Drug interactions Archives

Food Borne Illness Rears It’s Ugly Head

Disease, Drug interactions, Probiotics / By @drHoberman

Just this past August, Middle America saw the second year in a two-year salmonella outbreak. This root of this most recent outbreak was contaminated cantaloupe, grown stateside.

In the past, most food borne illness epidemics found their origin in porous fruits grown south of the border in Central America. However in recent years, the Centers for Disease Control and Prevention have discovered more and more epidemics originating with homegrown produce.

Legal and consumer actions teams grow angrier and more outspoken with each contamination outbreak. While CDC standards continue to work in favor of these interest groups and the consumers they represent, the typical individual would do well to take safe consumption matters into their own hands, as an added precaution.

One of the best ways to prepare to withstand food borne illness is to take a probiotic. Doing so has the potential to strengthen your immune and digestive systems to withstand the painful, and sometimes fatal, food poisoning symptoms of acute diarrhea, fever, and abdominal cramping.

To learn more on this recent salmonella outbreak and for information on how to avoid eating contaminated food, please read the full article posted here.

Food Borne Illness Rears It’s Ugly Head Read More »

More And More Research Affirms The Benefits Of Healthy Gut Bacteria

Digestive Health, Drug interactions, Healthy Aging / By @drHoberman

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.

More And More Research Affirms The Benefits Of Healthy Gut Bacteria Read More »

Pain Medications and Gastrointestinal Injury

Digestive Health, Drug interactions, Healthy Aging / By @drHoberman

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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Vaginal Yeast & Urinary Tract Infections

Disease, Drug interactions, Women’s Health / By @drHoberman

This month is directed to the female readers, but the men are also invited to read it.

I am often asked about the benefits of Probiotics in preventing recurrent vaginal and urinary tract infections. It is well known that the lactobacillus organisms are the major bacteria populating the vaginal lining cells (mucosa) and it’s these organisms that act as a barrier to prevent infections.

Scientific investigations have proven that female urinary tract infections result due to bacteria arising from the intestinal tract. These bacteria spread to the vagina, then enter and infect the urinary bladder.

Research studies have discovered how lactobacilli can enhance the immune system against infections; Different strains of lactobacilli have specific benefits.

For instance, certain strains can produce bacterocins, antibiotics against specific infectious organisms. Other lactobacilli produce a biofilm that prevents infectious bacteria from adhering and colonizing the lining cells. Additionally, some lactobacilli produce hydrogen peroxide, which is bacterocidal to many of the pathogenic bacteria. It’s these mechanism and others that have been shown to be important in maintaining the health of the female urogenital tract.

Women have known for decades that yogurt may help prevent vaginal yeast infections. The normal vaginal mucosa is colonized by Lactobacillus acidophilus which is in some yogurts. This bacteria is able to form lactic acid which lowers the pH and prevents the growth of Candida albicans. Unfortunately, taking antibiotics can kill Lactobacillus acidophilus and allow for the development of a vaginal yeast infection.

Candida is always present in low numbers within the intestinal tract and is ready to populate when given the opportunity. When antibiotics are taken, the good bacteria are reduced and the fungus can grow and spread.

There have been a number of studies and reviews on the benefits of taking probiotics containing different strains of lactobacillus bacteria. When the appropriate strains have been given, the recurrence rate of urinary tract infections has decreased.¹

In addition, oral probiotics have been shown to lessen vaginal yeast infections.²

Thanks for your interest in EndoMune.

Eat healthy and live well!

LawrenceJ Hoberman MD

(1) Probiotics for prevention of recurrent urinary tract infections in women: a review of the evidence from microbiological and clinical studies.- Falagas ME – Drugs – 01-JAN-2006; 66(9): 1253-61

(2) Probiotics for the prevention of recurrent vulvovaginal candidiasis: a review. Falagas ME – J Antimicrob Chemother – 01-AUG-2006; 58(2): 266-72

Take Home Message

If you are prone to recurrent urinary tract infections or vaginal yeast infections, consider taking a probiotic that contains several strains of lactobacillus, including Lactobacillus acidophilus….like EndoMune. Also, don’t forget to take a probiotic when prescribed an antibiotic.

