Title: Probiotics and Various States of Diarrhea
1Probiotics and Various States of Diarrhea
- By Lindsay Clapp-Hansen
- Medical Nutrition Therapy
- November 25, 2002
2Probiotics
- Microbes found in the food supply that enhance
human health. - Criteria bacteria of human origin, able to
adhere to the intestinal mucosa, have potential
to colonize in the GI tract, can produce
antimicrobial substances, stable against bile,
HCl, and other acids, enzymes, and oxygen, and
determined to be safe and effective.
3Altered Disease States
- Probiotics have been thought to improve or
ameliorate a plethora of states, the most
commonly reported upon are -
- Various states of diarrhea
- Inflammatory Bowel Disease
- H. Pylori Ulcers
- Urinary Tract Infections
- Vaginal Candida Overgrowth
- Cancer of the Gastrointestinal (GI) Tract
4What has Scientifically BasedResearch to Support
the Claims?
- After reviewing a majority of the research and
literature relative to probiotic use in humans,
it is clear that diarrhea is the condition most
beneficially treated by probiotic therapy. This
can include diarrhea associated with antibiotics,
travel, gastroenteritis, lactose intolerance, and
Inflammatory Bowel Disease. These areas were
reviewed. -
5Diarrhea Described
- Diarrhea is frequent loose stools, along with an
excessive loss of fluid and electrolytes (K Na
especially), abdominal cramping, pain, and often
presence of a fever. - It can be acute or chronic, and is secondary to
an underlying disease or condition or pathogenic
bacteria within the GI tract.
6Types of Diarrhea
- Osmotica result of poorly absorbed nutrients
that enter into the large intestine gt a
solute-related osmotic shift - Secretoryusually a result of bacterial or viral
infections, which causes excessive secretion of
electrolytes and water by the intestinal
epithelium - Exudative mucosal damage combined with a build
up of blood, mucous, and plasma proteins in the
colon - Limited Contact Mucosalcaused by insufficient
blending of chyme and decreased exposure to the
intestinal epithelium
7Antibiotic Associated Diarrhea
- This is the most well studied area of probiotics,
because antibiotic associated diarrhea is evident
in 20 of all people on antibiotic therapy which
provides a good sample. - Cause- by the antibiotic therapy destroying the
normal, health-promoting gut flora as well as the
pathogenic bacteria. - Result- the healthy bacteria that usually
protects the GALT and the intestinal epithelium
is not there, this enables pathogenic bacteria to
bind to the available receptors
8How Probiotics Aide in Decreased
Antibiotic-Associated Diarrhea
- The probiotics promote increase production of the
synergistic bacteria, thus increasing the
quantity in the intestine decreasing the number
of available receptor sites
9Antibiotics Probiotics Tested
- In 1989 the largest study on antibiotic-associated
diarrhea and probiotic intervention was
completed. This spurned more interest in the
area. - Prospective, double-blind, placebo-controlled
trial - N 180 hospital patients on antibiotics
- Experimental Received S. boulardii in
conjunction with antibiotics. - Results There was a 13 decrease in overall
diarrhea symptoms when comparing the experimental
to the control.
101999 Quantified Study Released
- A study using clear dosage levels was published
in 1999. It examined 119 children (2wks-12.8
yrs) on antibiotics. Half were given a placebo
and half a 2 1010 colony forming units of
Lactobacillus GG twice a day. This was examined
over a three month period. During this time
careful stool frequency and consistency logs were
maintained by the parents of subjects.
11Results
- There was a 11 decrease of diarrhea in the
initial two weeks of probiotic therapy when
comparing the experimental group to control. - By the third week, there was a 30 decrease
difference between the two groups.
12Confounds
- The study in 1989 was lacking in clearly
quantifiable values of probiotic dose. - The study that was completed in 1999 was a break
through because there were standardized amounts
of probiotics given. However, the age range of
children does not enable a clear dose per weight
determination to be made. - In all of the studies reviewed concerning
antibiotic-related diarrhea, there were one or
more of the following confounds lack of
specific detail of amount and consistency of
diarrhea and the quantity and viability of the
probiotic strains administered. There leaves much
to be researched.
13Conclusion for Antibiotic Associated Diarrhea
- There is a basis to believe that probiotics,
through competitive exclusion by the enhancement
of intestinal micro flora, are able to lessen the
frequency and duration of diarrhea. - More needs to be done in order to create
clinically applicable recommendations.
14Travelers Diarrhea
- It has been estimated that 20-50 of all people
who travel are struck by diarrhea. The frequency
and duration is associated with the destination
and location of the traveler. - Cause it is presently unknown, but believed to
be due to a change in ingested microbial content
and stress. Pathogenic E. coli is usually
protagonist. - Result unknown, however results in diarrhea.
15Tested Probiotic Affect on Travelers Diarrhea
- In 1993, a study was conducted that stated 47 of
Americans traveling to Mexico were able to avoid
Travelers diarrhea when a prophylactic dosage of
Lactobacillus GG was administered daily. - This study was one of many, but is in accordance
with the majority of published studies.
16Traveler's Diarrhea Continued
- Other trials conducted showed a HUGE range from
gt50 reduction with the supplementation of
probiotics to none at all. - However, in all of the studies that compared
various ages, the outcome showed diminished
diarrhea within the elderly population when
taking a probiotic supplement. This shows that
overall GALT and immune function are related to
how a person will respond to microbes. This
calls for studies to be conducted on the elderly
to determine if probiotics could diminish nursing
home GI-related distress.
17Infectious Diarrhea
- Infectious diarrhea can be induced by any
pathogenic virus or bacteria. Rotaviral diarrhea
will be covered here. - Rotavirus attacks the GI tracts of newborns and
infants, and because of this it can be well
isolated and studied in relation to probiotic
dosing. - Rotavirus induces biphasic diarrhea, initially
osmotic and then secretory.
