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Baby lying on its back with an graphic of a digestive system over its body. Text reads "Gut-Brain Axis in Babies

Gut-Brain Axis In Babies

Your Baby’s Developing Gut-Brain Axis

As adults, we know our gut-brain axis — the connection that links our brain, intestines and emotions — is working and when it isn’t.

When those signals between the brain and gut get scrambled, something as simple as eating a highly processed, fast-food diet creates disruptions in the delicate balance of bacteria in our guts that can soon lead to obesity and lots more stress in our lives.

You may be surprised to learn that the gut-brain axis is at work even at the beginning of our lives as infants, and it’s noticeable when it isn’t.

If you’re a new mom who wonders why her newborn may be more fearful and fussier than you expected, it may be linked to the diversity of your baby’s gut and how it may shape their developing gut-brain axis.

 

The Fear Factor

Looking for new ways to support healthy neurological development, researchers at Michigan State University and the University of North Carolina teamed up for a study to compare fearful reactions experienced by infants to the balance of bacteria in their developing microbiomes.

Reacting to fearful things is a normal part of infant development. But, when those responses continue even in safe situations, that could signal an elevated risk of your baby developing anxiety and depression later on in life, says Dr. Rebecca Knickmeyer of Michigan State, leader of the study published in Nature Communications.

To learn how infant gut microbiomes were connected to the fear response, investigators conducted a year-long study with 30 infants who were breastfeeding and hadn’t been prescribed antibiotics.

Scientists evaluated the mix of gut bacteria based on stool samples taken from infants at 1 month and 12 months and assessed their fear responses with a simple test: Watching how each baby reacted when a stranger entered a room wearing a Halloween mask.

Parents were with their babies the whole time and they could jump in whenever they wanted, Knickmeyer says. “These are really the kinds of experiences infants would have in their everyday lives.”

No surprise, newborns who were more fearful at age 1 had very noticeable imbalances in gut bacteria at 1 month compared to those whose microbiomes remained stable. But that’s not all.

Using MRI imaging of those children’s brains, researchers discovered the diversity or lack of it in their developing guts was linked to the size of their amygdala, the sector of the brain responsible for making quick decisions about potential threats.

 

The Future Of Your Baby’s Gut

The results of this report highlight how important it is to protect the balance of bacteria in your baby’s gut, even when they breastfeed, and avoid antibiotics, for the sake of their developing gut-brain axis.

This may be a good time to talk to your pediatrician about giving your baby’s gut some extra help in the form of a probiotic

If you’re looking for an easy-to-use probiotic with the right mix of beneficial bacteria from the Lactobacillus and Bifidobacterium families plus a prebiotic that feeds the good guys in their gut, we hope you’ll consider EndoMune Jr. Powder.

Just a half-teaspoon of EndoMune Jr. sprinkled in your baby’s formula or added to soft foods (when your baby is ready) once a day can make a healthy difference.

 

Resources

Nature Communications

Michigan State University

Father holding an infant in a brightly lit room. Text says "Antibiotics For Babies: Proceed with Caution"

Antibiotics For Babies: Proceed With Caution

Early Antibiotics May Harm Your Baby’s Gut

When we discuss the overuse of antibiotics, it’s usually focused on adults who rely on them too often to treat health problems that would be resolved in time on their own.

This over-reliance can often mean these one-time “miracle drugs” may not work when they’re truly necessary, and create openings for more health problems down the road.

Few of us expect babies to be exposed to antibiotics so early, but we recently learned how often they’re prescribed — even once — for little ones under age 2 may increase the possibility of food allergies, obesity and many more health challenges.

What’s more, little good happens when infants are treated with antibiotics during their first week of life, according to a recent report in Nature Communications.

 

Too Much Exposure To Antibiotics

Experts estimate as many as 10 percent of all newborns are prescribed an antibiotic and that doctors justify them based on “suspected” infections.

This overprescribing is justified by some doctors to prevent a problem they suspect could happen and get serious in a hurry, although a small number of babies ultimately experience an infection.

With those facts in mind, a team of researchers from the UK and The Netherlands conducted a clinical trial involving 227 babies to observe how antibiotics would affect their tiny microbiomes.

Nearly 150 babies with “suspected” sepsis were treated by one of three antibiotics, with the remainder were part of a control group who received no antibiotics. All babies had fecal or rectal samples taken before and after treatments at 1, 4 and 12 months of age.

