The Probiotics Dilema

[tex]

Hi All,

A post this morning by a member who mentioned that he had to discontinue using a probiotic because it contained soy, and he hadn't yet been able to find a suitable substitute, caught my eye. He went on to point out that there are so many options to choose from, but according to what he is reading, (presumably on this board), not many users seem to actually derive any tangible benefit from any of them.

I fully agree with everything that he said. We all "know" that a good probiotic should be beneficial for us. However, after years of reviewing the literature, studying the recommendations of experts, and reading about member's experiences with probiotics of many types, the logic behind the use of probiotics strikes me as an issue that is about as close to a paradox, (or an inverse paradox, if there is such a thing - maybe it's some sort of oxymoron), as one can get without actually making the grade. According to Webster, the definition of a paradox is:

1. a seemingly contradictory or absurd statement that expresses a possible truth.

2. a self-contradictory and false proposition.

3. a person, thing, or situation, exhibiting an apparently contradictory nature.

4. an opinion or statement contrary to commonly accepted opinion.

Let's consider the facts:

1. The theory behind probiotics seems logical.

2. I'm convinced that the medical experts who recommend the use of probiotics are sincere, and they truly believe that their advice is sound. Furthermore, the experts I'm referring to here are individuals who actually understand GI issues in general, and MC in particular - experts such as Dr. Kenneth Fine, (founder of Enterolab), and Dr. Scot Lewey, (the food doc). If anyone should understand the probiotics issue, they should.

3. Probiotics continue to "sell like hotcakes" and probiotic drinks are now going mainstream, with more being added to the list of options on a regular basis.

4. At least one probiotic, (VSL#3), has been proven to actually hydrolyze the gliadin polypeptides that are responsible for celiac sprue. IOW, it can theoretically expedite the digestion of gladin, to the point where it should no longer cause celiac symptoms.

http://www.ncbi.nlm.nih.gov/pubmed/16311022

5. Why, then, has no one here reported any consistently beneficial results from the regular use of probiotics?

My guess is that the answer to that question may be linked with these facts:

1. IMO, (and this is only my opinion - I haven't seen this discussed anywhere), on an individual basis, we each have a "normal" population mix of bacteria that suits our diet, lifestyle, etc., and this "normal" mix is as unique as our fingerprints. It seems logical then, that when this "normal" mix is disrupted, our body will try to re-establish it, (subject to what is available, and subject to the presence of invading "hostile" populations that may try to disrupt the balance).

2. No commercial probiotics developed to date, can actually establish a self-staining population in the gut, (IOW, they cannot reproduce in the gut, and thus they slowly disappear, by natural attrition. Only bacteria that became established during birth, and the first few days after birth, can successfully establish self-replicating populations in our gut, (other than hostile species, of course). Once this window of opportunity has closed, none of the beneficial bacteria species that are ingested as probiotics, can successfully reproduce in the gut, (unless they are taken from a successful, (established), population in your own, or someone else's gut). This suggests to me that if we could somehow extract a representative sampling of our gut bacteria during infancy, and save it, either by freezing, culturing, or or some other means of preservation, then later in life, anytime that our gut bacterial balance might be skewed by antibiotic treatment, MC, infection, or whatever, we could simply use a portion of that sample to re-inoculate our gut with our own "ideal" probiotic mix, and it would promptly return our gut to "normal", much like restoring a computer with a backup file.

3. Since the idea of taking a natural probiotic mix, (IOW, a sample of gut bacteria), from an anonymous donor, is pretty much unpalatable to most people, it's unlikely that "natural" probiotics, (that is , bacteria that have actually come from self-sustaining populations in someone's gut), will ever be mass marketed, and even if they were, I suspect this would be a very tough item to sell. A project such as this would certainly not be without risk, since the use of "foreign" bacteria could result in serious consequences, due to the fact that the target GI system would not have an existing immune system that was developed in sync with the "new" bacteria mix, and some species could conceivably "take over" the gut, to the exclusion of others. The liability issues would be challenging, to say the least.

4. Finally, even if natural probiotics, from an anonymous donor, were ever developed to the point where they might be considered "safe", the odds of getting a product that matched our own unique "bacteria profile", would be a pretty tall order, IMO.

Anyway, these are some of the reasons why I believe that even though we all "know" that probiotics are good for us - in the long run, I really doubt that we will ever be able to derive anything more than a temporary benefit, (such as using a commercial probiotic to keeping out hostile invaders after a round of antibiotics). This is such a complex, (and vital), issue, (healthwise), that unless we can find a way to "stockpile" a supply of our own gut bacteria, (during early infancy), I doubt that we will ever find a satisfactory solution.

