TRUTH ABOUT PROBIOTICS

Many companies, in developing a new product, will apply a new name to a bacterial strain to better hide its true identity, making it difficult for consumers to know what is inside.

Knowing what strains of bacteria are in a product is essential because the therapeutic effects, survivability in the human gastrointestinal tract, and interactions with other species is highly strain-specific.

For example, the following information should be considered for the respective populations:

Infants: Bifidobacterium infantis is the most desirable strain for use with infants. Research shows that its colonization in the gut is best associated with infants who are breastfed, vaginally delivered, and have fewer food and environmental allergies.

Seniors: Because this population loses bifidobacterium faster than other beneficial strains, these are the most important to replace. Even by the age of 40, many people have lost up to one half of their population of bifidobacteria due to the aging process! Bifidobacteria are the 2nd most abundant bacteria in the large intestine of healthy people after eubacteria or bacteroides, and according to many Japanese scientists, it is the most important type of enteric bacteria for maintaining good health.

For all populations, attention should be given to using complementary probiotic strains to holistically support the needs of the entire intestinal tract. For instance, bifidobacteria colonize better in the large intestine, and lactobacilli tend to populate better in the small intestine. Using a good combination can therefore offer more complete support and protection of the body.

Bogus Alert:
A product that lists many strains of bacteria and/or yeast, without a clear reason for their use. Even worse are those products that use spore-forming bacteria, which can be hard to control and may have unpredictable results (they are often selected for their improved survivability in an inferior product to help boost CFU claims.)

Stay tuned for the next topic in my series of “How to Spot a Bogus Probiotic Product,” where we will discuss two strains of bacterial organisms to always avoid.

CFU is an acronym used in microbiology which stands for “colony-forming unit.” This is a measurement of viable cells, which in the case of probiotics, means it has the ability to divide and form a colony. Without this identification, there is no way to know what a product actually contains. This is different then a direct count, which adds together all bacterial cells, both viable and dead.

Bogus Alert #1:
If a probiotic product uses any other term to quantify the number of bacteria present in the product (such as by weight), this is a bogus product.
Reason: you may have a product with an impressive amount of dead bacteria, but no evidence of viable bacteria present in the product.

If a product does supply a CFU number, the next step is to identify exactly what is being quantified.

Bogus Alert #2:
If you see a product with only one total CFU number listed with multiple bacterial strains, this is a bogus product.
Reason: Each bacterial strain needs to be listed with its own CFU. Ensuring that a desirable strain remains viable throughout shelf life can be difficult, so many companies instead use “filler” bacteria which have better rates of survival to boost CFU counts, but do not offer the same desired therapeutic benefits. For example, you could buy a product with a high total CFU, but if it contains 95% bacteria with no scientific value, and only 5% valuable strains, you have wasted your money!

Bogus Alert #3
Probiotics must be made with a special survivability technology to ensure efficacy of the product. If a product contains only neutral carriers such as maltodextrin and microcrystalline cellulose, this is a bogus product.
Reason: Probiotics require micro-enrobing technology to protect them during the passage through the stomach’s acidic environment. One industry insider alleges that only 5-10% of strains in a number of tested brands actually survive passage through the stomach! Based on my forty years of research and dedication, oil matrix survivability technology is the best way to protect the selected probiotic strains. Another technology (less effective than the oil matrix but much better than neutral carriers) is the inclusion of the intrinsic supernatant; this is the “home environment” of the cultured medium included with the bacteria. Both processes serve to substantially improve survivability.

Stay tuned for the next topic in my series to help you spot a bogus probiotic product…

A recent study conducted by researchers at the Third Military Medical University School of Nursing and the North Sichuan Medical College and Hospital in China found that traumatic brain injury patients who were supplemented with probiotics reduced the number of infections and reduced duration of stay in intensive care. Each patient receiving probiotics received seven sachets of viable probiotics three times a day for a total of 10⁹ bacteria. The contents of each sachet included: Bifidobacterium longum (0.5 x 10⁸), Lactobacillus bulgaricus (0.5 x 10⁷), and Streptococcus thermophilus (0.5 x 10⁷)
Read more: http://www.upi.com/Health_News/2011/12/02/Probiotics-help-with-brain-injury-outcome/UPI-69731322877162/#ixzz1ftuNJxud

Brain injury causes a state of hyper-inflammation, which the body attempts to calm by releasing higher amounts of glucocorticoids into circulation. These glucocorticoids cause a shift in immune function which makes the body less primed for attacking bacterial infections. Infections such as ventilator associated pneumonia and sepsis are serious risks for traumatic brain injury victims.

Probiotic administration increased interferon levels in patients, which are an important class of proteins that help the immune system fight pathogenic organisms.

Here are two important background points that we have discussed previously in this blog:

• L. acidophilus strains are the gold standard probiotic in research for showing the most benefits in gastrointestinal health. They are the most studied strains, and boast consistently positive results in many populations of people.

