A recent study, published in the journal Nutrition, demonstrated the effect of broccoli and blueberries on bowel inflammation in an animal model of inflammatory bowel disease (IBD).¹ Researchers fed IBD mice either a control diet, or a diet with 10 percent broccoli or ten percent blueberries. Both the broccoli- and blueberry-fed mice exhibited similar changes in gut microbiota with one exception: the broccoli-fed mice had lower levels of the bacteria Faecalibacterium prausnitzii. Both diets also increased the size of colon crypt cells and number of goblet cells per crypt. (Intestinal crypt cells are located in the “valleys” of the intestinal villi.)

Differences between the broccoli- and blueberry-fed mice were also observed. Higher concentrations of butyric acid and lower concentrations of succinic acid were found in the broccoli-fed mice; the only diet to reduce inflammation in the colon was the broccoli-fed diet; and broccoli-fed mice exhibited less translocation of microbes to mesenteric lymph nodes than the blueberry-fed or control mice. (This means in the broccoli-fed mice gut bacteria stayed in the gut rather than translocating through a leaky gut into gut-associated lymph nodes.)

One reason the blueberry-fed mice may not have had as beneficial an impact as the broccoli-fed mice could be the high fructose content of blueberries. Foods high in fructose can produce fermentation in the gut.² Inflammatory bowel disease involves a gut sensitivity to the microbes residing there. Increased fermentation may further disrupt an already sensitive environment.

Blueberries have been found to benefit microbial metabolism in the colon, likely due to the anti-inflammatory effects of blueberry’s phenolic compounds.³ Broccoli is also well known for its protective effects in the large bowel, mostly attributed to the sulforophane and indole-3-carbinol (I3C) bioactives.⁴

This study is helping to prove that whole foods absolutely affect the microbial population. The moral of the story? Well, more studies need to be done to confirm the effects in humans, and to elucidate the mechanisms at work, but in the meantime, eat more broccoli! In fact, eat more vegetables (and fruits if you aren’t sensitive) in general. The thousands of phytochemicals found in vegetables and fruits have more beneficial effects in our guts—and our entire bodies—than we will ever know.

References

1. G. Paturi, et al., “Influence of dietary blueberry and broccoli on cecal microbiota activity and colon morphology in mdr1a(-/-) mice, a model of inflammatory bowel diseases.” Nutrition. 2011 Nov 22. [Epub ahead of print]
2. P.R. Gibson, et al., “Review article: fructose malabsorption and the bigger picture.” Aliment Pharmacol Ther. 2007 Feb 15;25(4):349-63.
3. W.R. Russell, et al., “Availability of blueberry phenolics for microbial metabolism in the colon and the potential inflammatory implications.” Mol Nutr Food Res. 2007 Jun;51(6):726-31.
4. E.H. Jeffrey and M. Araya, “Physiological effects of broccoli consumption.” Phytochem Rev. 2009;8:283-9.

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...

anti-inflammatory, bacteria, beneficial, blueberries, bowel, broccoli, colon, diet, fermentation, foods, fructose, fruits, gut, gut microbiota, I3C, IBD, indole-3-carbinol, inflammation, inflammatory bowel disease, intestinal, large bowel, leaky gut, metabolism, microbes, phytochemicals, sensitive, sulforophane, vegetables, whole foods

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.

Share this Post...

acetate, alkaline, Bacteroides, Bifidobacteria, butyrate, colon, colonic microflora, diet, Digestive Enzymes, digestive system, E. coli, fiber, fruits, gut, healthy gut bacteria levels, high-fiber, intestines, lactobacilli, omega-3, omnivores, optimal health, pathogenic, Probiotic, propionate, proteins, SCFAs, short-chain fatty acids, stool, sugar, vegans, vegetables, vegetarians

The hygiene hypothesis states that a lack of exposure to microorganisms—both beneficial and potentially harmful—during early childhood increases susceptibility to development of allergic diseases by creating an imbalance in immune system development. Brenda has blogged on the topic before, and I’ve blogged about immune balance.

A recent study published in the Journal of Allergy and Clinical Immunology has found that gut diversity in infancy helps protect against the development of allergies.¹ The study involved 40 children: 20 with atopic eczema, and 20 children with no health conditions. Stool samples were collected from each child at one month and twelve months of age, and the DNA of bacteria present in the infants’ guts was identified. The diversity of gut microflora at one month of age was significantly greater in the healthy children than in those children who later developed allergies.

