Professional Documents
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Different strains of probiotic bacteria tend to have different effects on the body. For a
specific illness, you ideally want a probiotic containing a bacterial strain that has
shown effectiveness for that condition. A guide to probiotics for specific illnesses is
in Appendix 1. If there is a specific probiotic that can be taken, then the rest of this
document does not apply.
You can effectively divide probiotic products into two groups: the mild ones, as
commonly sold in supermarkets, and the “therapeutic” ones. The mild ones have a
very limited use, while the therapeutic ones generally aim to heal the gut.
A general therapeutic probiotic that is not targeted at a specific illness will often
contain around 10 or so different types of probiotic bacteria. Examples of general-
purpose therapeutic probiotics are Bio-Kult from the UK and Primal Defense from the
USA.
If you are using any probiotic – but in particular a “therapeutic” probiotic - then you
may well get a “die off” reaction.
In practice, a die-off reaction means that when taking a probiotic the usual symptoms
of an illnesses may well get worse for a time. In addition, odd health problems that
have never been seen before can occur. The following problems from probiotic use
have been reported:
depression
nausea
cough
teenage type pimples on the face
slightly blood-shot eyes
headache
swollen glands
bloating
constipation or diarrhoea
increased joint or muscle pain
elevated heart rate,
chills, cold extremities
itching, scratching, nail biting,
unusual perspiration
fever (usually low grade)
hypotension (low blood pressure),
Itching, hives and rash (sometimes assumed to be an allergic reaction)
In practice, any die off reaction is usually not severe. People vary a lot in how long
they are affected by this die-off effect, but in general it should be over within a couple
of weeks. Reducing the dosage of the probiotic - or starting off probiotic use at a dose
below the recommended level - may be helpful.
Be extremely careful about taking strong probiotics if you are very ill:
Although I do not think any complete explanation for these “excess deaths” has been
put forward, the Dutch researchers did not appear to have considered that a die-off
reaction could occur, and that in very ill people this immune-system overload might
prove fatal.
The mild probiotics - of the type you will typically find in a supermarket - do not
usually cause too much of a die-off reaction. The manufacturers of these probiotics
sometimes market them with a money-back guarantee “try it for two weeks and if you
don’t notice the difference we will give you your money back”. The manufacturers’
know that the bloating, wind and similar reactions that these supermarket probiotics
sometimes produce are usually over within two weeks. But if you do not continue
with the probiotic for the whole two-weeks – then you do not get your money back.
Probiotic Drinks
Probiotic drinks usually have additives in them to make them taste better, principally
sugar. As “bad” yeasts in particular tend to thrive on sugar, these drinks are arguably
counter-productive.
“Holly Marney and Camillo Fracassini, writing for the Sunday Times, claim that
some leading probiotic drinks contain up to 80% more sugar than cola. Such drinks
are often accompanied by health claims and are marketed as healthy products.
Four leading varieties of probiotic drinks were shown to contain concentrations of
sugar that exceeded the Food Standards Agency's benchmark for high sugar content
(above 10g per 100g). These were
• Yakult with 18g of sugar per 100g
• Danone Actimel multifruit 14.2g
• Muller Vitality Strawberry 12.6g
• Flora pro.activ raspberry 12.3g
Source: http://www.rssl.com/OurServices/FoodENews/Newsletter.aspx?ENewsletterID=129
Probiotic tablets and capsules on the other hand, do not normally contain sugar. They
also have a far longer-shelf life than the drinks, and many do not require refrigeration.
PROBIOTICS IN THE UK
In 2004 The Royal Free Hospital in London conducted tests on the supermarket-type
probiotics that are commonly found on sale in the UK. The results are summarized in
this article from the Saga website:
“Millions of us now buy supplements containing friendly bacteria. But are probiotics
really worth taking?
As marketing campaigns go, it's one of the most seductive: we all have nice, friendly
bacteria in our digestive systems, but stress, illness and bad diets kill them off and
allow the evil bacteria to thrive and make us ill.
So, the theory goes, by topping up our levels of friendly bacteria with a daily yoghurt
drink or probiotics supplement, we can keep the baddies at bay.
Probiotics in Britain are sold as food rather than drugs, enabling manufacturers to
claim general health benefits without having done rigorous clinical trials.
Most products - like the yoghurt drinks Yakult and Actimel, and the tablet Multibionta
- contain just one or two of the 400 bacteria species: Lactobacillus and
Bifidobacteria.
