Irritable Bowel Syndrome (IBS) Archives

Taking a multi-species probiotic is healthier than a placebo

Drug interactions, Probiotics / By @drHoberman

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

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

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

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

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

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

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

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

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Support Our Stressed-out Soldiers and Their Gut Health

Digestive Health / By @drHoberman

This month’s 14th celebration of National Military Appreciation Month couldn’t have come at a better time to spotlight the problems some of our stressed soldiers experience with their gut health.

A recent study concluded that higher stress, anxiety and depression felt by 37 male army soldiers during their fourth week of intense combat training (after a resting period) were connected to a greater incidence and severity of gastrointestinal problems, including irritable bowel syndrome (IBS).

The good news: The Department of Veterans Affairs is recognizing these IBS-related health problems suffered by soldiers.

Last year, the VA began implementing an assessment rule for disability benefits, taking into account the high numbers of deployed soldiers returning from Afghanistan and Iraq suffering from IBS and other gastrointestinal setbacks.

“The effects of IBS and other digestive disorders can be debilitating and disruptive to a person’s everyday life,” says International Foundation for Functional Gastrointestinal Disorders President and Founder Nancy Norton. “It’s important that veterans are aware of symptoms of IBS and the advancements in this arena so that they can be best cared for after returning home from service.

“IBS is a long-term condition with symptoms that can change over time in a person. There isn’t an easy remedy for people with IBS, but working in partnership with a knowledgeable care provider can often go a long way toward helping to manage the symptoms.”

The Institute of Medicine released Gulf War and Health Volume 9, a recent report that found there was no “one-size-fits-all” answer for veterans experiencing chronic, multi-symptom illnesses like IBS.

Ailmentary Pharmacology and Therapeutics

Medical News Today

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Probiotics May Battle IBS-Induced Stress

Mental Health, Probiotics / By @drHoberman

You may recall a recent study I posted about the possibilities of an anxiety-free future by taking probiotics. Those possibilities are looking a little more like probabilities, based on the results of a University of Michigan study on irritable bowel syndrome (IBS).

Although stressful emotions aren’t the primary cause of IBS, they can alter brain-gut interactions that trigger the intestinal inflammation that spurs diarrhea, belly pains (severe or chronic) or a loss of appetite.

In tests on mice, University of Michigan scientists discovered that stress may suppress an important element called an inflammasome, which is needed to maintain healthy gut microbes. The good news: Probiotics reversed the suppressive effect in these animals.

“This study reveals an important mechanism for explaining why IBS patients with probiotics makes sense,” said senior study author, gastroenterologist and associate professor of internal medicine at the University of Michigan John Y. Kao, M.D.

During the course of the study, researchers found inhibiting inflammosomes changed gut composition, resulting in intestinal inflammation. However, pretreating some rats with probiotics reduced inflammation in animals with stress-induced, small bowel inflammation.

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Feel Relief From IBS With Probiotics

Diet, Digestive Health / By @drHoberman

Constipation as a result of Irritable Bowel Syndrome, or IBS, can be uncomfortable and disconcerting. Although prescription drugs can provide some relief, it can cause unwelcomed side effects. In fact, in nearly 29 percent of clinical studies, medicines prescribed to treat IBS caused considerable side effects, such as diarrhea, abdominal pain and headache.

An EndoMune Advanced customer, who had previously been diagnosed with IBS, was prescribed a medication for chronic constipation. The medication caused her to experience side effects resulting in her feeling discomfort rather than relief. Because of this, she began taking EndoMune Advanced daily and noticed that she no longer relied on her prescription medication to treat her IBS.

Medications prescribed to treat IBS improve constipation by stimulating the intestines to secrete chloride, which, as a result, leads to more fluid in the intestines. These medications treat the symptoms of IBS rather than the underlying problem and disrupt the healthy balance of intestinal bacteria. Probiotics, on the other hand, re-establish the health balance that had been disrupted and corrects the underlying problem that causes the constipation.

Before turning to prescription medication to treat your IBS, try a probiotic supplement, like EndoMune Advanced, and you just might find the relief you seek.

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Ease “Tummy Aches” With Probiotics

Digestive Health, Healthy Aging / By @drHoberman

Surveys have found that 10-20% of children have been diagnosed with Irritable Bowel Syndrome (IBS). Symptoms of abdominal pain, distention, diarrhea and constipation can be very debilitating for the child and distressing for the parents.

A study conducted by Dr. Ruggiero Francavilla published in the Journal of Pediatrics in 2011 evaluated the benefits of probiotics versus a placebo in alleviating IBS symptoms in children.

The team of researchers studied 141 Italian children over the course of eight weeks. The children, whose ages ranged from five to 14, were divided into three groups, two receiving a probiotic supplement and one receiving a placebo. Results from the study concluded that those taking the probiotic had a 50% reduction in IBS symptoms compared to the placebo group.

If your child has been diagnosed with IBS and struggles with ongoing symptoms, you may want to consider a trial of a high quality probiotic like EndoMune Jr.

It is always best to check with your child’s physician before starting a probiotic.