At least, that's the way I see it. YMMV

Tex

[Polly]

Very interesting discussion (as usual), Tex. I'll add my own 2 cents.

I honestly do not believe that probiotics have ever helped me. I have tried them numerous times without any positive results. On several occasions I felt that they made my gut worse (more bloating, rumbling, pain, etc.). Of course, with my multiple intolerances, I may have been reacting to an inert ingredient that was one of my intolerances.

I read some time ago about a researcher who IS trying to develop a probiotic strain by running it through a human GI tract. Maybe you can find my post about it on here - I think I was having a discussion with Mike when I mentioned it.

BTW, your idea about freezing newborn gut bacteria is fascinating. There is a precedent for this, of course. Parents can choose to save/freeze a newborn's umblilcal cord blood (for a fee). Since it contains stem cells, that blood could eventually save the child's life if s(he) deveopled certain conditions like leukemia and needed treatment. Seriously, this really could be a way for you to make millions, I think.

Love,

Polly

[Gloria]

Tex, I think your suggestion is interesting, too. I seem to remember reading about using someone else's gut bacteria to add to a gut with poor bacteria, so this isn't a far-fetched idea. Saving and using a newborn's bacteria would be superior, of course. The trick would be to convince insurance companies or the medical profession that saving it would be worthwhile. One of my daughters decided to save her children's umbilical cords just in case they needed it someday. If preservation of umbilical cords is getting commonplace, perhaps gut bacteria isn't far behind.

Gloria

[cludwig]

Hi Tex,

I'd love your opinion of the probiotic from pharmax. I started the HLC intensive capsules last month when I got the results back from my stool test that found the worms. The stool test also found that I had a yeast overgrowth problem. This is the first test that agreed with enterolabs..(they said I had a yeast allergy and you told me I couldn't have that unless I had yeast overgrowth)...you were right as always my friend. BTW...all other tests missed the worms and the yeast as well. Anyway..back to the probiotic...they claim theirs comes from a human source and therefore will adhere to the intestinal wall. I am not having any problems with this probiotic at all. I was on medication to get rid of the yeast for two weeks and did experience some die off symptoms...joint aches and headaches. Now I am on a mixture of herbs that the test said my yeast was sensitive to and the probiotic. Too soon to tell but I am doing better. I will be re testing for worms and yeast in a couple of weeks. I am still so impressed with the accuracy of this new stool test that uses the DNA probe especially since it agreed with the enterolab results.

Love,
Cristi

[Gloria]

The book "Restoring Your Digestive Health" by Jordan S. Rubin, N. MD. and Joseph Brasco, MD. recommend taking an HSO, which is a homeostatic soil organism composed of "tiny bacterial microorganisms that live in the soil. They maintain that our ancient ancestors weren't as conscientious about cleaning their food as we are and that they ate these friendly bacterial organisms along with their food. The HSO can be purchased as a health supplement.

Gloria

[RUBYREDDOG]

Excellent discussion on a very important topic.

I have a yeast overgrowth, as determined by my Enterolab results, and probiotics are one of (some sites claim the best) the treatments for it.

The following site is the best I have found, so far, in offering solutions. They want to sell you some very expensive products as well.

www.candidasupport.org

Anyone who has any experience with yeast overgrowth solutions, your advice would be greatly appreciated.

Hotrod

P.S. Tex, I know that you have advised me to starve the fungus, but I am just looking for an easier way out. Giving up more and more foods is getting to me a bit.

[tex]

Hi Cristi,

That probiotic seems to be popular in many parts of Europe.

Here's what one of the vendors for HLC Intensive say about it:

HLC organisms successfully used in clinical trial
Virtually 100% survival through stomach
Ability to attach to human epithelial cells
Long shelf stability and full label claim within 6 months at room temperature
Independent verification of specification with every batch
Suitable for vegans

http://www.smhomeopathic.com/store/pharmax.html

Here is the full text of what the manufacturer says about it:

The HLC (Human Lactic Commensals) range of probiotics have been developed within the Pharmax alliance and have been proven in both human clinical trials and by practitioner usage for over 10 years in Europe. In many countries in Europe, they are the market leading probiotic nutriceutical used by professional healthcarers.

