, Riddle MS, Tribble DR.Curr Opin Gastroenterol. 2005 Jan;21(1):9-14. Review.

(8) Outcomes of diarrhea management in operations Iraqi Freedom and Enduring Freedom.Brown JA, Riddle MS, Putnam SD, Schlett CD, Armstrong AW, Jones JJ, Tribble DR, Sanders JW.Travel Med Infect Dis. 2009 Nov;7(6):337-43. Epub 2009 Sep 30.

(9) Int J Cancer. 2009 Oct 28. [Epub ahead of print]The anticancer effect of probiotic Bacillus polyfermenticus on human colon cancer cells is mediated through ErbB2 and ErbB3 inhibition.Ma EL,Choi YJ, Choi J, Pothoulakis C, Rhee SH, Im E.

(10) The effects of probiotics on colon cancer development. Rafter J.Nutr Res Rev. 2004 Dec;17(2):277-84.

(11) Use of probiotics in the management of chemotherapy-induced diarrhea: a case study.Abd El-Atti S, Wasicek K, Mark S, Hegazi R. JPEN J Parenter Enteral Nutr. 2009 Sep-Oct;33(5):569-70. Epub 2009 May 7.

(12) Lactobacillus supplementation for diarrhoea related to chemotherapy of colorectal cancer: a randomised study.Osterlund P, Ruotsalainen T, Korpela R, Saxelin M, Ollus A, Valta P, Kouri M, Elomaa I, Joensuu H.Br J Cancer. 2007 Oct 22;97(8):1028-34. Epub 2007 Sep 25.

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What Causes Gas – Is it a Normal Occurence?

Disease, Probiotics / By Staff Writer

All humans have gas in their gastrointestinal tract. The type of food, and beverages consumed and whether the individual smokes or chews gum will have a significant impact on the amount of gas produced and passed. Carbonated beverages will increase intestinal gas. Eating a healthy diet of fruits, vegetables and high fiber grains increases intestinal gas formation.

Dependent upon how it is measured, the gas in the intestinal tract varies from 3 to 6 ounces. The average adult produces 16 to 48 ounces of intestinal gas resulting in about 14 to 23 gas passages/day.

Complex Carbohydrates: The human intestinal tract can’t digest some of the complex carbohydrates in vegetables, fruits and whole grain products. These carbohydrates pass through the small intestines into the colon where they are fermented by gas producing bacteria. Hydrogen, carbon dioxide and methane are the main gases produced. Depending on the diet and the intestinal microflora, the amount of gas produced and expelled will vary from individual to individual. The strong odor sometimes associated with intestinal gas is due to the very small production of sulfide gases which is dependent on diet and intestinal bacteria.
Lactose is a sugar in dairy products which must be broken down to a simpler form to be absorbed by the intestines. Thirty to 50 million Americans develop lactose intolerance beginning after the age of 2. It is a common problem in the Asian, African American, American Indian, Hispanic, and Eastern European Jewish populations. Undigested lactose prevents fluid absorption and the sugar is fermented by the bacteria in the colon which results in increased intestinal gas and at times, diarrhea. The main form of therapy is to avoid lactose containing foods.
Fructose: Another dietary sugar that can cause excessive gas, bloating and loose stools is fructose. Fruits that are high in fructose include apples, apricots, pears, cherries, plums, prunes and peaches (as well as their juices). It is also a used as sweetener in soft drinks and other products. The small intestine has a limited ability to absorb dietary fructose. If it is exceeded, fructose will be fermented in the colon leading to excess gas formation.
Sorbitol is found naturally in fruits, including apples, pears, peaches, and prunes. It is also used as an artificial sweetener in many dietetic foods and sugar free candies and gums. Sorbitol is not well absorbed by the small intestines. Excess intake will also lead to bloating, gas, and diarrhea.

Studies have found that some individuals with symptoms of bloating and distention may be more sensitive to the amount of gas and fluid in the intestines. Some may have slow intestinal motility leading more fluid and gas in the intestines.

Having the right balance of bacteria in the intestines can be important to lessen the symptoms of bloating, distention and gas.

Probiotics, containing bacterial strains similar to those in Endomune have been studied and utilized to help lessen these symptoms. There have been positive results in many of the studies. There are no effective prescription medications to alleviate excess gas formation. One of the nice aspects of probiotics is the fact that they are safe and without significant side effects. Given the positive studies, taking Endomune may improve the digestion and absorption of the complex and simple carbohydrates.

What Causes Gas – Is it a Normal Occurence? Read More »

How Probiotics Can Aid IBS Sufferers

Disease, Probiotics / By Staff Writer

I have spent a lot of time talking with physicians, pharmacists, and patients about the benefits of probiotics. The one topic that comes up most frequently is how probiotics can aid individuals who suffer with Irritable Bowel Syndrome (IBS).

IBS affects up to one in five Americans. Second only to the common cold as a leading cause of workplace absenteeism in the U.S., IBS costs the U.S. healthcare system up to an estimated $30 billion annually in direct and indirect costs.

Medical Presciptions for IBS

When I first went into gastroenterology, the understanding of IBS was very limited. It was generally thought that the symptoms of bloating, gas, diarrhea, and constipation were most likely related to stress. If the intestinal symptoms were manifestation of the stress, then controlling the stress would alleviate the problem. Commonly prescribed therapies included tranquilizers like Librium and phenobarbitol, and antidepressants like Elavil and Aventyl, which were then combined with other drugs – antispasmotics – that affected the nerves that go to the GI tract. The typical drug armament included such medications as Librax, Bentyl, Levsin and Donnatal. They were relatively safe, but did have side effects of dry mouth and sedation.

