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The Mother of All Probiotic Articles

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The fact that there is research on probiotics playing a role in health should come as no surprise to anyone except for the average pediatrician.  But this article goes WAY beyond anything I’ve touched on before.

While this particular article is more of a review on the varied concepts of how the bacteria in our gut play a role in your health and disease, I felt this article was too important not to include as a blog article.  Rather than a single concept, I will excerpt some of the points in this article with some brief commentary.

What I really like the most, however, about this article, is that it reinforces aspects I have been writing about for almost 15 years now.  As much as I hate to point out when I’m right, I’m still sharing this info with you.

Concept 1

The human genome consists of around 23,000 different genes.  Scientists have raised concerns over the years that this small number of genes does not code for enough unique proteins to account for the massive diversity in the way our bodies work and look.  Enter the bacteria in your gut, collectively making up some 3.3 MILLION genes, responsible to hundreds of thousands of different chemical reactions and proteins produced.  It is entirely possible that the bacteria in your gut is a large part of what makes your body do what it is supposed to do.

Let this sink in as you consider that things like antibiotics, stress, anti-inflammatories, poor quality diets and Splenda (YES—Splenda / sucralose—that evil chemical compound that everyone seems to think is ok) all alter the bacterial composition of your gut.  And most often not in a friendly way.

The products that these bacteria can make such as proteins, carbohydrates and other molecules, can leave the gut and have effects elsewhere in your body.  This is one of ways that gut bacteria can play a role in brain health, depression, anxiety and obesity.

Concept 2

The commensal bacteria in your gut (the ones that benefit us as much as we benefit them) provide certain nutrients to your body (like B12 and short chain fatty acids), breakdown indigestible compounds and protect against invasion from nasty bacteria that cause diseases.

The last point is particularly important.  When you have the right blend of bacteria in your body, whether in the back of the throat, the stomach, the vaginal vault or the gut, they keep bad buggers from taking up residence.  The evidence for this is strong—ear infections from staph or strep, yeast / candida, H. pylori and C. diff are just a few of the examples.  Keep this in mind the next time your pediatrician wants to give your child antibiotics for anything non-life threatening.  That antibiotic will likely increase the risk of future infections.

Concept 3

70% of the immune cells of your body at any given point are in the intestines.  However, many of these immune cells will leave the gut and travel to other areas of the body.  Startling, these immune cells (many T-cells) are programmed in the gut.  In other words, if they are programmed by the gut bacteria to have anti-inflammatory actions, they will carry this function out to the rest of the body.  Likewise with a pro-inflammatory immune cell.

This means that the bacteria in your gut are the principal drivers of your immune system.  The wrong blend of bacteria can set you up for a nightmare of immune dysregulation, from frequent infections to autoimmune disorders.

Concept 4

By the time your child has reached 2 years of age, his or her bacterial composition in the gut more closely resembles an adult.  It had been believed that this remained stable throughout life, but it is now understood that there are periods in the lifecycle where the bacteria in your gut goes through significant changes.  This includes puberty and lactation.

I have always maintained that the first two years of your child’s life is one of the most critical for healthy development of the immune system, and this supports what I have promoted.  I have frequently stated that antibiotics given to infants and toddlers is one of the most destructive things you can do to his or her long-term health.   Despite this, some 90% of children have antibiotics by the age of 2.

Concept 5

Celiac disease, aka gluten sensitivity, has a genetic component, and yet less than 10% of those who are susceptible will go on to develop celiac disease despite exposure to gluten, and many times the condition develops many years after the first exposure.  The answer may lie in the gut.  In a small study comparing infants who were predisposed to celiac disease  to those who were not, it was seen that the bacteria in the gut of the susceptible infants developed more slowly than the non-susceptible infants.  In addition, infants exposed to gluten at 6 months were more likely to have antibodies to gluten than infants exposed after 12 months.

I have always maintained that the later infants are exposed to grains, the better off they will be.  Unfortunately, I am usually fighting against pediatricians who say that 4 months is fine, especially if it will help the child stay full longer and sleep longer.  By caving into this belief, you may be setting your child up for future immune imbalances over his or her lifetime.

Concept 6

This one was jaw dropping for me.  We have always known that C-section babies have a different blend of bacteria in the gut, which may account for the increased risk of allergies and asthma.  Turns out, this is not entirely accurate.  PLANNED C-sections lead to altered gut flora, but non-elective C-sections do not.  Something about labor triggers a change in the mom’s system, leading to the microbial transition of bacteria from the gut into breast milk.

What a concept!  In other words, that same hormonal trigger that induces labor also allows bacteria to show up in breast milk, ensuring that the nursing baby is going to get the right blend of bacteria to colonize the brand new GI tract.  I have often told moms who had C-sections that nursing can help counterbalance the negative effects of the C-section.  Turns out I’m going to need to modify that statement in the future.

