-IBIS-1.7.6-
rx
nutritional supplement
probiotic bacterial flora (acidophilus, bifidus, etc.)
Nutrition

definition

Probiotics Intestinal Flora: Lactobacillus acidophilus, Bifidobacterium bifidus, Saccharomyces boulardii, E. coli, etc.

» chemistry:
• The intestinal flora is made up of many kinds of living bacteria that have a symbiotic relationship with the rest of the body. At least 400 friendly species exist; L. acidophilus and B. bifidus are principal species that have been linked with successful rebuilding of friendly gut flora and which are available in supplement form.

» metabolism:
• Numerous nutrients not generally used by the body

» function:
• The intestinal flora have so many important functions that some have proposed that the intestinal micro-ecology be classified as a separate organ. They help to create conditions in the gastrointestinal tract that are conducive to optimal function, and produce numerous nutrients and enzymes that are useful to the body. They also inhibit pathogenic bacteria.

» requirements:
• A gastrointestinal tract that has a balanced, established flora, supported by a healthy diet, does not normally require supplementation. However, the presence of antibiotics in meats and aother parts of the food supply may suggest a need for intermittent replenishment of viable enteric cultures. Large-scale replenishment after use of antibiotics will reduce the risk of opportunistic overgrowth of candida albicans and associated pathogens.
• RDA: No RDA has been established.

» food sources:
• Primarily found in fermented food such as yogurt, cheese, miso and tempeh. However, most fermented foods are made with L. bulgaricus or Streptococcus thermophilus. While these are friendly, beneficial microorganisms, they do not perform long-term colonization of the gut; therefore, they are not as effective as probiotic supplements at re-establishing populations of friendly bacteria

» deficiency:
• A poor diet and/or antibiotic therapy are associated with a probiotic deficiency. Diarrhea is a frequent symptom of deficiency.

» mode of action: In addition to providing the body with useful nutrients, probiotics inhibit pathogenic bacteria in the gut in multiple ways:
• They secrete various substances, such as lactic and acetic acids, to decrease the pH of the gastrointestinal tract and vagina, rendering them less hospitable to pathogenic bacteria.
• They also secrete bacteriocins, natural antibiotics that kill undesirable bacteria.

» therapeutics:
Cancer: Lactobacilli has been shown to reduce the risk of colon cancer, as well as that of recurrent post-surgical bladder cancer. Given to cancer patients receiving chemotherapy or radiation treatments involving the gastrointestinal tract, it helps alleviate treatment-associated diarrhea.
Diarrhea: Saccharomyces boulardii has been found to prevent diarrhea in several human trials.
(Scarpignato C, Rampal P. Chemotherapy 1995;41:48-81; Golledge CL, Riley TV. Med J Austral 1996;164:94-95; Bleichner G, et al. Intensive Care Med 1997;23:517-523.)
Irritable Bowel Syndrome symptoms may be alleviated by acidophilus intake.
Lactose intolerance may be offset partially or completely by the ability of acidophilus to secrete lactase.
(McDonough FE, et al. Am J Clin Nutr 1987;45:570-574.)
Urinary Tract Infections: Vaginal insertion of Lactobacillus suppositories can help restore normal flora after antibiotic therapy for a urinary tract infection, helping prevent a recurrence.
Vaginal Yeast Infections: Studies have demonstrated that the introduction of yogurt or Lactobacilli into the vagina can assist in clearing up vaginal yeast infections and bacterial vaginitis. Use of acidophilus, both orally and locally, can prevent recurrences of yeast infections due to candida overgrowth.
(Hilton E, et al. Ann Int Med 1992;116:353–357; Reid G, et al. Lancet 1994;344:1229; Elmer GW, et al. JAMA 1996;275(11):870-876.)

» dosage:
Oral: Supplements will list the number of viable organisms (also known as CFUs or colony-forming units) contained within each unit of supplement. The ingestion of between one and ten billion organisms daily is sufficient for most people.
Vaginal: Douche twice daily with 10 ml of water containing 100 million viable organisms per milliliter (total 1 billion), prepared with an acidophilus supplement or live-culture yogurt. The douche can be left in as long as desired.