The role of probiotics in human physiology is both varied and of fundamental importance. However, part of the reason why their full benefits are not always achieved in practice is that the microorganisms do not reach the G.I. tract in either sufficient numbers or with sufficient activity to be effective. Moreover, many bacterial isolates used as probiotic organisms are poor colonizers of the G.I. tract, quickly passing straight through and thereby eliciting only a transitory effect.


Hence, for a probiotic to be effective, there are four criteria of primary importance that must be delivered:
Proven product shelf stability, ensuring that the probiotic organisms reach the user at the "correct" potency
Ability of the selected cultures to survive gastric juices/acidity
Ability of the cultures to attach to human epithelial tissue
Proven in clinical trials

HLC – Delivering a quality product with shelf stability and quality assurance
The organisms, Lactobacillus acidophilus and Bifidobacterium bifidum, as used in the HLC range are fragile organisms, sensitive to both temperature and moisture. As temperature increases from 40°F, there is an almost exponential drop in viable numbers with time and this is exacerbated by the presence of moisture.
It is for this reason that many probiotic products containing L. acidophilus and Bifidobacteria have failed in independent surveys to deliver label specifications of viable bacterial numbers to the end user. By addition of microbial overage at the time of manufacture combined with appropriate packaging and storage conditions, Pharmax ensures that all products reach the customer at above-label specification. Independent analysis of each batch (available to customers) proves the point.

The HLC probiotics have:
Virtually indefinite shelf life if kept frozen
Full 12 - 18 months shelf life if kept refrigerated
Over 3 months shelf life at room temperature...............
................. and still remain above the label specification!

This quality assurance promise has resulted in the HLC range being given top placing of all products analysed for meeting specification and value for money in two recent independent European probiotic surveys.

HLC – Highest survival through the stomach
The pH of the empty stomach is between 1.5 and 1.9 whereas, due to the buffering capacity of food, the pH is raised to between 3.8 and 4.3 in the full stomach. The aggressive nature of the stomach acts as an excellent barrier to invasion by potentially pathogenic microbes. So, for probiotics to be effective, they must survive in high numbers under the same environmental stresses as would severely inhibit or eradicate other bacteria.
The HLC organisms were compared with other probiotic strains for their ability to survive passage.

With over 90% survival in the full stomach and over 50% survival in the harshest environment of the empty stomach, the HLC organisms proved particularly robust and well adapted to the human stomach. This was in contrast to other probiotic organisms, which showed great sensitivity to gastric conditions and poor adaptation to the human host.
This study also demonstrated that probiotics should be taken in association with a meal to ensure maximum survival.

HLC - Proven attachment to human epithelial cells and antagonism to Candida albicans
In the small intestine (duodenum, jejunum, ileum) the transit time is rapid relative to the "doubling time" of normal flora bacteria so, if they are unable to attach or otherwise become associated with the epithelial surface, they will be washed through. Lactobacilli, particularly Lactobacillus acidophilus are the most important colonizing organism of the small intestine and it is therefore critical that any Lactobacillus strains used as probiotics are capable of human epithelial cell attachment.

HLC - Proven in clinical trials
Probiotics from the HLC range are continuously tested and shown to be effective in independent, placebo controlled, clinical trials. All such studies get published in peer-reviewed scientific journals. Results from recent clinical studies are outlined below.

Trial 1: Undertaken at Addenbrookes Hospital, Cambridge, U.K.
Aim: Reduction in post-antibiotic re-growth of potentially pathogenic facultative microorganisms
Results: HLC Intensive significantly prevented post antibiotic increase in Staphylococci, Enterobacteriaceae and Enterococci. These microorganisms are associated with post-antibiotic infection and overgrowth as well as the acquisition and transfer of antibiotic resistance.

Trial 2: Undertaken at Addenbrookes Hospital, Cambridge, U.K.
Aim: Prevention of post-antibiotic overgrowth of Clostridium difficile in hospitalized patients
Results: HLC Intensive lowered frequency of Clostridium difficile infection and overgrowth to the extent that justified its use in all hospitalized patients undertaking antibiotic therapy.

With further clinical trials already in progress, it is clear that the HLC range of probiotics from Pharmax is leading the way in innovative, clinical probiotic research and will pave the way for recognition of the benefits of probiotics in many new aspects of human health and disease.

