A new study, published in the European Journal of Clinical Nutrition, demonstrated a connection between diet, and stool pH and bacterial levels in adults.¹ The researchers studied stool samples from vegetarians, vegans, and omnivores. They found lower levels of potentially pathogenic bacteria, like E. coli, in people consuming the vegan or vegetarian diets. What they also found, in conjunction, was a decrease in stool pH level with decreases in consumption of animal proteins. Those on the omnivore diet had a stool pH of 6.9; those on the vegetarian diet (which included dairy and eggs) had a stool pH of 6.6; and those on a vegan diet (no animal proteins) had a stool pH of 6.3.

The higher pH in the omnivore diet is explained in part by an increase in the production of alkaline metabolites by enhanced growth of the protein-digesting putrefactive bacteria in the gut. That’s right—a diet high in animal protein promotes increased putrefying activity of gut bacteria, raising the pH of stool and making products like putracene, cadaverine, and nitrosamine, which could lead to colon cancer. Diets lower in animal protein and—this is key—higher in fiber promote gut bacterial activity that produces more acid via production of the beneficial short-chain fatty acids (SCFAs) butyrate, propionate, and acetate, promoting a more acidic environment in the gut.

The change in pH levels explains why potentially pathogenic bacteria were increased in the higher pH (more alkaline) stools of people consuming an omnivorous diet. Lower pH ranges do not support the growth of potential pathogens, which thrive in the higher pH range over 6.5.^2,3 So I say, stay alive under 6.5!  

Here is a major point. The lower pH may be mainly a biomarker indicating the production of the SCFAs, particularly butyrate. Butyrate is a major fuel for the colonocytes, and is critical for optimum colon health. Butyrate also affects nuclear transcription in a positive way. In other words, when colonic cells are under attack from absorption of free radicals from fecal material (more likely to happen with chronic constipation), the nucleus, under stress, sends a message to the cell: either commit suicide (apoptosis) or produce more damaged cells (cancer).  Butyrate is more likely to promote apoptosis, preventing cancerous cells and allowing new cells to come in and maintain a healthy colon lining.

However, we must always remember everything is a question of balance.  All of the SCFAs including butyrate come from the fermentation of soluble fiber from plants by commensal bacteria. Too much fermentation with too low of a pH (or too much acid) can damage the colonic lining creating increased permeability problems leading to numerous problems including immune imbalances which can have total body effects.

The researchers also found a decrease in levels of Bifidobacteria and Bacteroides in the people on a vegan diet. This is in contrast to other studies that have found increases in Bifidobacteria, and seems an anomalous finding, since high-fiber diets support the growth of Bifidobacteria, while suppressing the growth of potential pathogens. Perhaps a closer look at the diets would be in order. Many vegetarians and vegans eat high amounts of refined carbohydrates, and too much fats and oils which do not promote healthy Bifidobacteria levels.

The researchers state, “In addition to age, gender and diet, factors such as microbial interaction, food transit through different intestinal compartments with different bacterial colonization density, availability of nutrients, colonic supply, sulphate and bile acids, and bacterial adaptation may all be involved in the composition and activity of colonic microflora. This may help in understanding the lower abundance of Bifidobacteria and Bacteroides species in vegans and vegetarians, which was not linked to stool pH.”

At any rate, all diets—vegan, vegetarian, and omnivore—will benefit by adding probiotic-rich foods along with supplements to help replenish levels of the beneficial Bifidobacteria and Lactobacilli. These bacteria, along with a high-fiber diet high in vegetables and fruits, help to lower the pH in the intestines by producing the nourishing SCFAs.

Incidentally, this topic can confuse the message of the benefits of a high-alkaline diet. You may have heard that a diet high in animal protein, sugar, and refined carbohydrates creates acidity in the body. Yes, these foods do lower urine and salivary pH levels, which are thought to be associated with bone mineralization, a process that helps neutralize acidity by pulling alkaline minerals from bone.  Chronic low grade acidity (metabolic acidosis) also causes excess loss of calcium, magnesium and potassium in the urine. Diets high in vegetables and fruits, on the other hand, produce more alkaline urine and saliva levels, which is associated with reduced bone loss and reduced loss of minerals in the urine.⁴ These variabilities in optimum pH in different areas show the body’s ability to change based on local environment and physiologic and biochemical requirements.

