Pediatric illness

Ease “Tummy Aches” With Probiotics

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.

Probiotics for Pediatric Antibotic-Associated Diarrhea

Welcome to February, readers!

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

The Curious Case Of The Two Kiddie Colds

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

Consider these two cases:

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

 

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

A Serious Side Effect of Antibiotics

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

A Proof Is In The Probiotics

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

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

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

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

Take Home Message

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

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

Healthy Benefits of Probiotics for Children

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

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

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

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

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

Committee on Nutrition: Probiotic Recommendations

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

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

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

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

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

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

Prebiotics and Allergy Reduction

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

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

Safe and Promising Supplements

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

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

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

Wishing you and your loved ones a very healthy 2011.

Eat healthy, exercise and stay well.
Dr. Hoberman

References:

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

Probiotics in the News

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

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

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


Benefits of Probiotic Bacteria for Colicky Infants

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

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

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

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

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

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

The authors concluded:

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 are Effective Treatment for Pediatric IBS

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 ALogan SBennett CMacarthur CCochrane 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 HASchlett CDRiddle 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).

 

How Can Probiotics Keep Children Healthy?

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

Probiotics and Acute Infectious Diarrhea

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

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

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

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

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

Probiotics and Chronic Abdominal Pain (CAP)

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

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

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

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

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

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

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

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

Take Home Message

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

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

Eat healthy and live well!
Lawrence J Hoberman MD

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

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

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

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

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

 

Should You Take a Probiotic During Flu Season?

Everyday in the news there are updates about this year’s flu season, especially about the H1N1 virus (Swine flu).  By all accounts, the infectivity rate is going to be very high.

We have all heard the recommendations:

  • Get the vaccine
  • Wash your hands
  • Avoid crowds
  • Don’t sneeze or cough into your hands
  • Drink lots of fluid, eat lots of fruits and vegetables, exercise and get 7 hours of sleep

Is there any other preventive therapy that is over the counter and without any adverse effects? You guessed it, PROBIOTICS!!

This month in the medical journal, Pediatrics, a study was published: “Probiotics Effects on Cold and Influenza-like Symptom Incidence and Duration in Children” (1).

Method: Healthy children ages 3-5 were randomly placed in one of three groups: 104 received a placebo; 110 received a probiotic containing Lactobacillus acidophilus; 112 received a probiotic containing L acidophilus in combination with Bifidobacterium lactis. The children were given the probiotics daily for 6 months and monitored for cold and influenza-like symptoms.

Results: Compared to the placebo group, single and combination probiotics reduced the following symptoms, antibiotic usage, and reduction in days missed from school:

Conclusion: Daily intake of a probiotic supplement for 6 months during the cold and flu season was a safe and effective way to reduce the frequency of symptoms of colds and flu, reduce antibiotic usage and lessen missed days from school. A two strain probiotic in a dosage of 10 billon colonies is very beneficial.

Discussion: So I imagine you are all saying, “that is very interesting, but I am not a 3 year old.”

Well, there have been a number of studies (2,3,4,5,6) done over the last 4-5 years to determine if probiotics can lessen or prevent viral upper respiratory infections in not only children but also healthy adults, young and old.

One study done on healthy adults investigated the effect of long-term consumption of probiotics on viral respiratory infections during two winter/spring periods (4). The combination of a probiotic containing lactobacilli and bifidobacteriaa successfully shortened the duration of cold infections by two days and reduced the severity of symptoms. The incidence of infections, however, was not affected.

Another published paper did a systematic review of probiotics efficacy in preventing respiratory tract infections (5). Twelve controlled trials were reviewed, half reviewed adults and the other half reviewed children and infants. While the trials varied in duration of probiotic taken, dosage and type of bacterial strain, most of the trials noted a significant reduction in the severity of symptoms, but not the incidence of infection. A few did report a decrease in the frequency of infections.

There is a considerable amount of research being directed toward the mechanisms by which orally ingested probiotics can affect the immune system to lessen viral respiratory infections. Studies have shown that use of probiotics can stimulate the immune system in the gastrointestinal tract, producing more immune cells. In turn, those immune cells can stop inflammation and can also attack the viruses as they invade the lining of the respiratory tract (4, 7, 8, 9). The stimulated immune cells can migrate from the GI tract to other areas of the body…including the respiratory tract.

