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Probiotics are great for helping Diarrhea.

Do you know that you have literally millions of friendly bacteria that live in your gut?

What’s more, they’re essential to maintain good digestive function. Unfortunately, when you
experience diarrhea this upsets the normal balance of these friendly bacteria, also known as
probiotics. They are helpful bacteria or sometimes even healthy yeasts, and these friendly
bacteria help overcome many kinds of diarrhea.

The best understanding that we have about how beneficial probiotics can be is seen in studies
of diarrhea in kids, especially infectious diarrhea that is caused by rotavirus. The studies
show that probiotics shorten the time of kids having diarrhea by 1/2 to 2 days. The most
effective strains are Lactobacilllus reuteri and Saccharomyces boulardii. Infact Saccharomyces
Boulardii is one of the strains found in our best seller for kids, Primal Defense.

Traveling internationally is another reason for coming down with a bout of diarrhea. Very often
it’s a matter of eating contaminated food or water, or merely being a new environment where the
bacteria are unfamiliar to your body. is a frequent problem for travelers. Taking probiotics
before you travel can lower your risk of getting diarrhea. We get very good results with Dr
Ohhira’as Original Probiotics formula.

Talking about Dr Ohhira’s prrobiotic, there is clinical research to show its effectivity
against C. difficile
, which is often acquired after a hospital stay. C difficile may lead to
severe and sometimes life-threatening diarrhea and colitis. So taking these probiotics may help
prevent C. difficile infection and even more importantly that it may control repeat infections.

Other studies show that Saccharomyces boulardii and Lactobacillus GG are alos effective. In one
large study, people who were suffering with recurrent diarrhea were given a probiotic or a pill
that was not a probiotic, ie a placebo. They found that only 9 out of 26 people in the group
taking probiotics had a further recurrence of the diarrhea while in the other group who were
taking the placebo, 22 out of 34 had recurrent diarrhea.

Another probiotic that has been in the news lately, is VSL#3. This is because it has been shown
to be very effective in reducing symptoms of Ulcerative Colitis. This is a very important
finding because the drugs that are usually prescribed have many side effects with adverse
effects on the immune system.  Now the Junior Packs are also available.

Another very important time to be supplementing with probiotics is when taking antibiotics.
Unfortunately, although antibiotics kill the bad bacteria that make you sick, they also kill
the good bacteria. This leads to a dsiruption of the normal balance of the gut flora in the
gut and that may cause diarrhea. In fact, diarrhea is known to be a common side effect in as
many as 10% – 30% of those who take antibiotics. We recommend that you consider giving your
kids and even taking them yourself, before, during and most importantly after you take
antibiotics.

This will lower your risk or at least shorten the length of time you experience diarrhea.
Studies using Saccharomyces boulardii and Lactobacillus GG seem to be the most effective.
Lactobacillus GG is the probiotic used in Culturelle.

Probiotics are very safe to use for people of all ages. They rarely cause side effects, perhaps
some gas, however, that’s usually due to a type of  ‘detox’ or Herxheimer reaction when the bad
bacteria are dying off andcausing symptoms. Other important factors to take into account are
the quality and strength of the particular brand. Its very important to select effective
probiotics and also to take a high enough number of live microorganisms to make it worth while

24 Acknowledgements

Acknowledgements for Probiotics Article

O. Karimi received support from the Foundation of Immunogenetics. A.S. Pefia’s research in inflammatory bowel disease for 2002-2003 was supported in part by funding from the Crohn’s and Colitis Foundation of America (CCFA).