The bottom line is, healthy pH levels, whether in the colon or systemic, are found when you eat a high-fiber diet, high in vegetables and fruits, healthy proteins, and healthy fats. Complement this with foods and supplements high in beneficial bacteria, omega-3 fatty acids, and digestive enzymes, and you will be supporting optimal health (which begins in the digestive system).

References

1.  J. Zimmer, et al., “A vegan or vegetarian diet substantially alters the human colonic faecal microbiota.” Eur J Clin Nutr. 2012 Jan;66(1):53-60.
2. J. Adler, “A method for measuring chemotaxis and use of the method to determine optimum conditions for chemotaxis by Escherichia coli.” J Gen Microbiol. 1973 Jan;74(1):77-91.
3. G.R. Gibson, et al., “Prebiotics and resistance to gastrointestinal infections.” Br J Nutr. 2005 Apr;93 Suppl 1:S31-4.
4. B. Dawson-Hughes, et al., “Treatment with potassium bicarbonate lowers calcium excretion and bone resorption in older men and women.” J Clin Endocrinol Metab. 2009 Jan;94(1):96-102.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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Probiotic use for digestive conditions has seen a gradual increase in dosage over the past couple decades. Doses of 7 billion were thought to be very high just ten years ago, while average doses were about 250 million. Today, an average probiotic dose is around 1–5 billion with high-dose probiotics ranging from 30 to 450 billion or more. This increase comes with improvements in the development of probiotics and increased interest in studying high-dose probiotics, as is reflected in the literature.

The gut is home to about 100 trillion bacteria cells—10 times the amount of cells that make up the entire human body. For this reason, high-dose probiotic therapy may have a greater impact on the beneficial modulation of the gut flora, or microbiota. Here I’ll review a few studies on high-dose probiotics for gastrointestinal conditions.

In a randomized, double-blind, placebo-controlled study published in 2010 in the Journal of American Gastroenterology, 225 patients were randomized to one of three groups: two probiotic capsules per day providing 100 billion CFU (colony forming units) of live organisms, one probiotic capsule and one placebo capsule per day providing 50 billion CFU of live organisms, or two placebo capsules.¹ A dose-ranging effect was shown in which the group receiving the 100 billion CFUs had lower incidence of antibiotic-associated diarrhea (AAD) than the 50 billion group, and both probiotic groups had lower incidence versus placebo. In those patients who did acquire AAD, Clostridium difficile-associated diarrhea (CDAD) incidence was lower than the 500 billion CFU group, and both probiotic groups had lower CDAD incidence than placebo.

A previous dose-response study published in 1991 in the journal Microbial Ecology in Health and Disease investigated fecal recovery of the probiotic Lactobacillus casei strain GG (LGG).² In this study, healthy volunteers were assigned to six different groups: 1.5 million, 15 million, 150 million, 1.5 billion, 15 billion and 150 billion CFU per day of the probiotic. LGG could not be recovered from the feces of groups taking up to 150 million CFU per day. In the group taking 1.5 billion, LGG was occasionally recovered at low levels in two of the seven volunteers. In the group taking 15 billion CFU per day, all volunteers were colonized. LGG was recovered at the highest level with the highest dose—150 billion. This study showed a dose-response effect at higher dosage levels of 15 to 150 billion CFU per day required for fecal probiotic recovery.

