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Healthy Aging

Healthy Aging depends on maintaining a healthy digestive system aided by probiotics.

Probiotics and the Prevention of Food Allergies

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)

Probiotics May Decrease Allergies

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.

Tax Season Can Lead to Stress and IBS

April is a wonderful time of the year. Spring is nature’s way of saying, “let’s party.”(1)

Planting new flowers and watching the first blossoms of the year are very joyful and relaxing activities, especially after enduring the cold gray days of winter.

Unfortunately, despite its beauty, April can sometimes be stressful for various reasons. At the forefront of many people’s mind is the need to file taxes. Or, you may be waiting to hear where your children will be going to school next year, or if they will find a job. If you happen to be one of those millions of people experiencing stress this season, you may want to consider taking a probiotic after you read this month’s newsletter.

Stress Causes Changes in Bacteria

Two very interesting articles were published in March. These articles investigated how stress can adversely affect the healthy bacteria of intestines(2,3) .

In my practice of gastroenterology, I would see many patients who had ongoing symptoms of abdominal pain and change in stool habits. Despite comprehensive evaluations, no specific cause could be found for many of the patients. As a result, they would be labeled with the diagnosis of “Irritable Bowel Syndrome” (IBS).

At the time, it was thought that the symptoms of IBS were frequently due to stress. The common therapies included medications that combined an antispasmodic and a mild tranquilizer like Librax, Donnatal or Bentyl. These medications were treating the symptoms, but not the cause of stress. If medical researchers can determine the cause of the symptoms, then better therapy can be developed.

Immune System and Stress Regulation

The intestines contain 70% of our immune cells. It’s these cells that are responsible for monitoring the bacteria entering our system. Harmful bacteria stimulate the intestines to release inflammatory mediators (cytokines) in an effort to destroy the harmful bacteria. An increase in these mediators can result in intestinal inflammation, which in turn causes the symptoms of IBS.

One study(3)  published in March measured the level of inflammatory cytokines in 30 patients with IBS and in 30 normal controls. The level of cytokines were much higher in the IBS group – indicating there is a link between IBS and cytokines.

The other study(2)  investigated the intestinal bacteria in mice before and after they were exposed to a stressful situation. Following exposure to the stress, there was a change in the composition of the intestinal bacteria. With this change came an increase in harmful bacteria, which then induced the immune system to release inflammatory cytokines.

These research studies help to understand the cause of IBS symptoms. Now, the question is how to decrease the inflammation induced by stress. Doing this will be a giant step toward “treating” the symptoms of IBS.

Fortunately, scientific studies(4,5)  have already demonstrated that giving probiotics can reduce the immune system release of inflammatory cytokines, thereby easing IBS symptoms.

Take Home Message

If you are experiencing some stress and GI symptoms, consider taking a high quality probiotic like EndoMune so you can fully enjoy this springtime.

Eat healthy, exercise and live well!
Dr. Hoberman

References:

(1) Quote by Robin Williams

(2) Exposure to a social stressor alters the structure of the intestinal microbiota: implications for stressor-induced immunomodulation. Bailey MT, Dowd SE, Galley JD, Hufnagle AR, Allen RG, Lyte M. Brain Behav Immun. 2011 Mar;25(3):397-407

(3) Altered peripheral toll-like receptor responses in the irritable bowel syndrome. McKernan DP, Gaszner G, Quigley EM, Cryan JF, Dinan TG. Aliment Pharmacol Ther. 2011 May;33(9):1045-52.

(4) The role of microbiota and probiotics in stress-induced gastro-intestinal damage.Lutgendorff F, Akkermans LM, Söderholm JD. Curr Mol Med. 2008 Jun;8(4):282-98

(5) Therapies aimed at the gut microbiota and inflammation: antibiotics, prebiotics, probiotics, synbiotics, anti-inflammatory therapies.Quigley EM.Gastroenterol Clin North Am. 2011 Mar;40(1):207-22

 

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.

Can Probiotics Help Protect Against the Flu?