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  84. Kirjavainen, P.V., Salminen, S.J., Isolauri, E. Probiotic bacteria in the management of atopic disease: Underscoring the importance of viability. J Pediatr Gastroenterol Nutr 2003; 36: 223-7.
  85. Katelaris, P.H., Salam, I., Farthing, M.J. Lactobacilli to prevent traveler’s diarrhea? N Engl J Med 1995; 333: 1360-1.
  86. Vanderhoof, J.A., Whitney, D.B., Antonson, D.L., Hanner, TL., Lupo, J.V., Young, R.J. Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children. J Pediatr 1999; 135: 564-8.
  87. Surawicz, C.M., Elmer, G.W., Speelman, P., McFarland, LV, Chinn, J., van Belle, G. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study. Gastroenterology 1989; 96: 981-8.
  88. McFarland, LV, Surawicz, C.M., et al. Prevention of beta-Iactam-associated diarrhea by Saccharomyces boulardii compared with placebo. Am J Gastroenterol 1995; 90: 439-48.:·'”
  89. Surawicz, C.M., McFarland, LV., Elmer, G., Chinn, J. Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii. Am J Gastroenterol 1989; 84: 1285-7.
  90. Gorbach, S.L., Chang, TW, Goldin, B. Successful treatment of relapsing Clostridium difficile colitis with Lactobacillus GG. Lancet 1987; 2: 1519.
  91. Biller, JA, Katz, A.J., Flores, A.F., Buie, TM., Gorbach, S.L. Treatment of recurrent Clostridium difficile colitis with Lactobacillus GG. J Pediatr Gastroenterol Nutr 1995; 21: 224-6.
  92. Prantera, C., Scribano, M.L., Falasco, G., Andreoli, A., Luzi, C. Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn’s disease: A randomised controlled trial with Lactobacillus GG. Gut 2002; 51: 405-9.
  93. Biancone, L., De Nigris, F., Del Vecchio Blanco, et al. Lactobacillus GG is not effective in subsiding bowel tenderness in inactive Crohn’s disease. Gastroenterology 2003: T1402A.
  94. Vanderhoof, J.A., Young, R.J. Role of probiotics in the management of patients with food allergy. Ann Allergy Asthma Immunol 2003; 90: 99-103.
  95. Isolauri, E., Arvola, T, Sutas, Y, Moilanen, E., Salminen, S. Probiotics in the management of atopic eczema. Clin Exp Allergy 2000; 30: 1604-10.
  96. Kalliomaki, M., Salminen, S., Arvilommi, H., Kero, P., Koskinen, P., Isolauri, E. Probiotics in primary prevention of atopic disease: A randomised placebo-controlled trial. Lancet 2001; 357: 1076-9.
  97. Kalliomaki, M., Salminen, S., Poussa, T., Arvilommi, H., Isolauri, E. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet 2003; 361: 1869-71.
  98. Ibnou-Zekri, N., Blum, S., Schiffrin, E.J., Von Der Weid, T. Divergent patterns of colonization and immune response elicited from two intestinal Lactobacillus strains that display similar properties in vitro. Infect Immun 2003, 71: 428-36.
  99. Coakley, M., Ross, R.P., Nordgren, M., Fitzgerald, G., Devery, R., Stanton, C. Conjugated linoleic acid biosynthesis by human-derived Bifidobacterium species. J Appl Microbiol 2003, 94: 138-45.
  100. Steidler, L., Hans, w., Schotte, L. et al. Treatment of murine colitis by Lactococcus lactis secreting interleukin-1O. Science 2000, 289: 1352-5.
  101. Seegers, J.F. Lactobacilli as live vaccine delivery vectors: Progress and prospects. Trends Biotechnol 2002, 20: 508-15.

23 Future Perspectives

Future Perspectives in Probiotic Use

Lactobacilli derived from the endogenous flora of normal donors are being increasingly used as probiotics in functional foods and as vaccine carriers. However, a variety of studies carried out with distinct strains of lactobacilli have suggested heterogeneous and strain-specific effects (Table IV).

To dissect this heterogeneity at the immunological level, Ibnou-Zekri et al. (137) selected two strains of lactobacilli that displayed similar properties in vitro and studied their impact on mucosal and systemic B-cell responses in monoxenic mice. Germ-free mice were colonized with L. johnsonii (NCC 533) or L. paracasei (NCC 2461). Bacterial loads were monitored for 30 days in intestinal tissues, and mucosal and systemic B-cell responses were measured.

Although both Lactobacillus strains displayed similar growth, survival, and adherence properties in vitro, they colonized the intestinal lumen and translocated into mucosal lymphoid organs at different densities. L. johnsonii colonized the intestine very efficiently at high levels, whereas the number of L. paracasei decreased rapidly and it colonized at low levels. They determined whether this difference in colonization correlated with an induction of different types of immune responses, and observed that colonization with either strain induced similar germinal center formation and IgA bearing lymphocytes in the mucosa, suggesting that both strains may activate mucosal B-cell responses.

However, clear differences in the patterns of immunoglobulins were observed between the two strains in the mucosa and in the periphery. Therefore, despite similar in vitro probiotic properties, distinct Lactobacillus strains may colonize the gut differently and generate divergent immune responses.

In another study, Coakley et al. (138), assessed strains of Lactobacillus, Lactococcus, Pediococcus and Bifidobacterium for their ability to produce the health-promoting fatty acid conjugated linoleic acid from free linoleic acid. Strains of Lactobacillus, Lactococcus, Pediococcus and Bifidobacterium were grown in medium containing free linoleic acid. Growth of the bacteria in linoleic acid and conversion of the linoleic acid to conjugated linoleic acid was assessed.

Of the bacteria assessed, nine strains of Bifidobacterium produced the cg, t11 CLA isomer from free linoleic acid. The cg, t11 conjugated linoleic acid isomer was also produced by some strains, but at much lower concentrations. Thus, the production of conjugated linoleic acid by bifidobacteria showed considerable interspecies variation.

Bifidobacterium breve and B. dentium were the most efficient producers of conjugated linoleic acid among the range of strains tested, with B. breve converting up to 65% linoleic acid to cg, t11 conjugated linoleic acid when grown in 0.55 mg/ml linoleic acid. Strains also varied considerably with respect to their sensitivity to linoleic acid. The production of conjugated linoleic acid by probiotic bifidobacteria offers a possible mechanism for some health-enhancing properties of bifidobacteria and provides novel opportunities for the development of functional foods.

