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Do probiotics work? | Science Life

Do probiotics work? | Science Life.

From the 25 November 2014 University of Chicago press release

probiotic-yogurt

Walk past the dairy case or health food section of any grocery store and you’ll see a variety of yogurts, milk, shakes and even granola bars that say they contain probiotics. These “good” bacteria are added to foods to promote a healthy environment of microorganisms in the digestive tract, supposedly to aid in digestion and promote good gastrointestinal health. Are these claims based in real science, or are they just another food fad to squeeze money out of consumers?

We spoke to Stefano Guandalini, MD, Section Chief of Pediatric Gastroenterology, Hepatology, and Nutrition and Medical Director of the Celiac Disease Center at the University of Chicago, about probiotics and prebiotics, the precursor that provides fuel for the supposedly beneficial bacteria. He and his colleagues published a review paper recently looking at various studies and clinical trials that used pre- and probiotics to treat symptoms of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) in children. The following is an edited version of that conversation.

Many people are familiar with the term probiotics, but what are prebiotics?

Prebiotics are basically the metabolic fuel for probiotics. It’s a term that encompasses a number of mostly carbohydrates that are present in vegetables and grains, for instance in wheat, artichokes, legumes, etc. They are only partially digested by the human intestinal tract, so they reach the colon where they are fermented by bacteria. We have trillions of bacteria happily living in our colon, and they ferment these substrates. They’re happy with them, and so they thrive. The idea of taking prebiotics is that you can encourage the growth of good bacteria in the gut by providing them the food they like.

Can you do that by changing your diet? Or is there a pill you can take?

You can do in both ways. If your diet is rich in things like onions, garlic, wheat, legumes and artichokes, then you ingest a lot of prebiotics already. But there are also chemically identifiable supplements that also serve the same purpose.

Are prebiotics effective for treating digestive diseases?

In theory these are a good way of promoting a healthy microflora in your gut, and one would expect beneficial effects, but in reality it has been quite disappointing. There’s not a lot of practical use for prebiotics as we speak, in terms of clinical effectiveness. The only niche in which we found them to be successful is as an additive to formula for premature babies, because human milk actually contains plenty of prebiotics. Other than that, there hasn’t been much practical use. In fact, in our review, we saw that prebiotics have been tried for treating irritable bowel syndrome, but actually with mostly negative results.

With inflammatory bowel disease, it’s likely different. Several preparations have been tried with mixed results, but again, nothing sticks out as important or with clinical relevance. So in spite of good conceptual reasons to expect good results, they have not been proven very effective.

How are probiotics different from prebiotics?

Probiotics are microorganisms that, if ingested in adequate amounts, confer a health benefit to the host beyond the nutritional value. In practical terms, it’s a class of mostly live bacteria that have been studied for a long time and found useful for treating or preventing a number of clinical conditions.

Our review paper focuses on the efficacy of probiotics for IBS and IBD, including both ulcerative colitis and Crohn’s disease. For IBS, we have some good evidence in adults that some probiotics actually seem to be effective in relieving some of the symptoms, mostly the bloating and abdominal pain that accompanies IBS, especially when there is either diarrhea or constipation that goes along with it.

And in the case of ulcerative colitis, there is a growing body of evidence supporting the efficacy of some specific strains as an adjuvant in the course of the therapy. Crohn’s disease is different, however. People have tried multiple ways of addressing the problem with different strains of probiotics, different clinical settings, different endpoints, but none of the researchers were able to show any efficacy with probiotics in Crohn’s disease patients.

You can go into any grocery store and find yogurt and other foods that have probiotics added to them. Do those products do any good?

Not all probiotics are equal, that’s an important thing to stress. People think they can walk into a store and pick any probiotic from the shelf and they’re just the same. That is not the case. Different probiotics have different strains and concentrations of bacteria that have different properties. Only a minority of them has been tested properly in clinical trials to find if they were indeed effective.

In reality, yogurt by definition has to have two strains of bacteria—Lactobacillus bulgaricus andStreptococcus thermophilus—to create the yogurt. However these strains do not pass the gastrointestinal tract intact. They are destroyed by the acidity of the stomach and the enzymes of the pancreas, so nothing reaches the colon and it’s not beneficial. However, like you said, some yogurts are now enriched with other live bacteria of different strains. Some of them indeed include strains that survive the passage through the intestinal tract and then can be beneficial, and some make that claim but they don’t, and it’s hard for the general public to discriminate. Activia, for instance, is one of the good preparations. These yogurts actually do have strains of live Bifidobacteria that have been studied and may be beneficial. Yakult, containing well-studied strains of Lactobacilli, is another one that does the same.