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 GAlvarez SMedina MVintiñi ERoux E

(2) Nutrition. 2007 Mar;23(3):254-60.Oral intake of Lactobacillus fermentum CECT5716 enhances the effects of influenza vaccination.Olivares MDíaz-Ropero MPSierra SLara-Villoslada FFonollá JNavas MRodríguez JMXaus 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 GJLi SMubasher MEReifer COuwehand 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 FAnselmi GFonte LGiussani FSchieppati SSoletti L.

Probiotics to Treat IBD?

An article in the February 2010 issue of Journal of Medical Microbiology explores the potential of various bacteria strains to address the causes of Irritable Bowel Disease (IBD). Certain types of bacteria produce compounds that can reduce inflammation of the intestinal lining.

Nearly six months ago I wrote an article addressing the potential of bacteria within probiotics to address the issues associated with IBD. In that article I explained:

Here are the five top reasons to consider probiotics in individuals with IBD (3,5,6).

  • Probiotics adhere to the intestinal lining cells and competitively inhibit the harmful bacteria from taking up residence.
  • Probiotics suppress immune mediated inflammation by producing cytokines that inhibit the inflammatory process.
  • Probiotics produce antimicrobial products that inhibit the survival of harmful bacteria.
  • Probiotics enhance the intestinal lining cells health by tightening the junction between intestinal lining, thereby inhibiting the invasion by the harmful bacteria.
  • Probiotics have been shown to inhibit immune cells responses, which would result in further inflammation.

Researchers are now trying to identity which strains are the most effective for surviving within the intestinal tract of individuals with IBD, given their unique circumstances and depleted supply of functional bacteria.

To read more about this study, visit the Medical News Today article:
http://www.medicalnewstoday.com/articles/176550.php

Probiotics Provide Insurance Against Salmonella

What do peanut butter, pistachios, cantaloupes, and eggs have in common? They have all been recent sources of Salmonella food borne illnesses in humans.

Since we are in the middle of a nationwide outbreak of a Salmonella infection due to contaminated eggs, I thought it would be of interest to discuss the benefits of probiotics against Salmonella infections.

If you are feeling paranoid about what to eat, you may feel safer taking EndoMune after reading this newsletter.

There are a number of reasons why probiotics may prevent or shorten the duration of a bout of infectious diarrhea like Salmonella.

Probiotics(1,2,3):

  1. Secrete bacteriocins (proteins that can kill harmful invading bacteria)
  2. Produce products like lactic acid and hydrogen peroxide that inhibit infectious bacteria
  3. Stimulate the intestinal immune system to release antibodies and inflammatory cells to destroy the hostile bacteria
  4. Carpet the intestinal lining to prevent the harmful bacteria from attaching and invading the intestinal lining cells

With the knowledge that probiotics can have a beneficial effect against infectious bacteria, researchers have done several types of investigations.The following are studies where probiotics have been shown to be helpful:

Acute Infectious Diarrhea

A number of controlled trials(1) have compared probiotics versus placebo when treating children and adults with acute infectious diarrhea, including Salmonella. The general finding was that probiotic could reduce the duration and severity of the illness. The diarrheal illnesses were shortened, on average, 1-2 days in the individuals who were taking a probiotic.

Traveler’s Diarrhea

The cause of traveler’s diarrhea is exposure to food and water that has been contaminated with fecal matter due to poor sanitary and public health conditions. The organisms that cause the diarrhea are bacteria, viruses and parasites. Studies have found that bacteria like E. coli, Shigella, Salmonella and Campylobacter account for 80% of the episodes. There have been a number of published controlled trials giving travelers either probiotics or placebos. A review(5) of 12 well done clinical trials found that probiotics were safe and generally effective in preventing traveler’s diarrhea. Compared to the travelers receiving a placebo, the probiotic travelers had about 25-50% fewer bouts of diarrhea.

Experiemental Studies

Several recent research studies have investigated how probiotics inhibit Salmonella. One study(6)incubated either Salmonella alone or the combination of probiotics and Salmonella on cultures of human colon cells. The immune reactions in the intestinal cells that were exposed to the probiotic with the Salmonella were much greater than that seen in the cells in contact with only the Salmonella. The study showed that the probiotics could stimulate the release of protective immune reactions against the Salmonella bacteria.