Finally, it has been demonstrated that the therapeutic dose of IL-10 may be reduced by localized delivery of a probiotic genetically engineered to secrete the cytokine. Intra-gastric administration of IL10-secreting Lactococcus lactis caused a 50% reduction in colitis in mice treated with dextran sulfate sodium and prevented the onset of colitis in IL-10 gene-deficient mice (139). This observation has also opened the way for the use of probiotics as live vaccine delivery vectors (140).

22 Irritable Bowel Syndrome

Probiotics in Irritable Bowel Syndrome – IBS

Irritable Bowel Syndrome is a widespread and multi-factorial functional disorder of the digestive tract (114). It affects 8-22% of the population with a higher prevalence in women. It accounts for 20-50% of referrals to gastroenterology clinics and is char­acterized by abdominal pain, excessive flatus, vari­able bowel habit and abdominal bloating for which there is no evidence of detectable organic disease. Suggested etiologies include gut motility and psy­chological disorders as well as psycho-physiological phenomena and colonic fermentation (115).

A large proportion of patients have periods characterized by sudden and unforeseeable changes in the two main symptoms, constipation and diarrhea, even within a few days (115). It is very likely that the syndrome represents different groups of patients with probably different pathogenesis. Irritable bowel syndrome may follow gastroenteritis and may be associated with an abnormal gut flora and with food intolerance (117). The fecal microflora in some of these patients has been shown to be abnormal with higher numbers of facultative organ­isms and low numbers of lactobacilli and bifidobacteria (115).

Bacteria are the major component of formed stools and are influenced by substrates ar­riving with the ileal affluent. Stool production is re­lated to quantitative and qualitative aspects of the colonic microflora and nearly 80% of the fecal dry weight consists of bacteria, 50% of which are viable.

Although there is no evidence of food allergy in irritable bowel syndrome, food intolerance has been identified and exclusion diets are beneficial to many of these patients. Food intolerance may be caused by an abnormal fermentation of food residues in the colon, as a result of disruption of the normal flora (115).

Some reports suggest that probiotics play a role in regulating the motility of the digestive tract (114). This may result in improvements in pain and flatulence in response to probiotic administration (115).

To assess whether preceding gastroenteritis or food intolerance were associated with colonic malfermentation, King et al. (117) conducted a cross­over controlled trial with a standard diet and an ex­clusion diet matched for macronutrients in six fe­male patients with irritable bowel syndrome and six female controls.

In this study fecal excretion of fat, nitrogen, starch, and nonstarch polysaccharide was measured during the last 72 hours of each diet. The total excretion of hydrogen and methane were col­lected over 24 hours in purpose-built 1.4 m3 whole body calorimeter. Breath hydrogen and methane excretion were measured for 3 hours after 20 g oral lactulose. The maximum rate of gas excretion was significantly greater in patients than in controls. The total gas production in patients was not greater than in controls, whereas hydrogen production was higher.

After lactulose, breath hydrogen was greater on the standard than on the exclusion diet. This means that colonic-gas production, particularly of hydrogen, is greater in patients with irritable bowel disease than in controls, and both symptoms and gas production are reduced by an exclusion diet. This reduction may be associated with alterations in the activity of hydrogen-consuming bacteria. It was therefore concluded that fermentation may be an important factor in the pathogenesis of this syndrome (117).

Spiller et al. (118) studied the intestinal perme­ability (Iactulose/mannitol ratio) and histological and immunological features in rectal biopsy specimens in 21 patients who had acute Campylobacter enteritis, 10 patients with postdysenteric irritable bowel syndrome and 12 asymptomatic controls. They found that the increased enteroendocrine cell counts, T lymphocytes, and gut permeability, which may survive for more than a year after Campylobacter enteritis, contribute to post-dysenteric irrita­ble bowel syndrome (118), thus offering a rationale to use probiotics for several months after the infectious episode.

VSL3 in patients with Irritable Bowel Syndrome

The effect of the probiotics was studied by Brigidi et al. (119) in a clinical trial in which 10 patients suffering from this syndrome were adminis­tered the VSL#3 probiotic preparation. The results indicated that the administration of VSL#3 im­proved the clinical picture and changed the com­position and biochemistry of fecal microbiota. The exact mechanisms of the positive effects are not known. The selection of patients may have had an important role in detecting the positive effects. Whether the induction of a significant increase in lactobacilli, bifidobacteria, and S. thermaphilus con­tributed to the regulation of the motility disorders or the increase in fecal B-galactosidase with a decrease in urease content indicate that a good response requires further study. The importance of this study is that it showed that the measurement of specific parameters and changes in the specific microflora was possible.

Kim et al. (120) investigated the effects of VSL#3 on gastrointestinal transit and symptoms of patients with Rome II-Irritable Bowel Syndrome with predominant diarrhea. Twenty-five patients with diarrhea-predominant Irritable Bowel Syndrome were randomly assigned to receive VSL3 powder (450 billion lyophilized bacteria/day) or matching placebo twice daily for 8 weeks after a 2-week run-in period.

