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.

Share this Post...

abdominal, antibiotic associated diarrhea, Bifidobacteria, Bifidobacterium lactis, billion, bloating, bowel function, Clostridium difficile, colonic transit, colonize, Conditions, Diarrhea, digestive, dose, fecal, flatulence, functional bowel disorders, gastrointestinal, gut, Gut flora, high-dose probiotics, IBS, inflammatory bowel diseases, Irritable Bowel Syndrome, lactobacilli, Lactobacillus, Lactobacillus acidophilus, microbiota, multistrain, Probiotic, ulcerative colitis

I mention sleep from time to time because it is so important to your well-being.  Studies are finding that inadequate sleep can trigger a slew of health conditions.  These days, people are cramming more and more things to do into their days, but there are only so many hours in a day.  So what gets cut?  You guessed it—sleep!

A recent study found that dieters who got adequate sleep lost more fat weight than dieters who cut back on their sleep.  They also experienced less hunger. This is just one of the many benefits of a good night’s sleep.  

This week, I want you to pay attention to what you are cramming into your days.  You may even want to write down your actions for a week.  Now, make note of which tasks simply must be done.  Then notice which tasks are not necessary.  Also, check out which days are busiest.  Can some of the necessary tasks be moved to another day?  Spreading your tasks throughout the week can help even out your schedule.  And be sure to record how many hours of sleep you get. 

Recording your week can help you step back and take a good look at what is going on, day by day, hour by hour.  From there, you can make little adjustments that can add up to more sleep for you, and less hustle and bustle when you’re awake.

Share this Post...

adjustments, benefits, busiest, Conditions, day, dieters, fat, good, Health, hours, hunger, important, inadequate, lunch, necessary, night, notice, sleep, studies, tasks, week, weight

The gut-brain connection is fascinating. It involves an intimate communication between the gut and the brain, and it goes in both directions—from the brain to the gut, and from the gut to the brain. I mean, isn’t it cool that what happens in your gut can affect your brain?

Yet another study looking at the gut-brain connection has found that gut bacteria are associated with anxiety. The researchers used an animal model to study this link, as it is easier to work out the details of these connections in animal models. Researchers found that antibiotic treatment altered the normal gut bacterial count, producing a change in behavior—the mice became anxious. They also experienced an increase in brain derived neurotrophic factor (BDNF), linked to anxiety and depression. When the antibiotics were stopped, behavior returned to normal.

To take this one step further, the researchers added gut bacteria from mice genetically prone to be passive, to mice prone to be more active and exploratory, and vice versa. They found that by giving the mice a different set of bacteria, the mice began to behave as the mice from which the bacteria were originally isolated. One of the researchers stated, “these results lay the foundation for investigating the therapeutic potential of probiotic bacteria and their products in the treatment of behavioral disorders, particularly those associated with gastrointestinal conditions such as irritable bowel syndrome.”

Like I said, the gut-brain connection is fascinating.  Did you know your gut had so much power over your health?

Share this Post...

antibiotic, antibiotics, anxiety, behavior, behavioral disorders, brain, Conditions, depression, gastrointestinal, gut, gut bacteria, gut-brain connection, Irritable Bowel Syndrome, Probiotic

The Standard American Diet (aptly named SAD), also known as the Western diet, is full of processed and fried foods, refined carbohydrates and sugars, and saturated and trans fats. It is low in fiber, fruits and vegetables, whole grains, lean proteins and beneficial fats (like omega-3s).

This diet has been blamed (and rightfully so) for so many different health conditions, most notably, heart disease and diabetes. But cheer up! A change in diet and increase in exercise can reverse both these conditions. 

Another recent study links another condition to SAD. Attention-deficit hyperactivity disorder (ADHC, or as it used to be known ADD) is one of the most common childhood disorders, and may continue into adulthood. It involves difficulty staying focused, difficulty controlling behavior and hyperactivity. In adolescents, consumption of a Standard American Diet was found to more than double the risk of being diagnosed with ADHD when compared to a diet low in the foods found in the SAD diet.

