Children’s Health Archives

Healthy Benefits of Probiotics for Children

Children’s Health, Healthy Aging / By @drHoberman

As we start the New Year with resolutions for living healthy, I want to share with you an article⁽¹⁾ that assesses the healthy benefits of probiotics for children.

The December issue of Pediatrics included a report, “Clinical Report – Probiotics and Prebiotics in Pediatrics,” prepared by the Committee on Nutrition, a component of the American Academy of Pediatrics – an organization comprised of 60,000 pediatricians.

The purpose of the report was to provide guidance to pediatric health care providers on the usefulness and benefits of probiotics and prebiotics for children. In doing so, the committee:

Reviewed published clinical studies that provided children with probiotics or prebiotics to prevent or treat a variety of health issues, and
Analyzed the quality of the reports and determined whether there was enough evidence to recommend the use of probiotics for the specific disorders.

In the last five years there has been an explosion of clinical studies using probiotics. Most of the studies have proven efficacy or general positive benefits, leading to an increase in the recommendation of probiotics by mainstream medicine.

Committee on Nutrition: Probiotic Recommendations

After thoroughly reviewing and assessing previous studies, the American Academy of Pediatrics’ committee suggested probiotics and/or prebiotics may have a positive impact on the following conditions.

#1: Acute Infectious Diarrhea
The committee reviewed studies to determine if probiotics could prevent episodes of acute infectious diarrhea that occur in child care centers. Based on available studies, the committee did not recommend routine use of probiotics to prevent acute infectious diarrhea but did acknowledge there may be special circumstances that probiotics are beneficial.

#2: Viral Gastroenteritis
Trials of using probiotics to treat children with acute infectious diarrhea found that probiotics shortened the illness in children with viral gastroenteritis by one day. The conclusion stated “there is evidence to support the use of probiotics early in the course of childhood acute infectious diarrhea.”

#3: Antibiotic-Associated Diarrhea
Review of trials using probiotics to prevent antibiotic-associated diarrhea found that probiotics were beneficial. Antibiotics can decrease the healthy intestinal bacteria population and allow the unhealthy bacteria to overgrow and cause diarrhea. The conclusion was that probiotics can be used to reduce the incidence of antibiotic-associated diarrhea.

The committee reviewed numerous clinical trials that used probiotics to treat and prevent other pediatric medical disorders. While some of these studies found specific benefits, the general recommendation was that further studies were necessary to prove efficacy for the following conditions:

Irritable Bowel Syndrome
Infantile Colic
Ulcerative Colitis
Eczema

Prebiotics and Allergy Reduction

The committee also reviewed medical trials using prebiotics. Prebiotics refer to a special class of fiber in our diet that acts as “food” for the healthy bacteria, Lactobacillus and Bifidobacterium. These bacteria use the prebiotic as a source of nourishment for their growth and activity.

Studies of adding prebiotics to infant diets found reduced incidence of allergies. The conclusion of the committee was that “confirmatory studies of the benefits of prebiotics….are needed before recommendations cam be made…”

Safe and Promising Supplements

The committee also commented on the safety of both probiotic and prebiotic supplement. They stated “to date, these products seem to be safe for healthy infants and children.” Caution should be used in giving probiotics to children with compromised immune function.

The committee was generally positive about the use of probiotics in children. But, it was being very responsible in not making general recommendations. Although there are positive studies for the clinical use of probiotics, the committee wants to see more studies to confirm the benefits. Further confirmatory studies are being accomplished to prove the clinical health benefits. We await the next updated report.

In the meantime, if your child is suffering with one of the disorders mentioned above, it seems reasonable to consider a therapeutic trial with a probiotic like EndoMune – a safe supplement that contains both probiotics and a prebiotic.

Wishing you and your loved ones a very healthy 2011.

Eat healthy, exercise and stay well.
Dr. Hoberman

References:

(1) Probiotics and prebiotics in pediatrics. Thomas DW, Greer FR; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition. Pediatrics. 2010 Dec;126(6):1217-31.

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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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New Study Reveals Danger of Sack Lunches

Children’s Health, Mental Health / By @drHoberman

It is back to school time. While you are out shopping for school clothes and supplies, I want to encourage you to consider adding EndoMune to your shopping list.

Over the years I have written a number of newsletters that discuss the benefit of probiotics for children. Topics have included: lessening the risk of infectious diarrhea, preventing cold and flu symptoms and avoiding antibiotic related diarrhea.