In another study(7), one group of mice were fed probiotics for seven days before being challenged with Salmonella. The other group did not receive the probiotic. The survival rate was greater and the infection milder in the group receiving the probiotics. Studies of the intestinal fluid found much higher levels of antibodies against the Salmonella bacteria.  Again, this would indicate that the probiotics stimulate the intestinal immune system to fight harmful intestinal bacteria.

Take Home Message

Be careful about the eggs you consume and make sure you cook them thoroughly. Avoid the runny eggs like poached eggs or eggs that are served sunny-side up. Eggs Benedict with hollandaise sauce is probably not a good idea, at least for now. You may want to consider a bowl of oatmeal until all the bad eggs are recalled.

If you are still concerned about exposure to Salmonella, consider taking a high quality probiotic like EndoMune.

Eat healthy, exercise and live well!
Dr. Hoberman

(1) Guidance for substantiating the evidence for beneficial effects of probiotics: prevention and management of infections by probiotics.Wolvers D, Antoine JM, Myllyluoma E, Schrezenmeir J, Szajewska H, Rijkers GT.J Nutr. 2010 Mar;140(3):

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

(3) Clinical evidence for immunomodulatory effects of probiotic bacteria.
Ruemmele FM, Bier D, Marteau P, Rechkemmer G, Bourdet-Sicard R, Walker WA, Goulet O.J Pediatr Gastroenterol Nutr. 2009 Feb;48(2):126-41. Review

(4) Probiotics for treating infectious diarrhoea(Cochrane Review). Reviewers: Allen, Stephen J; Okoko, B; Martinez, Elizabeth G; Gregorio, Germana V; Dans, Leonila F. Review Group: Cochrane Infectious Diseases Group; Cochrane Database of Systematic Reviews; Edited/Substantively amended: 11 November 2008; Edited (no change to conclusions) this issue

(5)McFarland LV: Meta-analysis of probiotics for the prevention of traveler’s diarrhea. Travel Med Infect Dis. 2007;2:97-105

(6) Microbial products from probiotic bacteria inhibit Salmonella enteritidis 857-induced IL-8 synthesis in Caco-2 cells.Malago JJ, Nemeth E, Koninkx JF, Tooten PC, Fajdiga S, van Dijk JE.Folia Microbiol (Praha). 2010 Jul;55(4):401-8. Epub 2010 Aug 3

(7) Anti-infective mechanisms induced by a probiotic Lactobacillus strain against Salmonella enterica serovar Typhimurium infection.de LeBlanc Ade M, Castillo NA, Perdigon G.Int J Food Microbiol. 2010 Apr 15;138(3):223-31. Epub 2010 Feb 1.

Tips for Avoiding Foodborne Illness this Summer

School is out, summer is here, and it’s time to make plans for the 4th of July and perhaps a summer vacation.

There following are important reasons to take a good probiotic, like EndoMune during the summer:

  • To lessen the risk of food poisoning
  • To avoid traveler’s diarrhea

Foodborne illness is an ever-present threat that can be prevented with proper care and handling of food products. “It is estimated that between 24 and 81 million cases of foodborne diarrhea disease occur each year in the United States, costing between $5 billion and $17 billion in medical care and lost productivity”.(1)

In the last three years, there have been a number of outbreaks of foodborne illnesses due to Salmonella and E. coli found in contaminated peanut butter, cookie dough, chicken pot pies and beef products.

Friendly Fourth of July Food Reminders

With the 4th of July just around the corner, lots of Americans are planning a picnic or a BBQ.  In fact, the US census department says that one in four Americans will enjoy an outdoor picnic.  The big concern is to keep the cold dishes cold, and the hot foods well cooked(2). Bacteria are killed when the food is heated to 160 degrees or greater, and a temperature less than 40 degrees inhibits the growth of bacteria in refrigerated foods.

Every year we hear about outbreaks of food poisoning due to contaminated hamburger meat with bacteria like E. coli. The message is to check the temperature of the meat on the grill to insure it has reached at least 160 degrees. Cooked hamburgers with a pink inside could present a problem.

