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How to get rid of diarrhea

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 Avoid Traveler’s Diarrhea

Dear EndoMune subscribers,

It is summertime and that often means going on a vacation. This newsletter will give you some tips on how to avoid a common gastrointestinal illness while traveling.

During the peak travel seasons, we are bombarded by the Internet and television with all kinds of travel offers. Some trips are just a state or two away, but some journeys extend out of the United States to less developed countries.

This month’s newsletter is on traveler’s diarrhea (TD), a common problem encountered by vacationers visiting Latin America, the Middle East, India and South Asia.

I want to begin with a case report.

Case report

Recently back from her honeymoon at a Playa del Carmen resort in Mexico, Lisa visited her physician complaining of crampy abdominal pain, low-grade fever and diarrhea.

The first 4 days of the trip were terrific. The beaches and activities were wonderful and so was the food. In addition to the fresh fruits and seafood, Lisa particularly enjoyed the salad bar.

Unfortunately, on the fifth day she woke experiencing abdominal cramps and then diarrhea. What a way to end the honeymoon!!

Was there anything that Lisa could have done to prevent developing TD? (See answer at end of this month’s newsletter).


Diarrhea is the most common medical complaint for Americans visiting developing countries. It is estimated that for Americans traveling internationally, 9.5 to 15.9 million will experience TD. Most episodes last 3-4 days without therapy, but some infections can cause severe diarrhea and dehydration requiring hospitalization, IV fluids and antibiotics.

TD is due to consuming food or water that has been contaminated with fecal matter resulting from poor personal sanitary and public health conditions.

The organisms that cause the diarrhea are bacteria, viruses and parasites. Bacteria like E. coli, Shigella, Salmonella and Campylobacter account for 80% of the episodes of TD. The type of bacterial pathogen depends on the region travelled.

In the medical journal, Current Gastroenterology Report, an article entitled Advances in the Treatment of Traveler’s Diarrhea1 discusses recent recommendations on how to prevent and treat TD.


Diet: Food and water are the most common sources of infection. Reduce your risk of TD by ordering all of your foods well-cooked. Avoid raw vegetables and the skin of unpeeled fruits. Tap water and ice also present a high risk. That includes ice in sodas. The general recommendation to avoid TD is to “boil it, cook it, peel it, or forget it”. Even if it smells and looks great…don’t eat food from street vendors!!


Antibiotics can prevent TD, but it is not generally recommended to prescribe antibiotics as a prophylaxis due to the potential for adverse drug reactions and the development of drug resistant organisms.
Bismuth subsalicylate (Pepto Bismol) provides a protection rate of 60% against TD when two tablets are taken four times daily. It does cause the tongue and stool to turn black and can induce ringing in the ears.
Probiotic clinical trials using a probiotic or a placebo to prevent TD found that 85% of episodes were prevented by probiotics. The dosage of probiotic bacteria given and the type of organisms varied. The analysis found that probiotics containing Lactobacillus and Bifidobacteria strains were effective and so was the yeast, Saccharomyces boulardii. However, at this point it is still difficult to generalize that all probiotics are effective since the amount and strains of probiotic bacteria utilized varied in the different trials.


Fluids: Fluids and electrolytes are major concerns during an episode of TD. Drinking fluids like water and rehydration packets are very important, as is eating salty soups and saltine crackers.

Antimotility Agents: Bismuth subsalicylate (Pepto Bismol) and loperimide (Imodium) taken at the onset of diarrhea can lessen the severity and duration of the episode. They do not cure the infection, and they often are taken in combination with an antibiotic.

Antibiotics: Based on established guidelines, antibiotics are generally recommended if there are 3 or more loose stools in eight hours. Fever and blood in stools are other symptoms indicating the need for antibiotics. Most physicians are comfortable prescribing an antibiotic for their patients to have in case they do develop TD.

The most commonly prescribed antibiotic is a quinolone like Cipro. However, there are regions like Thailand where the bacteria are resistant to Cipro, and azithromycin (Zithromax) is recommended.

Probiotics: Probiotic organisms may help in preventing and treating TD in a number of ways.

They produce antibacterial substances that kill invading pathogens.
They adhere to the intestinal lining cells and act as a shield against invading harmful bacteria.
They stimulate the immune system to produce a response against the pathogens.
Recommendations To Prevent TD:

1) Start taking a good probiotic like EndoMune on a daily basis. Begin at least 2-3 days before starting the trip. When traveling, EndoMune will do fine at room temperature. It is best not to store probiotics at temperatures greater than 85 degrees for prolonged periods.