18What Probiotics Do to Combat Rotaviral Diarrhea
- Stabilize the intestinal micro flora thats been
altered by rotavirus (through reproduction
promotion) - The above results in reduced gut permeability,
which lowers the rate rotavirus can bind to the
GALT and cause gastroenteritis - Probiotics reduce the length of time rotavirus in
the intestine (due to competitive exclusion) - Probiotics increase the amount of IgA that the
body produces to fight infection.
19Key Study Rotavirus Probiotics
- In 1997, a prospective, randomized,
placebo-controlled trail was carried out to
determine how Lactobacillus reuteri affected
rotavirus. - Children between the ages of 6-36 months were
brought into the study post admit for
rotaviral-associated diarrhea - There were three groups placebo, 1 dose of 1010
cfu, and 1 dose of 107 cfu. The treatment was
given once daily for five days.
20Results for Rotaviral Study
- Results showed that the duration of diarrhea in
the placebo group was 2.5 days in length as
compared to 1.9 days with the 107 dose, and 1.5
with the 1010 dose. - Additionally, stool cultures show that there was
significant probiotic colonization in the GI
tract in both test groups. - This study, as well as others, shows that there
is a clear correlation between oral
administration of a probiotic strain and
diminished rotaviral diarrhea. - More must be researched to establish a clinically
meaningful therapy.
21Lactose Intolerance
- Lactose intolerance presents in 70-100 of adults
worldwide. - Probiotics function as a lactase isomer. When
probiotics deteriorate, they produce
B-D-galactosidase from the cell wall. This is an
isomer of lactase which then destroys ingested
lactose.
22B-D-Galactosidase
- In order for the B-D-galactosidase to appear in
the GI tract, the probiotic must be ingested in a
viable state, and then breakdown. - This means that frozen yogurt and pasteurized
yogurt are not as effective as fresh yogurt,
because they do not produce the
B-D-Galactosidase.
23Yogurt Conundrum
- So why is pasteurized yogurt tolerated?
- One study states that is it the decreased
intestinal transit time, which means that the
lactose spends less time as an undigested
molecule within the large intestine. If the
lactase were to spend a longer period of time in
the large intestine, fermentation and osmotic
diarrhea would result. - Other studies state that pasteurized yogurt
causes a delay in gastric emptying and orocecal
transit time, because the probiotics and organic
acids they produce result in a lower osmotic load.
24So now what?
- There must be more research on how non-viable
(aka pasteurized) probiotics alter the lactose
intolerants GI tract that makes the person able
to consume lactose-containing yogurt. - Over and over again the B-D-galactosidase has
been seen to break down lactose, so non-heat
treated yogurt is acceptable. - Overall, the viable probiotics have been seen to
have a positive effect on lactose intolerant
consumption of dairy. Additionally, there is
some manner in which non-viable microbes are
aiding in the acceptability of lactose in the
intolerant individual.
25Inflammatory Bowel Syndrome
- IBD includes both Crohns and ulcerative colitis.
The cause of these disease states are unknown,
but it is believed to be due to genetics and
immunlogic deficiencies. These disease states
present when there is an imbalance in the gut
micro flora. - The current method of treating IDB flare ups is
with antibiotics.
26- In 1997, a double-blind study was conducted that
examined a probiotic (non-pathogenic E. coli) and
an antibiotic (mesalazine). - The study included 120 adults, with inactive
colitis. They were divided into the two test
groups. Over a three moth period, they were asked
to assess the frequency, intensity, and an
overall health assessment. - Results The results were not clinically
significant, the E. coli group had a 16 rate of
controlled flare up, where as the mesalazine had
an 11 rate.
27Not Clinically Significant, but Still Significant
- Although the 11 vs. 16 is not clinically
different, this shows that the probiotic was
nearly as effective as the antibiotic. - Because IBD patients are immunosuppressed, the
reduction in antibiotic associated diarrhea would
improve the overall quality of life. - By taking the probiotic therapy instead of the
antibiotic, there would be commensal bacterial
growth within the intestine, which would act as a
barrier against ingested pathogens and promote
the production of IgA immune response within the
gut
28IBD Probiotics
- Although it seems that probiotics could at some
point be an alternative therapy for IBD, it is
not possible now, because standardized doses must
be determined. More research must be done to
determine if antibiotic-associated diarrhea in
the IBD patient can be significantly reduced. - After reviewing the literature, the consensus is
that probiotics as a supplement are not altering
IBD significantly.
29Probiotic Research Overall
- The studies that have been completed are limiting
because there are not standardized amounts, there
is a large variation in the strain used for
experimentation, the viability of the microbes
are not tested pre-experimentation. - More must be done so that this potentially
beneficial supplement can be used in practice
30Conclusion
- Probiotics are able to decrease the
length/incidence of antibiotic-induced diarrhea
through competitive exclusion. - Probiotics were seen to decrease the severity and
length of travelers diarrhea, especially among
the elderly. - Rotaviral-associated diarrhea cases were
positively altered when oral probiotics were
administered.
31Conclusion
- Lactose intolerance and probiotics is still
controversial. Viable probiotics clearly have a
positive function. Pasteurized probiotics are an
unknown area at present. - IBD is likely not significantly altered through
probiotic supplementation, however probiotics
could potentially be used instead of antibiotics
to control flare-ups, which may decrease the
incidence of antibiotic-associated diarrhea.
32Areas of Research
- The correlation between probiotic therapy and
increased production of IgA. - Determining the best strains and the quantities
that are needed to support intestinal health
promotion. - Research that has minimal confounds so that it
will be honored by the scientific community.