Some products don't even contain that: scientists at the Royal Free Hospital in
London tested 39 products against six criteria - including whether the bacteria were
able to reach the gut in sufficient numbers or whether they were killed off by stomach
acids on the way.
Only one, Multibionta, satisfied all six. Another 13 were satisfactory, and others
didn't work at all.
Many doctors are sniffy about probiotics, pointing out that when you take a dose of
lactobacillus, 99% are killed by the acid in your stomach before they even reach your
gut.
However, people have been eating live yoghurt as a digestive aid since biblical times.
The father of probiotics, Russian scientist Elie Metchnikoff, was intrigued by the fact
that so many Bulgarian peasants lived to be 100. In 1907 he concluded it was
because they ate so much yoghurt and began to do so himself, confidently expecting
to live to be 150. He managed 70.
Despite the shortage of proper, in-depth studies, there is some evidence that
probiotics can help people with gut disorders and inflammatory diseases.
Work at Dundee University with ulcerative colitis patients revealed that they had very
low levels of probiotics. They were given a specially formulated strain of bacteria,
and almost all noticed an effect.
However, in a round-up last October of all the trials so far, the Drug and
Therapeutics Bulletin could only conclude that they were inconclusive. Researchers
looked at ulcerative colitis, Crohn's disease, Clostridium difficile infection (a
common side effect of antibiotics, especially in the elderly) and Helicobacter pylori
infection, and found there was little evidence in favour of probiotics.
Although it's very early days, scientists in Israel in 2004 found that rats given
probiotics experienced fewer arthritis symptoms, and a Japanese study discovered
that patients taking Lactobacillus casei (the probiotic in some yoghurt drinks) were
less likely to develop colon cancer. Further trials are continuing.
"I've travelled a lot in Asia where people routinely take probiotics", says Dr Simon
Cutting, from Royal Holloway, University of London, "and I speak to people over
here with colitis and irritable bowel syndrome that use these supplements every day
and swear by them. But if I went to one of the research councils for a grant, they
would say it was snake oil and wouldn't be interested."
"I never would have believed it myself until I did a trial on chickens and yes,
probiotics absolutely do prevent infections. We've just got an awful lot more to find
out."
Only one, the tablet Multibionta, satisfied all six. Thirteen other products rated
satisfactory:
Source: http://www.saga.co.uk/health/healthyliving/medicinesandsupplements/Probiotics.asp
“A new consumer test report [2006] finds that many probiotic products do not
contain the stated number of viable "friendly bacteria".
Probiotic bacteria have become a prime medical research target over the past decade
and consumer awareness of their benefits has followed closely behind. The so called
"friendly bacteria" have been successfully used in a range of clinical applications
that include reducing symptoms of irritable bowel syndrome (IBS), treating H. pylori
infection (the bacteria that causes stomach ulcers), and treating diarrhea associated
with antibiotic use and Clostridium difficile infection. Probiotic supplements have
also been shown to reduce allergic reactions, and most recently, to have painkilling
actions in the gut.
The ConsumerLab.com investigation tested probiotics for both human, and animal
use. We'll focus on the human targetted products here. Of the 13 tested, only 8 passed
the tests.
ConsumerLab chose thirteen probiotic products for human consumption sold in the
U.S. and/or Canada. The products included offerings from some of the biggest brand
names in nutritional supplements, and probiotics in particular, including Enzymatic
Therapy, Jarrow Formula's, Allergy Research Group/ Nutricology (Culturelle),
Wakunaga (Kyo-Dophilus), Nature's way, Flora Source, and Garden of Life (Primal
Defense).
The test results showed that four of these products provided less than one billion
viable organisms in a daily serving. This is well below the 5-10 billion CFU's (colony
forming units) used in the majority of clinical studies and generally recommended by
physicians. Some studies have even used products that use hundreds of billions of
viable organisms. Shockingly, one of these four products, a major pharmacy brand,
provided only a few hundred million viable organisms, well below the levels
generally thought to provide any meaningful benefits. A fifth product met the widely
accepted minimum effective level of 1 billion CFU's, but this was well below what the
manufacturer claimed was in the product on labels and promotional materials. Only
eight products were found to meet the one billion minimum and contain the amounts
claimed on their labels. An additional six products tested through ConsumerLab's
Voluntary Certification Program also met these criteria. Some products provided
several billion organisms per day, with one containing 35 billion.
This report highlights the variability in the quality of probiotic products and the need
for consumers (and medical professionals) to choose a product very carefully.