2) Buy a bottle of Pepto Bismol and a box of Imodium to bring with you just in case you develop TD.

3) Check with your physician about getting a prescription for the appropriate antibiotic for TD.

Final Comments

I hope your travels are safe, joyful and healthy. I think Lisa would have been able to enjoy her entire honeymoon if she had avoided the salad bar and the skin of unpeeled fruits, and if she had taken a daily dose of EndoMune.

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

1) Advances in the treatment of travelers’ diarrhea. Paredes-Paredes M, Flores-Figueroa J, Dupont HL. Curr Gastroenterol Rep. 2011 Oct;13(5):402-7. Review.

Probiotics in the Medical News

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

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

Otitis Media: Probiotics Should be Given Alongside Antibiotics

We are in the full swing of cold and flu season. I’m hopeful everyone got their flu shot and is staying healthy. However, if you’re not so fortunate and your kids are suffering with symptoms, then this is a very timely newsletter for you to read.

This month we will explore two important clinical studies published in the January 13th issue of the New England Journal of Medicine (1,2).  These studies provide evidence that prescribing antibiotics is beneficial for infants and young children who are suffering with a very common disorder called otitis media.  This is an infection of the middle ear, usually due to bacteria.

For a number of years, the pediatric medical organizations recommended watchful waiting for some children with evidence of acute otitis media. This is primarily because some children with mild infections may improve without the use of antibiotics. Unfortunately, the problem is the identification of which children will do well without antibiotics.

While many physicians do not like to prescribe antibiotics, and often only do so if no other solutions are available, otitis media can become a very serious condition. In some children it can progress to the point of a perforation of the eardrum or even lead to the development of mastoiditis. Clearly, waiting to treat a child can be a risk.

To determine the efficacy of antibiotics on acute otitis media, the researchers in these recent studies prescribed a very effective antibiotic to one group of children and the other group received a placebo. The children were followed closely for 7-10 days to determine the treatment outcome.  If the children receiving the placebo developed worsening infections, they would be given “rescue therapy.”

The results were of the treatment were as follows:

  • Children on antibiotics: 18.6% treatment failure
  • Childen on placebo: 44.9% treatment failure

The authors concluded that otitis media in this age group is a treatable disease with the use of antibiotics: “More young children with a certain diagnosis of acute otits media recover more quickly when they are treated with an appropriate antimicrobial agent.” (2)

The next step in these research studies is to determine how to identify the children who may get better without the use of antibiotics.

Unwanted Side Effects of Antibiotics

It’s worth noting that two of the most frequent adverse events occurring in the children receiving antibiotics were diarrhea and diaper area dermatitis. More than 50% of the children in the antibiotic group developed diarrhea and/or diaper rash. Among the children who received a placebo, only 25% experienced these side effects.

So how can these effects be mitigated if your child needs to take an antibiotic? There are several published studies (3) that have found that taking a probiotic when antibiotics are prescribed can reduce the risk of developing diarrhea by roughly 50%.  While very few medications or treatments are 100% effective, taking a probiotic for a 50% chance to reduce the risk of antibiotic related diarrhea and diaper rash is a worthwhile effort.

Take Home Message

If your child is prescribed an antibiotic, consider adding a probiotic that will lessen the risk of diarrhea and diaper rash. Remember to separate the timing of the antibiotic and probiotic by two hours to insure the probiotic bacteria are not destroyed by the antibiotic.

Finally, to be successful, the probiotic serving size should be greater than 10 billion bacteria and consist of multistrain, multispecies organisms like those in EndoMune Jr.

Wishing you and your children a very healthy winter season!

Eat healthy, exercise and live well!
Dr. Hoberman


(1) A placebo-controlled trial of antimicrobial treatment for acute otitis media. Tähtinen PA, Laine MK, Huovinen P, Jalava J, Ruuskanen O, Ruohola A. N Engl J Med. 2011 Jan 13;364(2):116-26.

(2) Treatment of acute otitis media in children under 2 years of age. Hoberman A, Paradise JL, Rockette HE, Shaikh N, Wald ER, Kearney DH, Colborn DK, Kurs-Lasky M, Bhatnagar S, Haralam MA, Zoffel LM, Jenkins C, Pope MA, Balentine TL, Barbadora KA.N Engl J Med. 2011 Jan 13;364(2):105-15.