Among the infants who were prescribed an antibiotic, the harmful effects were obvious.

  • Babies experienced significant decreases in various species of Bifidobacterium, microbes that help them better digest breast milk and support their good gut health.
  • Scientists observed a change in more than 250 strains of bacteria in the guts of babies, flipping the balance in favor of more unhealthy harmful microbes.
  • Those microbial changes lasted at least 12 months and did not improve with breastfeeding.
  • Among the antibiotics prescribed, the combination of penicillin and gentamicin was the least detrimental on a newborn’s microbiome.

The start of antibiotic treatment, not its duration, appears to be trigger for gut health problems, says researcher Dr. Marlies van Houten, a pediatrician at the Spaarne Hospital in The Netherlands.

 

A Probiotic In Your Baby’s Future?

The evidence is clear that antibiotics are prescribed way too often, and breastfeeding may not restore the developing microbiomes of infants, so what are your options?

Should an antibiotic be necessary, we recommend talking to your pediatrician about giving your baby a probiotic with multiple species of beneficial bacteria that can boost the critical balance of bugs in their tiny microbiomes.

If you’re looking for a probiotic with the right made for your baby, consider EndoMune Jr. Powder formulated with 10 billion CFUs of beneficial bacteria from the Lactobacillus and Bifidobacterium families plus a prebiotic that feeds their developing microbiome.

Just a half-teaspoon of EndoMune Jr. sprinkled in your baby’s formula or added to soft foods (when your baby is ready for them) once a day can make a gut-healthy difference!

 

Resources

Nature Communications

University of Edinburgh

Medscape

Photograph of infant holding mother's thumb. Text reads "Protect Your Baby's Gut Health from Allergies

The Link Between Childhood Allergies And Gut Health

Protect Your Baby’s Gut Health From Allergies

Building great gut health starts with a solid foundation. For a new mom, that’s making gut-smart choices like breastfeeding her new baby for as long as she can and doing her best to avoid a c-section birth.

Doing those two things can go a long way toward developing a diverse, balanced microbiome that protects your child from persistent health issues like allergies as he/she grows up.

Unfortunately, c-section rates remain high for new moms (even for those first-time moms with low-risk births) and breastfeeding numbers drop sharply after 6 months, according to numbers collected by the CDC.

So, we shouldn’t be surprised that childhood allergies are also on the rise due to a lack of diversity in gut bacteria, according to a pair of reports.

 

Gut Bacteria Imbalances

The findings of the two studies, appearing recently in Nature Communications and Pediatric Allergy and Immunology, mirrored each other in one important way: The balance of bacteria determined a child’s susceptibility to food or respiratory allergies.

For example, Italian researchers in the Nature study identified specific microbial signatures that stood out due to their higher inflammatory potential (thanks to an uptick in the production of pro-inflammatory molecules) and depleted levels of beneficial bacteria in fecal samples taken from allergic kids compared to healthy ones.

Overall, less than a third of the children with food allergies developed a healthy immunity to problematic foods like cow’s milk, eggs, nuts, or fruit by the end of a three-year monitoring period.

These same challenges with the lack of microbial diversity were very evident in the Pediatric Allergy and Immunology study over an extended five-year time-frame too.

Based on stool samples taken from children ages 3-5, patients with allergies had far less diverse microbiomes than healthy kids, especially among young patients sensitive to peanuts and milk.

 

A Probiotic Solution

Although there were no mentions in either study about breastfeeding or natural childbirth, based on previous reports we’ve shared, we know both have a positive impact on reducing your child’s chances of food or respiratory allergies.

Not to mention, feeding your baby formula exclusively has been found to increase the incidence of respiratory problems and asthma significantly.

Unfortunately, more than a few new moms may not have the option of having natural childbirth or breastfeeding, so what do you do?

You may want to consider giving your baby a multi-species probiotic like EndoMune Junior Advanced Powder that contains four basic building blocks of beneficial bacteria from the Bifidobacterium and Lactobacillus families, along with a prebiotic (FOS) that feeds the good guys in her/his developing gut.

But, before starting your baby on EndoMune Junior in its powdered form or its Chewable berry-flavored tablet, please check in with your pediatrician.