» forms:
• Probiotic supplements are available as liquids, powders, tablets, or capsules. Look for formulas containing live, viable organisms and a diverse mix of species.

» side effects:
• Probiotics are extremely safe and are not associated with any significant or detrimental side effects.
• Often the initial 2-3 days of using a supplemental dose of vigorous flora are characterized by loose stools, gas and bloating, possibly accompanied by generalized flu-like achiness. This is typically attributable to a "die-off reaction" as yeast and other undesirable intestinal inhabitants are eliminated with the influx of probiotics and shift in the intestinal environment.

» toxicity:
• None found in sources cited.

» contraindications:
• None known.

» interactions:
• Research shows that probiotic therapy can offset the loss of gastrointestinal flora associated with antibiotic therapy, preventing up to 50% of infections recurring after antibiotic use.
L. acidophilus and B. bifidus may produce B vitamins including niacin, folic acid, biotin, and B6.
L. acidophilus and B. bifidus are adversely affected by alcohol and antibiotics.
L. acidophilus can affect the metabolism of sulfasalazine, chloramphenicol palmitate, and phthalylsulfathiazole.

 

footnotes

Akaza H. New strategy of biochemoprevention on recurrence of superficial bladder cancer based on a hypothesis of the mechanism of recurrence. Gan To Kagaku Ryoho 1997;24 Suppl 1:253-256.

Aso Y, Akazan H. Prophylactic effect of a Lactobacillus casei preparation on the recurrence of superficial bladder cancer. BLP Study Group. Urol Int 1992;49:125-129.

Aso Y, Akaza H, Kotake T, et al. Preventive effect of a Lactobacillus casei preparation on the recurrence of superficial bladder cancer in a double-blind trial. The BLP Study Group. Eur Urol 1995;27:104-109.

Barefoot SF, Klaenhammer TR. Detection and activity of Lactacin B, a Bacteriocin produced by Lactobacillus acidophilus. Appl Environ Microbiol 1983;45:1808-1815.

Bengmark S. Ecological control of the gastrointestinal tract. The role of probiotic flora. Gut 1998 Jan;42(1):2-7. (Review)

Bennet JD, Brinkman M. Treatment of ulcerative colitis by implantation of normal colonic flora. Lancet. 1989 Jan 21;1(8630):164.
Abstract: JDB had continuously active, severe UC for 7 years confirmed endoscopically and histologically. The condition was refractory to standard management including steroids and sulphasalazine and every time daily prednisone dosage was reduced below 30mg severe symptoms (bloody diarrhea, cramping tenesmus, skin lesions and arthritis recurred. For the past 4 years symptoms had been controlled with 4.2gms of alpha tocopherylquinone and a low fat diet. When the tocopheryl was discontinued or reduced, symptoms returned within 1-2 days. With a protocol developed to sterilize the bowel before surgery, his flora was greatly reduced. The donor flora was introduced by large volume retention enemas. 1 wk later tocopheryls were discontinued without any recurrence of symptoms. It has now been 6 months since this implantation of normal flora and patient has been symptom free for the first time in 11 years without any medications. 3 months after the implantation, colonic biopsy revealed chronic inflammatory cells but no active inflammation.

Berg R, Bernasconi P, Fowler D, Gautreaux M. Inhibition of Candida albicans translocation from the gastrointestinal tract of mice by oral administration of Saccharomyces boulardii. J Infect Dis 1993;168:1314-1318.

Bernet MF, Brassart D, Neeser JR, Servin AL. Lactobacillus acidophilus LA 1 binds to human intestinal lines and inhibits cell attachment and cell invasion by enterovirulent bacteria. Gut 1994;35:483-489.

Bigson GR. Dietary modulation of the human gut microflora using prebiotics. Br J Nutr 1998;80(Suppl 2):S209-S212.

Bleichner G, Blehaut H, Meutec H, Moyse D. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A multicenter, randomized, double-blind placebo-controlled trial. Intensive Care Med 1997;23:517-523.