A high-dose multistrain probiotic formula containing eight strains (three bifidobacteria, four lactobacilli and one Streptococcus) has also been shown to colonize the gut and maintain remission of ulcerative colitis (UC) in children and adults.^3-5 In children, 900 billion CFU per day of an eight-strain probiotic formula induced remission.³ In adults, 500 billion CFU per day of that same formula colonized the gut and maintained remission in UC patients.⁴ In another trial, a daily dose of 3.6 trillion CFU per day of the multistrain formula induced remission in adult patients not responding to conventional therapies.⁵

This same preparation (dosages ranging from 450 billion to 1.8 trillion CFU per day, based on weight of patient) was also found to induce and maintain remission of ulcerative colitis in children.⁶ In a randomized, double-blind, placebo-controlled trial of 29 children with UC, probiotics or placebo were added to standard treatment. In the probiotic group, 92.8 percent achieved remission compared to only 36.4 percent in the placebo group. Further, there were no biochemical or clinical adverse events related to the probiotic treatment in these children.

Two more randomized, controlled trials evaluated the effects of this probiotic preparation in twenty-five patients with diarrhea-predominant irritable bowel syndrome (IBS-D). In the first study, patients were assigned to receive either the probiotic mixture (450 billion CFU per day) or placebo for eight weeks. The multistrain probiotic relieved abdominal bloating when compared to placebo. In the second study, 48 IBS patients were randomized, double-blind, to receive either the probiotic mixture (450 billion CFU per day) or placebo for 4 or 8 weeks. The multistrain probiotic mixture reduced flatulence and slowed colonic transit without altering bowel function in patients with IBS and bloating.

In another double-blind, placebo-controlled trial, sixty patients with functional bowel disorders—non-constipation IBS, functional diarrhea and functional bloating—received a probiotic mixture of two strains, Lactobacillus acidophilus and Bifidobacterium lactis, at 200 billion CFU daily for eight weeks.⁷ Abdominal bloating improved in the probiotics group at four and eight weeks when compared to placebo. A subgroup of patients with IBS was analyzed and also found to have reduced bloating when compared to placebo.

Studies evaluating high-dose probiotics are most common for inflammatory bowel diseases, though as we see from the studies cited above, other conditions are also benefitted from a high-potency probiotic therapy. The trend toward increasing dosage of probiotics is influenced and supported by studies using doses ranging from 50 billion up to 3.6 trillion or more.

References

1. Gao XW, et al., “Dose-response efficacy of a proprietary probiotic formula of Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R for antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea prophylaxis in adult patients.” Am J Gastroenterol. 2010 Jul;105(7):1636-41.
2. Saxelin M, et al., “Dose-response colonization of faeces after oral administration of Lactobacillus casei strain GG.” MicroEcol Health Dis. 1991 Jan;4:209-14.
3. Miele E, et al., “Effect of a probiotic preparation (VSL#3) on induction and maintenance of remission in children with ulcerative colitis.” Am J Gastroenterol. 2009 Feb;104(2):437-43.
4. Ringel Y, et al., “Probiotic bacteria Lactobacillus NCFM and Bifidobacterium lactis Bi-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders—a double-blind study.” J Clin Gastroenterol. 2011 Jul;45(6):518-25.

1. Miele E, et al., “Effect of a probiotic preparation (VSL#3) on induction and maintenance of remission in children with ulcerative colitis.” Am J Gastroenterol. 2009 Feb;104(2):437-43.
2. Venturi A, et al., “Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis.” Aliment Pharmacol Ther. 1999 Aug;13(8):1103-8.
3. Bibiloni R, et al., “VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis.” Am J Gastroenterol. 2005 Jul;100(7):1539-46.

1. H.J. Kim, et al., “A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating.” Neurogastroenterol Motil. 2005 Oct;17(5):687-96.
2. H.J. Kim, et al., “A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome.” Aliment Pharmacol Ther. 2003 Apr 1;17(7):895-904.

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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Would you be surprised to know that eating a high-fat meal and/or high-sugar meal causes your arteries to not work in a normal manner? Let’s say we start the day with either coffee with cream/sugar and donuts, or same coffee/sugar with eggs and toast with butter/jam. And then for lunch or supper, we eat meals with high-fat meat, bread and butter, a baked potato with sour cream and butter along with an alcoholic drink (or even ice tea with sugar). Then we finish the meal with a nice dessert.

