Drug interactions Archives

Probiotics and Irritable Bowel Syndrome

Drug interactions, Healthy Aging, Probiotics / By Staff Writer

Studies of how and which types of probiotics improve IBS symptoms have yielded contradictory results. Some studies have shown that probiotics improve IBS, while others have resulted in less promising findings. This variance reflects, in part, differences in the studies, such as trial design, the limited number of participants, and the type, dose and formulation of the probiotics used in a particular study.

The term “probiotics” refers to the beneficial bacteria that are ingested to improve intestinal health. Some probiotic supplements contain just one bacterial strain whereas others have up to 8 different strains. It is reasonable that different studies will reach different conclusions, directly dependant upon the type of strains used. Similarly, the quantity of bacteria in each probiotic supplement can vary from a low of about one million to more than 400 billon organisms per dosage – and this too will also influence results.

In order to determine whether there is a statistical benefit of probiotics in easing the symptoms of IBS, researchers will review hundreds of studies and select those that have been done following specific guidelines for creditability.

The selected studies are then evaluated using a statistical method called meta-analysis. This involves combining all the studies and measuring the outcome for a specific issue. For example, there may be 20 studies evaluating the effects of probiotics on IBS. Some studies may have positive results and others negative. Combining all the results can give an overall statistical evaluation of whether probiotics are beneficial.

Meta-Analysis Reports

Over the last 18 months there have been four major meta-analysis reports published in respected medical journals ^(1,2,3,4).

All four meta-analysis studies concluded that probiotics benefit individuals suffering with IBS. They all found that probiotics could ease the symptoms of:

Abdominal pain
Bloating
Flatulence
Improve the passage of stools

Only a few minor adverse side effects were reported, the most common being a temporary increase in abdominal bloating and flatulence. No serious health or safety issues were identified.

The Conclusion: Probiotics are Promising

The general conclusion from these reports is that probiotics offer promise in the treatment of IBS. Further studies of longer duration and use of specific strains and dosages of probiotics are needed to determine which probiotics are statistically better in treating IBS.

Because the drug therapies currently available to IBS sufferers have shown limited success, a trial of probiotics certainly seems worthwhile.

Take Home Message

Probiotics are helpful in treating the symptoms of IBS. Look for one that has at least 5 billon bacteria in a serving size and contains multiple strains of lactobacillus and bifidobacteria…like EndoMune.

Eat healthy, exercise and stay well!
Dr. Hoberman

(1) A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome.Hoveyda N, Heneghan C, Mahtani KR, Perera R, Roberts N, Glasziou P. BMC Gastroenterol. 2009 Feb 16;9:15.

(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 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

(4) Effectiveness of probiotics in the treatment of irritable bowel syndrome. Wilhelm SM, Brubaker CM, Varcak EA, Kale-Pradhan PB. Pharmacotherapy. 2008 Apr;28(4):496-505.

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DNA Testing Provides Whole-Body Approach to Cancer Screening

Disease, Drug interactions, Healthy Aging / By Staff Writer

The 2009 Digestive Disease Week in Chicago presented numerous findings with regard to the GI tract and associated diseases. Among those findings is the usefulness of DNA testing of stool samples for the presence of cancer.

Previously, stool DNA testing was used for the early detection of colorectal cancer; recently scientists and physicians have discovered this screening is also a useful source of detection for other cancers such as pancreas, stomach, bile ducts and esophagus. This is a tremendous shift from the single organ approach to screening of such cancers. DNA sampling provides a “whole-body” approach to screening for multiple cancers at one time, potentially paving the way for early detection of cancers previously not screened.

According to ABC News, “The test developed by Mayo Clinic researchers, which checked a patient’s stool for the DNA of cells regularly shed from the surface of several types of tumors, detected 65 percent of esophageal cancers, 62 percent of pancreatic cancers, 75 percent of bile duct and gallbladder cancers and 100 percent of stomach and colorectal cancers. The test was equally successful at detecting early-stage and late-stage cancers.”

The report goes on to note, “One in four cancer deaths are the result of gastrointestinal cancers, the news release notes. These cancers are quite curable if detected at an early stage, but the only one widely tested for is colorectal cancer, generally through colonoscopy.”

Research and news with regard to GI disease continues to move in a positive direction.

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Probiotics Shed Light on Obesity and Diabetes

Diet, Disease, Drug interactions / By Staff Writer

Keeping up with the latest scientific developments on probiotics and human health is becoming very challenging because every month there are new and very exciting findings.

Recently, there have been several reports on how intestinal bacteria play a role in nutrition, obesity and diabetes.

Here are a few of the results of those studies:

Patients who received probiotics after gastric bypass surgery lost more weight than those who received a placebo ⁽¹⁾.
Women who took probiotics starting in the first trimester of pregnancy were less likely at one year postpartum to have central or abdominal obesity as compared to the control group who did not take a probiotic ⁽²⁾.
In a study of overweight adolescents who went on a weight loss diet, those who were successful at losing weight had a healthy change in the composition of the intestinal bacteria ⁽³⁾.

These and others studies in humans and animals have discovered that our intestinal bacteria affect the amount of calories we extract from the food we eat, and how we store or use those calories. The studies further suggest that obese and lean people have different intestinal bacterial flora.

Probiotics’ Regulation of Obesity and Type 2 Diabetes

There are ongoing scientific investigations aimed at determining how the gut bacteria participate in the regulation of our weight and the development of obesity and Type 2 diabetes.

