June 9, 2011
Florastor: a probiotic for many types of acute and chronic diarrhea
For many types of acute and chronic diarrhea, the probiotic Florastor can be recommended as the best natural approach. Florastor is the tradename of Saccharomyces boulardi lyo (lyo = freeze dried, the best means for preserving the effectiveness of this probiotic species; also means that Florastor is shelf-stable at room temperature).
Here are the main indications/conditions for which Florastor/Saccharomyces boulardii has been investigated:
Acute Diarrhea
A controlled study found a significant reduction in symptoms of diarrhea in adults taking 250mg of S. boulardii twice a day for five days or until symptoms were relieved.
Irritable Bowel Syndrome
A placebo-controlled study found that patients with diarrhea due mainly to irritable bowel syndrome (IBS) had a significant reduction in number and consistency of bowel movements.
Suggested dosage is 250mg twice daily.
Inflammatory Bowel Disease
Florastor benefits for inflammatory bowel disease (IBD) include: 1) prevention of relapse in Crohn’s disease patients currently in remission and 2) improvement for ulcerative colitis patients with moderate symptoms. Suggested dosage is three 250mg capsules a day.
Antibiotic-Associated Diarrhea
Some evidence for its usefulness in the prevention of antibiotic-associated diarrhea (AAD) in adults. Suggested dosage: 250mg twice a day with the standard antibiotic course.
HIV/AIDS-Associated Diarrhea
Saccharomyces boulardii was shown to significantly increase the recovery rate of stage IV AIDS patients suffering from diarrhea. On average, patients receiving S. boulardii gained weight while a placebo group lost weight over the 18 month study. There were no reported adverse reaction observed in these immunocompromised patients.
Recurrent Clostridium difficile Infection
Two 500mg doses per day of Saccharomyces boulardii when taken with one of two antibiotics (vancomycin or metronidazole) were found to significantly reduce the rate of recurrent Clostridium difficile (pseudomembranous colitis) infection. However, note that significant benefit was not found for prevention of an initial episode of Clostridium difficile-associated disease.
For more on Saccharomyces boulardii, see the NYBC entry:
Note that non-member price is $30, but member price is NOW ONLY $29. (NYBC Membership costs $5, $10, or $25 per year, depending on income.)
Some references (there are many more, since Saccharomyces boulardii is among the most-studied probiotics):
–Höcher W, Chase D, Hagenhoff G (1990). “Saccharomyces boulardii in acute adult diarrhoea. Efficacy and tolerance of treatment”. Münch Med Wochenschr 132: 188–92.
–McFarland L, Surawicz C, Greenberg R (1994). “A randomised placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease”. J Am Med Assoc 271: 1913–8.
–Maupas J, Champemont P, Delforge M (1983). “Treatment of irritable bowel syndrome with Saccharomyces boulardii: a double blind, placebo controlled study”. Medicine Chirurgie Digestives 12(1): 77–9.
–Guslandi M, Mezzi G, Sorghi M, Testoni PA (2000). “Saccharomyces boulardii in maintenance treatment of Crohn’s disease”. Dig. Dis. Sci. 45 (7): 1462–4. PMID 10961730.
–Guslandi M, Giollo P, Testoni PA (2003). “A pilot trial of Saccharomyces boulardii in ulcerative colitis”. Eur J Gastroenterol Hepatol 15 (6): 697–8. doi:10.1097/01.meg.0000059138.68845.06. PMID 12840682.
–Saint-Marc T, Blehaut H, Musial C, Touraine J (1995). “AIDS related diarrhea: a double-blind trial of Saccharomyces boulardii”. Sem Hôsp Paris 71: 735–41.
December 2, 2010
Supplements for Diarrhea and Malabsorption
We’re reprinting below the NYBC recommendations
for supplements that address the common gastrointestinal
problems of people with HIV:
Diarrhea. This is one of
the most common side effects of
antiretroviral drugs–especially protease
inhibitors. When it occurs, make
sure to drink plenty of (healthy) fluids
to replace electrolytes (potassium,
sodium, and magnesium ions) and
prevent dehydration. Avoid sugary
and/or caffeinated beverages.
One of the simplest remedies: bananas!
