Probiotics

Probiotics, according to a large number of  studies indicate that probiotics help restore and maintain healthy guts leading to overall better health.

Probiotics, Leaky Gut and Autoimmune Diseases

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.

Yale Workshop on Probiotics Presents New Research

I just returned from the 3rd Yale Workshop on “Advances in Probiotic Use” and am pleased to report there is a large amount of active research in the area of the intestinal bacteria. Namely, research is examining how bacteria impact human health and disease.

Among various findings, researchers presented new information about how probiotic bacteria can modulate the intestinal immune system. They have discovered how probiotic bacteria interact with the intestinal lining cells to improve the inflammatory conditions that occur due to infection colitis and ulcerative colitis.

In addition, there were a number of discussions about how the healthy intestinal bacteria can break down or ferment indigestible dietary starches. The breakdown products (short chain fatty acids) enhance the intestinal function, improve intestinal motility and lessen the risk of colon cancer. This is called a symbiotic relationship – mutually beneficial for the human host and the bacteria.

The conclusions from the various presentations are that probiotics can:

  • Lessen irritable bowel syndrome symptoms
  • Shorten the duration of infectious diarrhea in children
  • Aid in the prevention of antibiotic-associated diarrhea
  • Aid in the management of ulcerative colitis
  • Aid in the prevention of childhood allergies like eczema


Transplantation Therapy to Improve Bacteria Balance

An infection with a bacterium called Clostridia difficile can cause life-threatening colitis. The infection occurs when the healthy intestinal bacteria are reduced as a result of taking an antibiotic for something like a sinus infection.

There are special antibiotics that can destroy the Clostridia difficile infection. Unfortunately, there is a tendency for the infection to recur multiple times in the same person despite taking appropriate antibiotics to kill the Clostridia difficile organisms.

In an attempt to treat Clostridia difficile, a new innovative form of therapy was also discussed. The therapy involves the transplantation of stool from healthy individuals into patients as a means to re-establish a healthy intestinal bacterial balance.

There have been a few published case reports dating back to 1958 of transplanting healthy stool into patients who had recurrent Clostridia infections, and the results were very promising. Larger trials of infusing suspensions of healthy stool into ill patients have been recently done. The results have shown a cure rate of more than 90% within two days!!

This presentation was very thought provoking. To have this type of cure rate certainly indicates the importance of the healthy intestinal bacteria. The procedure is aesthetically unpleasing, but the alternative is to give the healthy bacteria in capsule form – accomplished when probiotics are prescribed.


Take Home Message

All of the presentations at the Yale Workshop provide further evidence of the importance of a healthy balance of intestinal bacteria. In addition, the studies confirm that probiotic bacteria have many beneficial benefits in helping to improve and maintain normal intestinal immune and digestive functions.

Please consider taking a high quality probiotic like EndoMune if you are going to take antibiotics or if you are struggling with ongoing GI symptoms despite medical evaluation.

Probiotics Recommended for Nursing Home Residents

Over the years, I have written a number of newsletters that discuss the benefits of probiotics for children and adults. This month will focus on the older generation, an important topic since there are currently 11.4 million people living in nursing homes in the United States (1). This figure includes 14% of the population older than 84.

For anyone who has loved ones in nursing homes and is concerned for their well-being, there are numerous reasons I recommend all nursing home patients take probiotics.

Scenario One: Hospitalization

A recurring story is that of a functioning senior citizen living at home who fractures a hip due to a fall or experiences a stroke. The following series of events is likely to happen:

  1. Upon injury, 9-1-1 is called.
  2. The individual becomes a hospitalized patient.
  3. The patient is required to take medications, including antibiotics.
  4. The antibiotics adversely affect the gastrointestinal tract.
  5. The individual is now at risk of developing hospital-acquired infections like Clostridia difficile and methicillin-resistant staph infections.
  6. Eventually, the patient improves and is transferred to a rehab unit or nursing home.

The seniors may have had normal intestinal function prior to hospitalization, but with all the medications and change in activity level, constipation and diarrhea become real problems. These disorders can severely affect quality life and health of the people within the nursing homes.

For instance, other healthy nursing home residents are now at risk of being exposed to surface areas that have become contaminated by the arrival of the recently hospitalized patients.

This scenario is one reason to consider giving probiotics to healthy nursing home residents. Should a resident be exposed, the probiotics can prevent harmful bacteria from colonizing the intestines and causing damage.

Scenario Two: General Aging Process

Another main reason to give probiotics has to do with the changes that occur in the normal intestines as they age. Due to reduction in acid production, enzyme secretions, reduced intestinal immunity and slowed motility, the healthy intestinal bacteria population is reduced. This change in the intestinal microflora contributes to the risk of diarrhea and constipation.