Each of these meals can cause your arteries not to function properly by the end of the meal which could last for several hours!¹ If you tend to eat this way, most of the day your arteries are constricted and not dilating normally in response to routine activities. The result, at the very least, is high blood pressure. This problem can be eliminated simply by cutting out the excess saturated fat and sugar, and adding probiotics or cultured foods high in bifidobacteria, in addition to eating plenty of vegetables throughout the day.

The above illustration of the diet-artery connection illustrates just one of the many ways to create a problem known as endothelial dysfunction, a condition that occurs when the cells lining the arteries, veins, and lymphatics don’t work properly.² There are a multitude of ways to cause the vessels to not dilate or constrict normally, and to cause the lining to leak (let’s call it leaky vessel syndrome). Endothelial dysfunction is a precursor to atherosclerosis.³ Here is a short list of endothelial dysfunction triggers:

1. Smoking, polluted air,⁴ food, and water⁵ – All of these create excess free radicals which are a major cause of endothelial dysfunction.

2. High blood sugar and/or high insulin levels – High blood sugar results in glycosylation (think of it like a sticky sugar coating) of the insulin receptor substrate, which eventually leads to an inability of protein kinase B (Akt) to increase endothelial nitric oxide synthase (eNOS) enzyme activity, resulting in low nitric oxide (NO) and poor blood vessel function.⁶

3. Microbes (bacteria, viruses, fungi and parasites), parts of microbes, and toxins made by microbes migrating from inside the intestinal lumen into the arterial, venous and lymphatic circulation – Microbes and their toxins activate white blood cells and they release bullets (anti-microbial peptides) named alpha-defensins that not only damage the microbes but the endothelial lining as well.

4. Stress – Stress increases cortisol, which can elevate blood sugar and insulin, again sugar coating receptors to result in low NO, and thus, endothelial dysfunction.

5 Aging – Aging decreases stem cells that help with repair processes, increases blood cortisol levels (see number 4), and decreases bifidobacteria levels in the colon. All of this leads to endothelial dysfunction.

6. Increased body fat, especially in abdomen – Even a modest gain of about 8 pounds (which can happen over a vacation) will cause endothelial dysfunction. “In normal-weight healthy young subjects, modest fat gain results in impaired endothelial function, even in the absence of changes in blood pressure. Endothelial function recovers after weight loss. Increased visceral (belly) rather than subcutaneous fat predicts endothelial dysfunction.”⁴

One of the mechanisms by which fat hurts the arteries is by releasing a cytokine known as resistin. Resistin has been shown to cause oxidative stress and decrease endothelial nitric oxide synthetase (eNOS) which is essential for nitric oxide (NO) production, itself essential for arterial health and function.

7. Physical inactivity – Merely by doing nothing, the process of ongoing free radical activity due to diet, stress and environment, will decrease nitric oxide (our natural vasodilator), superoxide dismutase (our own natural anti-oxidant) and citrate synthetase (the enzyme in our mitochondria involved energy production—essential to a healthy heart / blood vessel function). These natural sources of blood vessel protection return merely by walking briskly on a regular basis.⁵

8. Diabetes types 1 and 2 – Again, elevated blood sugar and either high or low insulin levels, as are seen in diabetes, will lead to endothelial dysfunction as described above.

9. Drugs which elevate or lower blood sugar and insulin – Many diabetic drugs can cause endothelial dysfunction by not maintaining steady levels of blood sugar and insulin. Insulin itself is one of the worst offenders.

10. Even children receiving second-hand smoke in a household with smokers, begin developing endothelial dysfunction at an early age.