This month I want to discuss a new reason for giving your child a daily probiotic: foodborne illnesses.

An interesting study⁽¹⁾ was published this month in the respected medical journal, Pediatrics. The study discussed the risk of foodborne illnesses in sack lunches prepared at home for preschool children going to day care centers. The researchers wanted to determine the temperature of the perishable foods during the morning hours prior to lunchtime.

What Causes Foodborne Illnesses?

Before diving into the findings of the article, I would like to make some general comments about how contaminated foods cause intestinal infections that lead to symptoms of nausea, vomiting, diarrhea, fever and abdominal pain.

Most foodborne infections are undiagnosed and unreported, although the Centers for Disease Control and Prevention estimates that every year about 76 million people in the United States become ill from contaminated foods. Of these people, about 5,000 die⁽²⁾.

Almost half of the reported foodborne illnesses occur in children, with the majority occurring in children under age 15 years. Frightening, right?

Children are at high risk for foodborne illness for several reasons: immature immune system, reduced stomach acid to kill harmful bacteria, and low body weight – which means a lower dose of pathogen is required to cause injury⁽³⁾.

There are three important factors when considering food safety: (1) type of food, (2) stored temperature, and (3) time exposed to unsafe temperature.

Bacteria that cause foodborne illnesses like Salmonella and E. coli grow rapidly in certain types of foods. Meat, poultry, fish, dairy products and cut fruits and vegetables are most likely to carry these bacteria.

If the bacteria are present when the food is prepared, then refrigerating the food to below 40°F prevents the bacteria from multiplying and causing an infection. Additionally, cooking foods to a temperature greater 165°F will kill any bacteria in food. Once cooked, the hot foods need to stay at a safe temperature of greater than 140° F prior to serving or refrigerated to less than 40°F for storing.

When perishable foods like chicken salad or bologna sandwiches are left in the “danger” temperature zone of 40°F to 140°F for greater than two hours, the harmful bacteria rapidly multiply. When this happens, the foods must be discarded due to risk of contamination by bacteria and toxins, which can cause mild to life threatening intestinal infections.

Pediatrics Study: Sack Lunches at Risk of Bacteria Proliferation

This brings us back to the study. The objective was to measure the temperature of the foods in preschool-aged children’s sack lunches. Using non-contact temperature guns, the researchers tested 705 lunches that contained a total of 1,361 perishable foods. The temperature was measured 90 minutes before lunchtime.

The results were astounding: Only 22 or 1.6% of the 1361 perishable food items were in a safe temperature zone. Overall, 97.4% of meats, 99% of dairy, and 98.5% of vegetables were in the danger zone.

The researchers found that the use of thermally insulated bags with ice packs only marginally improved the number of perishable foods in the safe temperature zone.

So what is a parent to do?

Here are some recommendations:

Wash hands and use clean cutting boards and knives.
Use safe foods like peanut butter (if allowed), raw, cooked or dry fruit and raw vegetables.
Consider making a meat sandwich of turkey or roast beef the night before and putting in the freezer using bags designed for freezing. It will take 3 to 3.5 hours for the sandwich to thaw.
Soups, stews and chili make a hearty lunch. To use them in a packed lunch, heat to boiling and put in a sterilized thermos bottle.

Finally, I recommend giving your child a high quality probiotic like EndoMune Junior.

Studies have shown that probiotics are able to defend the human intestinal tract against harmful bacteria. The probiotic bacteria stimulate the immune response, prevent pathogens from adhering to the intestinal lining cells and produce antibacterial proteins⁽⁴⁾.

There has been increasing evidence in the last 10 years for the benefit of probiotics in preventing and treating acute diarrhea in children. A number of studies have found that giving probiotics versus a placebo to children in day care facility can statistically lessen the risk of having an episode of diarrhea^(6,7).

Take Home Message

Given the results of the study on food temperature in school lunch bags, I would think it would be a good idea to give EndoMune Jr to lessen the risk of experiencing a bout of foodborne gastroenteritis.