Vaginal Yeast & Urinary Tract Infections Read More »

Probiotics in the Medical News

Drug interactions, Probiotics / By @drHoberman

Endomune Subscriber,

I am amazed by the number of new medical articles on probiotics. The scientific evidence of probiotic benefits keeps expanding.

In May 2012, two major medical journals published reports about the advantages of probiotics.

Why take a probiotic when prescribed an antibiotic?

A 53-year-old woman reports severe watery diarrhea with cramps. She is in her seventh day of a 10-day course of cefixime, which was prescribed for bronchitis.

Could the diarrhea have been prevented?

In the May 9th issue of Journal of the American Medical Association (JAMA), there was a report titled “Probiotics for the Prevention and Treatment of Antibiotic-Associated Diarrhea”(AAD).

When antibiotics are prescribed for infections like bronchitis, they can also destroy the healthy intestinal bacteria in the body. As a result, harmful bacteria can proliferate and cause diarrhea that ranges from mild to life-threatening.

The study reviewed 82 trials in which patients (adults and children) randomly received either an antibiotic alone or in combination with a probiotic.

A total of 11,811 studied patients were pooled together for the reviewed trials. The authors found that adding a probiotic when prescribing an antibiotic reduced the risk for diarrhea by 42%.

Take away message

Based on the results of this report, ask your health care provider if he/she would recommend a probiotic when prescribed an antibiotic. Remember to separate the time of taking an antibiotic and the probiotic by two hours. This will lower the risk of the antibiotic destroying the probiotic bacteria.

Can probiotics prevent urinary tract infections?

A 64-year old woman is on her third course of antibiotics for recurrent urinary tract infections. Unfortunately, the cultured E. coli bacteria are resistant to the antibiotic medication.

Was there anything else she could have tried?

In the May 14th issue of the Archives of Internal Medicine, a clinical trial² was published titled “Lactobacilli vs Antibiotics to Prevent Urinary Tract Infections.”

Recurring UTIs are common among some women and low-dose antibiotics can sometimes prevent them. The worry is that overuse of the drugs also reduces their effectiveness by making disease-causing bacteria like E. coli resistant.

The authors conducted a controlled trial in 252 postmenopausal women with recurrent UTIs.

The randomized patients would receive a daily antibiotic or a probiotic containing Lactobacilli for one year.

The researchers then tracked how many UTIs occurred in each group of women over a year. They also collected vaginal swabs and samples of the women’s urine and feces every month to test for the presence of good bacteria and infection-causing bacteria like E. coli.

Over the year, the antibiotic group had an average of 2.9 UTIs per woman, and the probiotic group had an average of 3.3 UTIs. In the year prior to the study, the average number of recurrent UTIs was 7 in each group.

About 20 percent to 40 percent of E. coli in samples from all the women resisted the antibiotic at the beginning of the study. At 12 months between 80 percent and 95 percent of the bacteria resisted the drug in the women taking the antibiotic.

The resistance rate of the E. coli in the women taking the probiotic was slightly lower at one year compared to the start of the study. That is, the E. coli did not develop antibiotic resistance.

The authors concluded that taking a daily antibiotic was not any better than taking a probiotic in lessening recurrent rate of UTIs. “However, the development of antibiotic resistance is considerably lower with the use of lactobacillus. Therefore, lactobacilli may be an acceptable alternative for prevention of UTIs, especially in women who dislike taking antibiotics.”

Take away message

If you have recurrent UTIs, consider taking a probiotic containing Lactobacillus…like EndoMune.

Eat healthy, exercise, take EndoMune and live well!