References

1. Rudolph TK, et al., “Acute effects of various fast-food meals on vascular function and cardiovascular disease risk markers: The Hamburg Burger Trial.” Am J Clin Nutr. 2007 Aug;86(2):334-40.
2. Endemann DH and Schiffrin EL, “Endothelial dysfunction.” J Am Soc Nephrol. 2004 Aug;15(8):1983-92.
3. Davignon J and Ganz P, Role of endothelial dysfunction in atherosclerosis.” Circulation. 2004 Jun 15;109(23 Suppl 1):III27-32.
4. Romero-Corral A, et al., “Modest visceral fat gain causes endothelial dysfunction in healthy humans.” J Am Coll Cardiol. 2010 Aug 17;56(8):662-6.
5. Suvorava T et al., “Physical activity causes endothelial dysfunction in healthy young mice.” J Am Coll Cardiol. 2004 Sep 15;44(6):1320-7.
6. Wautier JL and Schmidt AM, “Protein glycation: a firm link to endothelial dysfunction.” Circ Res. 2004 Aug 6;95(3):233-8.

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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An interesting study published in the journal Obesity points out that eating more soluble fiber, like that from apples and beans, and moderate exercise will selectively decrease belly fat.¹ The authors don’t seem to know why it is selective to belly fat, and not subcutaneous fat (fat just under the skin). I think one reason would be that the intake of high amounts of soluble fiber promotes growth of beneficial bacteria that produce short chain fatty acids, both of which may control some of the inflammation in the gut. Chronic inflammation causes marked increase in insulin resistance, and therefore, storage of more belly fat. Controlling this inflammation is key, and as we see, can be done by consuming soluble fiber.

Here are some recently discovered points that support the above concepts:

• Eating a high fat and sugar diet decreases the number of beneficial bifidobacteria and increases the number of potentially pathogenic gram negative bacterial species in the gut.
• As these potentially pathogenic bacteria die they release cell wall lipopolysaccharides (LPS) which happen to also be better absorbed through the gut lining when eating a high-fat, high-sugar, low-fiber diet on a regular basis. The LPS molecules easily pass through the epithelial gut lining and hit the gut immune system where they activate white blood cells including neutrophils, monocytes, and macrophages that all then release inflammatory cytokines: TNF alpha, IL-6 and IL-1 beta. These inflammatory cytokines can trigger inflammation in the small blood vessels throughout the body but probably start with the blood vessels in the intestines, causing endothelial dysfunction. This has been proven by measuring a significant decrease in blood vessel wall flexibility within minutes to hours after eating a high-fat, high-sugar meal.²  
• Conversely, supplementing with bifidobacteria and eating a plant-based, high-fiber diet seems to decrease translocation of LPS through the gut epithelial lining and may help prevent the negative effects of high-fat diet induced metabolic diseases.³
• The vascular inflammation in and around the intestinal tract, which is 20 or more feet in length, can stimulate stem cells adjacent to the blood vessel walls (known as stem cell pericytes) to develop into fat cells or adipocytes which accumulate wherever there are blood vessels in the abdomen—that’s almost everywhere!
• The inflammatory fire continues as the abdominal fat, or visceral fat (some people call it VAT) continues to produce more inflammatory cytokines (IL- 6, TNF alpha, etc.) that flow into other blood vessels, stimulating more stem cell conversion into fat cells or adipocytes.
• It is interesting that both vitamin D and stem cells are stored at high levels in abdominal fat. Perhaps the vitamin D is trying to cool down the inflammation and the stem cells are there to respond according to the body’s information: either make fat or something else.  

It makes sense that exercise  was found helpful for reducing abdominal fat. Exercise has many benefits. For one, it produces more adiponectin to help reverse the situation. Adiponectin is an anti-inflammatory hormone made in fat that both decreases inflammation in fat and travels to the pancreas to help sensitize and balance the release of insulin which can help reverse metabolic imbalances.

So it is pretty simple—eat your plant-based, high-fiber diet, supplement with probiotics (including good amounts of bifidobacteria), and exercise moderately on a regular basis.  Then be patient. The accumulation of abdominal fat, along with all the problems caused by this fat, including heart attacks and cancer, is reversible.

