bacteria Archives

Boost Your Serotonin without Medication

Protecting your body’s gut-brain axis—the connection linking your brain, emotions and intestines—is very important to your good physical and emotional well-being.

Taking a multi-strain probiotic can serve as a vital step to enhance the diversity of beneficial bacteria in your gut.

Guarding that diversity and your gut-brain axis is critical for your body’s production of serotonin, a chemical that works as a neurotransmitter to send messages from one part of the brain to another. In fact, scientists estimate that 80-90 percent of the body’s serotonin may be produced in the gut.

Important research by Caltech scientists, published in the medical journal Cell, has linked the production of peripheral serotonin in the gut by enterochromaffin (EC) cells to specific bacteria.

Specific gut bacteria connected to serotonin production

First, researchers investigated whether gut bacteria affected serotonin by comparing its production in normal and germ-free mice. No surprise, EC cells from germ-free animals produced some 60 percent less serotonin versus normal mice.

When gut bacteria was taken from normal mice and transplanted into germ-free mice, serotonin levels of germ-free animals rebounded.

Then, scientists tested gut bacteria (single species and groups) to determine which species work with EC cells to produce serotonin. They identified some 20 species of spore-forming bacteria that boosted levels of serotonin in germ-free mice.

Also, normal mice treated with these species experienced improved gastrointestinal motility and alterations in the activation of blood platelets (they use serotonin to promote clotting too).

“EC cells are rich sources of serotonin in the gut. What we saw in this experiment is that they appear to depend on microbes to make serotonin, or at least a large portion of it,” said Jessica Yano, one of the study’s authors in a press release.

Previously, research has concluded some strains of bacteria were solely responsible for producing serotonin, but this study saw things differently. Instead, specific bacteria normally present in the gut interact with intestinal cells to generate serotonin, said Yano.

These interactions between gut bacteria and intestinal cells may not be limited to producing serotonin, said Dr. Elaine Hsiao, research assistant professor of biology and biological engineering and senior author of the study.

“We identified a group of bacteria that, aside from increasing serotonin, likely has other effects yet to be explored. Also, there are conditions where an excess of peripheral serotonin appears to be detrimental.”

More natural serotonin boosters

Boost your levels of serotonin without depression medication, here’s four steps that can help without taking a drug:

Exposing your body to bright light every day, a treatment for seasonal affective disorder in the winter, may be a worthwhile alternative to treat depression year-round.
Get your body moving with daily exercise.
Modify your diet by cutting back on caffeine and foods made of simple carbs (white bread, white rice and sweets), and eating more protein and brightly colored veggies every day.
A recent University of Michigan study cited probiotics as a way to reduce stress by reversing intestinal inflammation.

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Is kombucha tea really the “Champagne of Life” or an imposter?

Diet, Digestive Health / By @drHoberman

A diet rich in colorful fruits and vegetables and protein sources that aren’t red meat, along with cutting back on your daily caloric intake, can do wonders for your overall health, waistline and, particularly, your gut health (promoting the presence of beneficial bacteria, including Lactobacillus).

So, you may be thinking eating probiotic-rich foods in addition to taking a good probiotic is a good thing for your health. However, the jury is very much on the fence about the true benefits of eating probiotic-rich foods.

These mixed messages haven’t slowed down the meteoric popularity of kombucha tea—affectionately called the Champagne of Life, Fungus Japonicus and Mushroom Infusion—on grocery and book store shelves as a complete cure-all nor has it changed the minds of foodies about its perceived value as an energy booster or “fountain of youth.”

Looking for the cultures

Tart and bubbly, kombucha tea is made when brewed black tea is steeped with sugar, then fermented with cultures of bacteria and yeasts in a glass container. After at least a week’s time, billions of microorganisms ferment, soon forming a kombucha mushroom or SCOBY (symbiotic colony of bacteria and yeast) on top of the tea.

The bacteria cultures contained in kombucha tea can vary greatly, from Saccharomycodes ludwigii to Candida stellate and Pichia fermentans. (Depending on how and where kombucha tea is made, it may also contain molds and fungi.

Despite the questions, people are buying millions of bottles of kombucha tea from companies like GT’s, Tonica and Celestial Seasonings at $4 per bottle. Last month, a new book by Steve Lee, the Portland-based entrepreneur behind Kombucha Wonder Drink, entitled Kombucha Revolution: 75 Recipes for Homemade Brews, Elixirs and Mixers, shows people how to incorporate the popular drink into daily diets.