According to the Administration of Aging (2), among healthy adults 65 years of age and older, 26% of men and 34% of women experience constipation. These numbers increase drastically for elderly people living in nursing homes – more than 80% suffer from constipation.  Medications, immobility, and dementia are all contributing factors for this increase.

Residents of nursing homes have a much higher risk of developing infectious diarrhea. In the United States, nursing home residents are four times more likely to die from gastroenteritis than those living outside nursing homes. Additionally, of all deaths occuring from diarrheal disease, nursing home residents account for 17.5% (3,4).

The physicians and nursing staff are very aware of the health risks associated with severe constipation and diarrhea. Unfortunately, nursing home patients often require medications that can slow intestinal motility, damage the lining cells, and disrupt the healthy balance of the intestinal bacteria. As a result, severe intestinal disorders can occur despite good medical care.

Probiotics Improve Constipation and Diarrhea

During the last three years, there have been several reports published that found that probiotics improved constipation and diarrhea in nursing home residents (5,6,7).  The research protocols were similar; One group of residents received probiotics containing Lactobacillus and/or Bifidobacteria, and the other group received a placebo. The research findings revealed that the frequency and consistency of the stools improved in the groups treated with probiotics, as compared to the control groups (5,6,7).

After considerable review of the literature, I have come to the conclusion that giving nursing home residents daily probiotics can help to improve intestinal function, quality of life, and lessen the risk of serious health issues.

The real concern in medicine is that we “do no harm.” Probiotics, fortunately, have an excellent safety profile. It is worth noting, though, that there have been rare reports of infections due to probiotics in seriously immune-compromised patients (9).

Take Home Message

If you have a loved one in a nursing home, ask the health care provider to consider giving them a probiotic. The daily dosage should be at least 10 billion and contain multiple strains of Lactobacillus and Bifidobacteria, like EndoMune Advanced.

Eat healthy, exercise and live well!
Dr. Hoberman

References:

(1) National Center for Health Statistics. Health, United States, 2009: with special feature on
medical technology. Hyattsville, MD, 2010.

(2) Sources: Data releases from the web sites of the National Center for Health Statistics; and from the Bureau of Labor Statistics web site

(3) Mortality due to gastroenteritis of unknown etiology in the United States. Frenzen PD.J Infect Dis. 2003 Feb 1;187(3):441-52. Epub 2003 Jan 24

(4) Clin Infect Dis. 2010 Oct 15;51(8):907-14.Surveillance for outbreaks of gastroenteritis in long-term care facilities, Australia, 2002-2008. Kirk MDFullerton KEHall GVGregory JStafford RVeitch MGBecker N

(5) Efficacy of Lactic Acid Bacteria (LAB) supplement in management of constipation among nursing home residents. 1)Sources: Data releases from the web sites of the National Center for Health Statistics; and from the Bureau of Labor Statistics web site

(6) Fermented cereal with specific bifidobacteria normalizes bowel movements in elderly nursing home residents. A randomized, controlled trial.Pitkala KH, Strandberg TE, Finne Soveri UH, Ouwehand AC, Poussa T, Salminen S.J Nutr Health Aging. 2007 Jul-Aug;11(4):305-11

(7) Clostridium difficile in the long-term care setting. Makris AT, Gelone S.J Am Med Dir Assoc. 2007 Jun;8(5):290-9. Review

(8) Probiotics and the nursing home: should we give bacteria for breakfast?Morley JE.J Am Med Dir Assoc. 2009 Jul;10(6):365-7.

(9) Safety assessment of probiotics for human use.Sanders ME, Akkermans LM, Haller D, Hammerman C, Heimbach J, Hörmannsperger G, Huys G, Levy DD, Lutgendorff F, Mack D, Phothirath P, Solano-Aguilar G, Vaughan E.Gut Microbes. 2010 May;1(3):164-185. Epub 2010 Mar 4.

Are Bugs in the Gut Good for Your Skin

Over the years, I have reviewed many of the diverse health benefits of probiotics, and the list keeps getting longer.

Probiotics have been shown to lessen the risk of:

  • Irritable Bowel Syndrome symptoms
  • Infectious diarrhea
  • Antibiotic related diarrhea
  • Vaginal yeast infections
  • Recurrent female urinary tract infections
  • Cold and flu illness symptoms in children
  • Allergy related disorders like eczema
  • Colon cancer

Most of the benefits of probiotics are related to their direct effects in the intestines, but there are extra-intestinal benefits.

