New York Buyers’ Club - The Blog

Here’s a story on the probiotic Saccharomyces boulardii from John James of AIDS Treatment News, posting at AIDS Treatment News Daily Alerts - www.aidsnews.org/now.

2008-04-30

Report raises C. diff concerns; yeast-based probiotic shown to help significantly reduce recurrence

Antibiotic-resistant Clostridium difficile (C. difficile) infection is becoming an increasingly serious problem. In principle at least, the use of a probiotic along with antibiotic treatment could make sense.

“A recent meta-analysis of 31 studies compiled and published in the American Journal of Gastroenterology concluded that S. boulardii is the only probiotic that is effective in fighting recurrent C. diff-associated disease.[reference] Additionally, an article in the March 2006 issue of Gastroenterology and Hepatology showed that use of S. boulardii provided an almost 50 percent decrease in subsequent recurrence among patients who suffered recurrent CDAD symptoms.[reference] ‘Because Florastor (S. boulardii) is a yeast and not a bacteria, it is not killed by the strong antibiotics that are being used to kill the C. diff bacteria, so it survives in the digestive tract,’ says Dr. Raymond. ‘When the ‘baby’ C. diff emerge from their spores, they are greeted by a well-colonized gut, rather than an empty playground.’”

Note: references and more detailed reporting at

http://www.eurekalert.org/pub_releases/2008-04/bi-rrc042908.php

For additional information, see the NYBC entry on Florastor or other entries on Saccharomyces boulardii on this blog.

This is an excellent and easy-to-read booklet that can be read online, or ordered from thebody.com at

http://www.thebody.com/content/art13137.html

Gastrointestinal or gut problems–diarrhea, nausea, indigestion, gas, loss of appetite–are very common for people with HIV, with consequences ranging from temporary to very serious. This booklet takes you through the common causes: HIV meds, other meds or supplements, the effects of HIV itself, your diet, psychological triggers, or other health problems (such as parasites). It then sorts through some of the most used treatments, including over-the-counter drugs, supplements, prescription meds, changing your diet.

Some of the many good points about this booklet: the “When to Call Your Doctor” sections, the personal stories, the “Doctor’s Notes,” and the dietary tips and supplement recommendations.

Lactobacillus acidophilus, L. acidophilus–acidophilus for short–is the most widely used probiotic, a beneficial microorganism that helps support gastrointestinal health in a variety of ways. For example, the byproducts of acidophilus (lactic acid, hydrogen peroxide) make for an environment that is hostile to undesirable organisms in the gut. And acidophilus also produces lactase, the enzyme that breaks down and allows digestion of milk sugar (lactose).

The University of Maryland Medical Center’s Complementary Medicine website provides a review of therapeutic uses of acidophilus and other probiotics. Here are some highlights:

–Treating overgrowth of “bad” organisms in the gastrointestinal tract (a condition that tends to cause diarrhea and may occur from use of antibiotics).
–Alleviating symptoms of irritable bowel syndrome and, possibly, inflammatory bowel disease (such as Crohn’s disease and ulcerative colitis).
–Preventing and/or reducing the recurrence of vaginal yeast infections, urinary tract infections, and cystitis (bladder inflammation). The best scientific evidence exists for vaginal infections.
–Improving lactose absorption digestion in people who are lactose intolerant
–Enhancing the immune response. Studies have suggested that consumption of yogurt or milk that contains specific strains of Lactobacillus or supplements with Lactobacillus or Bifidobacterium may improve the natural immune response. Further research is needed to confirm these early findings and to best understand how the improved immune function may or may not help in warding off infections.

NYBC carries Jarro-Dophilus, a combination of acidophilus and other probiotic species together with a prebiotic (basically, the foodstuff that probiotic species thrive on). Note that this item needs to be refrigerated to maintain its effectiveness.

NYBC also carries Jarro-Dophilus EPS. This is a probiotic that does not require refrigeration. As reported on the NYBC website, a recent consumerlabs.com test of this product gave it very good marks!

Here are two approaches for digestive / gastrointestinal support. The first is a combination of digestive enzymes in a vegetarian encapsulation. The second draws on Traditional Chinese Medicine in a formula from Health Concerns.

—Vegetarian Enzymes from Douglas Labs, which supplies:

Amylase 4200 D.U. (dextrinizing units)
Protease 12, 500 H.U.T. (hemoglobin units)
Lipase 2400 L.U. (lipase units)
Cellulase 600 C.U.
Suggested dosage: 1-2 tablets three times daily, with meals.

—Quiet Digestion (Health Concerns) Each bottle, 90 tablets. Each tablet 750 mg of Poria, Coix, shen chu (a dried mass of wheat flour, fresh aerial parts of Artemisia annua, Xanthium sibiricum, Polygonum hydropiper and water), Magnolia, Angelica, Pueraria, red Atractylodes, Saussurea, Pogostemon, Oryza, Trichosanthes root, Chrysanthemum, halloysite (a mineral product that contains aluminosilicates), citrus, Mentha and malt. Used to reduce gastric distress including pain, cramping, nausea, vomiting, diarrhea, regurgitation, poor appetite; addresses viral or bacterial gastroenteritis as well as motion sickness, hangover and jet lag effects.

Suggested use is 2 tablets taken after meals, 3 times per day; also may be taken between meals or as needed. Chew for best results.

NYBC stocks the probiotic Florastor, which is Saccharomyces boulardi lyo (lyo = freeze dried, the best means discovered for preserving the effectiveness of this agent). Saccharomyces boulardii, a yeast first investigated by French microbiologist Henri Boulard in Indochina in the 1920s, has been widely researched and distributed over the last fifty years, though it has a longer history of use in Europe than in the US.

We’re glad that Florastor has become available in the United States in the last five years, since before that we were obliged to import this pharmaceutical grade probiotic from Europe; the US versions of Saccharomyces boulardii often seemed quite a bit less effective, perhaps because the European production techniques were more advanced.

Here are the main indications/conditions for which 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
Additional benefits to inflammatory bowel disease (IBD) patients may be found in 1) prevention of relapse in Crohn’s disease patients currently in remission and 2) benefits to ulcerative colitis patients with moderate symptoms. Suggested dosage is three 250mg capsules a day.

Antibiotic-Associated Diarrhea
Some evidence for its use in the prophylaxis (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 versus placebo. On average, patients receiving S. boulardii gained weight while the 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.

Some citations (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.