The suggested reasons for this difference were:

• SAD diet has a less optimal fatty acid profile (too much omega-6 and not enough omega-3)
• SAD diet may not provide essential micronutrients needed for brain function
• SAD diet contains more artificial colors, flavors and additives linked to ADHD symptoms

More studies need to be done to figure out which came first, but I simply can’t wait that long to get the word out about how detrimental the SAD diet is to our children’s health. I know that children and adolescents are picky eaters, but it is essential that they get all the nutrients they need for the best start in life – one that will carry them through the years. The earlier they begin eating well, the more likely they will eat that way for life.

Standard American Diet, SAD, Western, diet, processed, foods, fried, refined, carbohydrates, sugars, saturated, fats, trans, fiber, fruits, vegetables, whole grains, lean, proteins, beneficial, omega-3s, health, conditions, heart disease, diabetes, exercise, reverse, study, ADHD, attention-deficit hyperactivity disorder, ADD, childhood, adulthood, behavior, hyperactivity, adolescents, consumption, risk, diagnosed, low, optimal, fatty acid, omega-6, essential, micronutrients, brain, function, artificial, colors, flavors, additives, linked, symptoms, detrimental, picky eaters, essential, nutrients, start, life, eating, well, eat

Share this Post...

add, additives, ADHD, adolescents, adulthood, artificial, attention deficit hyperactivity disorder, behavior, beneficial, brain, carbohydrates, childhood, colors, Conditions, consumption, detrimental, diabetes, diagnosed, diet, eat, eating, essential, exercise, fats, fatty acid, fiber, flavors, foods, fried, fruits, function, Health, heart disease, hyperactivity, lean, life, linked, low, micronutrients, nutrients, Omega-3s, omega-6, optimal, picky eaters, processed, proteins, refined, reverse, risk, SAD, saturated, Standard American Diet, start, study, sugars, symptoms, trans, vegetables, well, Western, whole grains

Unnecessary antibiotic use is a common practice, especially in pediatric medicine. Children with ear infections are often prescribed antibiotics, which often aren’t necessary. A recent analysis of 135 published studies found that most kids who see a doctor for ear infection do not need an antibiotic.

The review, published in the Journal of the American Medical Association (JAMA) determined that 80 percent of children with ear infections will get better on their own in about three days. When antibiotics are prescribed, this number only increases to 92 percent, but comes with many side effects—three in ten will develop a rash in reaction to the medication, five in ten more will get diarrhea, and an unpredictable number will be at risk of developing antibiotic resistance. 

Experts encourage doctors to give parents a “safety-net antibiotic prescription,” which is a prescription that parents take home and only use if the child does not improve after three days. This reduces the amount of office visits necessary (which can be one reason for parents to push early prescriptions), and reduces the number of children who take antibiotics unnecessarily.

I see so many people with digestive issues that stem from repeated antibiotic use as a child, and  I know how destructive that can be first hand. The long-term consequences of unnecessary antibiotics can wreak havoc on a person’s digestive system.  They did mine, and it took a long time (and the right supplements) for me to get back to vibrant health.  The more we know about safe ways to avoid antibiotics, the better. 

So the next time one of your little ones has an ear infection, talk to your doctor about a three-day safety-net antibiotic prescription. In the meantime, a bedtime dose of ibuprofen was recommended for best relief.

As always, when taking antibiotics, a probiotic should be taken (not within the same 2 hours) during and after, to help replenish the healthy gut bacteria that are depleted with antibiotic use.

Share this Post...

antibiotic, antibiotic resistance, bacteria, Children, Conditions, consequences, Diarrhea, digestive, doctor, ear infection, gut, healthy, infection, long-term, medication, prescribed, Probiotic, rash, reaction, replenish, safe, side effects, studies, system

Ok folks, my weekly challenge involves a very interesting study from Boston University that I came across the other day that I want to share with you. The study looked at a technique known as expressive writing, which involves writing one’s thoughts and feelings about a certain issue. In this study, participants with irritable bowel syndrome (IBS) expressed their thoughts and feelings about having IBS. They wrote for 30 minutes on four consecutive days.