The reality versus the hype

Unfortunately, the perceptions don’t match the debatable health benefits of kombucha tea. Surprisingly, the verdict from most conventional health sources (WebMD, Mayo Clinic, American Cancer Society) matches some of the same concerns voiced by alternative health expert Dr. Andrew Weil.

For one, it’s tough for consumers to make kombucha tea in germ-free home environments and at room temperatures for as long as 12 days where it can become contaminated with harmful bacteria. In an op-ed, Dr. Weil expressed grave concerns about the contamination of home-brewed kombucha teas, as some have contained aspergillus, a toxin-producing fungus.

The high amount of alcohol in home-brewed kombucha teas is another concern, according to Dr. Melissa Wdowik of Colorado State University. In fact, the Whole Foods grocery chain pulled all brands of kombucha teas four years ago due to fluctuations in alcoholic content above the legal 0.5 percent limit, until those amounts dropped.

Also, the “real” health benefits of kombucha teas from the scientific realm are almost non-existent. Although some research has been done with animals, no clinical studies related to kombucha tea have been conducted on humans.

Finally, never assume you’re getting the beneficial strains good bacteria you’d normally receive from taking a probiotic like EndoMune Advanced Probiotic in kombucha tea.

Taking a daily probiotic made from multiple strains of beneficial bacteria is far more effective in treating a wide range of problems, from irritable bowel syndrome (IBS) to traveler’s diarrhea, than drinking kombucha tea with no measurable benefits.

Is kombucha tea really the “Champagne of Life” or an imposter? Read More »

Taking a multi-species probiotic is healthier than a placebo

Drug interactions, Probiotics / By @drHoberman

Despite the 10 reasons we cited in a recent blog post, you may still be questioning why you should take a probiotic for your good health.

Unfortunately, a recent study published in the medical journal BMC Gastroenterology that compared the benefits of a probiotic to a placebo (a substance that may look like a drug but contains no medication and is taken merely to reinforce a patient’s belief he or she will get well) may have you doubting the effectiveness.

For the record, British researchers conducted a double-blind trial that compared the benefits 179 irritable bowl syndrome (IBS) patients felt after taking a functional probiotic yogurt or a placebo (non-probiotic yogurt) twice daily.

After four weeks, there was very little difference in the amount of relief felt by patients taking a probiotic (57 percent) versus a placebo (53 percent). By weeks eight and 12, however, patients taking the placebo experienced greater benefits compared to those taking a probiotic.

However, probiotic users shouldn’t be alarmed. The product tested in the study, like many food supplements of its kind, contained just a single strain of beneficial bacteria. It’s difficult to determine just how much beneficial bacteria are contained in yogurt, especially since most contain dead microbiota.

Shortly after BMC Gastroenterology published its study, the Journal of Gastroenterology and Hepatology released one of its own that found probiotics containing multiple strains of beneficial bacteria reduced IBS symptoms in 68 percent of participants compared to just 37.5 percent of those given a placebo.

In fact, studies have shown beyond a doubt that probiotics containing multiple strains of beneficial bacteria are more effective in treating a host of health problems in addition to IBS, including diarrhea, immune functioning and respiratory tract infections.

Taking a health-boosting probiotic like EndoMune Advanced, which contains at least 10 different varieties of bacteria, some 16 billion beneficial bacteria and prebiotics every day, can do wonders for your continued good health.

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Soothe Your Baby’s Colic with Probiotics

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

Babies cry for a variety of reasons: they’re hungry, they’re thirsty, they need changing or they’re sick. Sometimes they cry for no apparent reason at all. This is called infantile colic. A colicky baby cries or shows symptoms of discomfort, such as moaning or fussing, for up to several hours.

Three recent studies published by the National Center for Biotechnology Information found that many babies with infantile colic had an inflamed intestine caused by certain bacteria. Based on the results, scientists concluded that higher levels of beneficial bacteria, like those found in probiotics, lessened intestinal inflammation in babies.

Like adults, babies benefit from a healthy balance of intestinal bacteria that are found in probiotics. EndoMune Junior contains billions of bacteria that improves intestinal digestion, helping relieve colic and ease babies’ distress.

Soothe Your Baby’s Colic with Probiotics Read More »

Find the Right Probiotic for You

Drug interactions, Probiotics / By @drHoberman

There are numerous choices when trying to find a probiotic supplement. From supplements that contain one strain of bacteria to supplements that contain 10 strains, finding the right probiotic can be difficult. To assist you in making the best choice for your probiotic wants and needs, keep these three tips in mind:

Bacteria strains – When purchasing a probiotic, look at the amount of bacteria strains it contains. Supplements that have multiple bacteria strains have been proven to be more effective than supplements that contain one or two bacteria strains. EndoMune Advanced,
for example, contains 10 different bacteria strains.
Colony-Forming Units – The colony-forming units, or CFU’s, are also important to a probiotic purchasing decision. Probiotic supplements with 10 billion CFU’s might be more beneficial than probiotic supplements with one billion CFU’s.
Packaging – How a probiotic supplement is packaged directly affects its shelf-life. Those packaged in a darker container will generally last longer than supplements that are packaged in a lighter container.