Dr. Hoberman

1) Hempel,S PhD; Newberry,S PhD; Maher,A, MD; et al. Probiotics for the Prevention and Treatment of Antibiotic-Associated DiarrheaA Systematic Review and Meta-analysis JAMA. 2012;307(18):1959-1969. doi:10.1001/jama.2012.3507

2) Beerepoot MAJ, ter Riet G, Nys S, et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med. 2012;172(9):ioi120011704-712

Probiotics in the Medical News Read More »

Otitis Media: Probiotics Should be Given Alongside Antibiotics

Disease, Drug interactions / By @drHoberman

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.

Otitis Media: Probiotics Should be Given Alongside Antibiotics Read More »

Probiotics, Leaky Gut and Autoimmune Diseases

Disease, Drug interactions, Probiotics / By @drHoberman

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.

Probiotics, Leaky Gut and Autoimmune Diseases Read More »

9 Tips for Staying Healthy this Holiday Season

Diet, Drug interactions, Healthy Aging / By @drHoberman

What a terrific time of the year! We just finished sharing a relaxing turkey meal with family and friends, and now it’s time to focus on preparing for the upcoming holidays. This includes shopping in the malls, enjoying holiday treats and parties, and traveling to visit family and friends or going on a vacation.

Unfortunately, the exposure to others and consuming sweets and alcohol is challenging our immune system. This newsletter is about the top nine ways to boost our immune system and avoid developing cold and flu symptoms during this season.

Some Facts about Cold and Flu

Colds and flu (influenza) are virus infections. Cold and flu viruses attack the lining of the upper respiratory tract, which includes the nose, throat and sinuses. The main symptoms of a cold are sore throat, runny nose, cough and congestion of the nasal passages. Unfortunately, there is no cure for the common cold. Additionally, there is no vaccine against the cold viruses since there are too many, and they tend to mutate or change.

Influenza (or flu) is due to two main viruses – type A and B. The symptoms of influenza are similar to the common cold, but are usually more intense and include chills, fever, and body aches. If someone develops the flu, they are generally home ill for at least 2-3 days. Sometimes, especially in children, the illness can be more severe. Flu viruses are constantly changing. Each year the CDC identifies the most common forms of the influenza viruses and develops a vaccine.

The viruses for cold and flu are very contagious and transmission occurs mainly by inhalation of virally infected droplets from coughs and sneezes from infected individuals. Additionally, touching objects infected by droplets and then putting your fingers to your mouth or nose is another source of exposure.

New Study: Probiotic Benefits for Preventing Cold and Flu

Before listing the nine top tips on having a healthy holiday season, I want to report on a recent medical article. There have actually been a number of published clinical studies on the positive benefits of probiotics for the prevention of cold and flu symptoms.

The most recent article by Hao and his associates⁽¹⁾ reviewed 14 randomized clinical trials studying the prevention of upper respiratory tract infections. This study compared probiotics with a placebo. The studies involved 3451 children and adults. They found that the group taking probiotics had less cold and flu episodes and required fewer antibiotic prescriptions than the group taking a placebo. Probiotics reduced the number of individuals who had at least one acute upper respiratory tract infection by 42 percent.

It’s also important to note that side effects of probiotics were minor.

Now…9 Tips for Staying Healthy During the Holiday Season

Get the flu vaccine
Eat at least 6-8 daily servings of fruits and vegetables to boost the immune system⁽²⁾
Try to get at least 7 hours of sleep⁽³⁾
Maintain hydration
Exercise 30 minutes at least 5 days a week⁽⁴⁾
Avoid crowds if possible
Wash hands frequently or use hand sanitizers after touching potentially infected surfaces
Take a high quality probiotic…like EndoMune Advanced and EndoMune Junior
If you think you have the flu or have been exposed to someone with the flu, contact your physician as you may benefit from taking one of anti-viral flu medications

Thank You!

On a personal note, this is the fifth year that I have written a December newsletter. I want to say that developing EndoMune has turned out to be one of the most gratifying professional activities in my medical career. Researching the latest medical studies on the benefits of probiotics has been challenging, but stimulating. So many people have shared with me how EndoMune has had such a positive effect on their health.

