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Mental Health

Mental Health issues, according to an increasingly number of studies examining the link between digestive health and our brains, may improve by restoring our gut health.

Probiotics are Effective Treatment for Pediatric IBS

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 ALogan SBennett CMacarthur CCochrane 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 HASchlett CDRiddle 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).

 

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.

Probiotics Help with Stress Reduction

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

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

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

Probiotics: The Anti-Stress Pill?

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

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

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

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

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

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

Take Home Message

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

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

Eat healthy and live well!
Lawrence J Hoberman MD

References:

(1) Assessment of psychotropic-like properties of a probiotic formulation ( Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. Messaoudi M, Lalonde R, Violle N, Javelot H, Desor D, Nejdi A, Bisson JF, Rougeot C, Pichelin M, Cazaubiel M, Cazaubiel JM. Br J Nutr. 2010 Oct 26:1-9.

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

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

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

 

How Can Probiotics Keep Children Healthy?

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

Probiotics and Acute Infectious Diarrhea

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

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

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

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

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

Probiotics and Chronic Abdominal Pain (CAP)

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

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

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

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

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

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

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

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

Take Home Message

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

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

Eat healthy and live well!
Lawrence J Hoberman MD

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

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

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

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

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

 

Can Probiotics Lessen Infantile Allergies?

In last month’s newsletter, I mentioned some of the benefits of probiotics for children. This month I would like to discuss how probiotics may lessen childhood allergies like asthma, eczema and hay fever.

Emergence of the Hygiene Theory

Over the last 30 years, there has been a two-to-three fold increase in childhood allergies in developed countries. This is significant as compared to the 19th century when hay fever (allergic rhinitis) and asthma were rare.

The rise in allergies like asthma, rhinitis, and eczema has not been seen in underdeveloped countries.  This observation has resulted in the “Hygiene Theory”(1).

The theory attributes the rise of allergies to our sanitized lifestyle. In our super-clean world –
vaccinations, anti-bacterial soaps, antibiotics, and airtight doors and windows – we are keeping dirt and disease-causing germs at bay.

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 Hygiene Theory explains the rise of allergies to a change in the immune activity of the gut (2). Our bodies no longer need to fight germs as much as they did in the past. As a result, the immune system has shifted away from fighting infection to developing more allergic tendencies.

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 the balance of activity in favor of the Th2 lymphocytes, producing antibodies to parasites and also to harmless allergens.

The initial theory has been modified some (3).  There is another lymphocyte called a regulatory cell (Treg). This lymphocyte can regulate the activity of both Th1 and Th2 lymphocytes. By adding probiotic bacteria, the (Treg) cells can downregulate the Th2 allergy-mediated immune response.

Probiotics to Regulate Incidence of Eczema

In 2001, a study was done to determine if giving probiotics to mothers prenatally and to infants for the first six months could lessen the frequency of eczema (4). During the first two years of life, eczema occurred 50% less in the group given probiotics compared to the group given placebo.

Subsequent similar studies have had mixed results (5). However, a recent study found that giving a probiotic blend to pregnant women with a family history of allergies was beneficial. The women were given either a placebo or the probiotic starting 4-8 weeks before delivery and then for an additional three months. The infants receiving probiotics had a 55% less involvement with eczema at one year compared to the placebo group (6).

Based on the available studies, probiotics can modify the immune system in infants and lessen the risk of developing eczema and possibly childhood asthma.

There are very few studies that have shown that probiotics can treat existing allergies in children or adults (5). In this regard, it is of interest that a recent study reported probiotics lessened symptoms of nasal allergy in children during the birch pollen season (7).

Much more research is needed to understand how probiotics interact with the intestinal immune cells, but it is really fascinating how our intestinal bacteria play such a major role in our general health.

Take Home Message

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 to your doctor before taking new medications and supplements.

(1) Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989 Nov 18; 299(6710):1259–1260.

(2)Probiotics in children.Kliger B, Hanaway P, Cohrssen A. Pediatr Clin North Am.2007 Dec;54(6): 949 Kligler B, Hanaway P, Cohrssen A.

(3)Hygiene theory and allergy and asthma prevention. Liu AH.Paediatr Perinat Epidemiol. 2007 Nov;21 Suppl 3:2-7.

(4)Probiotics in primary prevention of atopic disease: a randomized placebo-controlled trial.Kalliomäki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E.Lancet. 2001 Apr 7;357(9262):1076-9.

(5)Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double-blind, randomized, placebo-controlled trial.Kim JY, Kwon JH, Ahn SH, Lee SI, Han YS, Choi YO, Lee SY, Ahn KM, Ji GE.Pediatr Allergy Immunol. 2009 Oct 14.

(6)Probiotics and prebiotics in atopic dermatitis: a review of the theoretical background and clinical evidence.van der Aa LB, Heymans HS, van Aalderen WM, Sprikkelman ABPediatr Allergy Immunol. 2009 Jul 2.

(7)Specific probiotics alleviate allergic rhinitis during the birch pollen season. Ouwehand AC, Nermes M, Collado MC, Rautonen N, Salminen S, Isolauri E. World J Gastroenterol. 2009 Jul 14;15(26):3261-8.

Probiotics Prevent Colds in Children?

“When given preventively over the winter months, probiotics reduce fever, cough, and runny noses in children, researchers said.”

This is very exciting news for parents across the country. Many parents deal with the frustration of sick children during the winter months and the many associated problems including missed school, missed work and restless nights.

A recent study evaluated 326 children ages 3 to 5 years. Two groups of these children in a childcare center in China were given “twice-daily doses of L. acidophilus or L. acidophilus in combination with Bifidobacterium animalis for six months from November 2005 to May 2006.” The third group was given a placebo.

Both the single strain and the multi-strain probiotic doses were effective at reducing fever, cough, and rhinorrhea; the combination strain, however, had a more profound, positive impact. This seems to imply multi-strain, multi-species probiotics continue to prove more efficacy for prevention rather than their single-strain counterparts.

With profound research studies, such as this study in China, physicians may be able to begin moving away from antibiotics toward other forms of prevention like probiotics. While more studies are necessary, probiotic research continues to move forward in a very exciting direction.

For the article in its entirety, visit:
http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/15251

Source reference:
Leyer GJ, et al “Probiotic effects on cold and influenza-like symptom incidence and duration in children” Pediatrics 2009; DOI: 10.1542/peds.2008-2666.

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