diarrhea Archives

Probiotics Provide Insurance Against Salmonella

Diet, Drug interactions, Healthy Aging / By @drHoberman

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

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

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

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

Probiotics^(1,2,3):

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

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

Acute Infectious Diarrhea

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

Traveler’s Diarrhea

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

Experiemental Studies

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

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

Take Home Message

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

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

Eat healthy, exercise and live well!
Dr. Hoberman

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

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

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

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

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

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

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

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Tips for Avoiding Foodborne Illness this Summer

Diet, Healthy Aging, Mental Health / By @drHoberman

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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Probiotics May Decrease Chemotherapy-Induced Diarrhea

Healthy Aging / By @drHoberman

Our March newsletter was just issued this week, and it addresses some interesting research findings with regard to the anti-cancer effect of probiotics and the ability of probiotics to assist with decreasing chemotherapy-induced diarrhea. Excerpts from the article are as follows:

There have been a number of studies on probiotics protective effect against colon cancer (10). There are no direct experimental investigations for cancer suppression in human subjects using probiotics. However, there are a wealth of studies indicating indirect evidence for cancer suppression in human subjects. This study helps to identify one of the mechanisms how probiotics can prevent cancer development. Bottom line, it doesn’t hurt to take a probiotic.

You may read the March newsletter in its entirety for more information about Probiotics’ Effects on Cancer and Chemotherapy.

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How Can Probiotics Keep Children Healthy?

Children’s Health, Mental Health, Probiotics / By @drHoberman

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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Study on Antibiotic-Associated Diarrhea

Disease, Probiotics / By @drHoberman

A study recently published in the Journal of Medical Microbiology further explores the potential benefits of probiotics at maintaining intestinal health while ingesting antibiotics such as Augmentin.

The study concluded probiotics, particularly Bifidobacteria, may be helpful in returning to a pre-antibiotic baseline:

This study does identify a benefit of probiotics, in part through increasing Bifidobacterium that may limit the disruption of gut microbiota by antibiotics, stabilizing concentrations of Enterobactereaceae and Bacteroides in particular. While this does not represent a clinical end point in itself this study provides important insight into the nature of the disruption of gut microbiota by antibiotics and a possible mechanism whereby probiotics limit gastrointestinal adverse events associated with antibiotics.

Further studies are necessary to assess the clinical relevance of these observations.

Engelbrektson, Anna, et al. “Probiotics to minimize the disruption of feacal microbiotia in healthy subjects undergoing antibiotic therapy.” Journal of Medical Microbiology (2009), 58, 663-670.

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