Thank you for your continued support of EndoMune Advanced and EndoMune Junior. We are continuing to work on maintaining the highest quality probiotics and developing new ones.

My very best wishes for a happy and healthy holiday season and New Year!

REFERENCES

(1) Probiotics for preventing acute upper respiratory tract infections.Hao Q, Lu Z, Dong BR, Huang CQ, Wu T.Cochrane Database Syst Rev. 2011 Sep 7;9

(2) Am J Lifestyle Med. 2009 Jul;3(1 Suppl):39S-43S. Functional Foods as Modifiers of Cardiovascular Disease. Johnston C.

(3)Sleep and immune function.Besedovsky L, Lange T, Born J.Pflugers Arch. 2011 Nov 10.

(4) Current perspective on exercise immunology. Nieman DC.Curr Sports Med Rep. 2003 Oct;2⁽⁵⁾:239-42. Review.

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Healthy Bugs Prevent Depression and Gut Distress

Children’s Health, Drug interactions / By @drHoberman

This month I am discussing some new, exciting research on the effect of probiotics on the gut-brain axis(1). Before proceeding, I think it is best to explain the relationship between the intestines and the brain.

We have all experienced the effect of this axis. Most of us have been in a situation where we become very anxious about an upcoming event – making a presentation, taking an exam – and, as a result, developed a terrible gut pain or “knot.”

As quickly as the pain surfaced, it similarly eases when the stressful event resolves. When this happens, we don’t develop an ulcer or any other structural intestinal problem. So what physically happened to cause this pain?

The brain releases chemicals that travel through the blood stream (or nerves) to the gut. The major nerves between the brain and intestines are called the vagus and the sympathetic nerves. The “knot” commonly experienced during stressful events is a result of the nerve endings releasing chemicals that cause spasms of the intestines and activation of the intestinal pain fibers.

Now, let’s get really geeky to explain how this happens in more detail. The gut-brain axis consists of:

(1) Vagus and sympathetic nerves that send messages to:

Stimulate or inhibit stomach and intestinal secretions
Increase or decrease stomach and intestinal motility
Enhance or decrease appetite
Transmit pain sensation from the gut to the brain
Alter our mood …positively or negatively

2) Hormones secreted by the brain and gut that stimulate or suppress the hunger and satiety centers in the brain affecting dietary intake. It is very common for people to attribute weight loss to stress. Their appetite seems to have just “disappeared.”

What really happened was that the emotional stress sent hormones and nerve signals to the intestines causing the following:

Disruption of the healthy intestinal balance of the bacteria.
Multiplication of the unhealthy bacteria, causing intestinal inflammation.
Release of chemicals by the inflamed intestines, stimulating the satiety center in the brain – resulting in loss of appetite.
Once the stress is resolved, both the healthy bacteria and appetite will return.

Be Happy…Take a Probiotic!

With this brief background, we will explore more clearly how intestinal bacteria can be impacted by stress and how probiotic bacteria can improve our mood. It is a two way street.

A research article published this month in the prestigious medical journal Proceedings of the National Academy of the Sciences discusses how probiotic bacteria may lessen anxiety and depression and help to maintain a positive attitude(3).

The point of the study was to determine how bacteria dwelling in the gut can effect the brain, and thereby influence mood and behavior. Since there are special neurotransmitters in the brain that impact mood, the researchers sought to evaluate whether these receptors could be modified by probiotics.

The researchers split their rodent subjects into two groups. One lot was fed a special broth containing Lactobacillus rhamnosus. The other group was fed an ordinary diet not fortified with microbes.

The mice were subjected to a battery of tests that measured their emotional state. The results indicated that the mice fed Lactobacillus performed more activities in a maze which indicated confidence and less anxiety. They were able swim in a container farther indicating a more positive mood.