Remember these tips when purchasing your next probiotic supplement. For more information, contact EndoMune Advanced Probiotic.

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How to get rid of diarrhea

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

Taking probiotics may be helpful in preventing diarrhea, but a review of more than 63 studies by the Cochrane Library suggests that it can help to get rid of diarrhea quicker.

This review of nearly 8,000 patients — including 56 focused on infants and young children — concluded the use of probiotics shortened the course of diarrhea by a day, and reduced the duration of diarrhea lasting more than four days by 59 percent.

Also, probiotics decreased the chances of spreading the diarrhea infection and relieved discomfort.

Lactobacillus acidophilus and Bifidobacterium bifidum — both critical strains of beneficial bacteria contained in EndoMune Advanced Probiotic and EndoMune Junior, –were among the strains of probiotic bacteria used in the studies.

Researchers found no difference between the strains of probiotic bacteria used as all the strains proved to be safe and beneficial to the study participants.

“A striking finding of this review is that most trials reported that probiotics reduced diarrhea,” said lead researcher Stephen Allen of the School of Medicine at Swansea University, UK, according to a press release. “The beneficial effect was consistent and significant across many different types of trials.”

Be wary of standard diarrhea treatments

Unfortunately, three of the more popular ways to treat diarrhea — taking an antibiotic or an over-the-counter medication or eating specific foods — may not be as safe or reliable and create more health complications you’ll want to avoid, especially if your child is at risk.

For example, some health experts advise taking antibiotics, but only if bacteria or parasites trigger diarrhea. Yet, antibiotics can cause great harm not only by disrupting the healthy balance of bacteria in your gut but by promoting the spread of antibiotic-resistant superbugs like C. diff infections.

Also, taking an over-the-counter drug like loperamide (Imodium) or bismuth-subsalicylate (Pepto Bismol) only treats diarrhea, but not the underlying cause of the problem. Plus, you should be very careful if your child has the flu or chickenpox that you don’t treat him/her with medicines that contain bismuth-subsalicylate due to their link to Reye syndrome, a rare but very serious disease.

Plus, the verdict is very much mixed about the value of following the BRAT diet (bananas, rice, applesauce and toast), particularly for children because it doesn’t contain enough nutrients to help their guts recover from diarrhea.

However, taking a probiotic is one of most effective ways, not only to shorten the duration of diarrhea, but to give your body a healthy boost to its natural defenses to prevent it altogether.

The real trick about probiotics: There’s a huge difference between taking a probiotic containing single or multiple strains of beneficial bacteria.

A growing number of studies have shown taking a multi-species probiotic like EndoMune — containing 10 strains beneficial bacteria plus a prebiotic– are effective in treating a host problems in addition to diarrhea, including IBS, respiratory tract infections and immune functioning. More information about traveler’s diarrhea can be found here.

How to get rid of diarrhea Read More »

Probiotics: Naturally Good

Disease, Probiotics / By @drHoberman

Probiotics are bacteria that help maintain the natural balance of the intestines’ microflora. The largest group of piobiotic bacterica, Lactobacillus acidophilus, is found in naturally in the intestines — as are many good gut bacteria used in probiotic suppliments.

Studies support the theory that probiotic supplements are not likely to harm the user. Rather, research suggests that probiotics can benefit the user by helping to create a balance digestive system and relieve the stomach pain or abdominal discomfort caused by diarrhea, gas, and cramping. They may also help to prevent the onset of vaginal yeast infections and urinary tract infections.

Although not a medical guarantee, probiotics have been seen to deliver a number of health benefits to those who take them. Read the full article here for more information, and consider trying a probiotics like EndoMune Advanced to see if probiotics could be right for you.

Probiotics: Naturally Good Read More »

Probiotics in the Medical News

Drug interactions, Probiotics / By @drHoberman

Endomune Subscriber,

I am amazed by the number of new medical articles on probiotics. The scientific evidence of probiotic benefits keeps expanding.

In May 2012, two major medical journals published reports about the advantages of probiotics.

Why take a probiotic when prescribed an antibiotic?

A 53-year-old woman reports severe watery diarrhea with cramps. She is in her seventh day of a 10-day course of cefixime, which was prescribed for bronchitis.