Outbreaks of food poisoning due to potato salad are common. One reported outbreak affected 125 people(3). It is important to avoid allowing any refrigerated salad to be at room temperature for any period of time before serving.

Risk of Traveler’s Diarrhea

Traveling exposes us to the risk of contaminated food and drinks. The risk of traveler’s diarrhea is related to the sanitary practices of storing, preparing and serving the food. Infectious gastroenteritis is a larger problem in less developed countries where running water and refrigeration is a problem.

International travel to exotic locations is becoming more popular. In 2008, one out of five Americans traveled abroad, and 38 million visits were to developing countries where there are significant health risks for travelers.

The rule for avoiding traveler’s diarrhea may be summarized by the CDC-coined phrase, “boil it, cook it, peel it, or forget it.”  The big concerns are salads, unpeeled fruits and vegetables.

EndoMune Can Lessen Risk of Foodborne Illness

So how does a probiotic like EndoMune help to lessen these foodborne illnesses?

There have not been any studies published on the benefits of taking a probiotic and avoiding gastroenteritis during the 4th of July!  But, there are several studies that have found probiotics lessen the risk of traveler’s diarrhea(4). It does make sense that a multispecies probiotic with at least 10 billion bacteria could lessen the risk of developing a foodborne infection. The probiotic bacteria carpet the intestines and produce proteins called bacterocins. The ingested harmful bacteria can’t penetrate the intestinal lining, and they are destroyed by the antibiotic proteins produced by the probiotic bacteria.

There is no guarantee that probiotics will prevent a bout of gastroenteritis, but there is a good chance it will lessen the risk.

Take Home Message

Don’t leave home without your EndoMune whether going to a BBQ or far away country. Have a great summer and remember…

Eat healthy, exercise and live well!
Dr. Hoberman

(1) Bacterial Food PoisoningAl B. Wagner, Jr.Extension Food Technologist Texas Agricultural Extension Service.

(2) Barbecue and food safety.” United States Department of Agriculture. Updated July 2, 2007.

(3) The Middleton outbreak: 125 cases of foodborne salmonellosis resulting from cross-contaminated food items served at a picnic and a smorgasbord.Levy BS, McIntire W, Damsky L, Lashbrook R, Hawk J, Jacobsen GS, Newton B.Am J Epidemiol. 1975 Jun;101(6):502-11

(4) McFarland LV: Meta-analysis of probiotics for the prevention of traveler’s diarrhea.Travel Med Infect Dis. 2007;2:97-105.

Risk of C. Difficile due to Acid Suppression Therapy

Two medical articles(1,2) published last month received a considerable amount of attention; I think they are very pertinent to the discussion of whether to take a probiotic to counter the risks of taking medications for the suppression of gastric acid.

Every day we are bombarded with ads about the benefits of taking medications to lessen the symptoms of heartburn and indigestion. Additionally, the medical profession recommends taking acid suppressive medicines to avoid the development of stomach ulcers as a side effect of taking pain and arthritis drugs like Advil and Aleve.

For years the mainstay of treatment was medications like Tums and Maalox – both antacids. They buffer or neutralize the acid produced by the stomach and are commonly used to relieve heartburn symptoms. Unfortunately, they have been only partially successful.

The pharmaceutical industry has developed better drugs that can lower or prevent acid production by the stomach’s acid producing cells. The most popular and effective of these medications to inhibit gastric acid production are called proton pump inhibitors or PPIs.

Proton pump inhibitors are big business in the United States: “A staggering 113.4 million prescriptions for proton pump inhibitors (PPIs) are filled each year, making this class of drugs, at $13.9 billion in sales, the third highest seller in the United States” (3).

There are 5 medications in this class of drugs which we all know thanks to the television ads: Prilosec, Prevacid, Protonix, Aciphex and the most famous – the purple capsule – Nexium.

What is the Concern with PPI Medications?

Since their introduction in 1998, there has been a progressive increase in intestinal infections with the bacterium called Clostridium difficile (C. difficile).