Pre- and post-treatment gastro-intestinal transit measurements were performed in all patients. The patients recorded their bowel function and symptoms daily in a diary during the 10-week study, which was powered to detect a 50% change in the primary colonic transit endpoint. There were no significant differences in mean gastrointestinal transit measurements, bowel function scores or satisfactory global symptom relief between the two treatment groups, pre- or post-therapy.

The differences in abdominal bloating scores between treatments were borderline significant. Abdominal bloating was reduced with VSL3, but not with placebo. Furthermore, VSL#3 had no effects on individual symptoms such as abdominal pain, gas and urgency. VSL3 was well tolerated by all patients, and thus it seems to relieve the abdominal bloating in patients with diarrhea-predominant Irritable Bowel Syndrome (120).

21 Probiotics in Crohn’s Disease

Probiotics in Crohn’s Disease

The therapeutic role of probiotics in the prevention of postoperative recurrence of Crohn’s disease has been reported in some studies. Gampieri et al. (111) studied the effects of VSL3 in a randomized, investigator-blind trial. Forty patients with curative resection randomized within 1 week post surgery were divided into two groups of 20 patients. One group received mesalazine 4 g/day for 1 year and the other group received rifaximin 1.8 g/day for 3 months followed by VSL#3 6 g/day for 9 months. The endoscopic activity was assessed after 3 and 12 months. In the mesalazine group, eight patients had severe endoscopic recurrence after 3 months as well as after 12 months, whereas in the group with rifaximin and VSL3, two patients had a severe recurrence after 3 months and two patients after 12 months.

These results suggested the efficacy of the combination of a nonabsorbable antibiotic with a highly concentrated probiotic preparation in the prevention of severe endoscopic recurrence of Crohns disease after surgical resection.

In a pilot study Guandalini et al (112) investigated the possible effect of Lactobacillus GG in children with active Crohns disease. Four male patients with a median age of 14.5 years (range 10-18) were enrolled. In terms of clinical outcome, the patients showed significant improvement. In three patients receiving Lactobacillus GG, it was possible to taper the dose of steroids.

In a third published study using Lactobacillus GG this effect could not be confirmed. Forty-five patients were randomized to receive Lactobacillus GG 12 billion GFU/day (23 patients) or placebo (22 patients). A clinical remission after 52 weeks was seen in 15 of the 23 patients with Lactobacillus GG (83.3%) and in 17 of the 22 patients with placebo (89.4%).

Mild endoscopic activity was seen in nine of the 15 patients with remission in the Lactobacillus GG group (60%) and in six of the 17 patients with remission in the placebo group (35.3%). This study failed to show effectiveness in the postoperative prevention on Crohn’s disease (113). More studies are therefore necessary. The limited experience indicates that different probiotics have different capacity to prevent intestinal inflammation.

20 Pouchitis & Probiotics

Probiotics in Pouchitis

Pouchitis is a nonspecific inflammation of the ileal reservoir, that may appear after surgery for ulcerative colitis, and results in various clinical symptoms. It is a well-recognized long-term complication of restorative proctocolectomy.

The risk of pouchitis increases in patients with a history of extra-intestinal manifestations, primary sclerosing cholangitis, positive serology for perinu­clear anti neutrophil cytoplasmic antibodies, and backwash ileitis (107).

Pouchitis is associated with bacterial over­growth and dysbiosis, and antibiotics represent the first-choice treatment. The distal ileum and the large bowel, the sites with the highest bacterial concen­tration, are the most frequently affected by inflammation. Enteric bacteria or their products have been detected within the inflamed mucosa.

A significant decrease of lactobacilli and bifidobacteria concentra­tions has been found in ulcerative colitis, Crohn’s disease and pouchitis. Lactobacilli as maintenance showed less frequent relapses of pouchitis than those using placebo. Diversion of the fecal stream in the small and large intestine reduces the activity of the inflammation. The luminal contents and purified bacterial products added to isolated intestinal loops trigger systemic and local signs of inflammation.

In a study by Campieri et al. (103), seven patients, after clinical, endoscopic, and histological diagnoses of inflammation of the ileal pouch anal anastomosis with a pouchitis disease activity index (PDAI) > 7, were treated with 2 g/day of rifaximin (a non absorbable antibiotic) and 1 g/day of ciprofloxacin for 1 month.

All patients went into remission during this month, as judged by clinical, endoscopic and histological examination.

After remission, all seven patients were treated with the highly concentrated probiotic mixture VSL3 for nine months. No patient had a relapse in this period. All patients who received placebo had a relapse.

Probiotics in the maintenance of remission of chronic Pouchitis

Gionchetti et al. (108) evaluated the efficacy of VSL#3 in the maintenance of remission of chronic pouchitis. Forty patients in clinical and endoscopic remission were randomized to receive either VSL3 6 g/day, or an identical placebo for 9 months.