Is a food product the best way to treat symptoms of IBS or IBD, or do you need a special preparation in a pill?

The best way is to use specific strains that have been validated through clinical trials and published in peer-reviewed journals to show efficacy, and if possible reproduced by different groups using the same preparations. So the list of probiotics that have gone through this process is actually very short:

  • There is a product called Align, based on a specific Bifidobacterium, which is mostly for adults with IBS.
  • For infants and colicky babies there is some proof of effectiveness for a product called Biogaia, which has the bacterium Lactobacillus reuteri in it.
  • Then we have Culturelle with Lactobacillus GG, another one with a long record of scientific, well conducted studies, which has been found effective in treating diarrheal diseases.
  • Florastor, which contains a yeast [Saccharomyces boulardii] instead of bacteria, is also effective in treating and preventing antibiotic associated diarrhea. Children who get antibiotics often develop diarrhea, and in many cases that can be prevented by the use of Florastor.
  • Finally there is a preparation called VSL #3, which is a highly concentrated preparation of 8 different strains of probiotics. This has received a great deal of attention by the scientific world to treat a number of conditions. It seems to be effective for ulcerative colitis, both in adults and children, and it has been found effective in irritable bowel syndrome as well.

Outside of this incredibly short list, however, there is nothing else. There is no other probiotic that has been found to be effective in rigorous, controlled clinical trials. This is not to say they aren’t working, it’s just to say we don’t have any scientific proof yet.

Are probiotics safe?

One thing that all these probiotics have in common is that they are relatively safe. They are very tolerable and basically create no side effects. One caveat is for premature babies and people with profoundly depressed immune systems. Some of these preparations might be contaminated by yeasts, which can be dangerous in those cases. But with these two exceptions, probiotics have been used in large amounts for generations now. So they are safe, but if there is no clear cut indication, I wouldn’t necessarily recommend them. That’s a question I often get from patients, “Could we use probiotics?” And if it’s not to treat a specific condition and they just think it will improve health, I tell them it’s not necessary.

Where is the research on prebiotics and probiotics headed?

It’s interesting. There was a boom for years and then it died down quite a bit. From a laboratory standpoint, we don’t understand a lot about how the probiotics work. So I think the attention of scientists now is more focused on understanding the mechanisms of the interactions between these bacteria and the host, which are different between different individuals. Each one of us has a unique composition of intestinal flora. The same probiotics may have a different effect for you and me, because they interact with trillions of other bacteria, which are different for each person. So all of these nuances are going back to basic science before moving further to the clinical arena.

That seems to be a theme of microbiome research. Everyone agrees on its profound effect on our health, but getting to where you could change something meaningfully to treat a disease is a different thing.

Right, we are not there yet. It’s very complicated. As we have said many times, the genome of the microbes is thousands of times more complex and more numerous than the human genome. When we are talking about personalized medicine, we are really talking about the microbiome: how to understand all the subtle interactions with the human host, and how to possibly exploit this for health reasons. It’s an incredibly interesting area, and my colleagues here at the University of Chicago,David RubinEugene ChangCathryn NaglerBana Jabri and others are actively working on this. We aren’t there yet, but we will. I have great enthusiasm in this. I think this is the medicine of the future.

November 28, 2014 Posted by | Medical and Health Research News, Nutrition | , , , | Leave a comment

[Reblog] Probiotics – A Cure for what Ails You?

From the 23 January 2014 Bite into Nutrition blog

Probiotics has become one of the biggest “bug” words among nutrition and health professionals today, partly because of all the time the scientific community has devoted to researching the topic.  Research has shown that probiotics are effective in reducing and treating various ailments ranging from antibiotic-induced diarrhea, Clostridium difficile and other digestive disorders.   Partly due to all the science and media buzz, manufacturers have been introducing (and marketing) probiotic products left and right. NPR news recently featured a report on all the potential benefits that probiotics can do ranging from curing colicky babies to and prevention of heart disease. Although more research is needed, this is encouraging evidence on the many benefits that probiotics can offer.

In the past couple of years, there were reports suggesting the use of probiotics offering immune health benefits.  The article from Environmental Nutrition offers more insight into this.