For example, the probiotic bacteria can stimulate the intestinal immune cells to release substances into the blood stream that will then strengthen the immune cell functions in the upper respiratory tract. The result is to lessen the flu and cold symptoms of cough, runny nose and fever.

So how does taking a probiotic orally have a benefit for our skin? It has to do with modifying the reactions of the immune cells in the skin.

Numerous recent human clinical trials involving the immune system have found that probiotic supplementation might be useful in the management of skin allergies like eczema and dry skin (1,2,3).


Protective Function of Probiotics

There are several recent studies that have demonstrated that UV exposure induces dramatic changes in the skin’s immune functions(4,5), and how probiotics may be protective.

Part of the aging process of the skin is related to our frequent exposure to UV radiation, which causes inflammation. The result is damage to skin collagen and cell DNA. We all know that repeated sun exposure increases the risk for wrinkles and skin cancer.

To determine if probiotics could modify the skin’s immune reaction to UV exposure, 54 volunteers were randomized in two groups (27 each group) taking a placebo or a probiotic for 8 weeks before UV exposure(6). Biopsies of the skin were taken to determine the effects of the probiotic versus the placebo on the immune reaction of the skin.

The results found that the probiotic could modulate the immune reaction and lessen the inflammatory damage. The authors of the study concluded that probiotics may “represent a new strategy for photoprotection.”

There are even studies looking at a topical cream containing probiotics. A recent clinical trial demonstrated that the bacterial extracts of cultured probiotics regulated skin reactivity and dryness in healthy female volunteers(7). So far these are clinical studies; there are no commercial preparations available.

The point is, though, that there is very exciting new research into how the intestinal bacteria can affect our overall health…even the skin!

I am often asked if it is worthwhile taking a probiotic daily. Several years ago I said to take them only if you have some intestinal problems, or if you are taking an antibiotic. Today, I truly believe probiotics should be considered a daily healthy supplement.

Take Home Message

If you are going on an outdoor outing, make sure you use sunscreen and take a good probiotic like EndoMune.

Eat healthy, exercise and live well!
Dr. Hoberman

(1) Probiotics and down-regulation of the allergic response. Kalliomäki MA, Isolauri E.Immunol Allergy Clin North Am. 2004 Nov;24(4):739-52

(2) The development of gut immune responses and gut microbiota: effects of probiotics in prevention and treatment of allergic disease.Rautava S, Isolauri E Curr Issues Intest Microbiol. 2002 Mar;3(1):15-22.

(3) Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo-controlled trial.Kalliomäki M, Salminen S, Poussa T, Isolauri E.J Allergy Clin Immunol. 2007 Apr;119(4):1019-21. Epub 2007 Feb 7.

(4) Sunlight and skin cancer: lessons from the immune system.Ullrich SE. Mol Carcinog. 2007 Aug;46(8):629-33. Review

(5) Alterations in human epidermal Langerhans cells by ultraviolet radiation: quantitativeand morphological study.Seité S, Zucchi H, Moyal D, Tison S, Compan D, Christiaens F, Gueniche A, Fourtanier A.Br J Dermatol. 2003 Feb;148(2):291-9

(6) Probiotics for photoprotection.Guéniche A, Philippe D, Bastien P, Blum S, Buyukpamukcu E, Castiel-Higounenc I.Dermatoendocrinol. 2009 Sep;1(5):275-9

(7) Bifidobacterium longum lysate, a new ingredient for reactive skin.
Guéniche A, Bastien P, Ovigne JM, Kermici M, Courchay G, Chevalier V, Breton L, Castiel-Higounenc I.Exp Dermatol. 2010 Aug;19(8):e1-8

 

Side Effects of Heartburn Drugs

According to Heath.com, too many people are taking heartburn drugs. These drugs, while beneficial for certain ailments, may have more negative consequences that outweigh the benefits.

Two of the new studies found that proton pump inhibitors are associated with an increased risk of infection from the bacterium Clostridium difficile, a hard-to-treat intestinal infection that can occur in people taking antibiotics. C. difficile typically results in severe diarrhea but can lead to removal of the colon or even death in extreme cases.

In the past I’ve discussed C. difficile at length. Scientists have discovered that C. difficile infections have not only been increasing, but are more severe, more difficult to treat, and more likely to relapse. Analyses of outbreaks have identified a new strain of C. difficile. It is more virulent because it produces more damaging toxins and is resistant to a commonly-used type of antibiotic called fluoroquinolones, like Cipro.

To read the CNN article at length, visit:
http://www.cnn.com/2010/HEALTH/05/10/….

IBS Sufferers Not at Greater Risk for Colon Cancer

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

What Causes Gas – Is it a Normal Occurence?