 

Resources

Pediatric Allergy Immunology

Medscape

Nature Communications

Microbiome Post.com

parent holding sick child with text: How Antibiotics May Harm Your Baby's Health

How Antibiotics May Harm Your Baby’s Health

When the topic of antibiotics comes up here, the concerns usually focus on adults who lean on them too often to treat common health problems. This over-reliance on antibiotics, in addition to daily exposures from antimicrobial soaps and cleaners plus drug residues hiding in the flesh foods we eat, is creating a world full of superbugs in which these powerful drugs are slowly losing their ability to work as they should.

Now, we’re learning how the health of children exposed to antibiotics is affected for the long term, and the results aren’t good.

Harmful early exposure to antibiotics

You probably wouldn’t expect infants to be exposed to enough antibiotics to create any health risks.

Yet, researchers from the Mayo Clinic and Rutgers University found evidence that even one dose of antibiotics given to children under age 2 was connected to greater risks of serious health problems as they grew up, according to a study appearing in Mayo Clinic Proceedings.

Among the laundry list of health problems associated with one dose of antibiotics faced by babies living in the Midwest:

  • Attention deficit hyperactivity disorder (ADHD)
  • Asthma
  • Eczema
  • Celiac disease
  • Obesity
  • Food allergies

Roughly, 70 percent of babies in Minnesota and Wisconsin had been prescribed at least one course of antibiotics but most had received multiple rounds, based on data collected by the Rochester Epidemiology Project.

What’s more, the long-term harm varied among a number of factors, including gender, the variety of antibiotics taken and how many times these drugs were prescribed. For example, penicillin was linked to higher incidences of celiac disease and ADHD in girls, obesity among boys and asthma in both sexes.

Reducing health risks with probiotics

When antibiotics were developed then prescribed for children, the emphasis was merely on controlling pathogens, not the greater effect these drugs could have on the microbiome, especially for a baby’s developing gut health, according to the study.

Now, we recognize the problems with antibiotics — an estimated 47 million are prescribed needlessly every year according to the CDC — the need to minimize their use and the collateral harm they can cause for a child’s developing microbiome.

If you’re looking to limit your child’s exposure, a recent report we shared with you showed how taking a probiotic may lessen the need for antibiotics.

What’s more, the probiotics these children were taking contained some of the same beneficial strains of bacteria in EndoMune Jr. Advanced Powder and EndoMune Advanced Probiotic.

Do you need guidance on how maximize the probiotic benefits for your son or daughter when they’re taking a round of antibiotics? Check out our updated to-do list of probiotic basics you need to know.

References

 

 

 

Parent Holding Preemie Baby's Foot

How Probiotics May Protect Your Preemie Baby

Premature babies have a lot of obstacles to overcome. One of the most serious health challenges they face is necrotizing enterocolitis (NEC), a condition that affects their intestines.

This problem occurs when bacteria attack the intestinal wall which causes inflammation, then cracks that can allow these invaders to leak into the abdomen. Without treatment, babies face serious infections and an increased risk of death very early in their lives.

Although scientists aren’t exactly sure what causes NEC, apart from being born prematurely, babies who are fed formula rather than human breast milk via breastfeeding (that’s easier to digest and full of the nutrients they need to boost their tiny immune systems) are at a greater risk for this serious disease.

Fortunately, doctors have had success treating preemie babies with probiotics to prevent risks of NEC, but how well do they really work?

The multi-strain probiotic difference

A group of European researchers compared the effect of treating three groups of preemie babies with two different mixes of probiotics from the Lactobacillus and Bifidobacterium families to infants who received no probiotics in a recent study appearing in Gut Microbes.

(Two strains of beneficial bacteria used in this study are the foundation of EndoMune Junior Advanced Probiotic Powder.)

Infants who were delivered mostly via C-section and up to 10 weeks early received a multi-strain probiotic or a placebo until 36 weeks. No surprise, the probiotic preemie groups experienced improved gut health (greater consistency, fewer variations) in their tiny microbiomes.

Even more promising, an analysis of fecal samples discovered reduced amounts of bacteria linked to NEC among infants given probiotics.

And, there’s even more good news!

Probiotic guidance for doctors

Many neonatal doctors struggle with making the best choices to help their preemie patients avoid NEC, but a very recent analysis of 45 trials and more than 12,000 infants published in Pediatrics gave the nod to the one-two power of probiotics and prebiotics.