Blomberg L, Henriiksson A, Conway PL. Inhibition of adhesion of Escherichia coli K88 to piglet ileal mucus by lactobacilli species. Appl Environ Microbiol 1993;59:34-39.

Boddy AV, Elmer GW, McFarland LV, Levy RH. Influence of antibiotics on the recovery and kinetics of Saccharomyces boulardii in rats. Pharm Res 1991;8:796-800.

Buts JP, Bernasconi P, Van Craynest MP, et al. Response of human and rat small intestinal mucosa to oral administration of Saccharomyces boulardii. Pediatr Res 1986;20:192-196.

Buts JP, Bernasconi P, Vaerman JP, Dive C. Stimulation of secretory IgA and secretory component of immunoglobulins in small intestine of rats treated with Saccharomyces boulardii. Dig Dis Sci 1990;35:251-256.

Caetano, JA, Parames, MT, Babo, MJ, et al. Immunopharmacological effects of Saccharomyces boulardii in healthy human volunteers. Int J Immunopharmacol 1986;8:245-259.

Clements, ML, Levine, MM, Black, RE, et al. Lactobacillus prophylaxis for diarrhea due to enterotoxigenic Escherichia coli. Antimicrob Agents Chemother 1981;20:104-108.

Clements ML, Levine MM, Ristaino PA, et al. Exogenous lactobacilli fed to man - their fate and ability to prevent diarrheal disease. Prog Food Nutr Sci 1983;7:29-37.

Coconnier, MH, Bernet, MF, Kerneis, S, et al. Inhibition of adhesion on enteroinvasive pathogens to human intestinal Caco-2 cells by Lactobacillus acidophilus strain LB decreases bacterial invasion. FEMS Microbiol Lett 1993;110:299-306.

de dios Pozo-Olano, J, Warram, JH Jr, Gomez, RG, Cavazos, MG. Effect of a lactobacilli preparation on traveler's diarrhea. A randomized, double blind clinical trial. Gastroenterology 1978;74:829-830.

De Simone C, Vesely R, Bianchi SB, et al. The role of probiotics in modulation of the immune system in man and in animals. Int J Immunother 1993;9:23-28.

Dias, RS, Bambirra, EA, Silva, ME, Nicoli, JR. Protective effect of Saccharomyces boulardii against the cholera toxin in rats. Braz J Med Biol Res 1995;28:323-325.

Dolgushina, VF. [The immunocorrective properties of bacterial preparations (lactobacterin, bifidumbacterin) and bemitil in pregnant women with a urogenital infection.] Zh Mikrobiol Epidemiol Immunobiol 1991;4:56-58. [Article in Russian]

Ducluzeau R, Bensaada M. Comparative effect of a single or continuous administration of "Saccharomyces boulardii" on the establishment of various strains of "candida" in the digestive tract of gnotobiotic mice. Ann Microbiol 1982;133:491-501.

Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. JAMA 1996;275(11):870–76.

Fredricsson B, Englund K, Nord CE, Weintraub L. Could bacterial vaginosis be due to the competitive suppression of lactobacilli by aerobic microorganisms? Gynecol Obstet Invest 1992;33:119-123.

Fukushima Y, Kawata Y, Hara H, Terada A, Mitsuoka T. Effect of a probiotic formula on intestinal immunoglobulin A production in healthy children. Int J Food Microbiol 1998 Jun 30;42(1-2):39-44.
Abstract: The anti-infectious effect of probiotics has recently been reported and one mechanism may be the non-specific stimulation of immunity. This study was performed to elucidate the influence of a probiotic formula on intestinal microflora and local immunity in healthy children. A follow-up formula containing viable bifidobacteria was given to seven healthy Japanese children (15 to 31 months old) for 21 days. During intake of the formula, the administered strain was detected in feces from five subjects (71%) and total fecal bifidobacteria slightly increased. Fecal levels of total IgA and anti-poliovirus IgA during intake of the formula were significantly higher than those before intake (P < 0.05). The increase in local IgA levels resulting from ingestion of the probiotic formula may contribute to enhancement of the mucosal resistance against gastrointestinal infections.