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.

How Probiotics Can Aid IBS Sufferers

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:

  1. Probiotics are safe and not associated with any severe adverse effects in healthy individuals.
  2. There are no drug interactions with other medications.
  3. 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:

  1. Dosage per serving size – how many billon organisms/serving?
  2. Number and type of different probiotic bacteria – how many Lactobacillus, Bifidobacteria strains in each serving?
  3. What is the shelf life at room temperature?
  4. Does the product also contain fructooligosaccharides (FOS) – prebiotics*?
  5. 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 Junior. 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.

Probiotics Help with Stress Reduction

This is a wonderful time of the year. The holiday season is about relaxing and visiting with family and friends. It’s a special time when many of us redirect our attentions to sharing and giving to those less fortunate.

It goes without saying, though, that the holidays can be stressful. There are so many things to do and many people to visit – perhaps even people with whom we’d rather not spend time!

With this in mind, I wanted to share with you a new medical report about the benefits of probiotics in lessening stress and anxiety.  I know what you’re thinking; How could the bugs in our gut affect our mood?

Probiotics: The Anti-Stress Pill?

A recent article in the British Journal of Nutrition(1) reported the beneficial psychological effects of probiotics. Years of research studies have already established a link between stress and gastrointestinal diseases, such as irritable bowel syndrome and ulcerative colitis(2,3). Based on these studies, it’s reasonable to conclude that probiotics may have a positive influence on our moods. The article explored various studies.

One study was a randomized, placebo-controlled pilot study that found probiotics to improve the emotional symptoms of chronic fatigue syndrome patients(4). This finding was the result of two studies. The first study, conducted on rats, gave one group a daily dose of probiotic bacteria for two weeks, and the other group received a placebo. The animals were then given a mild shock from an electrode. The rats that received the probiotic had lower stress and anxiety scores as compared to the control group.

After conducting the test on rats, the researchers moved to human volunteers; participants received either a probiotic or a placebo for 30 days. Everyone was given a battery of psychological tests at the beginning and at the completion of the study.

These tests assessed levels of stress and anxiety. Psychological distress, including measures of depression, anger-hostility, anxiety and problem solving were significantly improved in individuals who received the probiotics, as compared to those in the placebo group.

The researchers concluded that “the results of these studies provide further evidence that gut microflora play a role in stress, anxiety and depression”.(1)

Researches have inferred two possible reasons for the results: (1) the intestinal bacteria send signals via nerves going from the intestinal tract to the brain, or (2) the bacteria release mood-enhancing substances that travel through the blood stream to the brain. Further studies will be needed to confirm the findings, but probiotics might be a novel additional therapy in treating psychiatric disorders.

Take Home Message

This brings us back to the holidays. If you are shopping and planning for special family and friend gatherings, you may be feeling just a little bit of stress. Consider taking a high quality probiotic like EndoMune. It might just ease some of the holiday stress and prevent any GI disturbances.

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

Eat healthy and live well!
Lawrence J Hoberman MD

References:

(1) 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. 2010 Oct 26:1-9.

(2) The Brain-Gut Axis in Abdominal Pain Syndromes. Mayer EA, Tillisch K.Annu Rev Med. 2010 Jan 27.

(3) Curr Mol Med. 2008 Jun;8(4):282-98.The role of microbiota and probiotics in stress-induced gastro-intestinal damage.Lutgendorff FAkkermans LMSöderholm JD.

(4) A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome.Rao AV, Bested AC, Beaulne TM, Katzman MA, Iorio C, Berardi JM, Logan AC.Gut Pathog. 2009 Mar 19;1(1):6.

 

How Can Probiotics Keep Children Healthy?

During the holiday season, I thought I would dedicate this newsletter to discussing how probiotics can help keep children healthy. This discussion will review two articles that have been published in the last month about the benefits of probiotics for children.

Probiotics and Acute Infectious Diarrhea

The first study was to determine whether probiotics have clinical benefit for children with acute infectious diarrhea (1).

Study design:
The study involved 304 children, ages 3 months to 6 years who were hospitalized for acute diarrhea. All the children received rehydration therapy via intravenous fluids and oral rice or half strength formula as age appropriate. The children were randomized to receive a probiotic preparation or a placebo. The benefit of the treatment was assessed in terms of recovery time to the first normal stool. Other clinical symptoms evaluated included fever, vomiting, abdominal pain and appetite.

Results:
The average duration of diarrhea after start of therapy was reduced from 86.3 hours in the placebo group to 60.1 hours in the probiotic group. There was also lessening of abdominal pain, fever and overall length of hospital stay.

