Constipation Archives

Dear EndoMune subscribers,

Now that we are enjoying the beauty of the spring days, we really don’t want to be slowed down by any GI issues. The following real case report describes how EndoMune can make a positive difference in your health this season:

Case Study: Constrained By Constipation

Karen, a 34-year old corporate executive, saw her primary care physician due to a problem of constipation. Karen had a longstanding history of difficulty with normal stool habits. She had tried a variety of diets and laxatives with no real improvement.

A comprehensive gastroenterological evaluation did not reveal any abnormality. She was told that her problem was due to “irritable bowel syndrome.”

The physician recommended a high fiber diet, stool softeners and exercise.

Karen continued to have problems with bloating, distention and constipation. Her GI issues made it hard for her to function at work. Enjoying outdoor activities like hiking and biking with her family were difficult.

Karen read about probiotics and decided to try EndoMune.

After one week of therapy, Karen’s constipation markedly improved. She was so delighted with the results that she emailed to let me know how EndoMune had made such a difference in her life.

The Discomfort of Constipation

After reading the case report, it is apparent that this month’s newsletter is about how probiotics can ease the problem of constipation.

Constipation is a common condition affecting children and adults. In the vast majority of cases, no underlying natural cause is found and functional constipation or “irritable bowel syndrome” is diagnosed.

Did you know that:

Constipation is medically defined as less than 3 stools per week and associated with straining1

Constipation is one of the most common GI disorders in clinical practice

Approximately 20% of the general population suffers from chronic constipation during their lifetime

Childhood constipation accounts for 3-5% of all visits to pediatricians2

Approximately 70-80% of nursing home residents have constipation3

Finding Relief

In the last 5-6 years, there have been a number of medical studies evaluating whether probiotics can improve constipation and associated symptoms. Not all of them have shown benefit.

I have listed the results of some of the most well done studies:

In 2011, Guerra et al4 reported the results of a study involving 59 children suffering with constipation. Over a 10-week period, the group receiving probiotics had significant improvement in stool frequency, consistency and less abdominal pain.

In 2011, Waller et al5 published a study done on 100 adults with chronic constipation. The group receiving probiotics for 14 days had significantly improved stool frequency and decreased abdominal symptoms compared to the control group.

In 2010, Hyang et al6 reported the results of a clinical study using probiotics in a group of nursing home patients. After 2 weeks of therapy, there was a significant improvement in frequency and consistency of the stools.

In addition to improving GI function, there were no adverse side effects associated with the use of probiotics in these medical studies. This is a very important and unique benefit of probiotic use when compared to other constipation therapies.

How probiotics improve intestinal function is being actively researched by medical experts. Studies7 have found that the bacterial flora in constipated individuals is different than in individuals with regular bowel movements in that they lack the ability to produce beneficial fermented products that enhance intestinal function. Adding probiotics reestablishes a healthy intestinal flora resulting in improved intestinal activity.

Take Home Message

If you struggle with GI issues, consider adding EndoMune to your daily regimen and enjoy these beautiful spring days comfortably!

Eat healthy, exercise and take EndoMune!

Best Wishes,

Lawrence Hoberman MD

1) Epidemiology of constipation in North America: a systematic review.Higgins PD, Johanson JF.Am J Gastroenterol. 2004 Apr;99(4):750-9. Review

2) Epidemiology of childhood constipation: a systematic review.van den Berg MM, Benninga MA, Di Lorenzo C.Am J Gastroenterol. 2006 Oct;101(10):2401-9. Review.

3) Chronic Constipation in the Elderly free Juan F Gallegos-Orozco, Amy E Foxx-Orenstein, Susan M Sterler & Jean M StoaThe American Journal of Gastroenterology 107, 18-25
doi:10.1038/ajg.2011.349

4) Pediatric functional constipation treatment with Bifidobacterium-containing yogurt: a crossover, double-blind,controlled trial.Guerra PV, Lima LN, Souza TC, Mazochi V, Penna FJ, Silva AM, Nicoli JR, Guimarães EV.World J Gastroenterol. 2011 Sep 14;17(34):3916-21.

5) Dose-response effect of Bifidobacterium lactis HN019 on whole gut transit time and functional gastrointestinal symptoms in adults.Waller PA, Gopal PK, Leyer GJ, Ouwehand AC, Reifer C, Stewart ME, Miller LE.Scand J Gastroenterol. 2011 Sep;46(9):1057-64. Epub 2011 Jun 13.

6) Efficacy of Lactic Acid Bacteria (LAB) supplement in management of constipation among nursing home residents.An HM, Baek EH, Jang S, Lee do K, Kim MJ, Kim JR, Lee KO, Park JG, Ha NJ.Nutr J. 2010 Feb 5;9:5.

7) Functional dysbiosis within the gut microbiota of patients with constipated-irritable bowel syndrome (pages 828–838) C. Chassard, M. Dapoigny, K. P. Scott, L. Crouzet, C. Del’homme, P. Marquet, J. C. Martin, G. Pickering, D. Ardid, A. Eschalier, C. Dubray, H. J. Flint and A. Bernalier-DonadilleAlimentary Pharmacology and Therapeutics, 03/19/2012

Probiotics Recommended for Nursing Home Residents

Healthy Aging, Mental Health, Probiotics / By @drHoberman

Over the years, I have written a number of newsletters that discuss the benefits of probiotics for children and adults. This month will focus on the older generation, an important topic since there are currently 11.4 million people living in nursing homes in the United States ⁽¹⁾. This figure includes 14% of the population older than 84.