Fuller R, Gibson GR. Modification of the intestinal microflora using probiotics and prebiotics. Scand J Gastroenterol Suppl 1997;222:28-31.
Abstract: Probiotics and prebiotics modulate the composition of the human gut microbiota. The beneficial effects may result from suppression of harmful microorganisms or stimulation of organisms which contribute in a positive way to the nutrition and health of the host. Both types of supplement represent an attempt to reconstitute the gut flora to its normal composition which has been adversely affected by dietary and environmental stresses.

Fuller, R. Probiotics in human medicine. Gut 1991 Apr;32(4):439-442. (Review).

Gismondo, MR, Lo Bue, AM, Chisari, G, et al. Competitive activity of a bacterial preparation on colonization and pathogenicity of C. pylori. A clinical study. Clin Ter 1990;134:41-46. [Article in Italian]

Golledge CL, Riley TV. “Natural” therapy for infectious diseases. Med J Austral 1996;164:94-95. (Review)

Guarino A, Canani RB, Spagnuolo MI, Albano F, Di Benedetto L. Oral bacterial therapy reduces the duration of symptoms and of viral excretion in children with mild diarrhea. J Pediatr Gastroenterol Nutr 1997 Nov;25(5):516-519.
Abstract: BACKGROUND: Oral administration of live Lactobacillus casei strain GG is associated with the reduction of duration of diarrhea in children admitted to the hospital because of diarrhea. The purposes of this work were to investigate the clinical efficacy of oral administration of Lactobacillus in children with mild diarrhea who were observed as outpatients, and to see whether Lactobacillus GG can reduce the duration of rotavirus excretion. METHODS: Duration of diarrhea was recorded in 100 children seen by family pediatricians and randomly assigned to receive oral rehydration or oral rehydration followed by the administration of lyophilized Lactobacillus casei, strain GG. Rotavirus was looked for in the stools of all children and in those in whom results were positive, stools were examined again 6 days after the onset of diarrhea. RESULTS: In 61 children results were positive for rotavirus and in 39 results were negative. Duration of diarrhea was reduced from 6 to 3 days in children receiving Lactobacillus GG, with a similar pattern in rotavirus-positive and -negative children. Six days after the onset of diarrhea, stools in only 4 out of 31 children that received Lactobacillus GG were positive for rotavirus compared with positive findings in 25 out of 30 control subjects. CONCLUSIONS: Oral administration of Lactobacillus GG is effective in rotavirus-positive and rotavirus-negative ambulatory children with diarrhea. Furthermore, it reduces the duration of rotavirus excretion.

Hayatsu, H, Hayatsu, T. Suppressing effect of Lactobacillus casei administration on the urinary mutagenicity arising from ingestion of fried ground beef in the human. Cancer Lett 1993;73:173-179.

Hillier, SL, Krohn, MA, Rabe, LK, et al. The normal vaginal flora, H2O2 producing Lactobacilli and bacterial vaginosis in pregnant women. Clin Infect Dis 1993;16 Suppl 4:S273-S281.

Hilton E, Isenberg HD, Alperstein P, et al. Ingestion of Lactobacilli acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med 1992;116:353-357.

Holzapfel WH, Haberer P, Snel J, Schillinger U, Huis in't Veld JH. Overview of gut flora and probiotics. Int J Food Microbiol 1998 May 26;41(2):85-101. (Review)
Abstract: Scientific developments in recent years have opened new frontiers and enable a better understanding of the gastrointestinal tract (GIT) as a complex and delicately balanced ecosystem. This paper focuses on more recent information related to the microbial population of the GIT and its functional role in human physiology and health. Special attention is also given to modern approaches for improving or stabilising the intestinal system and its functioning by the deliberate application of viable microbial cultures, so-called 'probiotics', selected for special functional properties.

Isolauri, E, Juntumen, M, Rautanen, T, et al. A human Lactobacillus strain (Lactobacillus casei sp strain GG) promotes recovery from acute diarrhea in children. Pediatrics 1991;88:90-97.

Jahn, HU, Ullrich, R, Schneider, T, et al. Immunological and trophical effects of Saccharomyces boulardii on the small intestine in healthy human volunteers. Digestion 1996;57:95-104.