Eat healthy, exercise and live well!
Dr. Hoberman

References

(1) Temperature of Foods Sent by Parents of Preschool-aged Children. Almansour FD, Sweitzer SJ, Magness AA.
(2) Food-related illness and death in the United States.Mead, P., L. Slutsker, V Ddietz et al.Emerg Infect Dis, Sept-Oct 1999, 56(No. 53).
(3) Children and microbial foodborne illness.Buzbym H>C. Food Revuewm 2001l 24⁽²⁾:32-7.
(4) Use of probiotics in children with acute diarrhea. Szajewska H, Mrukowicz JZ. Paediatr Drugs. 2005;7⁽²⁾:111-22
(5) Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations. Canani RB, Cirillo P, Terrin G, Cesarano L, Spagnuolo MI, De Vincenzo A, Albano F, Passariello A, De Marco G, Manguso F, Guarino A. BMJ. 2007 Aug 18;335(7615):340
(6) Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials. Sazawal S, Hiremath G, Dhingra U, Malik P, Deb S, Black RE. Lancet Infect Dis. 2006 Jun;6⁽⁶⁾:374-82
(7) Probiotics for children with diarrhea: an update. Guandalini S.J Clin Gastroenterol. 2008 Jul;42 Suppl 2:S53-7

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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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Probiotics May Decrease Allergies

Children’s Health, Healthy Aging / By @drHoberman

The increased sterilization and pasteurization of foods has led to a decrease in the amount of bacteria to which we are exposed. There is a potential this has led to the increase in allergies which today’s children are experiencing.

A Finnish team of researchers conducted a study with pregnant women; some received a probiotic while others received a placebo. From eight months pregnancy to delivery, these women took a daily dose of probiotics or its placebo counterpart.

The children were examined by pediatricians at 3, 6 and 24 months of age. The conclusion was that:

To read the article in its entirety, visit: http://www.newscientist.com/article/dn13778

Key proteins associated with tissue inflammation were 50% higher on average in the blood of probiotic-treated infants than in the blood of placebo-treated infants. Inflammation is thought to stimulate the immune system, and so reduce allergic reaction.
Probiotic children were 30% less likely than their untreated counterparts to develop an itchy skin condition known as atopic eczema, which is often an early manifestation of allergies.

While more research is needed, it seems plausible that probiotics may be a key ingredient to decreasing the likelihood of your child developing allergies.

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Probiotics and the Prevention of Food Allergies

Children’s Health, Diet, Healthy Aging / By @drHoberman

Most of us are familiar with the term “food allergy.” Case in point, children with an allergy to peanuts can experience allergic reactions ranging from hives to coma, or even death. Sensitized children must have medication with them at all times to immediately treat reactions.

Strict avoidance of peanuts is their sole option to stay well. Schools have tried to create awareness for students and their parents to avoid bringing foods like peanut butter to school if there is a child with a peanut allergy.

In the last two weeks, there have been a number of news reports on the dramatic increase in food allergies experienced by children.

In the June issue of the medical journal Pediatrics⁽¹⁾, a study found that about eight percent of children under the age of 18 (almost 6 million) suffer from one or more food allergies. These numbers are twice as high as reported by the CDC in 2007, which reported a rate just below four percent. Additionally, the severity of the episodes has increased.

The lead author of the June study, Dr. Ruchi Gupta, reported that “based on our data, about one in 13 children has a food allergy. We are seeing a lot more cases in schools than we used to see. It does seem that food allergy is on the rise.” In addition, Dr. Gupta noted, “What’s more, nearly two out of every five affected children suffer from a severe food allergy. For these children, accidental ingestion of an allergenic food may lead to difficulty breathing, a sharp drop in blood pressure, and even death.”

With the growing severity of food allergies, how can probiotics help? There are some very interesting studies that suggest probiotics may lessen the risk of food allergies in children.

To get a better understanding of this topic, this newsletter will discuss:

What is a “food allergy”
What is the cause
How to diagnose a food allergy
How is a food allergy treated
Can probiotics help lessen the risk of developing a food allergy

What is food allergy?

Food allergy is a term used to describe an adverse immune response to a protein in some foods.

When we are born, our intestinal immune cells have to constantly survey what is being ingested. The immune cells determine if they have to mount a protective reaction to a potentially harmful virus, bacteria, parasite or toxin.

Sometimes, the immune cells react to harmless proteins in our food and produce antibodies that can result in allergic reactions like hives, eczema, asthma, rhinitis and gastrointestinal symptoms of cramps, nausea, vomiting and diarrhea.

The most serious reaction is called anaphylaxis, which causes severe breathing difficulty and a major drop in the blood pressure. Oxygen, epinephrine injections and IV fluids can be lifesaving.

Anaphylactic reactions due to food allergies account for 30,000 episodes annually and possibly 200 deaths each year.⁽²⁾

The CDC estimates that eight types of foods are responsible for 90 percent of all food allergies in children: milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat.