1.  Hairston KG, et al., “Lifestyle Factors and 5-Year Abdominal Fat Accumulation in a Minority Cohort: The IRAS Family Study.” Obesity (Silver Spring). 2011 Jun 16. doi: 10.1038/oby.2011.171. [Epub ahead of print]

2.  Plotnik GD, et al., “Effect of antioxidant vitamins on the transient impairment of endothelium-dependent brachial artery vasoactivity following a single high-fat meal.” JAMA. 1997 Nov 26;278(20):1682-6.

3.  Cani PD, et al., “Selective increases of bifidobacteria in gut microflora improve high-fat-diet-induced diabetes in mice through a mechanism associated with endotoxaemia.”

Diabetologia. 2007 Nov;50(11):2374-83.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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 Constipation is a common childhood condition, unfortunately. Even worse is the mainstream definition of constipation—less than three bowel movements per week. Say what! If you or little Johnny are only pooping three times a week, we’ve got a problem. Regular elimination helps remove toxins from the system. And the longer feces sit in the colon the more toxic it gets!

A recent study evaluated the effect of the probiotic Bifidobacterium breve in children with constipation. Twenty children between the ages of 3 and 16 took the probiotic daily for a 4-week period. Bowel movement frequency and stool consistency improved significantly in these children. That means their constipation improved. The results of this pilot trial are promising, and will lead to a larger randomized controlled trial.  

Bifidobacteria are the most prevalent probiotic bacteria in the large intestine, or colon, of children. Normal bifidobacteria colonization occurs when babies are born vaginally, and is improved during breastfeeding. Antibiotic treatment can interfere with colonization, especially during the first months and years of life. Maintaining a healthy balance of bifidobacteria is associated with intestinal health, which is the foundation of total body health.

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On May 27, 2011 a New York Times article reports that Sherwood Gorbach, a 71 year doctor, has been instrumental in the development of a new antibiotic, Dificid, also known as fidaxomicin, for treating C. difficle (C. diff) diarrhea. Dr. Gorbach spent most of his professional life as professor of medicine and public health at Tufts University. He is also well known in the natural health community as one of the co-inventors of a probiotic known as Lactobacillus GG  (GG stands for Drs. names: Sherwood Gorbach and Barry Golden).  So it is needless to say he is well versed in the use of probiotics.

The discovery and bringing to market of Dificid is no doubt a wonderful event. One reason is there are more antibiotic resistant C. diff strains due to the overuse of Flagyl and Vancocin which have been the mainstays for C. diff treatment. It is important to point out that there are many studies in the medical literature that show the concurrent use of probiotics or probiotic yogurts with antibiotics greatly reduce or prevent C. diff in the first place. ¹ Also, prolonged use of probiotics after a C. diff infection reduces the likelihood of getting recurrent C. diff infections. What a novel concept—why not use probiotics and/or fermented yogurt on a regular basis?  

It turns out that the Dificid, at this point in time being the “new kid on the block,” was shown to be much better than Vancocin in preventing recurrent C. diff. About 25 percent of the Vancocin users had a recurrence compared with only about 15 percent of the Dificid users. Why would this be?  It’s too soon and too new for resistant C. diff strains to develop! What’s more, Dificid like most prescription drugs, has its dark side—namely side effects of nausea, vomiting, abdominal pain and gastrointestinal hemorrhage. Now let’s talk about cost; the drug is likely to be at least as expensive as Vancocin, which costs $1,000 or more for a course of treatment. Optimer, the pharmaceutical company that sells Dificid, is predicted to make about $159 million per year after a few years of selling the drug.

If we really had a health care system in addition to a sickness care system, probiotics would be taken as seriously (if not more so) than antibiotics in both the prevention—and yes, the treatment—of most all infections. It would be interesting for both Dr Gorbach and the New York Times to tell the more complete story of how Dificid could be avoided, but if truly needed, be complemented with probiotics that would include multiple species and strains of Lactobacillus and Bifidobacteria in a high enough dose to really matter, several hundred billion probiotic bacteria per day.