Adding a yogurt with active
cultures to your regular diet can also
improve diarrhea. In addition to adding
beneficial flora to your gastrointestinal
tract, yogurt is nutritionally
rich in protein, calcium, riboflavin,
vitamin B6 and vitamin B12.However, for some, dietary changes may
not be enough to control the diarrhea
Supplements to consider in treating
diarrhea associated with protease
inhibitors include calcium, and glutamine
(up to 20-40 grams daily for
diarrhea while it persists). There are
some clinical data to support these
interventions. A note of caution: calcium
carbonate works fine but should
be avoided if you are using atazanavir
[Reyataz].If diarrhea is associated with the use
of antibiotics, go probiotic! Use acidophilus,
bifidus or Saccharomyces
boulardii (Florastor) to control C.
difficile (a problem frequently encountered
with antibiotic use) and to improve gut function.
Use of digestive enzymes may also help to improve
digestion (e.g., lipase, protease, amylase, and
lactase).Malabsorption is the difficulty in digesting or
absorbing nutrients from food. It’s a widespread
problem among HIVers, and a serious
one at that. HIV disease damages the
guts, where it is estimated that 80%
of the disease “lives,” hindering the
digestive tract’s ability to absorb nutrients
(or meds). Additionally, many
HIVers actually have too little acid
in their stomachs – a little-discussed
condition. This can cause the sphincter
at the opening of the stomach to
fail to close properly, resulting in
GERD: gastro-esophageal reflux disorder.
In general, gut function can be
improved with probiotics such as
acidophilus and bifidus, as well as
2-5 grams of glutamine, taken daily.
Further, digestive enzymes that help
break down fats, carbs and proteins
may be useful in promoting better
absorption. Again, a good diet and
a potent multi are important starting
points!
See the NYBC entries for more detailed
recommendations regarding these supplements:
Glutamine Powder:
http://nybcsecure.org/product_info.php?cPath=49&products_id=128
or Glutamine Caps:
http://nybcsecure.org/product_info.php?cPath=49&products_id=127
Douglas Vegetarian Enzymes:
http://nybcsecure.org/product_info.php?cPath=49&products_id=264
Jarro-Zymes Vegetarian Enzymes:
http://nybcsecure.org/product_info.php?cPath=49&products_id=335
Ultra Jarro-Dophilus (probiotic):
http://nybcsecure.org/product_info.php?cPath=27&products_id=354
Jarrodophilus EPS (No refrigeration needed):
http://nybcsecure.org/product_info.php?cPath=27&products_id=199
Saccharomyces boulardii (Florastor):
http://nybcsecure.org/product_info.php?products_id=217
June 25, 2010
Symptoms common, often ignored by docs
A recent report underscored the myriad symptoms and problems facing significant numbers of people living with HIV. The study involved 751 patients enrolled in the Veterans Aging Cohort Study, undertaken between 1999 and 2000. Commonly reported symptoms included fatigue (71%), difficulty sleeping, depression, muscle aches and diarrhea (each reported by 60% of the respondents). Over 50% of patients reported headache, difficulty remembering, tingling hands or feet (neuropathy), weight loss and body shape changes.
The worry is that some may be associated with meds and this may reduce adherence to drug schedules. This can lead to resistance, etc. Which is why we at NYBC take very seriously the methods and means that may be available to manage some of these side effects. Diarrhea has been managed in studies that investigated agents like calcium and glutamine. Acetylcarnitine has some benefit for nuke-related neuropathy. You can review our literature on what we know (and need to learn more) about such interventions along with the different symptoms and side effects people experience and how they can be managed.
The study included about 54% African American. The study noted that healthcare providers often don’t recognize these as important symptoms. Perhaps this is why there is a strong racist element within American health care, one that arises out of blindness and ignorance as much as any overt hostility.
The second aspect of such care is that many people, of every ethnicity, are economically impoverished. So how can many people access sometimes costly, nearly always out-of-pocket agents like acetylcarnitine? NYBC is working on ways to make this possible, though we will need additional help to assure such access. State-run programs like ADAP and Medicaid can help in some states–but many of these programs are facing cuts due to tight budgets. Tight budgets induced by banks getting a socialized bailout for their malfeasance while Americans suffer?