Formulations of probiotics containing Bifidobacterium or Lactobacillus blends plus a prebiotic significantly reduced the odds that an infant faces NEC, compared to a placebo, by 68 and 94 percent, respectively.

What’s more, treating infants with beneficial strains of Lactobacillus and a prebiotic decreased an infant’s risks of sepsis, another potentially life-threatening problem triggered by the body due to an infection, by an amazing 82 percent.

The probiotic advantage for your baby

Are you a Mom who may need to deliver your newborn via C-section? Breastfeeding is a great way to give your baby that gut-friendly head start. Should problems arise, you may want to take that extra step — with guidance from your pediatricians — to give your baby a probiotic tailored to his/her needs.

Protecting your baby’s developing immune system can be as easy as sprinkling a multi-species probiotic powder like EndoMune Junior in a liquid or noncarbonated formula or on soft foods once a day.

EndoMune Junior Infant Probiotic Powder features four beneficial strains of beneficial bacteria from the Lactobacillus and Bifidobacterium families, plus a prebiotic (FOS), that’s formulated to help reduce your newborn’s risks of NEC.

 

Resources

 

 

EndoMune Jr. now Parent Tested Parent Approved

ptpa-RGB-300dpi-larg1EndoMune Advanced Jr., the only children’s probiotic developed by a board-certified gastroenterologist, has won the much-coveted Parent Tested Parent Approved (PTPA) Winner’s Seal of Approval.

EndoMune Jr. is the first and only probiotic to be recognized by PTPA, the largest volunteer parent-testing organization in North America with more than 60,000 members.

To celebrate their new website (http://ptpa.com), PTPA, will host a Twitter party Oct. 25 from noon to 2 p.m. EDT, which will feature EndoMune Advanced Jr. The fun and informative online gathering also will include prizes of EndoMune Jr. and other PTPA-approved products. Three lucky winners will leave the party with a free jar of EndoMune Jr.

Look for the PTPA Twitter party by checking out @PTPA and looking for the hashtag #ptpaparty.

Endomune Jr.“At PTPA Media, we are proud to play a role in certifying innovative products that families can trust,” says Sharon Vinderine, CEO and founder of PTPA Media Inc. “When consumers search for our Seal of Approval on product packaging and web sites, they are essentially searching for validation from their peers.  Their peers will have objectively tested and approved these products based on their performance in a real life environment. That type of resource for families is priceless.”

Among the glowing compliments EndoMune Jr. received from PTPA reviewers:

  • This product was very easy to use. I really like the scoop that came with the product. It gave my oldest a chance to scoop it out herself and know she got it right. I also like how you just put it directly into the kid’s drink instead of having them take a pill every day.
  • We had been using probiotics for a while, as my kids were preemies and have had a lot of GI issues. I like that this probiotic doesn’t have the extra ingredients that gummies have. The kids drank it fine when put in juice and they had no digestive issues or sicknesses while they were on it. We will continue on this product. Thank you for making a good, safe probiotic for ALL ages.
  • The EndoMune Advanced Junior was easy to take and offered more than the typical probiotic.

Read more of the comments from parents who tested EndoMune Junior.

EndoMune Junior and its adult counterpart, EndoMune Advanced Adult Probiotic, are completely GMO-free and contain no dairy products, preservatives, artificial coloring or gluten.

Probiotics for Pediatric Antibotic-Associated Diarrhea

Welcome to February, readers!

February – the season for love, chocolate and valentines – is also, unfortunately, the season for colds and flu. Your littlest valentines will be especially susceptible to the bad weather bugs during the February freezes. The seasonal sniffles may not only impact your child’s sinuses and energy, but also their bathroom habits and regularity. This month’s newsletter will discuss how the use of probiotics can prevent your child from getting diarrhea when they are prescibed an antibiotic to cure a respiratory infection.

The Curious Case Of The Two Kiddie Colds

While your child may require an antibiotic to quickly and completely cure their cold or infection, prescribed medications often carry unintended negative consequences. Most of the antibiotics pediatricians prescribe to children can cause diarrhea – specifically AAD or Antibiotic Associated Diarrhea.