1. Hickson M, et al., “ Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial.” BMJ. 2007 Jul 14;335(7610):80. Epub 2007 Jun 29.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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The title of this article has been taken directly from the journal Gut Pathogens January 2011, and can be accessed for free at www.gutpathogens.com. This article tells the story of the gut connection. As we have been preaching for years, there is good evidence of a connection between gut bacteria and most (if not all) of the body organs, including the skin and brain.  What’s more, the above article presents much new, refined information, but the basic information is included from published references from 80-90 years ago!

Read, and be informed of the following concepts presented:

1.  The regular consumption of fat, sugar and simple carbs low in fiber, will decrease the beneficial bifidobacteria and other probiotic species in the colon and terminal small intestine (the end of the small intestine).

2.  Low  bifidobacteria allows increases of other bacteria that may promote colonic lining (epithelium) inflammation, with increased free radical damage and oxidative stress that leads to increased intestinal permeability (IP), or leaky gut.

3.  Increased IP leads to the passage (or translocation) of partially digested food particles, bacterial toxins, and other bacterial byproducts including fat (or lipids) from dead bacterial cell walls. 

4.  Bacterial cell wall lipids known as lipopolysaccarides (LPS), or also bacterial toxins, are easily measured in the blood, and are important indicators of how much overactivity will occur in the immune system.  Elevated LPS is very likely to occur after eating your favorite ice cream, or even too much bacon and eggs with toast and jelly (high fat, high sugar, and low fiber).

5.  Elevated blood levels of LPS cause the immune system to increase production of inflammatory markers (pro-inflammatory cytokines). These markers can cause many negative reactions, including decreased insulin receptor sensitivity, and thereby elevate blood sugar and insulin levels.

6.  Chronically elevated blood sugar and insulin promote increase in blood lipids, and  increase in inflammation which can contribute to acne, anxiety and depression, among other conditions.

Here is the good news,  a  high-fiber diet found in vegetables, whole grains, legumes, seeds and nuts, with some low glycemic fruits (especially berries) will promote high-normal levels of bifidobacteria. Taking prebiotic fibers was also shown in this article to increase bifidobacteria, and supplementing with bifidobacteria probiotics or fermented foods will definitely have overall beneficial effects on the body, including the skin and the brain. 

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years.  In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe.  Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.   

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I think the term probiotics is a good name for the beneficial microbes that inhabit the intestinal tract of human beings. Probiotics literally means “for life.” There are many ways in which probiotics function “for life,” for without them we would be seriously ill and succumb to many different diseases.

Modern science, on an almost daily basis, is discovering just how helpful our beneficial microflora (probiotics) can be. Beneficial microflora include mainly bacteria, but also some fungi or yeasts, even some parasites, and possibly viruses in certain cases. We do know that we have over 1000 species of bacteria, and over 100 trillion microorganisms of various types living inside of us. At the present time we do not know the exact percentage of beneficial microflora (or probiotics) living within us at any given time, but we do know it is wise to regularly replace the probiotic species.

Lack of beneficial bacteria in newborn children creates a situation that can range from overgrowth of pathogenic bacteria and fungi at one end of the spectrum, to immune deficiency at the other end (probiotics literally help develop our immunity). It is well known that newborn children do not have fully competent immune systems at birth and for several months thereafter. However, some children are less immune responsive than others in the first year of life. This is a big issue because it is also well known that many children receiving vaccines in the first year of life are unable to respond appropriately and benefit from the vaccines. This results in either no or low antibody levels (or titres) to the vaccine in the blood, which is easily measurable. In addition, it is well accepted that there can be side effects ranging from minor to quite significant in response to an immature immune system receiving a given vaccine.

So here is the good news. A recent double-blind, placebo-controlled study showed that newborns that were given probiotics versus the placebo had better antibody titers to their vaccine (meaning the vaccine worked), and also had fewer side effects than the placebo group.¹ Though this is a small study that was only slightly statistically significant, it certainly points the way toward more liberal use of probiotics, either as supplements or cultured drinks and foods—both for mom during pregnancy and breastfeeding, and for the newborn child.