So political activism will remain a key component in any comprehensive effort to provide care and treatment that includes the types of agents NYBC investigates and makes available. Ongoing research into dietary supplements and the ways in which they may improve health outcomes, enhance adherence to medications, reduce side effects and lower the burden of public costs by reducing morbidity and mortality are keenly needed.
March 31, 2010
Top search terms bringing visitors to this blog
Dear NYBC Blog Reader,
Thought you might be interested to see some of the most popular search terms that brought people to the New York Buyers’ Club Blog in the past year:
1. “Saccharomyces boulardii C difficile”
2. “glutamine ulcerative colitis”
3. “cholesterol lowering supplements”
4. “B vitamins depression”
5. “HIV Vitamin D”
6. “vitamins for neuropathy”
7. “Tylenol antidote”
And here, in very brief form, is the information these searchers found on the NYBC Blog:
Saccharomyces boulardii, which NYBC stocks in the form of Florastor, appears in a recent study to be the best probiotic for the stubborn gastrointestinal infection C. difficile.
Glutamine has shown effectiveness in reducing symptoms of ulcerative colitis and other gastrointestinal conditions in a number of research studies.
Plant sterols, fish oil, niacin, pantethine have been studied for cholesterol control.
B vitamins strongly affect mood and memory, and addressing a B vitamin deficiency can improve depressive symptoms.
Vitamin D deficiency is widely prevalent among people with HIV, and supplementing with 1000IU/day of D3 plus 1000mg/day of calcium may be a good way to support bone health for people taking HIV meds. Other research has noted the link between Vitamin D deficiency and cardiovascular disease, certain cancers, and susceptibility to cold and flus.
Acetylcarnitine, alpha lipoic acid and evening primrose oil are among the supplements studied for diabetic or HIV-related neuropathy (pain, tingling in feet, hands).
NAC (N-acetylcysteine) is used as the antidote to acetaminophen overdose. Acetaminophen is the active ingredient in Tylenol and is added to many other over-the-counter drugs, so overdose leading to liver damage or liver failure has become common in the US.
November 9, 2009
Saccharomyces boulardii: new research confirms effectiveness
Saccharomyces boulardii is a very well-researched probiotic, with several hundred peer-reviewed studies to its credit, many from the past two decades. It’s now the first choice for antibiotic-associated diarrhea, C. difficile colitis, and “traveler’s diarrhea.” It can also help in addressing irritable bowel syndrome, ulcerative colitis and Crohn’s disease. Here are some recent research highlights:
–Harvard Medical School researchers located specific pathways by which Saccharomyces boulardii decreases intestinal inflammatory responses; their 2006 report helps explain the broad range of protective effects that the probiotic exerts in a variety of gastrointestinal disorders.
–A 2006 meta-analysis (combined study of multiple individual studies) found that Saccharomyces boulardii was the only probiotic effective against Clostridium difficile disease, a common form of antibiotic-associated diarrhea.
–A 2008 study, meanwhile, found that Crohn’s patients receiving Saccharomyces boulardii treatment showed significant improvements in intestinal function compared with those given a placebo (dummy pill).
–Most recently, an investigation published in 2009 found that, of a variety of probiotics, Saccharomyces boulardii was uniquely able to stimulate production of secretory IgA, the main immunoglobin found in mucus, saliva, and secretions from the intestine and lining of the lungs, and a main component of the body’s protective mechanism against pathogens. (Thus Saccharomyces boulardii may now be credited with a general immune-modulating/strengthening ability.)
References:
Sougioultzis S, Simeonidis S, Bhaskar KR, Chen X, Anton PM, Keates S, Pothoulakis C, Kelly CP. Saccharomyces boulardii produces a soluble anti-inflammatory factor that inhibits NF-kappaB-mediated IL-8 gene expression. Biochem Biophys Res Commun. 2006 Apr 28;343(1):69-76.
McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol. 2006 Apr;101(4):812-22.
Garcia Vilela E, De Lourdes De Abreu Ferrari M, Oswaldo Da Gama Torres H, Guerra Pinto A, Carolina Carneiro Aguirre A, Paiva Martins F, Marcos Andrade Goulart E, Sales Da Cunha A. Influence of Saccharomyces boulardii on the intestinal permeability of patients with Crohn’s disease in remission. Scand J Gastroenterol. 2008;43(7):842-8.