The Functions of Lactobacilli & Bifidobacteria in the G.I. tract
Their major beneficial physiological functions are as follows:

Well established:
Protect against enteric infection, overgrowth and dysbiosis
Stimulate the development and balancing of the neonatal immune system
Continuously stimulate the mucosal immune barrier throughout life
Stimulate the digestion and absorption of nutrients such as lactose (by producing lactase) and minerals (by action of lactic acid)
Stimulate intestinal motility

Less well established:
Decrease absorption of dietary cholesterol by binding and excretion
Decrease production of intestinal mutagens and carcinogens

However, for most people, the benefits of having high numbers of Lactobacilli and Bifidobacteria are not fully achieved. This is because these organisms are the most adversely affected by any disturbance of the G.I. tract, leading to dramatically reduced populations and resultant dysbiosis. This can be overcome by supplementing with products from the Pharmax HLC range – the benchmark of probiotics and probiotic therapy.

HLC – Summary
Human strains
Proven by human double blind placebo controlled clinical trial


Tailored to address specific health/disease presentations:

* Dysbiosis and overgrowth
* Neonate immune system development
* Chronic inflammatory conditions
* Gastrointestinal (GI) tract syndromes
e.g. Irritable bowel syndrome (IBS)
* Stressful lifestyle
* Immune maintenance with age

High potency
Guaranteed quality by independent potency analysis with each delivery
Unique and proven synergistic interactions with other nutritionals

http://www.pharmaxllc.com/index.asp

Note that the claim of 6 month shelf life stability without refrigeration is twice what the manufacturer claims, and the claim of "Virtually 100% survival through stomach", is rather optimistic, (the manufacturer claims 50% survival when taken on an empty stomach, and 90% survival when taken on a full stomach). Some vendor sites, however, do accurately state these characteristics, and pretty much quote what the manufacturer claims.

Regarding the source of the bacterial strains, I see nothing on the manufacturer's site about the origin of these strains. One of the vendors of this product, however, makes this claim:

HLC Intensive Pharmax LLC, 30 capsules

The HLC products are powerful probiotics for relief of intestinal health problems. These Human Lactic Commensals (HLC) are human-derived strains including Lactobacillus acidophilus and L. bifidus, and the only product line of their kind in North America. All other probiotics are made from animal or dairy strains and may not adhere as well to the human gastrointestinal tract.

https://www.rockwellnutrition.com/asset ... rrhoea.pdf

With the lack of information on the manufacturer's site, that's difficult to verify. It pretty much boils down to whether or not you believe that the manufacturer has shared this information with them, and/or you believe them. The claim may simply be based on the fact that that the two strains mentioned, are indeed strains normally found in the human gut, and most strains used in commercial probiotics are cultured on dairy medium, (note, however, that they did not say that the ULC probiotics are not also cultured on animal or dairy medium). In fact, I find it rather difficult to believe that the ULC products would not be cultured on an animal or dairy medium, at a commercial production level. That means that this claim by this vendor, could just be a slick play on words, since L. bifidus is a probiotic strain that is not commonly available in this country, (so theirs may indeed be the only product line that contains it, for all I know), but they never actually state that their product is cultured on anything other than animal or dairy medium, (they just imply it).

There seem to be precious few research articles on specific probiotics, so the only study that I could locate that was actually published in a peer-reviewed publication, was this one, where the product was evaluated as a deterrent to C. diff infection, following antibiotic use:

Summary. Colonic infection with Clostridium difficile, leading to pseudomembranous
colitis, is a common complication of antibiotic therapy, especially in elderly
patients. It has been suggested that non-pathogenic probiotic bacteria might
prevent the development and recurrence of C. difficile infection. This double-blind,
placebo-controlled study examines the role of probiotic administration in the prevention
of C. difficile-associated diarrhoea (CDAD) in elderly patients receiving
antibiotic therapy. Consecutive patients (150) receiving antibiotic therapy were
randomised to receive either a probiotic containing both Lactobacillus and
Bifidobacterium or placebo for 20 days. Upon admission to hospital, bowel habit
was recorded and a faecal sample taken. Trial probiotic or placebo was taken
within 72 h of prescription of antibiotics, and a second stool sample was taken in
the event of development of diarrhoea during hospitalisation or after discharge. Of
the randomised patients, 138 completed the study, 69 with probiotics in conjunction
with antibiotics and 69 with antibiotics alone. On the basis of development of
diarrhoea, the incidence of samples positive for C. difficile-associated toxins was
2.9% in the probiotic group compared with 7.25% in the placebo-control group.
When samples from all patients were tested (rather than just those developing diarrhoea)
46% of probiotic patients were toxin-positive compared with 78% of the
placebo group. [Int Microbiol 2004; 7(1):59–62]