Expressive writing was found to improve IBS severity and cognition in participants with longer-term duration of IBS. More studies are needed to confirm the potential for using this method in IBS treatment, but these preliminary results are hopeful.

It turns out that expressive writing has been found to be beneficial for a number of health conditions, like depression, rheumatoid arthritis, high blood pressure, chronic pain, chronic infection, and even length of hospital stay. How cool!

So, this week, if you are suffering from a chronic illness (especially IBS) take 30 minutes out of four days in a row to record your thoughts and feelings about it. Here is an excerpt from the instructions used in the study:

“…Feel free to really let go and explore your very deepest emotions and thoughts. You might tie your topic to your relationships with others, including parents, lovers, friends, or relatives, to your past, your present, your future, or to who you have been, who you would like to be, or who you are now…”

So get out a pen and paper (or your laptop) and let it all out. It may just make you feel better in the long run.

Share this Post...

beneficial, chronic, chronic infection, chronic pain, cognition, Conditions, depression, disease, emotions, expressive writing, feelings, high blood pressure, hospital, IBS, illness, Irritable Bowel Syndrome, issue, method, relationships, rheumatoid arthritis, study, suffering, technique, thoughts, treatment

Probiotics are now being considered for use in treating many digestive (and even non-digestive) health conditions and diseases. Two such diseases in which probiotics have been studied are the inflammatory bowel diseases ulcerative colitis and Crohn’s disease. These conditions involve chronic inflammation of the intestines. Crohn’s disease primarily involves the lower small intestine, but may involve the entire digestive tract. Ulcerative colitis involves the rectum and large intestine, or colon (hence the name colitis—meaning inflammation of the colon).

A recent double-blind, randomized, placebo-controlled study found that in addition to standard treatment, a high-potency, multistrain probiotic improved symptoms. Equally important, it also improved appearance of the colonic mucosal lining in patients with relapsing mild-to-moderate ulcerative colitis compared to those patients only receiving standard treatment.

This is the strongest study to date on probiotics for ulcerative colitis and joins a growing body of evidence for their beneficial effects. Because ulcerative colitis is a serious disease, effective treatment is important. If you have ulcerative colitis, talk to your doctor about using probiotics. Want to learn more before you do? Tune in for my PBS Special The Road To Perfect Health, now airing on your local PBS station.

Share this Post...

beneficial, chronic, colitis, colon, Conditions, Crohn’s, digestive, diseases, doctor, effective, evidence, Health, high-potency, inflammation, inflammatory bowel disease, intestines, large, lining, mucosal, multistrain, patients, PBS, Probiotic, rectum, relapsing, serious, small intestine, standard, study, symptoms, tract, ulcerative

If you’re reading this blog, chances are good you’ve heard of probiotics. Probiotics are beneficial bacteria that are known for supporting digestive and immune health. From my perspective, probiotics are as important as a daily multivitamin and have many healing properties. I have seen so many people get well while taking probiotics.

When people think of probiotics, the first thing that comes to mind is usually yogurt. It’s true that all yogurt is cultured with probiotics, but not all yogurt contains live cultures in the finished product. This is because yogurt must be pasteurized, or heated, to kill off potentially pathogenic bacteria. Unfortunately, this also kills off the beneficial bacteria the yogurt was cultured with. Some yogurts do contain live cultures that are added back in after pasteurization. Next time you buy yogurt, be sure to look for the “live cultures” label.

The limitation of yogurt, however, is the amount of probiotics in yogurt—it’s low. It may not be enough, especially if your gut is out of balance. Unless you want to eat a gallon of yogurt each day, a probiotic supplement is best.

A recent study found that a high-potency (450 billion), multi-strain probiotic was able to ease irritable bowel syndrome (IBS) symptoms in children and adolescents who took the supplement for six weeks. This is a very high dose, but it can take that much (even in children) in certain conditions to rebalance the gut.