The patients were assessed clinically every month and endoscopically and histologically every 2 months or in the event of relapse. Three patients (15%) in the VSL#3 group had relapses within the 9-month follow-up period, compared with 20 (100%) in the placebo group. In the VSL3-treated group, the fecal concentration of lactobacilli, bifidobacteria, and S. thermaphilus increased significantly from base­line levels. These results suggested that oral administration of this new probiotic preparation is effective in preventing flare-ups of chronic pouchitis.

Probiotics in the prevention of the onset of Pouchitis

A positive effect of VSL3 in the prevention of pouchitis has been reported by Gionchetti et al. (109), who compared probiotic therapy with VSL#3 versus placebo in the ability to prevent the onset of acute pouchitis during the first year after ileal pouch­anal anastomosis. Forty patients who underwent ileal pouch-anal anastomosis for ulcerative colitis were randomized to receive either VSL3 or an identical placebo immediately after ileostomy closure for 1 year.

Both groups consisted of 20 patients. The patients were assessed clinically, endoscopically, and histologically after 1, 3, 6, 9 and 12 months. Health-related quality of life was assessed using the Inflammatory Bowel Disease Ouestionnaire (IBDO). Two of the 20 patients (10%) treated with VSL3 had an episode of acute pouchitis compared with eight of the 20 patients (40%) treated with placebo.

Treatment with VSL#3 determined a significant improvement in IBDQ score, which was not the case with placebo. During treatment with V8L3, fecal concentration of lactobacilli, bifidobacteria, and S. salivarius increased significantly.

The fecal concentration of Bacteroides, clostridia, coliforms, and enterococci were not modified. This suggested that the beneficial effect was not mediated by the suppression of the endogenous flora. The treatment with V8L#3 was effective in the prevention of the onset of acute pouchitis and improved the quality of life of patients with ileal pouch anal anastomosis.

As mentioned above, probiotic bacteria do not survive for long, and rapidly disappear as soon as the treatment is stopped. Therefore, prophylactic probiotic therapy of pouchitis might require longterm treatment and might not be indicated for all patients.

For this reason, V8L3 would be highly beneficial for patients at high risk of chronic pouchitis. In these cases prophylactic probiotics may be administered, pouch function improved and their quality of life after ileal pouch anal anastomosis could be maintained. Katz et al. (107) suggested that probiotics should be used for maintaining remission in chronic pouchitis and as prophylaxis against pouch inflammation in high-risk patients. Although preliminary results suggest that high doses V8L#3 may improve active pouchitis, probiotic therapy seems to be more effective to prevent mucosal inflammation than to treat it.

Kuisma et al. (110) investigated the efficacy of Lactobacillus GG supplementation as primary therapy for pouchitis and its effect on the microbial flora. Twenty patients, with a previous history of pouchitis and endoscopic inflammation were recruited for a prospective, randomized, double-blind, placebo-controlled trial of Lactobacillus GG supplementation.

Ten patients received Lactobacillus GG and 10 placebo, in two gelatin capsules b.i.d. for 3 months. Quantitative bacterial culture of fresh fecal samples and biopsies taken from the pouch and afferent limb was performed before and after supplementation. Lactobacillus GG supplementation was found to change the pouch intestinal flora by increasing the ratio of total fecal lactobacilli to total fecal anaerobes and enhancing the frequency of lactobacilli-positive cultures in the pouch and afferent limb mucosal biopsy samples.

Only 40% of patients were colonized with Lactobacillus GG, and no differences were observed between the groups with regard to the mean PDAI or the total anaerobes or aerobes of fecal or tissue biopsy samples.

Thus, a single-strain probiotic bacterium supplement of Lactobacillus GG changed the pouch intestinal bacterial flora, but was ineffective as primary therapy for a clinical or endoscopic response. More clinical trials are needed to evaluate the right placement and dosage of probiotics within a treatment regimen for pouchitis.

19 Probiotics in Ulcerative Colitis

Probiotics in Ulcerative Colitis

Two studies have shown a significant decrease in lactobacilli concentration in colonic biopsies in patients with ulcerative colitis. Preventing or controlling the colitis is reported when the concentration of Lactobacillus was modulated through dietary supplementation with lactulose (prebiotic). This is a non digestible food ingredient that affects the host by selectively stimulating the growth and activity of one or more “probiotic” bacteria, such as Bifidobacterium and Lactobacillus that have health-promoting properties (104).

Ulcerative Colitis is a chronic inflammation of the rectal and colonic mucosa, with a poorly defined etiology. Its characteristics are bloody diarrhea and mucus associated with a negative stool culture for bacteria, ova, or parasites. There is also fecal stasis with bacterial overgrowth and mucosal ischemia.

The therapeutic role of probiotics is shown through two studies; in one of these, oral administration of Lactobacillus GG caused an increase in intestinal IgA immune response in patients with Crohn’s disease. In the other study, exogenous administration of L. reuteri (pure bacterial suspension or as fermented oatmeal soup) prevented acetic acid-induced colitis or methotrexate-induced colitis in rats.