What is the cause of a food allergy?

The exact cause of food allergies is not known. However, there have been several proposed explanations why food allergies occur and have been on the increase over the last 20-30 years.

Factors thought to contribute to food allergies include genetic predisposition and the introduction of foods too early in infancy.

The other major factor is the “Hygiene Theory”.⁽³⁾ This theory is based on the idea that in the Western developed countries the exposure to harmful bacteria, parasites, viruses and other toxins has decreased due to our efforts at keeping everything sanitized. As a result, our immune system has more time to spend mounting a reaction to harmless proteins in our diet and other allergens like pollens.

Epidemiologic studies have found that the prevalence of allergies is highest in developed countries.

Over the last 30 years there has been a two-to-three fold increase in childhood allergies in developed countries when compared to those less developed.⁽⁴⁾

There have been a number of reports that have found children growing up on a farm have less allergies.⁽⁴⁾ Playing with animals and in the dirt may actually be healthy.

How to diagnose food allergies?

A child might have a food allergy, if he/she has recurrent swelling of lips and face, hives, eczema, wheezing, stuffy nose, abdominal pain, diarrhea.

The best method for diagnosing food allergy is to be evaluated by an allergist. The allergist will review the patient’s history and the symptoms or reactions that have been noted after food ingestion. If the allergist feels the symptoms or reactions are consistent with food allergy, special tests can be performed.

Skin testing can aid in detecting the antibody(IgE) to the suspected food protein.

Blood tests can measure IgE antibodies

Sometimes it is necessary to perform a food challenge while being observed by the physician

How is a food allergy treated?

The only proven therapy is food elimination. All patients at risk for anaphylaxis must be trained to identify early symptoms and be prepared to use an auto-injectable epinephrine pen.

Can Probiotics lessen the risk of developing a food allergy?

To understand how probiotics may lessen the risk of food allergies requires a little primer on how the immune system in the intestines works.

Seventy percent of our immune system is in the intestines. Since the intestines serve as our window to our environment, it is important that the intestines monitor our exposure to harmful infections and toxins.

The lymphocytes (immune cells) in the intestines are of several types:

Th1 helps to fight infections due to bacteria and viruses

Th2 responds to infections caused by parasites

If an infant is not exposed to infectious bacteria and viruses, then Th1 will be less active, causing a shift in the balance of activity in favor of the Th2 lymphocytes, producing antibodies to parasites and also to harmless allergens.

Recently, another lymphocyte called a regulatory cell (Treg) has been identified(5). This lymphocyte can regulate the activity of both Th1 and Th2 lymphocytes.

Probiotics can modulate the immune response by acting on the Treg cells. Studies have shown that probiotics can decrease or down regulate the activity of the Th2 cells and lessen the immune reaction against proteins in foods. ^(6,7) The term “oral tolerance” is used to describe the process when the immune cells don’t mount a reaction.

Mice raised in a germ-free environment do not develop oral tolerance to food protein.⁽⁸⁾ But when a mixture of oral probiotics were given to the mice, the IgE antibodies were not produced.

Since 1997, probiotics have been used in the management of food allergy. Infants with eczema due to cow’s milk had improvement when given a probiotic in their formula.⁽⁸⁾

In another study, either probiotics or a placebo were given to mothers during the last 4 weeks of their pregnancy. Their newborn infants were breast fed and given a probiotic supplement or a placebo for 6 months. The children who were exposed to probiotics had a 50% reduction in allergies compared to the placebo group.⁽⁹⁾

Not all clinical studies have shown that probiotics are able to lessen allergic diseases in children.⁽¹⁰⁾ The good news is that the probiotics seem very safe. No serious adverse effects have been reported in the clinical studies.

There is no question that probiotics can influence the intestinal immune system to lessen allergic responses. Some of the future challenges include determining the most effective:

Probiotic strains
Combination of bacterial species and strains
Dose of bacteria in a serving size
Timing of introducing the probiotic to the infant/child
Duration of probiotic therapy

Take Home Message

If you don’t live on a farm or your child doesn’t include dirt in their diet, you might consider giving your child a probiotic. For women who are allergy prone, taking a probiotic like EndoMune may help prevent eczema in their offspring. In addition, giving EndoMune Junior to your child during infancy may help to lessen the risk of developing allergies. It is always recommended that you talk with your doctor before taking new medications and supplements.

Eat healthy, exercise and live well!