Concept 7

The gut bacteria can be negatively impacted by chemicals we are exposed to.  Antibiotics are a given, but studies have shown that antibiotics disrupt to stability and diversity of the gut bacteria so much that, even FOUR YEARS LATER, it has not recovered.  This means that any prescription for antibiotics, if not followed up with probiotics, destroys the gut.  Period.  How many prescriptions have been filled and used without a recommendation for probiotics after?  Millions?  More?

In addition, in mice studies, as little as two days’ worth of exposure to polychlorinated biphenols (PCBs–common chemicals in society usually from manufacturing) let to alterations in gut bacteria as well.  I would not be surprised to find that BPA in plastic water bottles, Teflon in non-stick cookware and pesticides on our fruits and vegetables do the same.

Overall, do we need to have a discussion any longer about why a healthy bacterial flora is important?  It goes so far beyond merely helping diarrhea or constipation.  Until physicians begin to grasp the importance of the bacteria in our guts (after some 100+ years in the medical literature) we will continue to destroy the delicate balance that contributes to health.

Frequency of triggering bacteria in patients with reactive arthritis – (04-09-01)

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Frequency of triggering bacteria in patients with reactive arthritis

The well known fact that certain organisms infecting the GI tract can cause systemic arthritic symptoms becomes lost on most clinicians when they consider such conditions as fibromyalgia and many of the autoimmune disorders causing joint pain. In talking with a gastroenterologist and a rheumatologist that I know, they would never entertain the idea that the GI tract could be a source of joint pain unless the “well know” organisms are present. Maybe that’s why we’re missing the boat on chronic pain in civilized health systems…

Ann Rheum Dis — Abstracts: Fendler et al. 60 (4): 337

Read entire article here

M. avium subsp. paratuberculosis as one cause of Crohn’s disease – (03-01-01)

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M. avium subsp. paratuberculosis as one cause of Crohn’s disease

Crohn’s disease has the potential to be a devastating autoimmune disorder where the body attacks its own GI tract. Like many other chronic diseases, much emphasis has been placed on finding an ineffective etiology to the onset of this disease. This overall supports this ineffective cause, and ties it very nicely to multiple causes of the disease. The interesting thing about functional medicine is that many of the therapies are similar–achieving optimal health is achieving optimal health, regardless of the cause that got the patient sick in the first place.

Synergy Abstract

Read entire article here

SHUTTING DOWN ACID PRODUCTION LEADS TO VARIOUS CANCER RISKS – (11-30-03)

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Lifespan Prolonged in Autoimmune-Prone Mice Fed Diet with Indole-3-Carbinol

This study brings up an important factor of one of today’s common medical practices. Indole-3-carbinol has been shown to lower risk of cancer by affecting the 2/16 hydroxylation ratio of estrogen at a genetic level.

This study adds the benefit of potential modulation of autoimmune conditions as well. I3C is found in cruciferous veggies such as broccoli, brussel sprouts and cauliflower. The catch? I3C is not the active form–it must be converted to diindolmethane by stomach acid. Might our obsession with shutting down acid production lead to increased rates of certain types of cancer?

nutrition.org — Abstracts: Auborn et al. 133 (11): 3610.

Read entire article here

SELENIUM ASSOCIATED WITH CHEMOPREVENTION – (11-21-04)

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The Link between Selenium and Chemoprevention: A Case for Selenoproteins

I know I covered this article in the last Updates, but just the other day I had a patient come in who had had Hashimoto’s thyroiditis–an autoimmune condition where the body attacks its own thyroid gland–and underwent typical medical treatment which is to get rid of the thyroid via surgery or radioactive ablation. Kind of like if you had gang members shooting little old ladies–just pack up all the old ladies and take them to south Florida. The problem here is that a large chunk of patients with autoimmune thyroiditis may have their symptoms caused by either low selenium or an allergy to gluten containing grains.

This article illustrates one of the major shortcomings of mainstream medicine’s approach to disease. Destroy or cover up the symptom while allowing the underlying process that created it to continue. So, if this patient is deficient in selenium, this current article would also suggest that she has a reduced ability to fight off cancer. Do you think this was including in the surgeon’s informed consent to the patient?

The Link between Selenium and Chemoprevention: A Case for Selenoproteins — Diwadkar-Navsariwala and Diamond 134 (11): 2899 -..

Read entire article here

ABILITY OF GALT IN GUT REGULATES ENTIRE IMMUNE SYSTEM – (09-01-03)

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Normal intestinal microbiota in aetiopathogenesis of rheumatoid arthrits

There has been much theory in the past about an infectious etiology for RA and this article further supports the idea that an improper response to bacteria may be responsible for the onset of RA. Remember that the gut has the ability to regulate the entire immune system via the GALT (gut activated lymphoid tissue). If there is something in the GI tract that the GALT does not like, it can send a signal out to the rest of the immune system to up-regulate, thereby opening up a Pandora’s box of potential autoimmune problems.

