Nutrition Part III: Probiotics

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Dear All, This is my amateur bad attempt to try to make my videos a little more fun. It's a conversation s...
Dear All, This is my amateur bad attempt to try to make my videos a little more fun. It's a conversation starter -- not medical advice. If you'd like more information, please check out my blog, where under the article "probiotics" I posted more detailed information: www.bostonmedicalstudent.wordpress**** here are some references: The main point is that: 1) clostridium difficile is a serious, bad, bacterial problem in the U.S. that hits patients who have taken antibiotics and patients who are in the hospital. Just today, (4/30/07) our professor told us that four patients died of clostridium difficile at his hospital last year. The bad news is that conventional antibiotics can fail to cure clostridium difficile. And when they fail it could lead to death. The good news it that they could be potentially treated with probiotics (although a funkier version of probiotics) when conventional antibiotics fail. It might seem ridiculous to try Dr. Aas' probiotics -- but I want to bring his work to your attention because conventional antibiotics do fail with regards to c. difficile. With Dr. Aas, he's reported success with this form of treatment when patients can't fight off C. difficile with metronidazole or vancomycin (these are the common antibiotic treatments). Point #2: Von Niel argues that probiotics should be considered a mainstream therapy given the many positive results seen in randomized controlled trials (see the Von Niel reference). Unfortunately, it has been slow to catch on in the U.S., possibly because it usually takes 17 years for new scientific discoveries to get widely disseminated (Balas & Boren, 2000). _________________________________________________ For safety information on which strains are safe and who can take probiotics: *******www.ajcn****/cgi/content/abstract/83/6/1256 The authors noted: "We found that probiotics are safe for use in otherwise healthy persons, but should be used with caution in some persons because of the risk of sepsis." _________________________________________________ Probiotics (from Von Neil, 2005) We definitely know it works for: Acute infectious diarrhea Prevention of antibiotic-associated diarrhea Conditions that are potentially treatable by probiotics: Chronic diarrhea, Inflammatory bowel disease, Irritable bowel syndrome, Food allergy Conditions that are potentially preventable: Traveler's diarrhea, Necrotizing enterocolitis, Urogenital infections, Atopic disease, Dental caries Future applications proposed for: Cystic fibrosis, Rheumatoid arthritis, Cancers _________________________________________________ What is clostridium difficile? (from JG Bartlett, 2006) It's a nasty bacteria. Who gets it? If you've taken antibiotics, are of advanced age, or in the hospital or recently came from the hospital. What's the significance of this problem? A new epidemic strain of C. difficile has emerged that causes more frequent and more serious disease. What are some symptoms? "Clinical disease and C. difficile toxin are present almost exclusively in patients with recent antibiotic exposure, with rare exceptions." So if you've taken antibiotics, that increases your risk. Clinical expression of infection almost always includes diarrhea, but symptoms vary widely. Common findings in patients with infection: 1) colitis (inflammation of the colon) with cramps, 2) fever, 3) abdominal pain 4) fecal leukocytes (white blood cells in the stool), 5) and inflammation on colonic biopsy (if you do a biopsy of the colon). The disease is almost always restricted to the colon. A recent report implicates gastric acid--suppressive agents as a risk for disease, but this has not been consistently observed. _________________________________________________ How come probiotics seems really weird? "Frequently, years or even decades are required for laboratory discoveries to reach clinical practice. It takes an estimated average of 17 years for only 14% of new scientific discoveries to enter day-to-day clinical practice" (Balas & Boren). _________________________________________________ References Aas et al., 2003. Recurrent Clostridium difficile Colitis...Clinical Infectious Diseases 2003; 36: 580-5 Balas EA, Boren SA. Yearbook of Medical Informatics: Managing Clinical Knowledge for Health Care Improvement. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH; 2000 Bartlett, JG. Narrative review: the new epidemic of Clostridium difficile-associated enteric disease. Ann Intern Med. 2006 Nov 21;145(10):758-64. Review. Savino et al., (Randomized controlled trial talking about probiotics and cholic) Pediatrics 2007;119;e124-e130 Van Niel Pediatrics 2005; 115; 174-177 Weisman et al., (randomized controlled trial looking at probiotics and infections in day care centers) Pediatrics 2005;115;5-9