Dr. Hoberman

(1) The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States.Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, Holl JL.Pediatrics. 2011 Jun 20

(2) Epidemiology of anaphylaxis in Olmsted County: A population-based study. Yocum MW, Butterfield JH,Klein JS, Volcheck GW, Schroeder DR, Silverstein MD.Yocum MW,Butterfield JH, Klein JS, Volcheck GW, Schroeder DR, Silverstein MD.

(3) The hygiene theory: fact or fiction? Sheikh A, Strachan DP.Curr Opin Otolaryngol Head Neck Surg. 2004Jun;12(3):232-6. Review.

(4) Exposure to environmental microorganisms and childhood asthma. Ege MJ, Mayer M, Normand AC, Genuneit J, Cookson WO, Braun-Fahrländer C, Heederik D, Piarroux R, von Mutius E; GABRIELA Transregio 22 Study Group. N Engl J Med. 2011 Feb 24;364(8):701-9.

(5) Hygiene theory and allergy and asthma prevention. Liu AH.Paediatr Perinat Epidemiol. 2007 Nov;21 Suppl 3

(6) Probiotics, prebiotics, and synbiotics: impact on the gut immune system and allergic reactions.Gourbeyre P, Denery S, Bodinier M. J Leukoc Biol. 2011 May;89(5):685-95.

(7) Food allergy and probiotics in childhood. del Giudice MM, Leonardi S, Maiello N, Brunese FP. J Clin Gastroenterol. 2010 Sep;44 Suppl 1:S22-5.

(8) Probiotics: a novel approach in the management of food allergy.Majamaa H, Isolauri E.J Allergy Clin Immunol. 1997 Feb;99(2):179-85

(9) Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial.Kalliomäki M, Salminen S, Poussa T, Arvilommi H, Isolauri E. Lancet. 2003 May 31;361

(10) Probiotics in prevention of IgE-associated eczema: a double-blind, randomized, placebo-controlled trial.Abrahamsson TR, Jakobsson T, Böttcher MF, Fredrikson M, Jenmalm MC, Björkstén B, Oldaeus G.J Allergy Clin Immunol. 2007 May;119(5)

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Antibiotics Assist with Ear Infections

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

The debate over whether or not to prescribe antibiotics to treat infections continues. This time, research evidence has been presented supporting antibiotics for the treatment of ear infections in children.

Recent research from the Children’s Hospital of Pittsburgh and the University of Turku in Finland both found positive results for children that had been prescribed Augmentin, versus children treated with a placebo.

As allergy season continues to heat up, the temptation to prescribe antibiotics will grow as well. What’s important to remember, though, is that antibiotics do not discriminate with regard to bacteria. Yes, the bacteria causing the infection are attacked, but so are the good bacteria that keep your lower intestines in check. This is often why many people who take antibiotics experience gastrointestinal ailments such as diarrhea.

If you are taking an antibiotic, it is advisable to take also take a probiotic. This will help to replenish the good bacteria that are being attacked by the antibiotic. In essence, you are helping to protect yourself against the unwanted digestive side effects that are often accompanied by antibiotics.

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Can Probiotics Help Protect Against the Flu?

Children’s Health, Healthy Aging, Women’s Health / By @drHoberman

What a wonderful time of the year! October is just the beginning of the cooler weather and the varied, inspiring fall colors. Beyond the changes in nature, it’s the time when we all begin to feel the spirit of the joyful holiday season, and gather closer with family and friends.

There is one drawback: fall also ushers in the flu season. In the next several weeks, the flu season will start. According to the latest CDC report, two states (Hawaii and Texas) already report a slight increase in flu cases.

Before we begin to unpack those seasonal decorations, we should all start taking precautions to avoid the flu – especially getting the flu vaccine. If you are prone to making excuses against the vaccine, here are some flu facts to keep in mind concerning the US population:

5% to 20% of the population gets the flu
More than 200,000 people are hospitalized from flu complications
About 23,500 people die from flu; 80% of such deaths occur in persons aged 65 years and older.

At this point you may be wondering why we are discussing the flu in monthly probiotic newsletter. Great question!

Probiotics are Effective Blockade

Recently, there have been some very interesting medical studies reviewing the benefits of probiotics with regard to the flu. More specifically, how a probiotic might lessen the risk of contracting the flu and/or decrease flu symptoms.

In one such experiment, orally administered lactobacilli bacteria successfully assisted the immune cells to produce antibodies within the bronchial airway⁽¹⁾. Another investigation found that giving probiotics two weeks before the flu vaccine injection increased the immune system’s antibody response, as compared to the placebo control group⁽²⁾.