Direct measurements of the animals’ brains supported the behavioral results. Levels of cortisone, a stress hormone, were significantly lower in the bacteria-fed mice than they were in the control group.

In addition, the number of neurotransmitter receptors was higher in the mood altering portion of the brain. Stimulation of these receptors results in sensations of relaxation and euphoria.

Finally, to prove that the vagus nerve is responsible for transmitting signals from the gut to the brain, the study was done again. But in the second study, the vagus nerve was severed in both groups of mice. The results of the repeat study revealed that the behavior in the two groups of mice was the same. The probiotic fed mice didn’t demonstrate the same activities which had been associated with confidence, less anxiety and a more positive mood. The damaged vagus nerve couldn’t transmit the benefits of the probiotics to the brain.

At this point you may say “well that is very interesting but we are not mice. Are there studies in humans that also show similar results?”

A recent study in the British Journal of Nutrition(4) assessed whether a daily dose of a Lactobacillus and Bifidobacterium probiotic taken for 30 days could influence the psychological impact of everyday life events in normal human volunteers.

By using standardized psychological tests, the scores of the probiotic treated group had lower values for depression, anger-hostility and physical complaints.

The authors concluded that the beneficial effects of the probitotics may be explained by competitive exclusion of harmful gut bacteria and a decrease in inflammatory signals via the vagus nerve to the brain!

Take Home Message

If you are feeling a little “blue” or just want to feel positive about life, consider taking a beneficial probiotic like EndoMune. The best part of these studies is that there were no adverse effects of probiotics – no need for a black box!

References

(1) Gut-brain axis. Romijn JA, Corssmit EP, Havekes LM, Pijl H. Curr Opin Clin Nutr Metab Care. 2008 Jul;11(4):518-21.

(2) The new link between gut-brain axis and neuropsychiatric disorders. Fetissov SO, Déchelotte P.Curr Opin Clin Nutr Metab Care. 2011 Sep;14(5):477-82.

(3) Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Bravo JA, Forsythe P, Chew MV, Escaravage E, Savignac HM, Dinan TG, Bienenstock J, Cryan JF.Proc Natl Acad Sci U S A. 2011 Sep 20;108(38):16050-5.

(4) Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. Messaoudi M, Lalonde R, Violle N, Javelot H, Desor D, Nejdi A, Bisson JF, Rougeot C, Pichelin M, Cazaubiel M, Cazaubiel JM. Br J Nutr. 2011 Mar;105(5):755-64.

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Probiotics in the News

Children’s Health, Drug interactions / By @drHoberman

I receive daily emails from a number of sources about new developments in medicine, particularly in the areas of gastroenterology and probiotics.

There are two interesting articles I would like to briefly discuss this month:

Benefits of Lactobacillus probiotic bacteria against gas-producing E. Coli found in colicky infants⁽¹⁾
Probiotics for prevention of antibiotic-associated diarrhea and Clostridium difficile-associated disease in hospitalized adults⁽³⁾

Benefits of Probiotic Bacteria for Colicky Infants

The first report details the research that has been underway to determine how probiotics can lessen the problem of “Infantile Colic.” This is a condition in which a healthy baby shows periods of intense, unexplained fussing/crying lasting more than 3 hours a day, for more than 3 days a week over a duration of three or more continuous weeks. Parents have sleepless nights and stressful days trying to calm their baby. The pediatricians used to recommend trying simethicone drops, which works no better than tap water.

The exact cause of infantile colic is unknown, but a number of reports have associated colic to changes in the bacterial balance in a baby’s intestine.

A study published in the journal Pediatrics in 2007⁽²⁾ reported on the benefits of taking a probiotic. In the study, 83 colicky babies were divided into two groups: 41 were given a Lactobacillus probiotic and 42 babies received simethicone. The results were astounding:

After one week, babies treated with the probiotic had close to 20% less crying time

By 4 weeks, probiotic treated babies had 74% less crying
Overall, there was a 95% positive response to the Lactobacillus probiotic drops in colicky infants.