The researchers suggested that in the absence of stimuli from a diverse array of microbes, the immune system may overreact against harmless antigens in the environment, such as food. I have blogged on the topic of food sensitivities, as well, highlighting the importance of maintaining immune balance with a good balance of gut bacteria.

So how do infants acquire gut bacterial diversity? First, by vaginal delivery, through which they are inoculated with protective bacteria from their mother (which works best if mom is on a plant-based diet, eating prebiotic foods, and taking probiotics throughout the pregnancy); second, by breastfeeding, which delivers yet more beneficial bacteria and prebiotics to feed the beneficial bacteria establishing in the baby’s gut; three, without the use of unnecessary antibiotics, which decrease gut bacterial diversity; and four, with a healthy diet consumed by the mother. When any of these factors cannot be optimized, probiotics formulated for infants can help build the beneficial bacteria in the gut.

References

1.  T.R. Abrahamsson, et al., “Low diversity of the gut microbiota in infants with atopic eczema.” J Allergy Clin Immunol. 2011 Dec 6. [Epub ahead of print].

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...

allergic, antibiotics, balance, beneficial, beneficial bacteria, childhood, Children, eczema, food sensitivities, gut, gut bacteria, gut bacterial diversity, gut diversity, harmful, healthy diet, Hygiene Hypothesis, immune balance, immune system, infancy, microbes, microflora, microorganisms, prebiotic, Probiotics

Atrazine is the most widely used herbicide in the United States. Over 75 million pounds of it are applied to corn and other crops, many in the Midwest. Atrazine is the most common pesticide contaminant found in groundwater, surface water, and rain in the United States. A recent study has found that women living in areas where atrazine water contamination is found are more likely to experience menstrual irregularities than women living in regions where there is no contamination.

I have blogged on the adverse hormonal effects of atrazine before. It has been found to turn male frogs into females, even at low concentrations. In 2009 atrazine was also linked to low birth weight in Indiana newborns, and menstrual irregularities have been found in women exposed to atrazine through agricultural work.

In this new study, women from two different cities in Illinois were compared with women from two different cities in Vermont. Illinois has the highest rates of atrazine water contamination, though the levels found in the study were still under limits set by the Environmental Protection Agency. The women in the Illinois cities were almost five times more likely to report irregular periods than the Vermont women, and more than six times more likely to go more time between periods.

Emily Barrett, a reproductive health scientist at the University of Rochester in New York stated, “These types of changes to hormone concentration and ovarian function could potentially lead to problems with fertility.” The study did not look at fertility, but hopefully more studies will address this.

Atrazine is sprayed on 75 percent of corn, as well as other crops. Corn is used in so many foods, and is used to make so many different ingredients in foods. This week, start reading your food labels to discover how widespread corn is. Then, take measures to replace the largest sources of non-organic corn with organic corn in your diet. It’s worth it. We’ve got to reduce our chemical exposure. Eating organic, when possible, is a big way to do that.

Share this Post...

allergic, antibiotics, balance, beneficial, beneficial bacteria, childhood, Children, eczema, food sensitivities, gut, gut bacteria, gut bacterial diversity, gut diversity, harmful, healthy diet, Hygiene Hypothesis, immune balance, immune system, infancy, microbes, microflora, microorganisms, prebiotic, Probiotics

Small intestinal bacterial overgrowth (SIBO) is gut condition in which there are abnormally large numbers of gut bacteria in the terminal ileum of the small intestine (the end of the small intestine, just before the colon). SIBO is one form of dysbiosis, or gut imbalance. Normally, the colon is where gut bacteria greatly increase in number, with the small intestine housing smaller numbers of bacteria. In SIBO, the high amount of gut bacteria in the small intestine leads to excess gas and discomfort. The condition is common in people with irritable bowel syndrome (IBS).

It has been known for a while that SIBO is more common in alcoholics, but a recent study is the first to look at the relationship of SIBO in people with moderate alcohol consumption. As it turns out, the researchers, from the Mayo Clinic and Dartmouth-Hitchcock Medical Center, found that moderate alcohol consumption—one drink per day in women and two per day in men—could lead to SIBO.

Dr. Gabbard, the lead researcher, stated, “While typical treatment for SIBO has been antibiotics, probiotics or a combination of the two, the question now becomes what is the exact association between moderate alcohol consumption and SIBO and whether alcohol cessation can be used as a treatment for this potentially harmful condition.”

Certainly, the things we consume—food, drink and medication—affect our gut. If you have been considering decreasing your alcohol intake (there are many good reasons to do so), it may just help improve your gut balance.