Another important health tip for pregnant ladies: consider getting a vaginal culture a few weeks before delivery. If you are low in the beneficial vaginal microflora, start supplementing so that if you are fortunate enough to have a vaginal delivery, you will inoculate your baby during the birthing process. What’s more, it is during breastfeeding that the baby naturally receives the bifidobacteria that are so important for colon health. For those who have a C-section and/or don’t breast feed, it is even more critical to supplement with probiotics. In my opinion, I think everyone should take probiotics on a regular basis.

I. Youngster, et al., “Probiotics and the immunological response to infant vaccinations: a prospective, placebo controlled pilot study.” Arch Dis Child. 2011 Jan 24.

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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 Most people have a difficult time making the association between what is going on in the gut and health problems in other parts of the body. I help them connect the dots so that they can achieve better health. I help them get started on The Road to Perfect Health.

The Road to Perfect Health begins in the gut (your digestive system). If your digestive system is not healthy, the rest of you is typically unhealthy in some way.

Sure, you know that conditions like heartburn, gas, bloating and indigestion are related to your gut. But did you know that conditions like fibromyalgia, chronic fatigue, skin conditions, cardiovascular disease, diabetes and even arthritis are all related to the gut? It’s true. And I have seen it in so many people, including myself.

There are many different factors contributing to chronic illness that begin in the gut, but one primary factor is gut microbial balance. You need the proper balance of gut bacteria. I call it your “GPS”—your Gut Protection System. Your GPS is made up of 100 trillion bacterial cells. In fact, the bacterial cells in your gut outnumber the cells in your entire body by 10 to 1! That’s right, there are 10 times more gut bacteria than all the rest of the cells that make up your body.

The beneficial bacteria in your gut are known as probiotics. Probiotic means, literally, “for life.” Pro means “for” and biotic means “life.” This is in contrast to “antibiotic” (“against life”). The most common and most widely studied probiotic bacteria are what I call the L’s and the B’s—Lactobacillus and Bifidobacteria. Lactobacillus bacteria are most associated with the little (small) intestine, and the Bifidobacteria are mostly found in the big (large) intestine, or colon. Having the right balance of good bacteria (more good guys than bad guys) is essential on The Road to Perfect Health.

For more information on how your GPS can help you return to perfect health, check out my new PBS show, The Road To Perfect Health. Check your local PBS listings for show times.

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When you’re pregnant it seems like everyone has some important bit of advice to give—do this, eat this, stay away from this—but really the keys to good health during pregnancy are a lot like any other day: follow a healthy diet and lifestyle, and the benefits are sure to follow. So the other day when I came across a story about how probiotic supplements could provide added benefits for pregnant women and their babies, I wasn’t surprised at all.

Scientists in Finland recently followed more than 250 expectant moms to look at how taking probiotics during pregnancy (and afterwards while breastfeeding) may help with healthy blood sugar and preventing gestational diabetes. Gestational diabetes is another name for women who experience high blood sugar levels during pregnancy even though they’ve never had diabetes before, and it affects over 100,000 women in the U.S. every year!

All of the women in the study were considered healthy and had no history of chronic disease, and their daily diet was closely monitored by a nutritionist. But now for the really interesting part: about half of the women received a daily probiotic supplement with a combination of Lactobacilli and Bifidobacteria (those important L’s and B’s!), and those women had improved blood glucose control, which translated into fewer cases of gestational diabetes as well as healthy fetal and infant growth.

Now, I know I talk about probiotics all the time and how all those good bacteria in your gut play a BIG role in keeping your whole body healthy, but this just goes to show that the benefits of probiotics go way beyond just better digestion and a strong immune system. Because there’s been such a drastic rise in obesity and obesity-related disease in this country, researchers are excited about these study results and hope that starting probiotics early on in life will help to ensure a healthy body and weight in later years. More kudos for probiotics!

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