Kasper H. Protection against gastrointestinal diseases--present facts and future developments. Int J Food Microbiol 1998 May 26;41(2):127-131.
Abstract: The importance of the intestinal microflora and, more specifically its composition, in physiological and pathophysiological processes in the human GIT is becoming more evident. Examples of such processes are translocation, the production and resorption of endotoxins, immune-modulation, and colonic motility. This leads to new possibilities for prevention and therapy of diseases, mainly of the gastrointestinal organs. New discoveries are specifically related to the beneficial effects of lactobacilli which have been discussed for decades. It is possible to increase the proportion of lactobacilli in the gastrointestinal microflora by consumption of fermented dairy products or by oral administration of specific non-digestible substrates such as oligofructose. Results from clinical trials and scientific studies have confirmed the preventive and therapeutic effects of selected strains of lactobacilli in viral- and bacterial-induced intestinal infections, in positively influencing immunological parameters, in normalizing the intestinal motility, and in inhibiting metabolic events in the gut lumen which promote colonic carcinogenesis. Nevertheless, there are still unresolved issues which can only be answered by well designed and well controlled clinical trials.

Kawase K. Effects of nutrients on the intestinal microflora of infants. Jpn J Dairy Food Sci 1982; 31:A241-243.

Kirchhelle, A, Fruhwein, N, Toburen, D. Treatment of persistent diarrhea with S. boulardii in returning travelers. Results of a prospective study. Fortschr Med 1996;114:136-140.

Klein, SM, Elmer, GW, McFarland, LV, et al. Recovery and elimination of the biotherapeutic agent, Saccharomyces boulardii, in healthy human volunteers. Pharm Res 1993;10:1615-1619.

Kollaritsch, H, Holst, H, Grobara, P, Wiedermann, G. Prevention of traveler's diarrhea with Saccharomyces boulardii. Results of a placebo controlled double-blind study. Fortschr Med 1993;111:152-156.

Korshunov, VM, Kafarskaia, LI, Volodin, NN, Tarabrina, NP. The correction of dysbiotic disorders of the vaginal microflora by using a preparation made from highly adhesive lactobacteria. Zh Mikrobiol Epidemiol Immunobiol 1990;7:17-19.[Article in Russian]

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Kuznetsov VF, Iushchuk ND, Iurko LP, Nabokova NIu. Intestinal dysbacteriosis in yersiniosis patients and the possibility of its correction with biopreparations. Ter Arkh 1994;66:17-18. [Article in Russian]

Lankaputhra WE, Shah NP. Antimutagenic properties of probiotic bacteria and of organic acids. Mutat Res 1998 Feb 2;397(2):169-182.
Abstract: Antimutagenic activities of live and killed cells of 6 strains of Lactobacillus acidophilus and 9 strains of bifidobacteria and of organic acids usually produced by these probiotic bacteria were determined using 8 potent chemical mutagens and promutagens. The mutagens and promutagens used were N-methyl, N'-nitro, N-nitrosoguanidine; 2-nitroflourene; 4-nitro-O-phenylenediamine; 4-nitroquinoline-N-oxide; Aflatoxin-B; 2-amino-3-methyl-3H-imidazoquinoline; 2-amino-1-methyl-6-phenyl-imidazo (4,5-b) pyridine, and 2-amino-3-methyl-9H-pyrido (3,3-6) indole. The mutagenicity of these mutagens and antimutagenic activity of probiotic bacteria against the mutagens were determined according to the Ames TA-100 assay using a mutant of Salmonella typhimurium. Efficiency of bacterial cells in binding or inhibiting these mutagens was also investigated. Live cells of probiotic bacteria showed higher antimutagenic activity and their efficiency in inhibiting the mutagens was better than killed bacterial cells. Live bacterial cells bound or inhibited the mutagens permanently, whereas killed bacteria released mutagens upon extraction with dimethyl sulfoxide. Among the organic acids, butyric acid showed highest inhibition of mutagens followed by acetic acid. Lactic and pyruvic acids did not show appreciable levels of inhibition.