Share this Post...

alcohol, bacteria, colon, consumption, discomfort, dysbiosis, gas, gut, gut bacteria, gut balance, gut imbalance, IBS, Irritable Bowel Syndrome, SIBO, small intestinal bacterial overgrowth, small intestine

The gut-brain axis involves the connection of the gut to the brain. This connection goes in both directions—from the brain to the gut and from the gut to the brain. In one way, the gut-brain axis is connected by the vagus nerve—a large nerve connecting the brain to the intestines and other organs. The vagus nerve both sends messages to various organs, and also receives messages from these organs—including the gut—to send to the brain. A new study has established the vagus nerve as a main form of communication from the gut bacteria to the brain.

In an animal model, researchers were able to show that mice fed the probiotic Lactobacillus rhamnosus JB-1 showed less stress-, anxiety-, and depression-related behaviors than did mice not fed the bacteria. Further, the probiotic mice had lower levels of the stress hormone corticosterone, and they also experienced changes in the expression of receptors of the neurotransmitter GABA (gamma-aminobutyric acid) in the brain—highlighting the ability of probiotics to directly affect brain chemistry under normal conditions.

This is an early study that will need to be replicated in humans, but studies like these pave the way for our understanding of the complexities of the gut connection. Did you ever think your gut could have such an effect on your health? If you read my blog regularly, I sure hope so!

Share this Post...

anxiety, bacteria, brain, connection, depression, GABA, gut, gut connection, gut-brain axis, Health, intestines, Lactobacillus rhamnosus, neurotransmitter, Probiotic, stress, vagus nerve

Renew You Challenge

Let’s start this week off right!

Weekly challenge (I mean opportunity!) to help set you off on the right foot and in the right direction for bringing health to your week. You could even add it to your calendar.  Join us! 

Anxiety, or worry, is experienced by just about everyone at some point. Some people have anxiety disorders, which are more serious conditions, but it’s safe to say that most people experience at least occasional anxiety. That’s why a new study on omega-3s found in fish oil is so exciting. It’s the first study to look at the effects of fish oil on anxiety in a healthy population—meaning, in people who don’t already have an anxiety disorder. It’s already known that fish oil can be helpful for those people. But what about people who only experience anxiety here and there?

The researchers took a group of medical students and gave them omega-3 supplements for three months. The supplements contained 2,085 mg of EPA and 348 mg of DHA. Another group got a placebo. After three months, the group taking the fish oil showed a 20 percent reduction in anxiety scores and a 14 percent reduction in the production of the inflammatory marker interleukin-6 (IL-6) over the placebo group.

IL-6 is an inflammatory cytokine. Depression and anxiety are both known to involve the production of inflammatory cytokines. This is one of the gut-brain connections, actually, since the inflammation can originate in the gut. Omega-3s were able to reduce these inflammatory compounds, highlighting just one way they may be helping mood disorders like depression and anxiety.

This week, if you tend to get anxious about things, even if occasionally, and you’re not taking fish oil, you might want to reconsider. The studies on fish oil are hard to ignore.

Share this Post...

anxiety, anxious, cytokines, depression, DHA, EPA, fish oil, gut, gut-brain connections, healthy, inflammation, mood disorders, omega-3 supplements, Omega-3s, study

Belly fat, or visceral adipose tissue (VAT), is the fat that accumulates around the organs in the abdomen. It is strongly related to metabolic disorders including insulin resistance, fatty liver and inflammation. Because of the close proximity of belly fat to the intestines, and the ability of gut bacterial toxins to affect inflammation outside the gut, the relationship of increased intestinal permeability, or leaky gut, to increased abdominal fat has been investigated. 

Indeed, previous studies in animals and in people with illnesses like Crohn’s disease¹ and non-alcoholic fatty liver disease (NAFLD), have found a link between leaky gut and belly fat. Until recently, however, no studies had been done in healthy humans. Now the picture is all coming together nicely, as a new study highlights.

In 55 healthy women, intestinal permeability was estimated by measuring urinary excretion of ingested nonmetabolizable sucralose and mannitol. (They measure the ratio of excreted sucralose to mannitol—if the sucralose level is high, it means it leaked through the gut, even though it shouldn’t.) Further, imaging was performed of subcutaneous fat (fat just under the skin) visceral fat, and liver fat. The researchers found that increased leaky gut was associated with increases in both visceral fat and liver fat content in healthy women.² This is important because previous studies have found this in people with illnesses, but it was not known if leaky gut could was associated with belly fat in healthy individuals. Now we have a better picture of this gut connection.