Two recent studies were conducted to specifically evaluate the benefits of taking probiotics during the flu season.

The first investigation was completed with 356 children ages 3-5 years old attending daycare⁽⁴⁾. The children who took a probiotic twice a day (the other group took a placebo) experienced the following benefits:

More than two-thirds less fevers (72%)
62% less coughs, and 59% less runny noses
Duration of illness was nearly HALF of that in the placebo group (48%)
Missed 38% less school days, and used 84% less antibiotics

The other study⁽⁵⁾ was conducted on 250 healthy adults. Two different probiotic preparations were used, and there was also a control group who received a placebo. As compared to the control group, the two groups who consumed probiotics for 90 days during the cold and flu season experienced these astounding benefits:

41% less number of infections
25% less severity of infections
25% decrease in the length of infections
27% reduced days out from work.

What Can You Do to Avoid Getting the Flu This Season?

The single, most important step is to get the flu vaccine. A vaccine is your insurance against the flu – it may not stop contraction of the flu, but it will greatly decrease your symptoms, helping you to get healthy much more quickly.

Additionally, here are 5 healthy habits to avoid the flu:

Get at least 7 hours of sleep
Eat healthy, fruits and vegetables which help to support the immune system
Exercise and regular workouts enhance the immune system
Avoid crowds and people who are coughing and sneezing
Wash your hands or use sanitizers after touching public objects

And based on the findings from the studies discussed above, it is extremely worthwhile to add a good probiotic like EndoMune to your daily regimen.

Eat healthy, exercise and live well!
Dr. Hoberman

References:

(1) Int J Immunopathol Pharmacol. 1999 May-Aug;12⁽²⁾:97-102.Influence of the oral administration of lactic acid bacteria on iga producing cells associated to bronchus.Perdigon G, Alvarez S, Medina M, Vintiñi E, Roux E

(2) Nutrition. 2007 Mar;23⁽³⁾:254-60.Oral intake of Lactobacillus fermentum CECT5716 enhances the effects of influenza vaccination.Olivares M, Díaz-Ropero MP, Sierra S, Lara-Villoslada F, Fonollá J, Navas M, Rodríguez JM, Xaus J

(3) Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial.Hatakka K, Savilahti E, Pönkä A, Meurman JH, Poussa T, Näse L, Saxelin M, Korpela R.BMJ. 2001 Jun 2;322(7298):1327

(4) Pediatrics. 2009 Aug;124⁽²⁾:e172-9. Epub 2009 Jul 27.Probiotic effects on cold and influenza-like symptom incidence and duration in children.Leyer GJ, Li S, Mubasher ME, Reifer C, Ouwehand AC

(5) J Clin Gastroenterol. 2008 Sep;42 Suppl 3 Pt 2:S224-33.A new chance of preventing winter diseases by the administration of synbiotic formulations.Pregliasco F, Anselmi G, Fonte L, Giussani F, Schieppati S, Soletti L.

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Probiotics are Effective Treatment for Pediatric IBS

Children’s Health, Mental Health, Women’s Health / By @drHoberman

If you’re a parent, then you are probably familiar with the phrase, “My stomach hurts!”

This is often a self limited problem, but some children do experience recurrent abdominal pain which is often diagnosed as Irritable Bowel Syndrome (IBS).

A recently published study examined the benefits of probiotics for alleviating the symptoms of IBS in children⁽¹⁾. IBS is a common problem in pediatrics, and no safe and effective treatment has been available up until now⁽²⁾.

Suspected Causes of IBS

The symptoms of abdominal bloating, gas, pain and change in stools are very common in both children and adults. Once appropriate tests have ruled out any underlying disorder like ulcers, colitis, or celiac disease, the diagnosis is often IBS.

Between 5 to 20% of kids have IBS, and about one in five adults do, too. It’s not fun, but the good news is that IBS doesn’t lead to more serious problems. It is more about quality of life for the child and the family.

Since the cause is not really known, and the symptoms can vary, IBS can be hard to treat.

Over the years a variety of theories have been offered to explain IBS symptoms in children. These have included emotional stress, intestinal hypersensitivity, altered intestinal motility, dietary intolerances and genetics^(3,4).

In the last several years there has been a shift in the paradigm, and now alterations in the intestinal bacteria are thought to be a major factor leading to IBS.