Ann Rheum Dis — Abstracts: Toivanen 62 (9): 807

Read entire article here

ROLE OF DENDRITIC CELL IN INTESTINAL INFLAMMATION WITH GUT BACTERIA – (10-01-03)

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The dendritic cell: its role in intestinal inflammation & relationship with gut bacteria

Frequent readers of the Updates will not be surprised at this information. However, the idea that the gut controls inflammation (usually too much such as in autoimmune conditions) has never taken hold in clinician’s offices. The use of probiotics, very simple, cheap and safe, is still limited to recommendations to eat yogurt after antibiotic use. We need to understand the the balance of the bacteria in the gut can have a huge impact on our overall health, and take this in context with every decision to pull out the script pad and write for antibiotics.

Gut — Abstracts: Stagg et al. 52 (10): 1522

Read entire article here

Eosinophilic Esophagitis Treatment with the Esophagitis Diet

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Say that 3 times fast…Eosinophilic Esophagitis Treatment with an Esophagitis Diet. This autoimmune condition has been on the rise, especially in children.

Overall, most autoimmune disorders, especially those tied to the gut (think Crohn’s disease, ulcerative colitis and eosinophilic esophagitis) have been on the increase.  The scare thing is that this rise has been playing out in children more so than adults.  I have no doubt that our sterile “hygienic” lifestyles are to blame.  The combination of antibiotics and vaccinations to try to wipe out every possible communicable disease, coupled with antibacterial wipes, lotions, facial tissues and toilet paper (ok..maybe not toilet paper, but only because they couldn’t find a good market for it…), has left our immune systems dysfunctional.

Another strong player in the autoimmune circuit is food allergies.  Actually, let me correct that.  When I think of allergies, I think anaphylactic shock from peanuts, skin prick testing and allergy shots.  What seems to play a larger role is food sensitivity.  Allergies are hard-wired into our immune system, but sensitivites come and go based on the overall health of the individual.

Eat a food you’re sensitive to day in and day out for years and you’re systems not going to be very happy with you.  Avoid that food for several weeks and your immune system begins to calm back down.

So how do we determine if we are sensitive to a food?  I can tell you that I’m not a big fan of skin scratch testing or even bloodwork such as a RAST panel.  Blood allergy testing can get very expensive (it’s easy to rack up a $1,000 bill).

I prefer elimination diets.  Approximate cost?  $0.  Accuracy?  Pretty darn high if done correctly.  High enough to be considered the gold standard for allergies and sensitivities.

Basically, in an elimination diet, you avoid all commonly sensitive foods (principally dairy, wheat, eggs, corn and soy) for 2 weeks.  If you begin to feel better in this time period (based on whatever symptoms caused you to try the elimination diet in the first place), you reintroduce one of these foods at a single point and check for symptoms to return within a few days.

This is considered elimination with subsequent food challenge.

So what does this have to do with the tongue twisting eosinophilic esophagitis? 

Researchers have already determined that food allergies play a huge role in flare ups and symptoms of esophagitis in children.  I remember writing a blog on the relationship between celiac disease and reflux esophagitis in March of 2003, almost a decade ago.  This is not new news.

So, since the relationship between food allergies in children is well established, someone decided to ask if the same relationship was present in adults.  What brilliant thinking from the researchers, because most GI docs don’t make too many recommendations on food elimination diets.

In this particular study looking at food elimination diets in adult with eosinophilic esophagitis, the results were nothing short of shocking:

  • Common symptoms of EoE included dysphagia (96%), food impaction (74%), and heartburn (94%)
  • The number of eosinphils (white blood cells related to allergy) dropped 76% with the diet
  • Symptom scores decreased in 94% of those on the program (yes–you read that right–94%, as in “almost all”)
  • After food reintroduction, eosinophil counts returned to pretreatment values
  • Foods most problematic were wheat (60%) and milk (50%), soy (10%), nuts (10%), and egg (5%)
  • Skin-prick testing predicted only 13% of foods (in other words, just short of worthless)

Realise that NONE of the patients in this study realized that they had food allergies / sensitivities prior the program.  Which also means that their gastroenterologists likely never brought the subject up.

Remember that 94% of patients complained of heartburn, despite being put on acid suppressive drugs like Nexium or Prilosec.  This means that ACID WAS NOT THE PROBLEM.

Did I mention that acid was not what was causing the reflux symptoms in these patients?

So, by giving acid suppressive drugs, not only did their physicians completely disrupt healthy digestion, but they did not address the real problem.  These food allergies, left to run rampant for decades create the chronic inflammation associated with other diseases such as osteoporosis, dementia, cancer, heart disease and stroke.

So, if you deal with reflux, regardless of whether is it eosinophilic esophagitis or not, have you identified any foods that contribute to your symptoms?