Take Home Message

With these kinds of study results, it seems reasonable during the flu season to take a daily probiotic that contains a combination of lactobacilli and bifidobacteria in a serving size or dosage of 10 billon colonies or more — like EndoMune.

Thank you for your interest in EndoMune.
Eat healthy, exercise and live well!!

Larry Hoberman MD

(1)Probiotic effects on cold and influenza-like symptom incidence and duration in children.Leyer GJ, Li S, Mubasher ME, Reifer C, Ouwehand AC; Pediatrics. 2009 Aug;124(2):e172-9. Epub 2009 Jul 27

(2) Effect of a dietary supplement containing probiotic bacteria plus vitamins and minerals on common cold infections and cellular immune parameters. Winkler P, de Vrese M, Laue Ch, Schrezenmeir J; Int J Clin Pharmacol Ther. 2005 Jul;43(7):318-26.

(3)A new chance of preventing winter diseases by the administration of synbiotic formulations.Pregliasco F, Anselmi G, Fonte L, Giussani F, Schieppati S, Soletti L; J Clin Gastroenterol. 2008 Sep;42 Suppl 3 Pt 2:S224-33.

(4) Probiotic bacteria reduced duration and severity but not the incidence of common cold episodes in a double blind, randomized, controlled trial.de Vrese M, Winkler P, Rautenberg P, Harder T, Noah C, Laue C, Ott S, Hampe J, Schreiber S, Heller K, Schrezenmeir J; Vaccine. 2006 Nov 10;24(44-46):6670-4. Epub 2006 Jun 6.

(5) Probiotics for the prevention of respiratory tract infections: a systematic review.Vouloumanou EK, Makris GC, Karageorgopoulos DE, Falagas ME; Int J Antimicrob Agents. 2009 Sep;34(3):197.e1-10. Epub 2009 Jan 28.
Probiotics in intestinal and non-intestinal infectious diseases–clinical evidence.
Hatakka K, Saxelin M; Curr Pharm Des. 2008;14(14):1351-67. Review.

(6) Effect of fermented milk containing the probiotic Lactobacillus casei DN-114001 on winter infections in free-living elderly subjects: a randomised, controlled pilot study.Turchet P, Laurenzano M, Auboiron S, Antoine JM; J Nutr Health Aging. 2003;7(2):75-7.

(7) Probiotics in intestinal and non-intestinal infectious diseases–clinical evidence. Hatakka K, Saxelin M; Curr Pharm Des. 2008;14(14):1351-67. Review.

(8) Molecular and cellular basis of microflora-host interactions.Winkler P, Ghadimi D, Schrezenmeir J, Kraehenbuhl JP; J Nutr. 2007 Mar;137(3 Suppl 2):756S-72S. Review.

(9) Probiotic and prebiotic influence beyond the intestinal tract. Lenoir-Wijnkoop I, Sanders ME, Cabana MD, Caglar E, Corthier G, Rayes N, Sherman PM, Timmerman HM, Vaneechoutte M, Van Loo J, Wolvers DA; Nutr Rev. 2007 Nov;65(11):469-89. Review

Can Probiotics Lessen Incidence of Infantile Allergies?

In last month’s newsletter, I mentioned some of the benefits of probiotics for children. This month I would like to discuss how probiotics may lessen childhood allergies like asthma, eczema and hay fever.

Emergence of the Hygiene Theory

Over the last 30 years there has been a two-to-three fold increase in childhood allergies in developed countries. This is significant as compared to the 19th century when hay fever (allergic rhinitis) and asthma were rare.

The rise in allergies like asthma, rhinitis and eczema has not been seen in underdeveloped countries.  This observation has resulted in the “Hygiene Theory”(1).

The theory attributes the rise of allergies to our sanitized lifestyle. In our super-clean world –
vaccinations, anti-bacterial soaps, antibiotics and airtight doors and windows – we are keeping dirt and disease-causing germs at bay.

Seventy percent of our immune system is in the intestines. Since the intestines serve as our window to our environment, it is important that the intestines monitor our exposure to harmful infections and toxins.

The Hygiene Theory explains the rise of allergies to a change in the immune activity of the gut (2). Our bodies no longer need to fight germs as much as they did in the past. As a result, the immune system has shifted away from fighting infection to developing more allergic tendencies.

The lymphocytes (immune cells) in the intestines are of several types:

  • Th1 helps to fight infections due to bacteria and viruses
  • Th2 responds to infections caused by parasites.