https://www.rockwellnutrition.com/asset ... rrhoea.pdf

As you can see, of the patients who developed diarrhea, 40% fewer, tested positive to C. diff, when compared with the control group. Over the entire group, 41% fewer tested positive to C. diff, when compared with the control group, (based on the fact that 46% of the probiotic patients tested positive to C. dif, while 78% of the controls tested positive to C. diff). I would have hoped to see better results, but maybe I'm expecting too much of a probiotic. When I look at these high infection rates, I can't help but wonder why more of them didn't show symptoms of C. diff. If you dig through the numbers in the full report, it's interesting to note that of the probiotic group, 40 % of those who tested positive to C. diff had diarrhea, while in the control group, 86% of those who tested positive to C. diff had diarrhea. That suggests that the probiotic helps to prevent diarrhea, especially in the case of C. diff infection, which implies a better degree of protection than the report summary would indicate.

My opinion? Well, despite the "overzealousness" of a few vendors, I suspect that this may well be one of the better ones on the market. You have to take my opinion with a huge helping of salt, though, since I have never intentionally taken any probiotic products in my life, (other than yogurt and sauerkraut, and some people probably don't consider them to be probiotics).

Please keep us updated on your progress. I don't recall anyone here using that one before, but I could be wrong, of course.

Love,
Tex

[tex]

Hotrod,

I hear you - ultra-restrictive diets really suck. Considering the nature of candida, though, I really don't believe you can conquer it, (assuming that you actually have an overgrowth problem in the first place), without restricting carbs/sugar intake. At least a couple of members here have gone through that process, (under a doctor's care). One was CAMary, but I don't recall any other names, at the moment. I'm thinking that she started with an antibiotic, and then restricted her diet, but that was several years ago, and my memory is fuzzy on it. Hopefully, she will check in, and offer some insight, or maybe someone else with experience will help out here.

They certainly do seem to be proud of those products on the website you referenced. I have no idea whether or not any of those products might substantially benefit the recovery process, but I doubt that anyone here has tried them.

I suspect the right probiotic might indeed help to speed up the elimination process - the question is, "which one would be best for the job?".

Tex

[tex]

Polly,

I really appreciate your insight into your own experiences with probiotics. I suspected as much, but I wasn't sure. I've been searching, but I still haven't found the post that you mentioned, (about a researcher developing a probiotic strain by running it through a human GI tract).

While it would certainly be nice to make a few million on that idea, I'm not sure that I have the resources that it would take to bring that idea to fuition. I have no doubt that the concept is sound, (would be effective and safe), and we already know that bacteria will keep virtually forever when frozen properly, but setting up all the necessary infrastructure, and selling the idea to consumers, might be a formidable task, especially since the only, (current), practical way to collect the samples would be by means of a specially modified colonoscope. That could be a hard sell.

Incidentally, check out this abstract - apparently the mother is not the only significant influence on the gut colonization of newborns:

http://www3.interscience.wiley.com/jour ... 1&SRETRY=0

Love,
Tex

[cludwig]

Hi Tex,

Thanks for all the details. This is the probiotic that the Bastyr clinic recommends as well as the Jonathom Wright Tahoma clinic FWIW. I live about a half hour from both so have visited.

I agree with you that the results don't match up to the hype. My naturopath recommended that I use it a long time ago. I finally agreed when I got the second piece of good evidence that I have yeast overgrowth. If I remember correctly she researched the product the first time to make sure it had no dairy for me and said that it didn't...that it came from human vaginae. But I understand your point as to exactly what medium they use to grow the cultures on. I will try to find out. I'll keep you posted on how I do on it.


Hotrod...I'd love to share my symptoms with you but honestly I wouldn't be able to tell what was coming from the yeast and what from the worms....fatigue, joint aches, cramps ,brain fog,hunger,weight loss....could be from one, both or neither. I'm not able to understand what is causing what.


Love, Cristi

[RUBYREDDOG]

Cristi, Well this whole pribiotic issue is very confusing. Tex has made some very interesting points and his research work has prompted me to take a wait and see approach. Some promising probiotics which have shown results (claimed results) contain dairy and soy. A big no-no for me right now.

Since you mentioned him, I take a monthly newsletter from Dr. Jonathan Wright at the Tahoma Clinic. I have a lot of respect for his medical advice on nutrition and healing. (nothing substantial about MC however.....) In his archived articles he recommends the use of a product that contains silver for yeast overgrowth. I can't remember the name off hand but if you are interested you can go to his web site (access is by membership only) or I would be happy to download the info and post it on this site.

Thanks for sharing your information.

Hotrod