Gut health issues are a major concern for environmental illness sufferers so this is an
important issue. Gut infections with bacteria, yeasts, and parasites have been
demonstarted to be contributing factors to these illnesses, with a solid evidence base
for the role of small intestinal bacterial overgrowth (SIBO) in irritable bowel
syndrome (IBS) and fibromyalgia, for example. Probiotic products have been
demonstrated to be effective in treating symptoms associated with these conditions in
clinical studies.
When selecting a product to take then, it is important to make sure you are actually
getting enough of the right kind of bacteria. This is one area where it is best to pay
for the premium, professional quality, products that physicians tend to recommend.
You are far more likely to get the number of viable organisms that is claimed on the
label, and these amounts are more likely to be closer to what has been found effective
in clinical trials. Of course, if you have the time it is also wise to research products
used in clinical trials on for yourself on the internet or elsewhere. If a product has
been found effective in a clinical trial, or even better, multiple trials, then you can be
sure you will be getting what you pay for. It is generally advisible to avoid the
bargain basement products sold in pharmacy chains and certain health food chains.
There are also a number of measures you can take ensure you don't damage the
product after you have puchased it. Always read the label and follow storage
instructions for example.
Source: http://www.ei-resource.org/news/candida-&-gut-dysbiosis-news/popularity-of-probiotics-
growing-but-viable-bacteria-are-lacking-in-some-supplements/
The results of the ConsumerLabs tests are available only to those that take out a
subscription. However this document from the American Academy Of Pediatrics
effectively names the probiotics that passed the 2006 ConsumerLabs tests. But note
that there has been no change to the AAP’s list of recommend probiotics since 2006 –
which may imply that they are not keeping up with more recent research.
PROBIOTIC SUPPLEMENTS
Probiotics are healthy bacteria that normally live in our GI tract. They help maintain healthy gut and
immune function. These products have met quality tests by ConsumerLabs (www.consumerlab.com)
or are recommended by our GI doctors.*
Source: http://www.aap.org/sections/chim/PROBIOTICSUPPLEMENTS.doc
PROBIOTICS IN EUROPE
European probiotics seem to have the same issues with quality and viability as in the
UK and USA. Austrian research conducted in 2007 tested six probiotics to see if they
survived passage through the gastrointestinal tract:
Those that did were - in order of effectiveness - Mutaflor, Bioflorin and Infloran.
The products that did not were - Antibiophilus, Omniflora and Actimel.
Source: http://www.ncbi.nlm.nih.gov/pubmed/17721765
PREbiotics
There is still controversy over whether commercial prebiotics may be feeding some of
the “bad” bacterial species in the gut as well as the “good” ones.
Natural prebiotic substances exist in plant-life and elsewhere. It is interesting to note
that many of the plants and so on that have prebiotic properties – such as garlic - have
been regarded as “health foods” for many centuries.
Prebiotics have been a key feature of the human diet for aeons, as research has
detailed.
The prebiotic Inulin can be found in products like Fibresure, where it is described as
“dietary fibre” rather than the more-accurate “prebiotic”.
GOS and FOS are harder to find in pure form. FOS, due to its sweetness, is being
increasingly incorporated into food and drink products aiming to market themselves
as “healthy”. Personally, of all the prebiotics available, I have rather more doubts
about the use of FOS than any other.
A note of caution on self-dosing with pure prebiotic substances: I have read anecdotal
reports of gut-obstruction problems suddenly occurring in a few people when they
have started to use prebiotics. Therefore if you are taking a raw prebiotic substance it
would be wise to start from a very low dose before increasing the amount gradually.
Prof. Glenn Gibson is one of the researchers who originally coined the phrase
“prebiotic”. He has been actively involved in the development of a prebiotic based on
a form of GOS, sold in the UK as Bimuno. Bimuno claims to be a "second-
generation” prebiotic as it “can prevent bad bacteria adhering to the gut wall”. As this
product is quite modestly priced, it is one I would recommend if you want to use a
prebiotic.
Some information on Bimuno can be found here: “Second generation prebiotics get
clinical trial support.”
Gary Tivendale
Gary.Tivendale @ gmail.com
APPENDIX 1
Source: Article: The Wall Street Journal “Bug Crazy: Assessing The Benefits of
Probiotics” By Laura Johannes, January 13th, 2009
http://online.wsj.com/article/SB123180831081775767.html
Probiotic Products Proven in Human Trials (mainly products
from the USA, or widely available in the USA)