Consider these two cases:

    1. Peter, a 4-year old preschooler, caught a cold from his classmates. He developed a cough, sore throat and 102º fever. His mom gave him an over the counter children’s cold remedy, but over the next 2 days young Peter developed a productive cough. Worried and upset, Peter’s mother took him to his pediatrician who prescribed an antibiotic to treat his bronchitis. Peter began to get better but was then stricken by a terrible case of diarrhea that left him weak and dehydrated. His mother rushed him to the ER where he was diagnosed with antibiotic associated diarrhea. Peter was hospitalized, received an IV’s and eventually became well enough to return home.

 

  1. Brian, an 8-month old, contracted a fever while at his daycare center and became fussy. His mother took him to the ER where he was diagnosed with an ear infection. The doctor prescribed an antibiotic and recommended a second medicine – a probiotic to be taken two hours after the first medication. Brian’s infection healed, and he never developed diarrhea.

A Serious Side Effect of Antibiotics

More than 100 trillion bacteria live in our intestines and play an important role in intestinal digestion and immunity. Generally, 85-90% of the bacteria are beneficial and keep bad bacteria at bay. However, while antibiotics effectively resolve the bacterial infections like Peter and Brian experienced, the antibiotics also risk causing diarrhea by destroying the good bacteria and upsetting the healthy balance of the bacterial flora. Studies have found that up to 50% of children who receive antibiotics for ear infections will develop AAD1.

A Proof Is In The Probiotics

The November 2011 issue of the Cochrane Database System Review revealed new evidence supporting using probiotics to prevent pediatric antibiotic-associated diarrhea2.

Sixteen studies tested 3,432 children from 2-weeks old to 17-years. The children received a variety of probiotics co-administered with antibiotics for the prevention of AAD.

Final analysis revealed that AAD was reduced by 50% in the group receiving probiotics versus the group receiving a placebo. Even more, the greater the probiotic colony count, the lesser the incidence of AAD – 63% less in fact.

The study’s authors also noted that the probiotic group experienced no significant, unusual side effects due to the probiotics, other than a reduction of AAD.

Take Home Message

If your child requires an antibiotic to recover from a late winter cold, consider administering a probiotic like EndoMune Jr., which contains a 10 billion colony count in each serving. Administer this probiotic two hours after administering the antibiotic to protect the bacteria cultures and effectively protect your child from AAD.

Eat healthy, exercise, take EndoMune and live well!
Best Wishes,
Dr. Hoberman

Healthy Benefits of Probiotics for Children

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

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

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

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

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

Committee on Nutrition: Probiotic Recommendations

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

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

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

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

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

  • Irritable Bowel Syndrome
  • Infantile Colic
  • Ulcerative Colitis
  • Eczema

Prebiotics and Allergy Reduction

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

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

Safe and Promising Supplements

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

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

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

Wishing you and your loved ones a very healthy 2011.

Eat healthy, exercise and stay well.
Dr. Hoberman

References:

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

Probiotics in the News

I receive daily emails from a number of sources about new developments in medicine, particularly in the areas of gastroenterology and probiotics.

There are two interesting articles I would like to briefly discuss this month:

  • Benefits of Lactobacillus probiotic bacteria against gas-producing E. Coli found in colicky infants(1)
  • Probiotics for prevention of antibiotic-associated diarrhea and Clostridium difficile-associated disease in hospitalized adults(3)


Benefits of Probiotic Bacteria for Colicky Infants

The first report details the research that has been underway to determine how probiotics can lessen the problem of “Infantile Colic.” This is a condition in which a healthy baby shows periods of intense, unexplained fussing/crying lasting more than 3 hours a day, for more than 3 days a week over a duration of three or more continuous weeks. Parents have sleepless nights and stressful days trying to calm their baby. The pediatricians used to recommend trying simethicone drops, which works no better than tap water.

The exact cause of infantile colic is unknown, but a number of reports have associated colic to changes in the bacterial balance in a baby’s intestine.

A study published in the journal Pediatrics in 2007(2) reported on the benefits of taking a probiotic. In the study, 83 colicky babies were divided into two groups: 41 were given a Lactobacillus probiotic and 42 babies received simethicone. The results were astounding:

After one week, babies treated with the probiotic had close to 20% less crying time

  • By 4 weeks, probiotic treated babies had 74% less crying
  • Overall, there was a 95% positive response to the Lactobacillus probiotic drops in colicky infants.