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To Go or Not To Go… that is the problem

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

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

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Yale Workshop on Probiotics Presents New Research

Drug interactions, Probiotics / By @drHoberman

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.

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Tax Season Can Lead to Stress and IBS

Healthy Aging, Mental Health / By @drHoberman

April is a wonderful time of the year. Spring is nature’s way of saying, “let’s party.”⁽¹⁾

Planting new flowers and watching the first blossoms of the year are very joyful and relaxing activities, especially after enduring the cold gray days of winter.

Unfortunately, despite its beauty, April can sometimes be stressful for various reasons. At the forefront of many people’s mind is the need to file taxes. Or, you may be waiting to hear where your children will be going to school next year, or if they will find a job. If you happen to be one of those millions of people experiencing stress this season, you may want to consider taking a probiotic after you read this month’s newsletter.

Stress Causes Changes in Bacteria

Two very interesting articles were published in March. These articles investigated how stress can adversely affect the healthy bacteria of intestines^(2,3) .

In my practice of gastroenterology, I would see many patients who had ongoing symptoms of abdominal pain and change in stool habits. Despite comprehensive evaluations, no specific cause could be found for many of the patients. As a result, they would be labeled with the diagnosis of “Irritable Bowel Syndrome” (IBS).

At the time, it was thought that the symptoms of IBS were frequently due to stress. The common therapies included medications that combined an antispasmodic and a mild tranquilizer like Librax, Donnatal or Bentyl. These medications were treating the symptoms, but not the cause of stress. If medical researchers can determine the cause of the symptoms, then better therapy can be developed.

Immune System and Stress Regulation

The intestines contain 70% of our immune cells. It’s these cells that are responsible for monitoring the bacteria entering our system. Harmful bacteria stimulate the intestines to release inflammatory mediators (cytokines) in an effort to destroy the harmful bacteria. An increase in these mediators can result in intestinal inflammation, which in turn causes the symptoms of IBS.

One study⁽³⁾ published in March measured the level of inflammatory cytokines in 30 patients with IBS and in 30 normal controls. The level of cytokines were much higher in the IBS group – indicating there is a link between IBS and cytokines.

The other study⁽²⁾ investigated the intestinal bacteria in mice before and after they were exposed to a stressful situation. Following exposure to the stress, there was a change in the composition of the intestinal bacteria. With this change came an increase in harmful bacteria, which then induced the immune system to release inflammatory cytokines.

These research studies help to understand the cause of IBS symptoms. Now, the question is how to decrease the inflammation induced by stress. Doing this will be a giant step toward “treating” the symptoms of IBS.

Fortunately, scientific studies^(4,5) have already demonstrated that giving probiotics can reduce the immune system release of inflammatory cytokines, thereby easing IBS symptoms.

Take Home Message

If you are experiencing some stress and GI symptoms, consider taking a high quality probiotic like EndoMune so you can fully enjoy this springtime.

Eat healthy, exercise and live well!
Dr. Hoberman

References:

(1) Quote by Robin Williams

(2) Exposure to a social stressor alters the structure of the intestinal microbiota: implications for stressor-induced immunomodulation. Bailey MT, Dowd SE, Galley JD, Hufnagle AR, Allen RG, Lyte M. Brain Behav Immun. 2011 Mar;25⁽³⁾:397-407

(3) Altered peripheral toll-like receptor responses in the irritable bowel syndrome. McKernan DP, Gaszner G, Quigley EM, Cryan JF, Dinan TG. Aliment Pharmacol Ther. 2011 May;33⁽⁹⁾:1045-52.

(4) The role of microbiota and probiotics in stress-induced gastro-intestinal damage.Lutgendorff F, Akkermans LM, Söderholm JD. Curr Mol Med. 2008 Jun;8⁽⁴⁾:282-98

(5) Therapies aimed at the gut microbiota and inflammation: antibiotics, prebiotics, probiotics, synbiotics, anti-inflammatory therapies.Quigley EM.Gastroenterol Clin North Am. 2011 Mar;40⁽¹⁾:207-22

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Probiotics are Effective Treatment for Pediatric IBS

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

If you’re a parent, then you are probably familiar with the phrase, “My stomach hurts!”

This is often a self limited problem, but some children do experience recurrent abdominal pain which is often diagnosed as Irritable Bowel Syndrome (IBS).

A recently published study examined the benefits of probiotics for alleviating the symptoms of IBS in children⁽¹⁾. IBS is a common problem in pediatrics, and no safe and effective treatment has been available up until now⁽²⁾.

Suspected Causes of IBS

The symptoms of abdominal bloating, gas, pain and change in stools are very common in both children and adults. Once appropriate tests have ruled out any underlying disorder like ulcers, colitis, or celiac disease, the diagnosis is often IBS.

Between 5 to 20% of kids have IBS, and about one in five adults do, too. It’s not fun, but the good news is that IBS doesn’t lead to more serious problems. It is more about quality of life for the child and the family.

Since the cause is not really known, and the symptoms can vary, IBS can be hard to treat.

Over the years a variety of theories have been offered to explain IBS symptoms in children. These have included emotional stress, intestinal hypersensitivity, altered intestinal motility, dietary intolerances and genetics^(3,4).