On the other hand, a lower dose (even that found in yogurt) can be beneficial for certain health concerns. Another recent study found that a particular probiotic yogurt containing Lactobacillus acidophilus and Bifidobacterium lactis decreased cholesterol and increased HDL (“good”) cholesterol in women when eaten for six weeks.

It’s a fact: Bacteria are everywhere. It’s just a matter of striking the right balance. Yet another study found that household dust even contains up to 1,000 different microbe species per gram! (No wonder no one likes to dust!) We can only do so much to reduce our daily exposure to harmful toxins and pathogens, but we can do a lot to improve our health by choosing the right foods and nutrients to optimize the body’s functions.

Share this Post...

acidophilus, adolescents, amount, bacteria, balance, beneficial, Bifidobacterium, Children, Conditions, cultured, daily, digestive, dose, gut, Health, high, high-potency, IBS, immune, important, Irritable Bowel Syndrome, kill, label, Lactobacillus, live, live cultures, multistrain, multivitamin, of, out, pasteurized, pathogenic, Probiotic, Probiotics, product, rebalance, study, supplement, well, yogurt

Sure, we hear all the time about the benefits of vitamin C, vitamin A, and of course all those good-for-you B vitamins, but chances are you’ve been hearing lately about another vitamin too—one that’s also important for your body and your health: vitamin D.

Research shows that vitamin D helps with a wide range of health conditions, but unfortunately most people don’t get enough of this beneficial nutrient in their daily diets. Studies have even shown that people low in vitamin D are at risk for many different illnesses and diseases, but what I want to talk about is the importance of vitamin D when it comes to a healthy gut.

A recent study found that vitamin D plays a big role in the body’s response to harmful Salmonella bacteria in the intestines (salmonella bacteria are the most frequently reported cause of foodborne illness in the U.S.). Specifically, scientists found that vitamin D is especially effective at helping to quell inflammation caused by Salmonella in the gut. 

The bottom line? If you’re not taking a vitamin D supplement, you should be!  Vitamin D is widely available and inexpensive—just make sure you take vitamin D3 since it’s easiest for your body to absorb and use. Remember also to take vitamin D with a meal that contains fat, since it’s a fat-soluble vitamin. Or better yet, look for a daily Omega oil supplement with preferrably 1000 IU added vitamin D3 to get even more healthy benefits!

Share this Post...

bacteria, benefits, bioavailable, Conditions, fat, foodborne, gut, Health, healthy, illness, illnesses, inexpensive, inflammation, insufficient, Intestine, meal, nutrient, oil, Omega, pathogenic, salmonella, supplement, vitamin, vitamin D, vitamin D3

Here’s something I thought you might find interesting: researchers at Harvard University Medical School recently discovered that bacteria in the gut can trigger the autoimmune response associated with rheumatoid arthritis.

In simple terms, an autoimmune response means that there’s an immune response in the body that goes astray, causing the body to attack its own tissues instead of a foreign invader, in this case causing the breakdown in healthy joint cartilage seen in people with rheumatoid arthritis.

So what does all this mean when it comes to the trillions of bacteria living in your digestive tract every day? It means that they can affect your whole body, sometimes even causing conditions nowhere near the gut, and it’s something I’ve been saying for years! Not only that, but more and more studies these days are proving me right, showing that many autoimmune conditions begin right in the gut.

This isn’t surprising, since more than 70% of your body’s immune defenses are found in the gut—and when things like digestive problems, gut bacteria imbalance and toxin overload put a strain on the immune system, it often leads to the development of autoimmune conditions. 

The folks at Harvard are planning to look at the effects of intestinal bacteria on other autoimmune conditions as well, including type 1 diabetes, so stay tuned! And remember to take good care of your gut!

Share this Post...

autoimmune, autoimmunity, bacteria, body, breakdown, cartilage, Conditions, defenses, digestive, digestive tract, dysfunction, gut, Harvard, healthy, imbalance, immune, immune system, intestinal, invader, joint, overload, rheumatoid arthritis, study, tissues, toxin, type 1 diabetes