To better understand how probiotics lessen infantile colic, this study was performed to evaluated the interaction between Lactobacillus probiotics and gas-forming coliforms that were isolated from stools of colicky infants. The results showed that several strains of Lactobacillus produced antibiotics against six different species of gas-forming coliforms.

The authors concluded:

  1. There was a greater presence of of coliform bacteria in colicky infants, and
  2. Certain Lactobacillus probiotic bacteria can improve colicky symptoms by reducing the ability of coliform bacteria to colonize the gut.


Probiotics for Prevention of Antibiotic-Associated Diarrhea, C. Difficile

This report published in the American Academy of Nurse Practioners reviewed all the relevant studies on probiotic efficacy for preventing diarrhea and colitis due to taking antibiotics.

I have written several newsletters on how antibiotics can upset the healthy balance of the intestinal bacteria, resulting in mild diarrhea or life-threatening clostridia difficile colitis. There are a 100 trillion bacteria in the gastrointestinal tract. Generally, 85% or more are healthy beneficial bacteria that help in digestion and immunity.

Antibiotics prescribed for an infection like sinusitis or bronchitis can destroy the healthy intestinal bacteria and result in problems with diarrhea. A particular bacteria called Clostridia difficile can multiply when the healthy bacteria are destroyed.

C difficile produces toxins that cause a severe colitis. Unfortunately, this bacteria is becoming more common in hospitals and other health care facilities. As a result, the risk of developing colitis and diarrhea has increased. In 2006, it was reported that patients with C difficile colitis stayed in the hospital 3.6 days longer and the additional hospital costs averaged $3,669 per patient day.(4) A conservative estimate of the cost of this disease in the United States was $3.2 billion annually.(5)

This report was to determine if giving probiotics to patients receiving antibiotics would lessen the risk of developing antibiotic-associated diarrhea and C difficile-associated disease.

The meta-analysis found that the administration of probiotics led to a statistically significant relative risk reduction. Compared to patients given a placebo, the patients receiving probiotics had a:

  • 44% reduction for antibiotic-associated diarrhea
  • 71% reduction for C difficile-associated disease

The authors concluded that administering probiotics concurrently with antibiotics in hospitalized patients could potentially lessen the healthcare spending, morbidity and mortality due to the gastrointestinal complications related to the use of antibiotics.

Articles like these two indicate the amount of research that is going on to determine the health benefits of probiotics. Since I started researching the importance of the healthy intestinal bacteria and probiotics in 2005, the amount of new scientific information published annually is amazing.

(1) Antagonistic effect of Lactobacillus strains against gas-producing coliforms isolated from colicky infants.Savino F, Cordisco L, Tarasco V, Locatelli E, Di Gioia D, Oggero R, Matteuzzi D. BMC Microbiol. 2011 Jun 30;11(1):157.

(2)Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Savino F, Pelle E, Palumeri E, Oggero R, Miniero R. Pediatrics. 2007 Jan;119(1):e124-30.

(3) Probiotics for prevention of antibiotic-associated diarrhea and Clostridium difficile-associated disease in hospitalized adults-A meta-analysis.Avadhani A, Miley H.J Am Acad Nurse Pract. 2011 Jun;23(6):269-74

(4) Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile.Kyne L, Hamel MB, Polavaram R, Kelly CP. Clin Infect Dis. 2002 Feb 1;34(3):346-53. Epub 2001 Dec 17.

(5) Strategies to prevent clostridium difficile infections in acute care hospitals. Dubberke ER, Gerding DN, Classen D, Arias KM, Podgorny K, Anderson DJ, Burstin H, Calfee DP, Coffin SE, Fraser V, Griffin FA, Gross P, Kaye KS, Klompas M, Lo E, Marschall J, Mermel LA, Nicolle L, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS. Infect Control Hosp Epidemiol. 2008 Oct;29 Suppl 1:S81-92

How Can Probiotics Keep Children Healthy?

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

Probiotics and Acute Infectious Diarrhea

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

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

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

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

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

Probiotics and Chronic Abdominal Pain (CAP)

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

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

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

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

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

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

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

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

Take Home Message

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

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

Eat healthy and live well!
Lawrence J Hoberman MD

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

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

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

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

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

 

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