In the last several years there has been a shift in the paradigm, and now alterations in the intestinal bacteria are thought to be a major factor leading to IBS.

We are all familiar with the term “food poisoning” — a bout of infectious diarrhea due to the consumption of harmful bacteria in contaminated foods or drinks.

Researchers in the area of IBS noted that many of the people who developed symptoms of IBS had experienced a recent episode of food poisoning⁽⁵⁾. It was theorized that the infection caused a disruption of the healthy intestinal bacteria resulting in ongoing intestinal inflammation and GI symptoms⁽⁶⁾.

Recent studies have supported this association and identified post-infectious irritable bowel syndrome (PI-IBS) as a disorder due to a previous bout of infectious gastroenteritis. Approximately 30% of individuals with IBS can date the onset of their symptoms following an episode of gastroenteritis⁽⁷⁾.

Pediatric Medical Studies

In February of this year, a study⁽⁸⁾ was published that documented for the first time that exposure to acute gastroenteritis in childhood is associated with an increased risk of IBS in early adulthood. There was an outbreak of infectious gastroenteritis due to drinking contaminated city water. Children were followed for 8 years after the exposure. The children who had a bout of gastroenteritis had a greater than fourfold increase in IBS compared with unexposed children.

This now brings us back to the new medical article that I mentioned at the beginning of this newsletter. The study⁽¹⁾ enrolled children 4 to 18 years of age who fulfilled the criteria for IBS. The children received a probiotic or a placebo. A daily record of their symptoms was maintained. At the end of the study, the results were reviewed.

The group receiving probiotics had a better than 50% improvement in their symptoms of abdominal pain, and bloating compared to the placebo group. There was also an improvement in the passage of stools. Additionally, no adverse effects were noted in the group taking probiotics.

In 2008, a review article⁽²⁾ on medications to ease the symptoms of IBS in children stated, “The lack of clear evidence of effectiveness for any of the recommended drugs suggests that there is little reason for their use outside of clinical trials.” The new study on childhood IBS, though, does show that probiotics are effective.

Take Home Message

If your child has IBS, probiotics may help to ease their symptoms. Fortunately, there have been no adverse effects associated with their use. Consider using EndoMune Jr for children less than 8 years of age and EndoMune Advanced for older children. It won’t hurt, and it certainly may help!

Eat healthy, exercise and live well!
Dr. Hoberman

(1) VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study.Guandalini S, Magazzù G, Chiaro A, La Balestra V, Di Nardo G, Gopalan S, Sibal A, Romano C, Canani RB, Lionetti P, Setty M.J Pediatr Gastroenterol Nutr. 2010 Jul;51⁽¹⁾:24-30.

(2) Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.Huertas-Ceballos A, Logan S, Bennett C, Macarthur C. Cochrane Database Syst Rev. 2008 Jan 23;⁽¹⁾.

(3) Irritable bowel syndrome: epidemiology, diagnosis and treatment: an update for health-care practitioners.Grundmann O, Yoon SL.J Gastroenterol Hepatol. 2010 Apr;25⁽⁴⁾:691-9. Epub 2010 Jan 13.

(4) Pathogenesis of IBS: role of inflammation, immunity and neuroimmune interactions.Ohman L, Simrén M.Nat Rev Gastroenterol Hepatol. 2010 Mar;7⁽³⁾:163-73. Epub 2010 Jan 26. Review.

(5) The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases.CHAUDHARY NA, TRUELOVE SC. Q J Med. 1962 Jul;31:307-22.

(6) Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis . Wang LH , Fang XC , Pan GZ . Gut 2004 ; 53 : 1096 – 101.

(7) Postinfectious irritable bowel syndrome–a meta-analysis.Halvorson HA, Schlett CD, Riddle MS.Am J Gastroenterol. 2006 Aug;101⁽⁸⁾:1894-9; quiz 1942.

(8) An Outbreak of Acute Bacterial Gastroenteritis Is Associated With an Increased Incidence of Irritable Bowel Syndrome in Children Marroon Thabane, Marko Simunovic, Noori Akhtar-Danesh, Amit X Garg, William F Clark, Stephen M Collins, Marina Salvadori, John K Marshall The American Journal of Gastroenterology 105, 933-939 (23 February 2010).

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IBS Sufferers Not at Greater Risk for Colon Cancer

Disease, Drug interactions, Probiotics / By @drHoberman

Some very reassuring news was just released from a recent research study. The study, published in the American Journal of Gastroenterology found Irritable Bowel Syndrome (IBS) patients to be at no greater risk than healthy patients for polyps, colon cancer or inflammatory bowel disease.

According to the article:

This research shows that it is unnecessary to order colonoscopies for patients with IBS, unless they show alarming symptoms like unexplained weight loss or anaemia, bleeding from the GI tract, or have a family history of colon cancer, inflammatory bowel disease, or celiac disease, says Dr. Chey.

If you’re interested in reading the article in its entirety on DocGuide.com, visit:
http://www.docguide.com/news/content.nsf/news/852576140048867C852576E20000C862

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