Flaviano S. Martins, Aparecida A. Silva, Angélica T. Vieira, Flávio H. F. Barbosa, Rosa M. E. Arantes, Mauro M. Teixeira and Jacques Robert Nicoli. Comparative study of Bifidobacterium animalis, Escherichia coli, Lactobacillus casei and Saccharomyces boulardii probiotic properties.
Archives of Microbiology, Volume 191, Number 8 / August, 2009.
Saccharomyces boulardii is available from NYBC as Florastor, recognized as the most reliable commercially available form of the probiotic.
October 28, 2009
The Probiotic Saccharomyces boulardii
This 2007 article reviewed several well-designed clinical studies of Saccharomyces boulardii and found good evidence for this non-pathogenic yeast’s ability to prevent and treat several forms of diarrhea. Antibiotic-associated diarrhea, recurrent Clostridium difficile (C.difficile) infection, “traveler’s diarrhea,” and inflammatory bowel disease were the conditions investigated in these studies.
Review article: yeast as probiotics — Saccharomyces boulardii.
Czerucka D, Piche T, Rampal P.
ABSTRACT
BACKGROUND: Probiotics are defined as live micro-organisms which confer a health benefit on the host. Although most probiotics are bacteria, one strain of yeast, Saccharomyces boulardii, has been found to be an effective probiotic in double-blind clinical studies. AIMS: To compare the main properties that differentiate yeast from bacteria and to review the properties of S. boulardii explaining its potential benefits as a probiotic. METHODS: The PubMed and Medline databases were searched using the keywords ‘probiotics’, ‘yeast’, ‘antibiotic associated diarrhea’, ‘Saccharomyces boulardii’,'bacterial diarrhea’ and ‘inflammatory bowel disease’ in various combinations. RESULTS: Several clinical studies have been conducted with S. boulardii in the treatment and prevention of various forms of diarrhoea. Promising research perspectives have been opened in terms of maintenance treatment of inflammatory bowel diseases. The mechanism of S. boulardii’s action has been partially elucidated. CONCLUSION: Saccharomyces boulardii is a strain of yeast which has been extensively studied for its probiotic effects. The clinical activity of S. boulardii is especially relevant to antibiotic-associated diarrhoea and recurrent Clostridium difficile intestinal infections. Experimental studies clearly demonstrate that S. boulardii has specific probiotic properties, and recent data has opened the door for new therapeutic uses of this yeast as an ‘immunobiotic’.
Reference: Aliment Pharmacol Ther. 2007 Sep 15;26(6):767-78.
See also the NYBC entry:
March 5, 2009
NYBC’s Quick Guide to Gastrointestinal Health
The latest issue of the NYBC newsletter, THE SUPPLEMENT, includes a “Quick Guide to Gastrointestinal Health.” Here’s the introduction:
Gastrointestinal or gut health is basic to overall health, whether you’re talking about how well you feel on a daily basis (nausea, cramps, diarrhea, etc. being among our least favorite experiences), or the importance of properly absorbing food that you eat and thereby supplying your body with the nutrients it needs to stay healthy over the long term.
Gastrointestinal health can also be a complicated issue, since gut disturbances may stem from many different causes, whether it’s a bug picked up from poor food handling practices, a side effect of medications, or one of the symptoms of an underlying disease or infection (such as HIV) that requires treatment in itself. Identifying the root cause or causes of gastrointestinal problems can be a major challenge, and of course we urge you to work with your healthcare provider to sort that question out, especially if your condition lingers, becomes acute, or has an impact on your ability to go about your daily life.
And here are the major topics covered by the guide:
Probiotics: only some types of probiotics, such as lactobacillus and bifidus, have been studied for gastrointestinal health (to prevent diarrhea, for example); Saccharomyces boulardii, available in the US as Florastor, is one of the most researched of the probiotics, and has been shown to be useful for antibiotic-related diarrhea and traveler’s diarrhea
Glutamine and other supplements to maintain body weight: glutamine, calcium carbonate, and other supplements have been investigated for their application to gastrointestinal health, and particularly for minimizing diarrhea and improving absorption in people with HIV, which in turn helps maintain body weight
Traditional botanicals/remedies for GI health: Chinese or Tibetan herbal formulas from Health Concerns and Pacific BioLogic; and Mastic Gum, a traditional remedy for heartburn from the Eastern Mediterranean, now recently studied for additional health benefits
Read the complete “Quick Guide to Gastrointestinal Health” online:
February 2, 2009
Calcium carbonate for protease inhibitor-related diarrhea
Calcium is best-known as a supplement to support bone health, but it also has a long history of use to control diarrhea, especially protease inhibitor-related diarrhea, in people with HIV.