These studies showed a significant decrease in lactobacilli concentration in patients with active ulcerative colitis. The results showed that L. plantarum was more effective in methotrexate-induced colitis, and Lactobacillus treatment prevented development of spontaneous colitis in IL-10 gene-deficient mice.

In an open label study with 20 patients, intolerant or allergic to 5-aminosalicylic acid (5-ASA), a’ treatment consisting of VSL3 6 g (1800 billions bacteria)/day for 12 months was instituted. Clinical, endoscopic assessment and stool culture and fecal pH determination were recorded (105). Nineteen patients completed the trial and 15 were in remission for the whole year. Fecal concentrations of bifidobacteria, lactobacilli, and S. salivarius spp. Thermophilus were significantly increased in all patients and remained stable throughout the study. No changes were noted in the concentrations of total aerobic bacteria, suggesting that the beneficial effects of VSL3 were not related to suppression of endogenous luminal flora. The treatment was welltolerated with no reported significant side effects like those seen in the treatment with 5-ASA oral compounds.

This shows that the probiotic preparation was able to colonize the intestine and suggested its possible usefulness in maintaining remission in ulcerative colitis patients intolerant or allergic to 5ASA (105). The hypothesis from these studies is that the intestinal environment may contribute to the pathophysiology of ulcerative colitis.

Guslandi et al. (106) studied the efficacy of S. boulardii in ulcerative colitis patients. Twenty-five patients with a mild to moderate clinical flareup of ulcerative colitis received additional treatment with S. boulardii 250 mg three times a day for 4 weeks during maintenance treatment with mesalazine. These patients were unsuitable for steroid therapy. Rachmilewitz’s clinical activity index was calculated before and after the treatment. Of the 24 patients who completed the study, 17 attained clinical remission; this was endoscopically confirmed. The preliminary results suggested that S. boulardii may be effective in the treatment of ulcerative colitis.

Bacteria is Good for Us?

How Can Bacteria be Good for Us?

Decker Weiss, NMD, AACVPR
Integrative Interventions

    • Q: How can bacteria be good for us?

      A: Some kinds of bacteria do cause illnesses and disease in humans. However, the majority of bacteria do not cause disease. In fact, there are types of bacteria that are actually beneficial. “Good” bacteria, known as probiotic bacteria, are used in the manufacturing of food beverages. Some examples of foods that have probiotic food ingredients are buttermilk, yogurt, cheese, sausage, and acidophilus milk.

      These same kinds of probiotic bacteria are present in our intestines and help to keep the digestive system running by digesting food and processing waste.

    • Q: What are probiotics?

      A: Probiotics are live bacteria that are non-toxic and do not cause disease (non-pathogenic).1

      Some of the best-understood probiotic bacteria include members of the Lactobacillus and Bifidobacterium groups. Because of the Lactobacillus and Bifidobacterium’s ability to break down lactose, these probiotic bacteria are also known as lactic acid bacteria. Both of these types of probiotic bacteria are well studied and are available in both food and dietary supplements.1

    • Q: Is there a difference between the probiotic bacteria that is found in yogurt, and in nutritional supplements?

      A: Actually, the bacteria that is in yogurt, our intestine, and most natural supplements are the same types of probiotic bacteria, Lactobacillus acidophilus and Bifidobacteria longum. Because of this, these bacteria are referred in a generic sense as probiotics. So, the term probiotics may refer to the “good” bacteria that are present in food, or that live in our intestine, or that are part of a natural supplement.

  •  
    • Q: Why are probiotic bacteria important for digestive health?

      A: Normal microflora (the term commonly used for intestinal bacteria) is associated with good health. An imbalance in this natural microflora (when the beneficial probiotics are outnumbered by the harmful bacteria) is frequently associated with various disease states such as yeast infections and colon cancer.2

      Eating foods or taking a nutritional supplement containing probiotic bacteria can help support and modify the composition of the large intestine microflora.3 Microflora of the large intestine assist digesting through fermentation (by making the intestines more inhospitable to invading bacteria species), protection against disease-causing bacteria, and stimulation of the immune system.2 The probiotics, Lactobacillus and Bifidobacteria, occupy a central role in the intestinal flora and provide health benefits.

    • Q: How do probiotic bacteria help with digestion?

      A: Lactose is an important sugar that is converted to lactic acid by lactic acid bacteria. Lactose intolerance results from an inability to digest lactose, due to the failure of small intestine mucosal cells to produce lactase, an enzyme needed to digest lactose.4 This often results because of genetics, gastrointestinal disease, or because of the decline in the amount of intestinal lactase levels associated with aging.5 Lactase deficient people accumulate non-absorbed lactose in the gastrointestinal tract, which draws water and electrolytes into the gut and speeds waste through the intestines, leading to bloating, cramping, and diarrhea.5,6

      Approximately 50 million people in the United States have partial to complete lactose intolerance.