• Most probiotic supplement manufacturers are unregulated and fail to process and deliver these strains in a viable form, thus negating their efficacy.

Some people have therefore asked me- why bother shopping for the right supplement, when you can just eat yogurt to get L. acidophilus? Both the general public and medical professionals are surprised to learn that yogurt is not a good way to get L. acidophilus, and here is why:

First, we will focus only on those yogurt products labeled to contain live cultures. What this means is that the product must contain one or both of the culture strains commonly used to make yogurt, which in the U.S. is Lactobacillus bulgaricus and/or Streptococcus thermophiles. These strains serve to culture milk into palatable yogurt products and survive through refrigeration. However, most commercially available yogurt starter bacteria do not survive well in the GI tract. Thus, many of these “probiotic cultures” are often of little to no benefit to the human GI tract when consumed in yogurt, even though they can be classified as “live cultures.” (To survive passage into the intestines, vulnerable probiotic cultures need to be protected by a specific encapsulation process which allows them to pass safely through the acidic secretions of the stomach.)

Health professionals often recommend eating “live culture” yogurts to help ward off yeast infections during and after antibiotic treatments. Not only do they NOT help to prevent many infections, but they also ADD to the problem by supplying extra added sugars into the diet which further promotes the growth of yeast in the vaginal tract.

On the website of the leading yogurt producer in the country, its website acknowledges that “some” of its yogurt cups may contain extra cultures such as L. acidophilus, L. casei, and bifidobacterium. The problem is that adding these cultures to the mix does not guarantee that they will survive in the product.

The reason is due to the fact that yogurt starter cultures (especially L. bulgaricus) can be highly inhibitory to the survivability of some L. acidophilus strains. This is why yogurt and other fermented milk products marketed for GI health must rely upon developing other strains which can survive storage and entry into the human GI tract. However, studies on these new strains are often limited as to their efficacy and long term safety.

So in summary: yogurts and fermented dairy products are not a reliable source of probiotic bacteria which can survive storage and entry into the human GI tract to offer health benefits, and at this time cannot be recommended as a functional food or treatment for any health condition.

What makes a probiotic blend “promiscuous?” This is when a manufacturer throws in a lot of strains of organisms together without much thought or effort into their combined actions in the body. To make a combination more marketable- companies often think “more is better.” Unfortunately, “more” can be at best useless, and occasionally it can be harmful.

One example is the introduction of strains of yeast to a probiotic blend. Given the data to support the use of probiotic bacteria, why would anyone need to ingest more yeast? Many people are already sensitized to yeast, and may feel worse when taking these supplements. Some compromised patients risk acquiring fungemia from exposure to high dose live yeasts. Because yeasts are more difficult to eradicate than bacteria, this can become a dangerous situation for a sensitive person. One manufacturer touts the addition of 7 additional strains of yeast as a competitive edge, yet this includes strains that the scientific community is not even familiar with yet.

Another example is one company’s claim of “synergy” between its multitude of included strains. Synergy is defined as cooperative action and it is not a preferred state between microbial organisms. The truth is, no one really knows what happens when you put together a number of largely unstudied organisms into a blend. The most common result is mutual antagonism.

A better approach would be to ask, “What is the purpose of each strain included in this combination?” Species of bacteria within bifidobacteria and lactobacilli (genus) are well researched in their many beneficial effects on the large and small intestines, respectively. In addition, their safety is well established.

As a final reminder: if there are multiple strains in a product, there should be a clear purpose for each strain’s inclusion, and an expiration date needs to be listed for each.

In a recent prospective cohort study of 800 hospitalized patients in Japan,  those who were on proton pump inhibitor medications (PPI’s) were more than 3 times as likely to Clostridium difficile associated diarrhea (CDAD) than those who were not on PPI’s.

http://www.medpagetoday.com/MeetingCoverage/ICAAC/28584

According the Mayo Clinic, C. difficile infections have become more frequent, more severe, and more difficult to treat in recent years.  Each year, tens of thousands of Americans become sick with this illness, and some occur in otherwise healthy who are not hospitalized or taking antibiotics.

While a healthy intestinal flora usually protects the gut from infection with this pathogenic bacteria, it was well-known that infections can occur after antibiotic use, which wipes out the beneficial bacteria. The acid in the stomach is another defense mechanism many bacteria cannot survive long enough to reach the intestines.  PPI’s method of action is to inhibit acid secretion.

According to Takatoshi Kitazawa, MD, of Teiko University in Tokyo and who is associated with the study, the clinical take home message is, “don’t use PPI’s so much.”

How is that PPI’s have become a first line treatment for chronic reflux and heartburn? With so much scientific research supporting the use of probiotic strains of bacteria to prevent gastrointestinal disturbances, doesn’t it make more sense to first encourage a good balance of beneficial bacteria as an essential part of digestion?