To better understand how probiotics lessen infantile colic, this study was performed to evaluated the interaction between Lactobacillus probiotics and gas-forming coliforms that were isolated from stools of colicky infants. The results showed that several strains of Lactobacillus produced antibiotics against six different species of gas-forming coliforms.

The authors concluded:

There was a greater presence of of coliform bacteria in colicky infants, and
Certain Lactobacillus probiotic bacteria can improve colicky symptoms by reducing the ability of coliform bacteria to colonize the gut.

Probiotics for Prevention of Antibiotic-Associated Diarrhea, C. Difficile

This report published in the American Academy of Nurse Practioners reviewed all the relevant studies on probiotic efficacy for preventing diarrhea and colitis due to taking antibiotics.

I have written several newsletters on how antibiotics can upset the healthy balance of the intestinal bacteria, resulting in mild diarrhea or life-threatening clostridia difficile colitis. There are a 100 trillion bacteria in the gastrointestinal tract. Generally, 85% or more are healthy beneficial bacteria that help in digestion and immunity.

Antibiotics prescribed for an infection like sinusitis or bronchitis can destroy the healthy intestinal bacteria and result in problems with diarrhea. A particular bacteria called Clostridia difficile can multiply when the healthy bacteria are destroyed.

C difficile produces toxins that cause a severe colitis. Unfortunately, this bacteria is becoming more common in hospitals and other health care facilities. As a result, the risk of developing colitis and diarrhea has increased. In 2006, it was reported that patients with C difficile colitis stayed in the hospital 3.6 days longer and the additional hospital costs averaged $3,669 per patient day.⁽⁴⁾ A conservative estimate of the cost of this disease in the United States was $3.2 billion annually.⁽⁵⁾

This report was to determine if giving probiotics to patients receiving antibiotics would lessen the risk of developing antibiotic-associated diarrhea and C difficile-associated disease.

The meta-analysis found that the administration of probiotics led to a statistically significant relative risk reduction. Compared to patients given a placebo, the patients receiving probiotics had a:

44% reduction for antibiotic-associated diarrhea
71% reduction for C difficile-associated disease

The authors concluded that administering probiotics concurrently with antibiotics in hospitalized patients could potentially lessen the healthcare spending, morbidity and mortality due to the gastrointestinal complications related to the use of antibiotics.

Articles like these two indicate the amount of research that is going on to determine the health benefits of probiotics. Since I started researching the importance of the healthy intestinal bacteria and probiotics in 2005, the amount of new scientific information published annually is amazing.

(1) Antagonistic effect of Lactobacillus strains against gas-producing coliforms isolated from colicky infants.Savino F, Cordisco L, Tarasco V, Locatelli E, Di Gioia D, Oggero R, Matteuzzi D. BMC Microbiol. 2011 Jun 30;11(1):157.

(2)Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Savino F, Pelle E, Palumeri E, Oggero R, Miniero R. Pediatrics. 2007 Jan;119(1):e124-30.

(3) Probiotics for prevention of antibiotic-associated diarrhea and Clostridium difficile-associated disease in hospitalized adults-A meta-analysis.Avadhani A, Miley H.J Am Acad Nurse Pract. 2011 Jun;23(6):269-74

(4) Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile.Kyne L, Hamel MB, Polavaram R, Kelly CP. Clin Infect Dis. 2002 Feb 1;34(3):346-53. Epub 2001 Dec 17.

(5) Strategies to prevent clostridium difficile infections in acute care hospitals. Dubberke ER, Gerding DN, Classen D, Arias KM, Podgorny K, Anderson DJ, Burstin H, Calfee DP, Coffin SE, Fraser V, Griffin FA, Gross P, Kaye KS, Klompas M, Lo E, Marschall J, Mermel LA, Nicolle L, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS. Infect Control Hosp Epidemiol. 2008 Oct;29 Suppl 1:S81-92

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