The women in the study had no history of gut disorders, yet some of them still had leaky gut, and those with the worst leaky gut also had the most belly and liver fat. The researchers stated, “The current findings suggest that even without pathologically compromised gut function, intestinal permeability still appears to play a role in visceral adipose and liver fat accumulation.” Importantly, they go on to mention the role that the gut microbiota plays in this picture. Alterations in gut bacteria composition has been associated with metabolic dysfunction,³ and gut bacteria help regulate gut barrier function,⁴ they mention.

They conclude, “Our data suggests that intestinal permeability may be an important part of the link between diet, gut microbial balance, inflammation, and metabolic disorders. The present findings are consistent with the emerging role of gut in metabolic health.”

Abdominal fat has even been considered an organ of its own, due to the many chemicals and hormones it produces, just as organs do. The role of VAT as a contributor to metabolic diseases is possibly the most important factor to consider when trying to reduce disease risk. That the accumulation of this belly fat is related to the gut, and might even originate in the gut, takes our search into the prevention of diseases yet one more step closer to the source. A healthy gut is truly the foundation of total body health.

References

1. Desreumaux P, et al., “Inflammatory alterations in mesenteric adipose tissue in Crohn’s disease.” Gastroenterology. 1999 Jul;117(1):73-81.
2. Gummesson A, et al., “Intestinal Permeability Is Associated With Visceral Adiposity in Healthy Women.” Obesity (Silver Spring). 2011 Aug 18. [Epub ahead of print]
3. Cani PD and Delzenne NM, “The role of the gut microbiota in energy metabolism and metabolic disease.” Curr Pharm Des. 2009;15(13):1546-58.
4. Sharma R, et al., “Molecular modulation of intestinal epithelial barrier: contribution of microbiota.” J Biomed Biotechnol. 2010;2010:305879.

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...

abdomen, bacterial toxins, belly fat, chemicals, Crohn’s disease, diet, fat, fatty liver, gut, gut bacteria, gut bacteria function, gut connection, gut disorders, gut function, gut health, gut microbial balance, gut microbiota, healthy, hormones, inflammation, insulin resistance, intestinal permeability, intestines, leaky gut, liver fat, metabolic disorders, NAFLD, non-alcoholic Fatty Liver Disease, total-body health, VAT, visceral adipose tissue

I talk about probiotics a lot. I even have a PBS show on the topic—The Road to Perfect Health. I call your gut bacteria the Gut Protection System, or GPS. The word probiotics means, “for life.” Probiotics are defined as beneficial bacteria (sometimes yeast) that benefit the person taking them in some way. Many people relate probiotics to yogurt, because some yogurts contain probiotics. (Many don’t—if the probiotics aren’t added back in after pasteurization, there won’t be any probiotics in the yogurt due to high heat required during pasteurization. Plus, check the sugar levels in yogurt—yikes!)

Awareness of probiotics is increasing. In 2007, about 58 percent of people surveyed were aware probiotics might be good for the digestive system. In 2011 that percentage increased to 81 percent. People are starting to get it.

What about prebiotics? Prebiotics are non-digestible food ingredients that promote the growth of beneficial microorganisms (like probiotics) in the gut. They are essentially food for the beneficial gut bacteria—the fuel for the Gut Protection System, if you will. Prebiotics are often soluble fibers, like FOS (fructo-oligosaccharides) and acacia fiber.

If you think about it, soluble fibers escape digestion, arriving in the colon (large intestine) largely intact. Then, beneficial bacteria use the soluble fibers like food. A fermentation process occurs, yielding beneficial compounds like the short-chain fatty acid, butyrate, which fuels intestinal lining cells, and lactic acid, which lowers the colon pH to a healthy level.

Prebiotics and probiotics go hand-in-hand. When these two are found together, they are often called a “synbiotic,” highlighting their beneficial relationship. Studies show that the prebiotic FOS is particularly helpful in increasing levels of beneficial gut bacteria, while inhibiting an increase in harmful bacteria.

If you’re taking a prebiotic, be sure to take it with a probiotic to get the added benefit and to ensure you’re giving the “food” to the right kind of bacteria—the good kind.

Share this Post...

acacia fiber, beneficial bacteria, butyrate, digestion, digestive system, FOS, fructo-oligosaccharides, gut, Gut Protection System, harmful bacteria, healthy, intestinal lining, lactic acid, PBS, pH, prebiotics, Probiotics, short-chain fatty acid, soluble fibers, synbiotic, The Road to Perfect Health, Yeast, yogurt

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