C. difficile causes a severe diarrhea and life threatening colitis. Roughly 3-5% of the healthy adult population has this bacterium in their intestines. These individuals do fine until they are given an antibiotic for an infection like pneumonia or sinusitis. The antibiotic wipes out the healthy intestinal bacteria which then allows the C. difficile to multiple and produce a toxin that causes a serious colitis. In addition, hospitalized patients are at risk of acquiring this bacterium from contaminated bed rails and other surfaces(4).

Risks of Acid Suppression Therapy

There has been an increasing rate and severity of C. difficile infections in hospitalized patients. Acid suppressive therapy has been suggested as a risk factor. The articles previously mentioned studied the risk of hospitalized patients taking PPI’s and developing C. difficile infections. The first study(1) found a 70% increased risk of a C. difficile infection in patients taking a PPI versus patients not receiving a PPI.

The second article(2) studied the risk of recurrent C. difficile infections in hospitalized patients taking PPIs. These patients had been successfully treated for a C. difficile infection.  There is a known recurrent rate of 20% after treatment. The concern was if PPIs could increase the risk of recurrent infections. The study found that recurrent C. difficile infection rate was 42% higher in those patients receiving PPIs vs. patients not receiving PPIs.

The exact reason why PPIs increase the risk for C. difficile infection is unknown. One potential mechanism has to do with the ability of gastric acid to destroy harmful bacteria. It is known that the stomach acid is the first defense against ingested harmful bacteria in contaminated drinks and foods. The harmful bacteria are destroyed by the stomach acid and never have an opportunity to invade the intestines.

Experimental studies in mice and hamsters have shown an increase in susceptibility to C. difficile infections when the stomach acid is suppressed(5). In addition, other studies have found that humans are more susceptible to other intestinal infections when the gastric acid is suppressed.

Based on a number of reports(6), there is reason to believe that probiotics may help to lessen the risk of C. difficile infections in patients taking PPIs. Probiotics have been shown to produce proteins that destroy harmful bacteria. In addition, they interact with the intestinal immune system to stimulate the immune reaction against harmful bacteria.

Take Home Message

Consider taking a high quality probiotic like EndoMune if you are going to be on long-term PPIs. If someone needs to be hospitalized, consider taking a probiotic to lessen the risk of acquiring a C. difficile infection, especially if PPIs and/or antibiotics are prescribed.

Thank you for your interest in EndoMune.

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

(1) Arch Intern Med. 2010 May 10;170(9):784-90.Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection.Howell MDNovack VGrgurich PSoulliard DNovack LPencina MTalmor D

(2) Arch Intern Med. 2010 May 10;170(9):772-8.Proton pump inhibitors and risk for recurrent Clostridium difficile infection.Linsky AGupta KLawler EVFonda JRHermos JA.

(3) Arch Intern Med. 2010 May 10;170(9):747-8.Failing the acid test: benefits of proton pump inhibitors may not justify the risks for many users.Katz MH.

(4) Am J Infect Control. 2010 Jan 31. [Epub ahead of print]Significant impact of terminal room cleaning with bleach on reducing nosocomial Clostridium difficile.Hacek DMOgle AMFisher A,Robicsek APeterson LR.

(5) Microbiol Immunol. 2007;51(12):1209-14.Comparative role of antibiotic and proton pump inhibitor in experimental Clostridium difficile infection in mice.Kaur SVaishnavi CPrasad KKRay P,Kochhar R.

(6) Am J Gastroenterol. 2006 Apr;101(4):812-22.Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease.McFarland LV.

Probiotics Benefits for IBS, Cancer and Chemotherapy

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

1) Post Infectious Irritable Bowel Syndrome

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

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

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

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

2) Anticancer Effect of Probiotics

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

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

3) Chemotherapy-Induced Diarrhea

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

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

Take Home Message

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

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

Thank you for your interest in EndoMune.

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

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

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

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

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

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

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

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

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

(9) Int J Cancer. 2009 Oct 28. [Epub ahead of print]The anticancer effect of probiotic Bacillus polyfermenticus on human colon cancer cells is mediated through ErbB2 and ErbB3 inhibition.Ma EL,Choi YJChoi JPothoulakis CRhee SHIm E.

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

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

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

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