If an infant is not exposed to infectious bacteria and viruses, then Th1 will be less active, causing a shift the balance of activity in favor of the Th2 lymphocytes, producing antibodies to parasites and also to harmless allergens.

The initial theory has been modified some (3).  There is another lymphocyte called a regulatory cell (Treg). This lymphocyte can regulate the activity of both Th1 and Th2 lymphocytes. By adding probiotic bacteria, the (Treg) cells can down regulate the Th2 allergy-mediated immune response.

Probiotics to Regulate Incidence of Eczema

In 2001, a study was done to determine if giving probiotics to mothers prenatally and to infants for the first six months could lessen the frequency of eczema (4). During the first two years of life, eczema occurred 50% less in the group given probiotics compared to the group given placebo.

Subsequent similar studies have had mixed results (5). However, a recent study found that giving a probiotic blend to pregnant women with a family history of allergies was beneficial. The women were given either a placebo or the probiotic starting 4-8 weeks before delivery and then for an additional three months. The infants receiving probiotics had a 55% less involvement with eczema at one year compared to the placebo group (6).

Based on the available studies, probiotics can modify the immune system in infants and lessen the risk of developing eczema and possibly childhood asthma.

There are very few studies that have shown that probiotics can treat existing allergies in children or adults (5). In this regard, it is of interest that a recent study reported probiotics lessened symptoms of nasal allergy in children during the birch pollen season (7).

Much more research is needed to understand how probiotics interact with the intestinal immune cells, but it is really fascinating how our intestinal bacteria play such a major role in our general health.

Take Home Message

For women who are allergy prone, taking a probiotic like EndoMune may help prevent eczema in their offspring. In addition, giving EndoMune Junior to your child during infancy may help to lessen the risk of developing allergies. It is always recommended that you talk with your doctor before taking new medications and supplements.

(1) Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989 Nov 18; 299(6710):1259–1260.

(2)Probiotics in children.Kliger B,Hanaway P, Cohrssen A. Pediatr Clin North Am.2007 Dec;54(6): 949 Kligler B, Hanaway P, Cohrssen A.

(3)Hygiene theory and allergy and asthma prevention. Liu AH.Paediatr Perinat Epidemiol. 2007 Nov;21 Suppl 3:2-7.

(4)Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial.Kalliomäki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E.Lancet. 2001 Apr 7;357(9262):1076-9.

(5)Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double-blind, randomized, placebo-controlled trial.Kim JY, Kwon JH, Ahn SH, Lee SI, Han YS, Choi YO, Lee SY, Ahn KM, Ji GE.Pediatr Allergy Immunol. 2009 Oct 14.

(6)Probiotics and prebiotics in atopic dermatitis: review of the theoretical background and clinical evidence.van der Aa LB, Heymans HS, van Aalderen WM, Sprikkelman ABPediatr Allergy Immunol. 2009 Jul 2.

(7)Specific probiotics alleviate allergic rhinitis during the birch pollen season. Ouwehand AC, Nermes M, Collado MC, Rautonen N, Salminen S, Isolauri E. World J Gastroenterol. 2009 Jul 14;15(26):3261-8.

Probiotics Prevent Colds in Children?

“When given preventively over the winter months, probiotics reduce fever, cough, and runny noses in children, researchers said.”

This is very exciting news for parents across the country. Many parents deal with the frustration of sick children during the winter months and the many associated problems including missed school, missed work and restless nights.

A recent study evaluated 326 children ages 3 to 5 years. Two groups of these children in a childcare center in China were given “twice-daily doses of L. acidophilus or L. acidophilus in combination with Bifidobacterium animalis for six months from November 2005 to May 2006.” The third group was given a placebo.

Both the single strain and the multi-strain probiotic doses were effective at reducing fever, cough, and rhinorrhea; the combination strain, however, had a more profound, positive impact. This seems to imply multi-strain, multi-species probiotics continue to prove more efficacy for prevention rather than their single-strain counterparts.

With profound research studies, such as this study in China, physicians may be able to begin moving away from antibiotics toward other forms of prevention like probiotics. While more studies are necessary, probiotic research continues to move forward in a very exciting direction.

For the article in its entirety, visit:
http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/15251

Source reference:
Leyer GJ, et al “Probiotic effects on cold and influenza-like symptom incidence and duration in children” Pediatrics 2009; DOI: 10.1542/peds.2008-2666.

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