Boost Your Immunity with Probiotics

Environmental Nutrition: February 2014 Issue

Inside each one of us is an “inner ecosystem”—a unique microbiome teeming with bacteria that lines the gastrointestinal (GI) tract or gut, which is the largest organ of immunity in the body. Fortifying the gut microflora with probiotics—also known as friendly bacteria—should be one of your top health priorities, as this promotes a stronger immune system. “We know that the make-up of our gut microbiome—the total of all microorganisms in the gut—has changed over time, due to environmental factors, and that this change may be partially responsible for the rise in prevalence of allergic and autoimmune disorders, which involve the immune system,” explains registered dietitian nutritionist Rachel Begun, MS, RDN.

 

Plant foods, such as whole grains and fruit, and yogurt with live and active cultures boost gut bacteria.

Boost plant foods. A plant-based, high-fiber diet is the best way to positively impact your gut microflora, according to an August 2013 article in the Journal of the Academy of Nutrition and Dietetics. Fiber-rich plants boost a greater volume and diversity of microorganisms in the gut, offering better defense against disease-causing invaders. And researchers are discovering that just by eating fewer calories, you can change your gut bacteria profile for the better.

“It’s best to eat whole foods that are natural sources of probiotics, as these are nutrient-dense foods that contribute other health benefits, such as yogurt made with live and active cultures, fermented vegetables like kimchi and sauerkraut, fermented soybean products like miso and tempeh, as well as kombucha, fermented tea,” says Begun.

Prebiotics (non digestible carbs that act as food for probiotics)

“It’s just as important to eat a diet rich in prebiotics, which are the foods that fuel the good bacteria in the gut.” Prebiotic foods include high-fiber plants, such as artichokes, asparagus, bananas, raisins, onions, garlic, leeks, and oats.

 

Read the entire post here

 

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January 26, 2014 Posted by | Nutrition | , , , | 2 Comments

[Repost] A Galaxy Within Us: Our Gut Microbiota and How It Can Be Programmed by Food

From the1 November 2013 ScienceDaily article

Who would have thought that the human body contains over 10 times the amount of bacterial cells as human cells? These bacteria — now collectively called the gut microbiota — number in their trillions and are made up of more than a 1,000 different species most of which are beneficial in some way.

“Research is starting to show that the food we eat has a huge bearing on the composition of this collective and also that the profile of the collection of bacteria can be associated with a person’s health status,” explains Dr Paul Ross, Head of the Teagasc Food Research Programme and Principal Investigator at the Alimentary Pharmabiotic Centre, Teagasc, Food Research Centre, Moorepark.

To the team at the Alimentary Pharmabiotic Centre (APC), an SFI-funded CSET at Teagasc, Food Research Centre, Moorepark and at University College Cork, the study of the human microbiota has the potential to transform much of the thinking around basic human nutrition, gut health and disease prevention: “This has been made possible through developments made in DNA sequencing technology which has allowed the study of complex microbial communities such as the human gut microbiota, the majority of which cannot be cultured on an individual basis,” explains Dr Ross.

Although the composition of the microbiota is highly stable during adulthood, there are times when it can be highly dynamic — such as at the extremes of life, e.g., following birth, during inflammatory bowel conditions, gastrointestinal infection and in the elderly. Despite this stability, the microbiota also displays a high degree of interindividual variation reflecting differences in lifestyle, diet, host genetics, etc.

In a project called ELDERMET, a team of UCC/Teagasc scientists headed by Professor Paul O’Toole has recently profiled the faecal microbiota from elderly people in different residences including community, day-hospital, rehabilitation or long-term residential care locations.

This study found that the microbiota correlated with the residence location. “The results demonstrated that the individual microbiota of people in long-stay care was significantly less diverse than those that resided in the community,” explains Dr Ross. “In addition, these subjects were also clustered by diet by the same residence location and microbiota groupings. Interestingly, the separation of microbiota composition correlated significantly with health parameters in these individuals including measures of frailty, co-morbidity, nutritional status, markers of inflammation and with metabolites in faecal water.”

Taken together these data suggest that diet can programme the gut microbiota — the composition of which correlates with health status. Such a suggestion opens up great potential for the food industry in the design of food ingredients and supplements which may in the future shape the microbiota in a particular direction to correlate with an improved consumer health status. Interestingly, a related study called INFANTMET, funded by the Department of Agriculture, Food and the Marine and led by Professor Catherine Stanton at Teagasc Moorepark, is looking at the development of the gut microbiota in early life as a consequence of breast feeding.