Other longtime therapies have included fiber type products that increase stool bulk, like Metamucil and Fibercon.

More recently, drugs that interact with serotonin receptors in the GI tract have been developed. Serotonin is a neurotransmitter that is primarily found in the gastrointestinal tract and in the brain. Serotonin increases intestinal motility, probably by stimulation of 5-HT4 and 5-HT3 receptors. Two prescription medications that interact with the serotonin receptors were developed and approved by the FDA.

Zelnorm, approved by the FDA in 2002, eases constipation by stimulating the 5HT4 serotonin receptor. It was withdrawn from the market in 2007 due to serious adverse effects on the blood supply to the intestines.

Lotronex was approved by the FDA in 2000 for women with severe diarrhea-predominant irritable bowel syndrome. Lotronex blocks the 5HT3 serotonin receptor. It is called a 5HT3 antagonist. Clinical studies showed only a 15-20% improvement in diarrhea symptoms in patients taking Lotronex versus placebo. There have been serious adverse effects associated with this medication. Overall, Lotronex has very limited use in treating IBS patients.

A major concern with prescribing prescription medications is adverse drug interactions. Most medications are metabolized and eliminated by the liver. In the liver there are enzymes that can modify and eliminate drugs. The blood level of a specific medication can be increased or decreased by a second drug’s effect on the liver enzymes. The second medication can induce or inhibit the enzyme system resulting in elevated or reduced blood levels of the first drug. Changing the blood level of a medication can cause significant adverse drug reactions.

What About Probiotics for IBS Sufferers?

Here is the good news with regard to probiotics:

Probiotics are safe and not associated with any severe adverse effects in healthy individuals.
There are no drug interactions with other medications.
Studies have shown that probiotics can alleviate symptoms of IBS.

Two recent reports^{(1, 2)} reviewed the available studies using probiotics to treat symptoms of IBS. Both reports concluded that probiotics appear to be efficacious in IBS but the magnitude of the benefit and the most effective species and strains are uncertain. This means that probiotics show statistical significance in reducing IBS symptoms compared to patients taking a placebo. The problem is determining what types of probiotic bacteria and what dosage of probiotics work best.

There are a number of studies that indicate that the dosage of a multispecies/strain probiotic should be at least 5-10 billon organisms per day.

The mechanisms by which probiotics lessen IBS symptoms are being actively investigated⁽³⁾. For example, studies have shown that the bacterial flora in patients with IBS is different than in individuals without IBS symptoms. The bacteria in IBS patients can produce increased gases like methane which causes constipation and bloating⁽⁴⁾. By altering the bacteria population with probiotics, it is possible to lessen methane production and ease symptoms of constipation.

I can go on about how probiotics improve intestinal function, but I am afraid I will start to bore you.

The point I am trying to make is that probiotics can help people with IBS symptoms, and they are very safe. If you have symptoms, then consider a trial of a probiotic. Obviously, if you have new onset symptoms, it is best to consult your physician first.

The problem is trying to choose the right probiotic product. It’s important to consider:

Dosage per serving size – how many billon organisms/serving?
Number and type of different probiotic bacteria – how many Lactobacillus, Bifidobacteria strains in each serving?
What is the shelf life at room temperature?
Does the product also contain fructooligosaccharides (FOS) – prebiotics*?
Is the packaging in dark, glass bottles, helping to lessen exposure to oxygen and sun light?

Take Home Message

If you have symptoms of IBS, consider taking an excellent probiotic like EndoMune Advanced. Each capsule contains 10 different bacteria strains. A serving size of two capsules contains 16 billon organisms and 50mg of FOS.

For children, consider EndoMune Kids. Each serving size of ¼ Tsp contains four bacterial strains, a total of 10 billon organisms, and 50mg of FOS.

Eat healthy and live well!
Lawrence J Hoberman MD

*FOS are prebiotics. Prebiotics are starches in foods like those found in the fiber of fruits, beans and the bran in whole grain breads and cereals. They are called resistant starches because our intestines can’t break them down. These starches enter the colon and are used as nourishment by the good bacteria, Lactobacillus and Bifidobacteria. These bacteria ferment these starches and produce short chain fatty acids that nourish the colon cells and enhance its healthy function.

(1) The efficacy of probiotics in the therapy of irritable bowel syndrome: a systematic review.Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein A, Brandt L, Quigley E.Gut. 2008 Dec 17.

(2) Meta-analysis of probiotics for the treatment of irritable bowel syndrome. McFarland LV, Dublin S.World J Gastroenterol. 2008 May 7;14(17):2650-61.

(3) The role of probiotics in management of irritable bowel syndrome. Borowiec AM, Fedorak RN.Curr Gastroenterol Rep. 2007 Oct;9(5):393-400.

(4) Methane and the Gastrointestinal Tract.Sahakian AB, Jee SR, Pimentel M. Dig Dis Sci. 2009 Oct 15.

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Inflammatory Bowel Disease Increases Risk of Malnutrition

Children’s Health, Disease, Probiotics / By Staff Writer

Inflammatory Bowel Disease (IBD) increases the risk of malnutrition in both adults and children, according to the American College of Gastroenterology. This incidence, likely due to malabsorption of essential nutrients, was the result of a recent study among a cross-section of adults a pediatric patients.

The study addressed patients with both Ulcerative Colitis and Chrohn’s Disease, with the latter showing higher incidence of malnutrition. Fortunately, the occurrence of malnutrition was low – but this study still indicates the need to monitor nutrients and maintain medical treatment to not only address the medical disease, but its impact on overall health and nutrition.

For more information:
http://www.medpagetoday.com/Gastroenterology/InflammatoryBowelDisease/16681

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