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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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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It is well known that probiotics are beneficial for the digestive tract. Indeed, these beneficial gut bacteria outnumber cells in the body (and their genes GREATLY outnumber our own genes).

Scientists have taken the research of probiotics beyond the gut lately, finding that their effects are far reaching. A recent study in pregnant women found that daily administration of two probiotic strains—Lactobacillus rhamnosus and Bifidobacterium lactis—along with dietary counseling during the first trimester of pregnancy resulted in reduced waist circumferences six months after giving birth.

Three groups were involved; one taking probiotics along with counseling, one taking a placebo along with counseling, and one taking a placebo without counseling. The probiotic + counseling group had the lowest percentage of women with waists measuring over 31.5 inches at the end of the study.

It has long been known that probiotics are beneficial during pregnancy, both for mom and baby, and studies continue to support their many advantages.  I recently talked about probiotics protecting against development of gestational diabetes.

Research of probiotics and metabolic outcomes like abdominal fat and weight loss is relatively new. With obesity rates at an all-time high, going back to the gut in order to build a strong foundation of health is essential. Whether pregnant or not, when our guts are out of balance, the rest of the body suffers. Begin with balancing the gut, and good health for the rest of the body will follow.

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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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Probiotics are well known for their beneficial effects on the gut. After all, that’s where they thrive. But these beneficial bacteria have far-reaching effects that you wouldn’t think had anything to do with the digestive tract. One of the main reasons for this is due to the fact that immune system that resides in the gut, in the gut-associated lymphoid tissue (GALT). These beneficial gut bacteria “communicate,” in a sense, with the immune system. When there is a healthy balance of good bacteria, the immune system responds properly. When there is an imbalance, the immune system might miss the message altogether. Then the sniffles begin.

A recent study found that daily consumption of the probiotic strains Lactobacillus plantarum and Lactobacillus paracasei helped protect study participants against the common cold, as well as reduced symptoms for those who contracted colds. Just more proof that the gut is connected to other systems of the body. Our gut health is truly at the heart of our total-body health. Studies like these support the “gut instincts” I’ve had for a long time. So next time you reach for a tissue, reach for some probiotics, too.

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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.

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Notable News – A few months back a study came out that found that the two most common (not to mention the most important!) types of healthy gut bacteria—Bifidobacteria and Lactobacilli—were decreased in people on a gluten-free diet. My first thought was, “Oh great, now everyone is going to think the gluten-free diet is bad for you.” Not true!

The main difference between the gluten-free diet and the ‘normal’ diet in this study was the polysaccharide content (polysaccharides are just complex carbohydrates made of long chains of simple sugars). The gluten-free diet was lower in polysaccharides, which makes sense since polysaccharides often have a prebiotic effect. That means they nourish the good bacteria, or probiotics, and help them multiply, so a diet lower in polysaccharides might mean a decrease in the good bacteria that rely on them for food. But… THIS DOES NOT MEAN THAT YOU SHOULD AVOID THE GLUTEN-FREE DIET! 

The gluten-free diet is essential for people who are gluten-sensitive or have a gluten allergy. And today more and more people are discovering that they’re sensitive to gluten and feel better on a gluten-free diet. So what should you do if you’re on a gluten-free diet but worried about a change in your gut bacteria? That’s easy—probiotics!

I can’t say enough about how important probiotics are. Not only do they help balance the good and bad bacteria in our intestines to help with digestion and immunity, but they also help to strengthen the protective intestinal lining, which can become damaged due to inflammation in people who are gluten-sensitive (including those with celiac disease).

So as the old saying goes, don’t throw the baby out with the bath water! The gluten-free diet has helped so many people—the key is simply staying informed about the best ways to maximize your health when avoiding gluten.

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Colic in babies is one of those conditions that the medical community cannot seem to figure out. Colic occurs in up to 28% of infants. Babies with colic cry for hours, unconsolable, sometimes every day. The cause of colic is unknown and the treatment of colic is uncertain. So many infants suffer from colic and parents are at a loss for how to deal with it. A colicky baby can be quite a handful for new parents who may not feel equipped or emotionally able to handle the situation, especially when doctors don’t provide many answers.

A new study from the University of Texas Health Science Center has found that babies with colic are more likely to have higher amounts of gut inflammation and a bacteria called Klebsiella in their intestines. They also found that the babies who did not have colic had a greater diversity of bacteria in their guts. The lead researcher also suggested that colic may prove to be a precursor to other conditions such as irritable bowel syndrome, celiac disease and other gut allergies.

This study is exciting because the next step, researchers say, is to investigate the use of a probiotic to control gut inflammation in these babies. Now they are on to something.

The establishment of healthy gut bacteria, in a vaginally born baby, begins at birth. It then continues during breastfeeding and through contact with the outside world. Many factors can inhibit this process leaving the infant with less-than-optimal gut flora. In many ways these beneficial bacteria act as a partial immune system for the infant. The importance of establishing a healthy and diverse bacterial population in those little guts is vitally important, as this study has pointed out. Renew Life’s Flora Baby was developed specifically for babies and toddlers. It contains five strains of Lactobacillus and Bifidobacteria and comes in a powder that can be mixed with liquid.

Learn the ABC’s of Probiotics.

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