We are all familiar with the term “food poisoning” — a bout of infectious diarrhea due to the consumption of harmful bacteria in contaminated foods or drinks.

Researchers in the area of IBS noted that many of the people who developed symptoms of IBS had experienced a recent episode of food poisoning⁽⁵⁾. It was theorized that the infection caused a disruption of the healthy intestinal bacteria resulting in ongoing intestinal inflammation and GI symptoms⁽⁶⁾.

Recent studies have supported this association and identified post-infectious irritable bowel syndrome (PI-IBS) as a disorder due to a previous bout of infectious gastroenteritis. Approximately 30% of individuals with IBS can date the onset of their symptoms following an episode of gastroenteritis⁽⁷⁾.

Pediatric Medical Studies

In February of this year, a study⁽⁸⁾ was published that documented for the first time that exposure to acute gastroenteritis in childhood is associated with an increased risk of IBS in early adulthood. There was an outbreak of infectious gastroenteritis due to drinking contaminated city water. Children were followed for 8 years after the exposure. The children who had a bout of gastroenteritis had a greater than fourfold increase in IBS compared with unexposed children.

This now brings us back to the new medical article that I mentioned at the beginning of this newsletter. The study⁽¹⁾ enrolled children 4 to 18 years of age who fulfilled the criteria for IBS. The children received a probiotic or a placebo. A daily record of their symptoms was maintained. At the end of the study, the results were reviewed.

The group receiving probiotics had a better than 50% improvement in their symptoms of abdominal pain, and bloating compared to the placebo group. There was also an improvement in the passage of stools. Additionally, no adverse effects were noted in the group taking probiotics.

In 2008, a review article⁽²⁾ on medications to ease the symptoms of IBS in children stated, “The lack of clear evidence of effectiveness for any of the recommended drugs suggests that there is little reason for their use outside of clinical trials.” The new study on childhood IBS, though, does show that probiotics are effective.

Take Home Message

If your child has IBS, probiotics may help to ease their symptoms. Fortunately, there have been no adverse effects associated with their use. Consider using EndoMune Jr for children less than 8 years of age and EndoMune Advanced for older children. It won’t hurt, and it certainly may help!

Eat healthy, exercise and live well!
Dr. Hoberman

(1) VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study.Guandalini S, Magazzù G, Chiaro A, La Balestra V, Di Nardo G, Gopalan S, Sibal A, Romano C, Canani RB, Lionetti P, Setty M.J Pediatr Gastroenterol Nutr. 2010 Jul;51⁽¹⁾:24-30.

(2) Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.Huertas-Ceballos A, Logan S, Bennett C, Macarthur C. Cochrane Database Syst Rev. 2008 Jan 23;⁽¹⁾.

(3) Irritable bowel syndrome: epidemiology, diagnosis and treatment: an update for health-care practitioners.Grundmann O, Yoon SL.J Gastroenterol Hepatol. 2010 Apr;25⁽⁴⁾:691-9. Epub 2010 Jan 13.

(4) Pathogenesis of IBS: role of inflammation, immunity and neuroimmune interactions.Ohman L, Simrén M.Nat Rev Gastroenterol Hepatol. 2010 Mar;7⁽³⁾:163-73. Epub 2010 Jan 26. Review.

(5) The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases.CHAUDHARY NA, TRUELOVE SC. Q J Med. 1962 Jul;31:307-22.

(6) Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis . Wang LH , Fang XC , Pan GZ . Gut 2004 ; 53 : 1096 – 101.

(7) Postinfectious irritable bowel syndrome–a meta-analysis.Halvorson HA, Schlett CD, Riddle MS.Am J Gastroenterol. 2006 Aug;101⁽⁸⁾:1894-9; quiz 1942.

(8) An Outbreak of Acute Bacterial Gastroenteritis Is Associated With an Increased Incidence of Irritable Bowel Syndrome in Children Marroon Thabane, Marko Simunovic, Noori Akhtar-Danesh, Amit X Garg, William F Clark, Stephen M Collins, Marina Salvadori, John K Marshall The American Journal of Gastroenterology 105, 933-939 (23 February 2010).

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Gut Microbes: From Bugs to Drugs

Children’s Health, Drug interactions / By @drHoberman

Spring has finally arrived! With the new season, it’s time to start thinking about how you can add new healthy habits to your daily routine.