For anyone who has loved ones in nursing homes and is concerned for their well-being, there are numerous reasons I recommend all nursing home patients take probiotics.

Scenario One: Hospitalization

A recurring story is that of a functioning senior citizen living at home who fractures a hip due to a fall or experiences a stroke. The following series of events is likely to happen:

Upon injury, 9-1-1 is called.
The individual becomes a hospitalized patient.
The patient is required to take medications, including antibiotics.
The antibiotics adversely affect the gastrointestinal tract.
The individual is now at risk of developing hospital-acquired infections like Clostridia difficile and methicillin-resistant staph infections.
Eventually, the patient improves and is transferred to a rehab unit or nursing home.

The seniors may have had normal intestinal function prior to hospitalization, but with all the medications and change in activity level, constipation and diarrhea become real problems. These disorders can severely affect quality life and health of the people within the nursing homes.

For instance, other healthy nursing home residents are now at risk of being exposed to surface areas that have become contaminated by the arrival of the recently hospitalized patients.

This scenario is one reason to consider giving probiotics to healthy nursing home residents. Should a resident be exposed, the probiotics can prevent harmful bacteria from colonizing the intestines and causing damage.

Scenario Two: General Aging Process

Another main reason to give probiotics has to do with the changes that occur in the normal intestines as they age. Due to reduction in acid production, enzyme secretions, reduced intestinal immunity and slowed motility, the healthy intestinal bacteria population is reduced. This change in the intestinal microflora contributes to the risk of diarrhea and constipation.

According to the Administration of Aging ⁽²⁾, among healthy adults 65 years of age and older, 26% of men and 34% of women experience constipation. These numbers increase drastically for elderly people living in nursing homes – more than 80% suffer from constipation. Medications, immobility, and dementia are all contributing factors for this increase.

Residents of nursing homes have a much higher risk of developing infectious diarrhea. In the United States, nursing home residents are four times more likely to die from gastroenteritis than those living outside nursing homes. Additionally, of all deaths occuring from diarrheal disease, nursing home residents account for 17.5% ^(3,4).

The physicians and nursing staff are very aware of the health risks associated with severe constipation and diarrhea. Unfortunately, nursing home patients often require medications that can slow intestinal motility, damage the lining cells, and disrupt the healthy balance of the intestinal bacteria. As a result, severe intestinal disorders can occur despite good medical care.

Probiotics Improve Constipation and Diarrhea

During the last three years, there have been several reports published that found that probiotics improved constipation and diarrhea in nursing home residents ^(5,6,7). The research protocols were similar; One group of residents received probiotics containing Lactobacillus and/or Bifidobacteria, and the other group received a placebo. The research findings revealed that the frequency and consistency of the stools improved in the groups treated with probiotics, as compared to the control groups ^(5,6,7).

After considerable review of the literature, I have come to the conclusion that giving nursing home residents daily probiotics can help to improve intestinal function, quality of life, and lessen the risk of serious health issues.

The real concern in medicine is that we “do no harm.” Probiotics, fortunately, have an excellent safety profile. It is worth noting, though, that there have been rare reports of infections due to probiotics in seriously immune-compromised patients ⁽⁹⁾.

Take Home Message

If you have a loved one in a nursing home, ask the health care provider to consider giving them a probiotic. The daily dosage should be at least 10 billion and contain multiple strains of Lactobacillus and Bifidobacteria, like EndoMune Advanced.

Eat healthy, exercise and live well!
Dr. Hoberman

References:

(1) National Center for Health Statistics. Health, United States, 2009: with special feature on
medical technology. Hyattsville, MD, 2010.

(2) Sources: Data releases from the web sites of the National Center for Health Statistics; and from the Bureau of Labor Statistics web site

(3) Mortality due to gastroenteritis of unknown etiology in the United States. Frenzen PD.J Infect Dis. 2003 Feb 1;187⁽³⁾:441-52. Epub 2003 Jan 24

(4) Clin Infect Dis. 2010 Oct 15;51⁽⁸⁾:907-14.Surveillance for outbreaks of gastroenteritis in long-term care facilities, Australia, 2002-2008. Kirk MD, Fullerton KE, Hall GV, Gregory J, Stafford R, Veitch MG, Becker N

(5) Efficacy of Lactic Acid Bacteria (LAB) supplement in management of constipation among nursing home residents. 1)Sources: Data releases from the web sites of the National Center for Health Statistics; and from the Bureau of Labor Statistics web site

(6) Fermented cereal with specific bifidobacteria normalizes bowel movements in elderly nursing home residents. A randomized, controlled trial.Pitkala KH, Strandberg TE, Finne Soveri UH, Ouwehand AC, Poussa T, Salminen S.J Nutr Health Aging. 2007 Jul-Aug;11(4):305-11

(7) Clostridium difficile in the long-term care setting. Makris AT, Gelone S.J Am Med Dir Assoc. 2007 Jun;8⁽⁵⁾:290-9. Review

(8) Probiotics and the nursing home: should we give bacteria for breakfast?Morley JE.J Am Med Dir Assoc. 2009 Jul;10⁽⁶⁾:365-7.

(9) Safety assessment of probiotics for human use.Sanders ME, Akkermans LM, Haller D, Hammerman C, Heimbach J, Hörmannsperger G, Huys G, Levy DD, Lutgendorff F, Mack D, Phothirath P, Solano-Aguilar G, Vaughan E.Gut Microbes. 2010 May;1⁽³⁾:164-185. Epub 2010 Mar 4.

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Probiotics Recommended for Nursing Home Residents