Discussion:
To understand how probiotics benefited these children, the immunologic effects of probiotics were evaluated. The study reveals the immune cells of the intestine reacted in two ways; 1) by increasing production of molecules that decrease inflammation and 2) by increasing the quantity of protective intestinal bacteria (bifidobacteria and lactobacillus).

While other studies have shown that probiotics can lessen infectious diarrhea in children, this is the first study that has simultaneously evaluated the clinical, immunologic, and microbiologic effects of probiotics.

Probiotics and Chronic Abdominal Pain (CAP)

The second article deals with the occurrence of chronic abdominal pain (CAP) in children. CAP accounts for approximately 25% of pediatric gastroenterology office visits.

This study’s purpose was to determine if excess build up of intestinal bacteria in the small intestine could be a common cause of the CAP symptoms (2). This condition is called small intestinal bacterial overgrowth and is referred to as “SIBO”. Sometimes, the bacteria in the small intestines can increase and disrupt the normal digestive process. When this occurs, diarrhea, excess gas, and abdominal pain can occur.

Study Design:
This study evaluated children ages 8 to 18. Of those involved in the study, 40 were healthy and 75 had chronic abdominal. Using a breath hydrogen test, it was possible to determine if there was abnormal buildup of small bowel bacteria.

Results:
The study found 91% of children with CAP had abnormal breath hydrogen indicating excess small intestinal bacteria, or SIBO. The control group had a 35% positive breath test.

Discussion:
This study found an objective measure to explain chronic abdominal pain in these children.  Often, psychological explanations are proposed to explain the ongoing symptoms, and the correct diagnosis is missed.

To the best of the authors’ knowledge, this is the first report on the frequency of abnormal breath hydrogen test in children with CAP.

If the breath test is abnormal, then the current recommended therapy is to use antibiotics to decrease the bacterial count in the small bowel (3).  Studies have shown up to a 75% improvement in symptoms after a course of antibiotics. Sometimes there is a relapse and further courses of antibiotics are required (4).

Another approach to treat SIBO is to give probiotics.  A recent study using a probiotic in patients with SIBO found a 47% decrease or normalization of the breath hydrogen test (5). The authors concluded that, “probiotics are a promising, easily handled and well-tolerated treatment option for SIBO”. In addition, since SIBO has a high recurrence rate, the availability of a treatment alternative to antibiotics could reduce both the risk of antibiotic resistance and the incidence of side effects.

Take Home Message

Current medical research continues to gain a better understanding of how the intestinal bacteria affect the function and health of our intestines. The results of these studies certainly further our knowledge about how probiotics can improve gastrointestinal disorders in children. Consider discussing with your child’s doctor taking a good probiotic, like EndoMune, if your child is having a problem with infectious diarrhea or chronic abdominal pain.

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

Eat healthy and live well!
Lawrence J Hoberman MD

(1) Probiotics Have Clinical, Microbiologic, and Immunologic Efficacy in Acute Infectious Diarrhea Chen, Chien-Chang; Kong, Man-Shan; Lai, Ming-Wei; Chao, Hsun-Chin; Chang, Kuei-Wen; Chen, Shih-Yen; Huang, Yhu-Chering; Chiu, Cheng-Hsun; Li, Wen-Chen; Lin, Pen-Yi; Chen, Chih-Jung; Lin, Tzou-YienThe Pediatric Infectious Disease Journal.2010 Feb;29(2)

(2) Chronic Abdominal Pain in Children Is Associated with High Prevalence of Abnormal Microbial Fermentation.Collins BS, Lin HC.Dig Dis Sci. 2009 Nov 4.

(3) Small intestinal bacterial overgrowth: diagnosis and treatment.Gasbarrini A, Lauritano EC, Gabrielli M, Scarpellini E, Lupascu A, Ojetti V, Gasbarrini G.Dig Dis. 2007;25(3):237-40.

(4) Small intestinal bacterial overgrowth recurrence after antibiotic therapy. Lauritano EC, Gabrielli M, Scarpellini E, Lupascu A, Novi M, Sottili S, Vitale G, Cesario V, Serricchio M, Cammarota G, Gasbarrini G, Gasbarrini Am J Gastroenterol. 2008 Aug;103(8):2031-5.

(5) Bacillus clausii as a treatment of small intestinal bacterial overgrowth. Gabrielli M, Lauritano EC, Scarpellini E, Lupascu A, Ojetti V, Gasbarrini G, Silveri NG, Gasbarrini A.Am J Gastroenterol. 2009 May;104(5):1327-8. Epub 2009 Apr 7.

 

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