This last month I read a very interesting article⁽¹⁾ by Dr. Fergus Shanahan – the chairman of the Department of Medicine/Director of Alimentary Pharmabiotic Centre, University College Cork in Ireland. His research interest is in the area of the intestinal immune system and the way in which intestinal bacteria interact with the intestinal immunity.

The title of the article is: “Gut Microbes: From Bugs to Drugs.”

Dr. Shanahan starts by pointing out how the scientific community had been misled for decades with their efforts to determine the cause of stomach ulcers. In the 1970s, discoveries revealed that peptic ulcer is an infectious disease caused by the bacteria Helicobacter pylori⁽²⁾. Instead of the standard practice of operating on the stomach to reduce the acid production or by giving medications to lessen acid output, peptic ulcers are now cured with antibiotics!

Recently, discoveries revealed that cervical cancer is caused by a virus, and now there is a vaccine to prevent this cancer⁽³⁾ as well.

The point is that the solutions to a number of chronic human diseases will come as we gain a better understanding about how the bacteria and viruses in our environment interact with the cells in our body.

For example, new research on the cause of Crohn’s disease has discovered a genetic mutation in affected individuals⁽⁴⁾. This mutation causes the intestinal immune cells to produce an excessive immune response to normal intestinal bacteria. This inappropriate reaction results in the development of inflammatory bowel disease.

Recent studies using probiotic bacteria, like those in EndoMune, have discovered how these bacteria can down regulate the immune response that occurs in Crohn’s disease.

Segments of intestines that have been surgically removed from patients with Crohn’s disease have been cultured with certain Probiotic bacteria. These bacteria release messenger proteins that inhibit the immune mediated inflammation in the lining to the intestinal segment⁽⁵⁾.

The goal would be to develop a strain of bacteria or isolate the messenger protein that could then be used as a safe, essentially natural therapy for Crohn’s disease.

Dr. Shanahan suggests that studying how our diet, intestinal immune cells and intestinal bacteria interact can potentially lead to new drug therapies for intestinal disorders like irritable bowel disease, inflammatory bowel disease and even colon cancer.

The Implication for Future Cures

Dr. Shanahan believes that the future pharmalogic cures for intestinal disorders will come from studies on how to manipulate our intestinal bacteria with diet and probiotics. He uses the term, pharmabiotics, to refer to “any material with a potential health benefit that can be mined from the host-microbe-dietary interactions.”

An example of a pharmabiotic is ‘bacteriocin’ which is a protein produced by certain strains of bacteria that acts as an antibiotic. One strain of Streptococcus produces a bacterocin that suppresses the bacteria in the mouth that causes halitosis or bad breath.

Another bacteriocin that belongs to the family called ‘thuricin’ acts as a strong antibiotic against a bacteria called Clostridia difficle. This bacteria can cause life threatening colitis. The hope is that this chemical can be developed as a drug to use against Clostridia difficle as this dangerous bacteria is becoming resistant to the currently available antibiotics.

Research in the area of probiotics has produced a number of very interesting and potentially new therapeutic options for dealing with some chronic human illnesses.

As Dr. Shanahan titled his paper, the idea is to find “drugs from bugs.”

Reading this article provides new understanding how ongoing research is identifying the biologic benefits of probiotics. I am amazed how often someone tells me that EndoMune has made such a difference in his/her life!

Take Home Message

Probiotics can suppress harmful bacteria and down regulate intestinal inflammation. Consider EndoMune Advanced for adults or EndoMune Junior for children to help improve gastrointestinal function and ease intestinal symptoms.

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

(1) Gut microbes: from bugs to drugs.Shanahan F. Am J Gastroenterol. 2010 Feb;105(2):275-9. Epub 2010 Jan 12

(2) Helicobacter pylori’s unconventional role in health and disease. Dorer MS, Talarico S, Salama NR.PLoS Pathog. 2009 Oct;5(10):e1000544. Epub 2009 Oct 26

(3) HPV vaccination: the beginning of the end of cervical cancer? – A Review.Lepique AP et al. Mem Inst Oswaldo Cruz. (2009)

(4) The genetic basis of inflammatory bowel disease.Cooney R, Jewell D.Dig Dis. 2009;27(4):428-42. Epub 2009 Nov 4.

(5) Lactobacillus casei downregulates commensals’ inflammatory signals in Crohn’s disease mucosa.Llopis M, Antolin M, Carol M, Borruel N, Casellas F, Martinez C, Espín-Basany E, Guarner F, Malagelada JR.Inflamm Bowel Dis. 2009 Feb;15(2):275-83.

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