Larsen, B. Vaginal flora in health and disease. Clin Obstet Gynecol 1993;36:107-121.

Larvol, L, Monier, A, Besnier, P, Levecq, H. Liver abscess caused by Lactobacillus acidophilus. Gastroenterol Clin Biol 1996;20:193-195. [Article in French]

Levy J. Immunonutrition: the pediatric experience. Nutrition 1998 Jul;14(7-8):641-647.
Abstract: The health benefits of specific nutrients in the diet are reviewed as they pertain to the pediatric population and its unique needs. Secretory immunoglobulins, lysozyme, interferon, and growth factors, among others, are known to confer immunological advantages to breast milk. Inhibition of bacterial pathogens, as well as permissive growth of a protective colonic ecoflora occur as a result of various cellular and biochemical mechanisms at play. The immunomodulatory properties of minerals such as iron, zinc, and selenium, are presented and the newly recognized protective role of vitamin A and its importance in developing countries and in conditions of compromised nutrition are discussed. The review also covers the role of arginine, glutamine, and nucleotides in adaptive responses of the developing gut and in pathologic states such as necrotizing enterocolitis, short bowel syndrome, and inflammatory bowel disease. Probiotics (specific microbial feeds with potential benefits to the host), and prebiotics (dietary components such as complex carbohydrates able to change the colonic microenvironment fostering colonization with non-enteropathogens) are areas of current interest because they offer alternatives for the management of the growing problem of multiple antibiotic resistance and overwhelming infections in the hospitalized patient.

Litiaeva, LA. The effect of a combination of immune and bacterial preparations on the microbial ecology of pregnant women in a risk group. Akush Ginekol (Mosk) 1993;1:19-22. [Article in Russian].

Lodinova-Zadnikova R, Sonnenborn U, Tlaskalova H. Probiotics and E.coli infections in man. Vet Q 1998;20(3 Suppl 3):S78-S81.
Abstract: After oral administration of live oral vaccines COLINFANT and MUTAFLOR prepared from non-enteropathogenic E.coli strains, both strains colonized effectively the intestine in full-term and preterm infants and remained for many weeks showing, that they were capable to establish themselves as a resident strain in the infant's gut. The presence of E.coli stimulated significantly antibody production in gut, saliva and serum of colonized infants. An early induction of secretory IgA production is important particularly in formula-fed infants, where it partly replaces the lacking immunoglobulin supplied with mother milk. In full-term and premature infants the early presence of non-pathogenic E.coli strains in the intestine decreased significantly the presence of pathogenic bacterial strains in the intestine but also other mucosal surfaces of the body. The COLINFANT strain decreased the number of nosocomial infections, mortality rate in connection with infection, and the need for antibiotics. Both strains replaced successfully pathogenic strains in carriers after treatment with antibiotics.

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Majamaa H, et al. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol. 1997 Feb; 99(2): 179-185.

Malin, M, Suomalainen, H, Saxelin, M, Isolauri, E. Promotion of IgA immune response in patients with Crohn's disease by oral bacteriotherapy with Lactobacillus GG. Ann Nutr Metab 1996;40:137-145.

Masycheva VI, Danilenko ED, Pustoshilova NM, Beliavskaia VA. [Design of stimulating agents of non-specific resistance system]. Vestn Ross Akad Med Nauk 1998;4:13-17. [Article in Russian] (Review)
Abstract: The paper briefly reviews a study on the design of drugs enhancing the body's nonspecific resistance to pathogenic agents. To examine the potential regulatory effects on cytokine function was a main trend. The interferon inductor ridostin, dsRNA of microbiological origin, cytokines, as well as the recombinant probiotic strain yielding interferon alpha-2 synthesis were used as a pharmacological agent. This was shown by using a wide range of experimental models wherein these preparations activated the components of the non-specific resistance system resulting in the host's increased capacity to eliminate invasive agents and transformed cells.

McDonough FE, Hitchins AD, Wong NP, et al. Modification of sweet acidophilus milk to improve utilization by lactose-intolerant persons. Am J Clin Nutr 1987;45:570-574.

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