Many factors in our healthcare and diet can affect the population of beneficial bacteria in our guts in adverse ways, such as alcohol, antibiotics and other medications.  But research at Duke University demonstrated that rats fed a 12-week diet containing varying levels of sucralose (Splenda) decreased total gut friendly bacteria by an average of 50%, and showed significant weight gain over controls.

http://www.foodnavigator.com/Science-Nutrition/Splenda-may-damage-gut-bacteria-boost-weight-gain-study

Another concerning finding was when the surviving animals were studied at 12 weeks after the discontinuation of sucralose, they still showed significantly decreased populations of beneficial bacterial populations.

This study casts doubt on whether Splenda should be considered a viable weight management aide, and also warrants some additional studies on whether it puts humans at risk for dysbiosis and impaired intestinal defense, even after discontinuation.

I find it interesting to note here that fructooligosaccharides (FOS) are another type of indigestible sugars often used in commercial probiotic combinations. Is it possible that these forms might also have unintended adverse effects on beneficial gut bacteria?

Food Contamination Concerns Part 2: Hot Delivery Trucks

A story recently aired on MSNBC regarding Indiana’s push for regulating safe temperatures in trucks transporting perishable foods to restaurants and grocery stores. In the midst of increasingly common national food recalls due to bacterial contamination- we see stark examples of how, many times, trucks transport perishable items without refrigeration. Sometimes the refrigeration units are broken, and sometimes they are even intentionally turned off to save fuel.

http://www.msnbc.msn.com/id/21134540/vp/44623239#44623239

The FDA outlines that foods must be transported at or below 41 degrees Fahrenheit to prevent growth of dangerous bacteria which can cause illness in humans- such as E. coli and salmonella. The problem is, there is very little policy to regulate shipping practices to protect the public. In 2005, Congress ordered the FDA to make rules to enforce shipping standards, but the FDA has yet to act. These examples illustrate an important point- we often limited by what we see and read to define “freshness” in foods we find in stores, and then rely upon the assumed good manufacturing processes of the facilities that make these foods. But in between, there lies a very real public danger that currently remains largely invisible to both the public and to the federal government. Even in Indiana, where there is now a state government push for road inspections, they can only inspect 1% of food trucks for proper handling!

This same logic also applies to probiotics. Probiotics are sensitive living cultures which require extra care to preserve their viability. This is why they must be shipped quickly, on cold packs or dry ice, when transported from one refrigerated facility to another. Check with your local health food store or product distributor to find out how it enforces proper shipping of probiotic products; if the product is refrigerated in the manufacturer’s warehouse and the distribution center, and on the way to store. Customers should also ask the store whether all products in the refrigerator were shipped to the store in a thermally controlled shipping container. Many times, the probiotics arrive in hot container, and the store simply then puts them into the refrigerator. We find this practice reprehensible and unacceptable.

FDA’s Food Safety Modernization Act (FSMA) was put in place to help strengthen the FDA’s ability to enforce food safety controls. The problem is, the FDA only oversees about 80% of our food, the USDA controls poultry, meat and egg products. Funding is another big problem for ensuring food safety, there is simply not enough to go around. FSMA exempts small food businesses, which helps the financial burden of regulating the larger producers, but also leaves open more risks.

As our food chain has become more global, we accelerate the ability for a contaminant to be spread across the US (and world) and sicken many, before we even realize that there is a problem. In the U.S., the CDC estimates that 48 million people get sick, 128,000 are hospitalized, and 3,000 people die each year from food-borne illnesses. Last June, Europe struggled with a wide-spread infection from a virulent form of E. coli which sickened over 2,000 and caused 20 deaths. Beans and sprouts from Egypt were the likely source, but there is still much that is unknown about the exact sources.

With an increasingly global supply chain, it is important to do what we can to protect ourselves from contaminants. Probiotics have shown to be effective in preventing infectious forms of diarrhea, and may stack up as another type of defense against potentially contaminated foods.

Acute upper respiratory tract infections (URTI’s) are the most common reason for medical care visits in the U.S. According to a Cochrane review, using probiotics as prophylactic medicine is associated with fewer colds (according to research by Bi Rong Dong, MD, or Sichuan University in China.) Another important factor is that probiotic use was also found to significantly limit the number of antibiotic prescriptions needed for those with URTI’s. (Even though antibiotics should never be used to treat colds, they are often prescribed when a person gets a subsequent bacterial infection resulting from the inflammatory consequences of a viral infection- such as ear, lung or sinus infections.)

Dong’s research pooled the results from 10 randomized controlled trials which included 3,451 study participants ranging in age from infants to adults in their forties, and involved taking probiotics preventatively for more than a week. Probiotic use reduced the number of participants who had at least one acute upper respiratory tract infection by 42%!

Researchers believe that probiotics may boost systemic activity of phagocytes (which are part of our first line of defense against infections) as well as increase gut wall integrity. Now that we know that some of the infectious agents which cause upper respiratory disease actually infect through the gut wall first, this theory makes sense.

So- in addition to getting enough sleep, employing good hygiene practices, and good nutrition, access to a good quality probiotic has been shown to help prevent colds.