Could the diarrhea have been prevented?

In the May 9th issue of Journal of the American Medical Association (JAMA), there was a report titled “Probiotics for the Prevention and Treatment of Antibiotic-Associated Diarrhea”(AAD).

When antibiotics are prescribed for infections like bronchitis, they can also destroy the healthy intestinal bacteria in the body. As a result, harmful bacteria can proliferate and cause diarrhea that ranges from mild to life-threatening.

The study reviewed 82 trials in which patients (adults and children) randomly received either an antibiotic alone or in combination with a probiotic.

A total of 11,811 studied patients were pooled together for the reviewed trials. The authors found that adding a probiotic when prescribing an antibiotic reduced the risk for diarrhea by 42%.

Take away message

Based on the results of this report, ask your health care provider if he/she would recommend a probiotic when prescribed an antibiotic. Remember to separate the time of taking an antibiotic and the probiotic by two hours. This will lower the risk of the antibiotic destroying the probiotic bacteria.

Can probiotics prevent urinary tract infections?

A 64-year old woman is on her third course of antibiotics for recurrent urinary tract infections. Unfortunately, the cultured E. coli bacteria are resistant to the antibiotic medication.

Was there anything else she could have tried?

In the May 14th issue of the Archives of Internal Medicine, a clinical trial² was published titled “Lactobacilli vs Antibiotics to Prevent Urinary Tract Infections.”

Recurring UTIs are common among some women and low-dose antibiotics can sometimes prevent them. The worry is that overuse of the drugs also reduces their effectiveness by making disease-causing bacteria like E. coli resistant.

The authors conducted a controlled trial in 252 postmenopausal women with recurrent UTIs.

The randomized patients would receive a daily antibiotic or a probiotic containing Lactobacilli for one year.

The researchers then tracked how many UTIs occurred in each group of women over a year. They also collected vaginal swabs and samples of the women’s urine and feces every month to test for the presence of good bacteria and infection-causing bacteria like E. coli.

Over the year, the antibiotic group had an average of 2.9 UTIs per woman, and the probiotic group had an average of 3.3 UTIs. In the year prior to the study, the average number of recurrent UTIs was 7 in each group.

About 20 percent to 40 percent of E. coli in samples from all the women resisted the antibiotic at the beginning of the study. At 12 months between 80 percent and 95 percent of the bacteria resisted the drug in the women taking the antibiotic.

The resistance rate of the E. coli in the women taking the probiotic was slightly lower at one year compared to the start of the study. That is, the E. coli did not develop antibiotic resistance.

The authors concluded that taking a daily antibiotic was not any better than taking a probiotic in lessening recurrent rate of UTIs. “However, the development of antibiotic resistance is considerably lower with the use of lactobacillus. Therefore, lactobacilli may be an acceptable alternative for prevention of UTIs, especially in women who dislike taking antibiotics.”

Take away message

If you have recurrent UTIs, consider taking a probiotic containing Lactobacillus…like EndoMune.

Eat healthy, exercise, take EndoMune and live well!

Dr. Hoberman

1) Hempel,S PhD; Newberry,S PhD; Maher,A, MD; et al. Probiotics for the Prevention and Treatment of Antibiotic-Associated DiarrheaA Systematic Review and Meta-analysis JAMA. 2012;307(18):1959-1969. doi:10.1001/jama.2012.3507

2) Beerepoot MAJ, ter Riet G, Nys S, et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med. 2012;172(9):ioi120011704-712

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Probiotics Provide Insurance Against Salmonella

Diet, Drug interactions, Healthy Aging / By @drHoberman

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):

Secrete bacteriocins (proteins that can kill harmful invading bacteria)
Produce products like lactic acid and hydrogen peroxide that inhibit infectious bacteria
Stimulate the intestinal immune system to release antibodies and inflammatory cells to destroy the hostile bacteria
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.

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Probiotics and Irritable Bowel Syndrome

Drug interactions, Healthy Aging, Probiotics / By @drHoberman

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

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

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

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

Meta-Analysis Reports

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

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

Abdominal pain
Bloating
Flatulence
Improve the passage of stools

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

The Conclusion: Probiotics are Promising

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

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

Take Home Message

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

Eat healthy, exercise and stay well!
Dr. Hoberman

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

(2) Meta-analysis of probiotics for the treatment of irritable bowel syndrome. McFarland LV, Dublin S. World J Gastroenterol. 2008 May 7;14(17):2650-61.

(3) The efficacy of probiotics in the therapy of irritable bowel syndrome: a systematic review.Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein A, Brandt L, Quigley E. Gut. 2008 Dec 17

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

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