(3) Probiotics for prevention of antibiotic-associated diarrhea. Doron SIHibberd PLGorbach SLJ Clin Gastroenterol. 2008 Jul;42 Suppl 2:S58-63.

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

Yale Workshop on Probiotics Presents New Research

I just returned from the 3rd Yale Workshop on “Advances in Probiotic Use” and am pleased to report there is a large amount of active research in the area of the intestinal bacteria. Namely, research is examining how bacteria impact human health and disease.

Among various findings, researchers presented new information about how probiotic bacteria can modulate the intestinal immune system. They have discovered how probiotic bacteria interact with the intestinal lining cells to improve the inflammatory conditions that occur due to infection colitis and ulcerative colitis.

In addition, there were a number of discussions about how the healthy intestinal bacteria can break down or ferment indigestible dietary starches. The breakdown products (short chain fatty acids) enhance the intestinal function, improve intestinal motility and lessen the risk of colon cancer. This is called a symbiotic relationship – mutually beneficial for the human host and the bacteria.

The conclusions from the various presentations are that probiotics can:

  • Lessen irritable bowel syndrome symptoms
  • Shorten the duration of infectious diarrhea in children
  • Aid in the prevention of antibiotic-associated diarrhea
  • Aid in the management of ulcerative colitis
  • Aid in the prevention of childhood allergies like eczema

Transplantation Therapy to Improve Bacteria Balance

An infection with a bacterium called Clostridia difficile can cause life-threatening colitis. The infection occurs when the healthy intestinal bacteria are reduced as a result of taking an antibiotic for something like a sinus infection.

There are special antibiotics that can destroy the Clostridia difficile infection. Unfortunately, there is a tendency for the infection to recur multiple times in the same person despite taking appropriate antibiotics to kill the Clostridia difficile organisms.

In an attempt to treat Clostridia difficile, a new innovative form of therapy was also discussed. The therapy involves the transplantation of stool from healthy individuals into patients as a means to re-establish a healthy intestinal bacterial balance.

There have been a few published case reports dating back to 1958 of transplanting healthy stool into patients who had recurrent Clostridia infections, and the results were very promising. Larger trials of infusing suspensions of healthy stool into ill patients have been recently done. The results have shown a cure rate of more than 90% within two days!!

This presentation was very thought provoking. To have this type of cure rate certainly indicates the importance of the healthy intestinal bacteria. The procedure is aesthetically unpleasing, but the alternative is to give the healthy bacteria in capsule form – accomplished when probiotics are prescribed.

Take Home Message

All of the presentations at the Yale Workshop provide further evidence of the importance of a healthy balance of intestinal bacteria. In addition, the studies confirm that probiotic bacteria have many beneficial benefits in helping to improve and maintain normal intestinal immune and digestive functions.

Please consider taking a high quality probiotic like EndoMune if you are going to take antibiotics or if you are struggling with ongoing GI symptoms despite medical evaluation.

Probiotics Recommended for Nursing Home Residents

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

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

Scenario One: Hospitalization

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

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

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

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

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

Scenario Two: General Aging Process

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

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

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

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

Probiotics Improve Constipation and Diarrhea

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

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

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

Take Home Message

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

Eat healthy, exercise and live well!
Dr. Hoberman


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

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

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

(4) Clin Infect Dis. 2010 Oct 15;51(8):907-14.Surveillance for outbreaks of gastroenteritis in long-term care facilities, Australia, 2002-2008. Kirk MDFullerton KEHall GVGregory JStafford RVeitch MGBecker N

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

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

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

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

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

Probiotics Provide Insurance Against Salmonella

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

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

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

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


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

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

Acute Infectious Diarrhea

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

Traveler’s Diarrhea

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

Experiemental Studies

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

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

Take Home Message

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

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

Eat healthy, exercise and live well!
Dr. Hoberman

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

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

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

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

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

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

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

Tips for Avoiding Foodborne Illness this Summer

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

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

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

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

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

Friendly Fourth of July Food Reminders

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

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

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

Risk of Traveler’s Diarrhea

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

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

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

EndoMune Can Lessen Risk of Foodborne Illness

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

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

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

Take Home Message

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

Eat healthy, exercise and live well!
Dr. Hoberman

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

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

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

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

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