November 3, 2013 Posted by | Nutrition | , , | 1 Comment

As probiotics use grows for gut health, VSL#3 has designations for specific GI issues

 

diagram of a human digestive system

Image via Wikipedia

From the 17 November 2011 Eureka News Alert

VSL#3, classified as medical food, is designated for the dietary management of UC, ileal pouch and IBS

GAITHERSBERG, MD, Nov. 18 – As clinical studies continue to validate the use of probiotics to help promote general gastrointestinal health, a growing U.S. market1 for probiotics indicates that the U.S. healthcare community and consumers alike are recognizing the value of these beneficial microorganisms. However, because most probiotics are classified as dietary supplements, directing patients to the best probiotic for their individual needs can be challenging. And, as the category matures, one probiotic preparation — VSL#3 — stands apart and ahead because it is not a supplement; it has been classified as a refrigerated medical food designated for the dietary management of three major gastrointestinal conditions: Ulcerative Colitis, Ileal Pouch and Irritable Bowel Syndrome (IBS).

The World Health Organization (WHO) defines probiotics as “live microorganisms which, when administered in adequate amounts confer a health benefit to the host.” But research also shows that probiotics are not “one size fits all.”

“As the amount of research in the field of probiotics increases, clinical evidence continues to indicate that not all probiotics are the same; probiotic activity is strain-specific and unique, and some strains can have antagonistic or synergistic activities when mixed together,” said Marc Tewey, vice president, commercial operations, at Sigma-Tau Pharmaceuticals, Inc., manufacturer of VSL#3. “VSL#3 is formulated with a precise mix of eight proprietary strains of live bacteria, and the result is a probiotic medical food so potent, it must be used under medical supervision and must be shipped and sold as a refrigerated product.”

What are medical foods?

According to the FDA, medical foods are:

  • Specially formulated and processed products for the partial or exclusive feeding of a patient by means of oral intake or parenteral tube feeding
  • For dietary management of patients with special medically determined nutrient requirements that cannot be achieved by diet alone
  • Designed to provide nutritional support specifically modified for the management of the unique nutrient needs
  • Only for use under medical supervision
  • Only for a patient receiving active medical care on a recurring basis for the use of the medical food

The VSL#3 line of products contain between 112.5 billion and 900 billion live, colony-forming units (CFU), the large numbers of which make them the most potent brand of probiotics available and require the product to be refrigerated. VSL#3 utilizes a synergistic combination of diverse strains of bacteria including: Streptococcus thermophilus, Bifidobacteria longum, Bifidobacteria infantis, Bifidobacteria breve, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus paracasei and Lactobacillus delbrueckii subsp. Bulgaricus. Clinical studies using VSL#3 and published in notable journals, such as Gut, Gastroenterology and the American Journal of Gastroenterology have indicated that it colonizes the GI tract with beneficial bacteria, and in doing so, forms an intestinal barrier, which may help protect the GI tract and promote the absorption of nutrients.

“One of the main goals of physicians whose patients are living with these chronic diseases is to lengthen the periods between symptom ‘flares’ as much as possible,” said Tewey. “Studies show that incorporating the use of this type of dietary therapy alongside traditional drug therapies can be an effective step in achieving that goal for many who suffer from these debilitating conditions.”

VSL#3 is one of the few probiotic preparations supported by Level 1 (double-blind, placebo-controlled) scientific data, and has been the subject of a collection of more than 80 studies that have demonstrated its efficacy, specifically in the dietary management of IBS, Ulcerative Colitis and Ileal Pouch. It is the only probiotic recognized as an effective tool in the dietary management of pouchitis by the American College of Gastroenterology2 and by the Cochrane Review3 for the treatment and prevention of pouchtis after ileal pouch-anal anastamosis for chronic ulcerative colitis.

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VSL#3 products are available online at www.vsl3.com, as well as behind the pharmacy counter at pharmacies nationwide. They come in three formulations: VSL#3 DS prescription-only packets, VSL#3 OTC packets and VSL#3 OTC capsules. Physicians and pharmacists interested in additional information about the product can call 1-866-634-2765 and consumers may call 1-866-GET-VSL3 or visit www.vsl3.com for more information.

1 Source: “U.S. Digestive Health Enzymes, Prebiotics & Probiotics Market (2010 – 2015)” Markets and Markets, July 4, 2011

2Kornbluth, A, Sachar DB. Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee.; Practice Parameters Committee of the American College of Gastroenterology. AM J. Gastroenterol. 2010 Mar; 105(3):501-23

3Holubar SD et al., (Review) The Cochrane Library 2010, Issue 6.

 

Educational Resources

 

 

 

November 18, 2011 Posted by | Consumer Health, Educational Resources (High School/Early College(, Medical and Health Research News | , , | Leave a comment

   

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