In a series of experiments, it was found that mice fed a normal diet had 40% higher body fat content than germ-free mice fed a similar diet ⁽⁴⁾. The bacteria in the colon, particularly Bifidobacteria, can metabolize certain starches in our diet that we can’t digest otherwise. These extra calories harvested by the bacteria contribute to our net calorie balance. A mere 1-2% increase in calorie absorption on a daily basis can add up to many extra pounds over a year.

These studies are a little confusing. If a healthy gut flora includes Bifidobacteria, why don’t the lean individuals who have more of the Bifidobacteria gain weight?

Scientists are trying to sort out these conflicting results. To understand how the good bacteria can help control weight gain, it is important to briefly review a little biochemistry.

Whole grain foods contain starches that are resistant to digestion in the small intestines. These starches enter the colon where they are used as fuel by Bifidobacteria and Lactobacillus. The bacteria break the starches down and produce short chain fatty acids (SCFA) by a process called fermentation. The SCFA are absorbed in the colon and contribute to the calories in the diet. But the SCFA also have other effects.

One proposed mechanism is that the short chain fatty acids produced by the Bifidobacteria stimulate the release of intestinal hormones that slow the stomach emptying after a meal ⁽⁵⁾. This results in a sense of fullness or satiety with less calorie intake; it takes less to fill you up. It may be that people with the healthy bacteria who consume whole grain foods don’t eat as much.

In addition, the healthy bacteria in lean individuals suppress the proliferation of a group of bacteria called “gram negative bacteria.” Gram negative bacteria can produce a substance called lipopolysaccharide (LPS) that causes the liver to convert ingested carbohydrate calories into fat instead of burning the calories as an energy source ⁽⁶⁾. The fat is then stored in our adipose or fat tissues.

Finally, LPS has been shown to lessen our cells’ sensitivity to the insulin our pancreas produces ⁽⁶⁾. This can result in Type 2 diabetes. Studies have shown that modifying the bacterial content of the intestines can lessen the production of LPS and the potential for developing diabetes.

The evidence indicates that the gut bacteria composition can be different between healthy individuals and those who are obese and have Type 2 diabetes. The challenge is how to manipulate the intestinal bacteria to lessen these metabolic disorders.

Take home message. Eat whole grain foods, avoid high fatty diets and consider a probiotic like EndoMune. You may just avoid weight gain and the risk of developing diabetes.

Eat healthy and live well.
Lawrence J Hoberman, MD

(1) Probiotics Improve Outcomes After Roux-en-Y Gastric Bypass Surgery: A Prospective Randomized Trial: Woodard G, Encarnacion B, Downey J, et al:J Gastrointest Surg. 2009 Apr 18

(2) Probiotics May Help Ward Off Obesity, Laitinen K: Study In Pregnant Women. European Association for the Study of Obesity; Presented 2009 May 8

(3) Interplay Between Weight Loss and Gut Microbiota Composition in Overweight AdolescentsSantacruz A, Marcos A, Wärnberg J, Martí A, Martin-Matillas M, Campoy C, Moreno LA, Veiga O, Redondo-Figuero C, Garagorri JM, Azcona C, Delgado M, García-Fuentes M, Collado MC, Sanz Y. Obesity (Silver Spring). 2009 Apr 23

(4) The gut microbiota as an environmental factor that regulates fat storage. Backhed F, Ding H, Wang
T, et al. Proc Natl Acad Sci U S A. 2004 Nov 2;101(44):15718-15723

(5)Oligofructose and long-chain inulin:influence on the gut microbial ecology of rats associated with a human faecal flora. Kleessen B, Hartmann L, Blaut M. Br J Nutr. 2001;86(2):291-300

(6) Metabolic endotoxemia initiates obesity and insulin resistance. Cani PD, Amar J, Iglesias MA, et al
Diabetes. 2007 Jul;56(7):1761-1772. Epub 2007 Apr 24.

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iPhone to Assist IBD Patients

Disease, Drug interactions / By Staff Writer

Individuals who suffer from Inflammatory Bowel Disease (IBD), Crohn’s Disease and a variety of other gastrointestinal ailments are often faced with the need to maintain daily bowel logs. Consistent logs help physicians track and monitor a patient’s progress and adjust medication as needed; insufficient data or sporadic logs, however, are often not helpful for monitoring long-term trends.

With this in mind, patients find it burdensome and difficult to remain on track with this daily regimen.

Enter technology…

A new iPhone application, “GI Monitor,” was developed by Brett Shamosh, CEO and founder of WellApps, Inc. For nearly two decades, Shamosh has suffered from IBD, and understands firsthand both the importance and burden of monitoring his daily BMs. In an effort to ease this task, a patient can download this application to their iPhone to monitor bowel movements and other related symptoms. In one organized, simple format, patients can log their individual data digitally, including prescription information.

The iPhone and other mobile devices make sense. Rarely do you leave home without your phone or PDA device; but how often do you want to carry your dietary journal? Shamosh says this was his reason for developing the application.

In the future, Shamosh indicates he would like to track symptoms of all users, and use these results for research benefits. The implications for monitoring trends are promising. As for advances in future releases, since there has been so much interest in not only BM logs but dietary logs, the next release will allow users to input and track dietary intake.

If you currently suffer from a GI ailment, you can download the application for $4.99 at the iTunes Store. The application will also be released in a format compatible with Blackberrys in the near future.

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