Below are a couple of recent Canadian studies that tend to re-affirm the effectiveness of this widely used strategy. See also the NYBC entry on Digestive Maintenance, which includes two types of Calcium supplement.
Turner MJ, Angel JB, Woodend K, Giguère P. The efficacy of calcium carbonate in the treatment of protease inhibitor-induced persistent diarrhea in HIV-infected patients. HIV Clin Trials. 2004 Jan-Feb;5(1):19-24. Pharmacy Department, The Ottawa Hospital, Ontario, Canada.
BACKGROUND: Although some evidence exists to support the practice of using calcium carbonate to treat nelfinavir-induced diarrhea, there is a lack of data supporting the role of calcium in diarrhea induced by other protease inhibitors (PIs). PURPOSE: The objective of this prospective open-label study is to evaluate the efficacy of calcium carbonate in the treatment of PI-induced persistent diarrhea in HIV-infected patients. METHOD: Along with dietary advice, patients were asked to take oral calcium carbonate 500 mg twice daily for 2 weeks. Visual Analog Scale (VAS) and the National Cancer Institute of Canada (NCIC) scale were used to assess the severity of diarrhea. Data were analyzed using paired t tests to test for differences in VAS and NCIC scores between baseline and 14 days. Pearson correlation was used to explore the relationships between change in diarrhea and patient baseline factors. RESULTS: At day 0, the mean VAS +/- standard deviation was 6.6 +/- 2.1 and decreased to 5.3 +/- 1.9 (p=.01) after 14 days. At day 0, the mean NCIC score was 1.9 +/- 0.8 and decreased to 1.2 +/- 0.9 (p=.005) after 14 days. No baseline patient factors predicted change in NCIC or VAS grade. CONCLUSION: Calcium carbonate is associated with a reduction of diarrhea in individuals with diarrhea induced by PI.
**
Rachlis A, Gill J, Baril JG, LeBlanc RP, Trottier B, MacLeod J, Walmsley S, Van der Vliet W, Belsky G, Burgoyne R. Effectiveness of step-wise intervention plan for managing nelfinavir-associated diarrhea: a pilot study. HIV Clin Trials. 2005 Jul-Aug;6(4):203-12. Sunnybrook and Women’s College Health Sciences Centre, University of Toronto, Ontario, Canada. a.rachlis@utoronto.ca
PURPOSE: Pilot study to evaluate the effectiveness of a step-wise diarrhea management strategy for nelfinavir-associated diarrhea. METHOD: HIV-infected adults (CD4 count > 100 cells/mm3, and no evidence of enteric pathogens) developing symptoms of diarrhea after initiation of nelfinavir for a duration of > or = 1 month were enrolled into this 9-week prospective pilot study. Step-wise interventions, reviewed and adjusted additively at 2-week intervals, included nutritional counseling (+/- lactase and/or psyllium), calcium carbonate, and loperamide. Outcome measure included stool-form consistency, bowel movement frequency, and incidents of associated morbidity (urgency, incontinence) daily. Patient quality of life was also assessed. RESULTS: Eighteen patients completed the study. Mean daily bowel movement frequency decreased by 32%, from 2.98 to 2.03 (p = .005). Mean daily stool form shifted from a rating of 4.24 to 2.37 (p = .0001), representing a shift to firmer stools. Period prevalence of incontinence (28%) and urgency (33%) decreased to 6% each, respectively. Quality of life ratings relating to gastrointestinal disturbance and overall physical/psychosocial function were improved. CONCLUSION: The results of this pilot study demonstrated that a step-wise intensified approach may be successful in managing nelfinavir-associated diarrhea and will need to be validated in a larger scale, randomized controlled trial.