      Lactic acid bacteria have been shown to help the breakdown of lactose, specifically by enhancing the activity of lactase (beta galactosidase), which improves lactose digestion and tolerance.6,7 Furthermore, in a randomized, controlled clinical trial, Bifidobacteria longum was shown to assist in the breakdown of lactose and relieve the symptoms of lactose intolerance (flatulence) in people with lactose intolerance.8

    • Q: What is the difference between digestive enzymes and probiotics? Can they be taken together?

      A: Digestive enzymes, such as protease, amylase, and lipase, act upon food, breaking it down into simpler components that can be used by the body for energy.9 Without enzymes, digestion could not take place. Therefore, the food that we eat could not be absorbed and utilized by our bodies.

      Probiotics help the enzymes to digest food and process waste. In essence, probiotic bacteria and enzymes work together to ensure that the digestive tract is running smoothly. When taken together, enzymes assure greater levels of digestion and absorption of your food, and probiotic bacteria aid the enzymes in digestion and keep problems in check.

    • Q: Is helping to ensure a healthy digestive system the only use for probiotics?

      A: Absolutely not! Probiotic bacteria, such as lactobacillus acidophilus, have been found to help prevent vaginal yeast infections in women that suffer from these reoccurring infections.10

      Approximately 35% of vaginal infections are caused by the yeast, Candida albicans. Candida is a fungus that is a component of the normal gastrointestinal microflora.11 However, Candida must not be allowed to increase in numbers. An overgrowth is associated with adverse health effects like vaginal infections, oral thrush, or even serious systemic yeast infections. Probiotics have been shown to keep levels of Candida in check.11

      Probiotic bacteria have also been demonstrated to have anti-cancer properties. In a clinical study, colon cancer patients given Lactobacillus acidophilus fermented milk showed a significant increase in numbers of intestinal Lactobacilli and a decrease in risk factors associated with colon cancer.

      Patients suffering from inflammatory bowel diseases, such as ulcerative colitis and Crohn’s disease, can benefit from probiotic bacteria supplementation. Studies have shown that probiotic bacteria assist in maintaining remission in ulcerative colitis and preventing reoccurrence of Crohn’s disease. Manipulating the intestinal flora may prove to be more effective and better tolerated than the durgs that are conventionally give to treat these diseases.12-16 In one study, Lactobacillus acidophilus was found to improve the intestinal barrier and clinical status in children suffering from Crohn’s disease.12

      Probiotics supplementation can also improve and prevent skin diseases, such as eczema. Studies have shown that probiotic bacteria can actually control inflammation associated with skin conditions.17-19 In one study, infants with eczema who were given probiotic-supplemented formulas showed a significant improvement in skin condition.19

    • Q: How often should probiotics be taken to ensure optimal support of the digestion system?

      A: Probiotic bacteria do not permanently colonize in the body. They need to be replenished by the consumption of foods containing probiotic bacteria or by taking a probiotic natural supplement. Whatever form you choose to replenish the intestinal probiotics, they need to be ingested daily for their health-promoting effects to continue.

References:

  1. Sanders M. Probiotics. Food Technology. 1999; 11:67-77
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  3. Macfarlane GT, Cummings JH. Probiotics and prebiotics: can regulating the activities of intestinal bacteria benefit health? BMJ. 1999;318:999-1003.
  4. Tortora GJ, Grabowski SR. The digestive system. In: Principles of Anatomy and Physiology. 8th ed. Menlo Park, Calif: HarperCollins College Publishers;1996: 752-805.
  5. Marteau P, Vesa T, Rambaud JC. Lactose maldigestion. In: Fuller, R ed. Probiotics 2 Applications and Practical Aspects. London, England: Chapman & Hall; 1997:65-88.
  6. Gismondo MR, Drago L, Lombardi A. Review of probiotics available to modify gastrointestinal flora. Int J Antimicrob Agents. 1999; 12:287-292.
  7. Martini MC, Lerebours EC, Lin WJ, et al. Strains and species of lactic acid bacteria in fermented milks (yogurts): effect on in vivo lactose digestion. Am J Clin Nutr. 1991;54:1041-1046
  8. Jiang T, Mustapha A, Savaiano DA. Improvement of lactose digestion in humans by ingestion of unfermented milk containing Bifidobacterium longum. J Dairy Sci. 1996;79:750-757.
  9. Lee L., Turner L, Goldberg B. Enzymes. In: The Enzyme Cure. Tiburon, CA: Future Medicine Publishing, Inc.;1998:19.
  10. Hilton E, Isenberg HF, Alperstein P, France K, Borenstein MT. Ingestion of yogurt containing Lactobacilluys acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med. 1992;116:353-357.
  11. Hilton E, Isenberg HD, Alperstein P, France K, Borenstein MT. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med. 1992;116:353-357.
  12. Gupta P, Andrew H, Kirshner B, Guandalini S. Is lactobacillus GG helpful in children with Crohn’s disease? Results of a preliminary, open-label study. J Pediatr Gastroenterol Nutr. 2000;31:453-7. Abstract.
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Probiotics by Jule Klotter

Probiotics

By: Jule Klotter

Jule Klotter tells us how “Basic Health Publications User’s Guide to Probiotics” by Earl Mindell, RPh, PhD really opened her eyes to the many ways in which ‘friendly’ bacteria (probiotics) maintain our health.

Firstly, she says, probiotics commonly found in a healthy Gi tract inhibit the growth of pathogens by producing lactic acid. Yeast and harmful bacteria tend to flourish in environments with a neutral pH. Lactic acid holds them in check. Some probiotics also produce hydrogen peroxide, which the immune system uses to destroy pathogens.

One of the predominant friendly bacteria, L. Acidophilus (DDs-1 Strain), produces acidophilin. This substance is lethal to at least 22 potentially harmful bacteria, including E. coli, Shigella dysenteriae, Stapyhlococcus aureus, Streptococcus lactis, Klebsiella pneumoniae, and Salmonella schottmuelleri.

In addition to preventing the growth of harmful bacteria, she says, probiotics protect us in other ways: Firstly, they keep harmful microbes from adhering to or crossing the intestinal lining and entering into the bloodstream.

Mindell says, “Friendly bacteria can actually move through already-adhered layers of harmful bugs to offer this protection.”

Probiotics also support immune response throughout the body. Various strains of friendly bacteria increase the activity of lymphocytes (white blood cells that produce antibodies) and phagocytes (cells that engulf and digest microbes and debris). Probiotics, such as Lactobacillus, stimulate antibody production as well.

The friendly bacteria even have a role in disrupting autoimmune responses, she says. They are known to increase interleukin-10 activity. Interleukin-10 is a cytokine that tells the immune system to calm down before it harms us.

Not only do these friendly bacteria defend our bodies, Jules Klotter tells us, they also nourish us. Probiotics in the intestines produce B-complex vitamins, including biotin, thiamine (B1), riboflavin (B2), pantothenic acid (B5), and pyridoxine (B6). They also make shortchain fatty acids, antioxidants, and amino acids, and vitamin K. Probiotics also aid digestion.

Many strains of these bacteria produce enzymes that help break down food. The bacteria’s acidifying effect creates an environment that promotes the passage of nutrients through the intestinal wall and into the bloodstream. Nutrients in foods that have been fermented with bacteria cultures (e.g., yogurt, kefir, sour cream, sauerkraut, miso, tempeh) are more readily absorbed than the nutrients in non-fermented milk, cabbage, or soy.

Until recently, she notes, friendly bacteria have been a regular part of everyone’s diet from the first day that they have their mother’s milk. All traditional diets include lacto-fermented food. Fermentation is a traditional way to preserve vegetabless, according to Sally Fallon, author of Nourishing Traditions.

People eating a Western diet of processed, refined foods are not ingesting these friendly bacteria. In fact, the refined carbohydrates and sugars so common in the Western diet actually promote the growth of yeasts and harmful bacteria. In addition to processed foods, many medications, including antibiotics, antacids, synthetic estrogens (birth control pills and hormone replacement), and steroid drugs (oral and inhaled) discourage probiotic growth.

Chlorinated water also damages friendly bacteria. Eating fermented foods regularly boosts the probiotic population. She warns everyone to be aware that probiotic bacteria does not last long in yogurt. She recommends watching due dates and avoiding yogurts with gelatin, used to give yogurt it’s thickness as the bacteria dies off.

Jule Klotter explains that a diet that contains plenty of fiber-rich vegetables, fruits beans and whole grains provides the probiotics with their food-of-choice: fructooligosaccharides (FOS).

Sometimes, probiotic supplements are needed to get the gut back on track, she says. She tells us that in choosing supplements, Dr. Mindell recommends choosing a brand that has a statement about the number of living bacteria and an expiration date on the bottle. Bacteria viability decreases with exposure to heat, mositure and oxygen, so refirdgeration is advisable.

In addition, liquid preparations tend to be unstable. Dr. Mindell recommends that a healthy person take two to five billion CFU/day. (‘CFU’ stands for ‘colony forming units.’) People with gastrointestinal problems can take up to ten billion CFU/day.

Dr. Mindell also recommends that adults and children over two years take supplements containing L. acidophilus and/or other Lactobacillus strains and strains of Bifidobacteria. For younger children, he recommmends a powdered formula prepared specifically for babies, which generally includes Bifidobacteria, with lesser amounts of L. rhamnosus, L. Paracasei, and L. salivarius.

For children, the powdered supplent can be mixed with juice or milk. Adults should take probiotic capsules, or powder mixed in unchilled water, ten to 30 minutes before meals. People using the higher therapeutic doses may experience ‘cleansing symptoms’ as yeast and harmful bacteria die off.

Dr Mindell also recommends that people with severe immune dysfunction or life-threatening illness proceed cautiously and check with their doctor before using probiotics, as seriously ill people have developed infections in rare cases.

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