Acidophilus and Gut Flora

A BBC story today reports that scientists are considering the vast variety of flora that colonize our guts as a “second genome” that has yet to be fully explored. They managed to create a metagenome that contains the sequences of all the bacteria that hang out with us.

These bacteria are important in so many ways. As the article notes: “The bacteria help digest food, provide vitamins, protect us from invading pathogens. If there’s a disturbance, people get all sorts of diseases such as Crohn’s disease, Ulcerative colitis, and a link has also been made to obesity.”

And indeed, in HIV disease, the gut is severely damaged from the get-go. HIV infection hangs out there–where many of the CD4+ T cells hang out. So would supplements of things like acidophilus or bifidus make sense? Indeed, there HAVE been clinical studies that show a positive benefit, for kids with HIV to adults (see the abstract below).

Add to that, many people take antibiotics either to treat a concurrent infection or as prophylaxis, and you add the further damage to the gut caused by the death of these friendly gut flora. Replacing this even during treatment (i.e., taking the acidophilus as many hours from the antibiotic) can help.

Further, studies are ongoing for use of vaginal application of acidophilus among women both as a spermicidal and to prevent vaginal candidiasis (see, e.g., J Assoc Nurses AIDS Care. 2001 Jul-Aug;12(4):51-57). It can also help babies.

This seems to be one of those cornerstone therapies that are relatively inexpensive.

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Trois L, Cardoso EM, Miura E. Use of probiotics in HIV-infected children: a randomized double-blind controlled study. J Trop Pediatr. 2008 Feb;54(1):19-24. Epub 2007 Sep 17.
Department of Nutrition, Unilasalle, Brazil. liviatrois@gmail.com

HIV/AIDS is an infection characterized by immune cell dysfunction and subsequent immunodeficiency, as well as intestinal disorder. Probiotics are live microbial feed supplements that beneficially affect the host animal by improving intestinal microbial balance and promoting health benefits. The goals of this study were to determine whether the use of probiotics could improve the immune response determined by CD4 cells mm(-3) counts and reduce liquid stool episodes. A randomized double-blind controlled trial with 77 HIV-infected children (2-12 years), divided into two groups: one receiving probiotics (formula containing Bifidobacterium bifidum with Streptococcus thermophilus -2.5 x 10(10) colony forming units) and the other, a standard formula (control group), for 2 months. The CD4 counts (cells mm(-3)) were collected at the beginning and end of the study. The quality and number of stools were assessed by a questionnaire (watery to normal stool consistency). There was an increase in the mean CD4 count in the probiotics group (791 cells mm(-3)) and a small decrease in the control group (538 cells mm(-3)). The change from baseline in mean CD4 cell count was +118 cells mm(-3) vs. -42 cells mm(-3) for children receiving the probiotic formula and control formula, respectively (p = 0.049). A similar reduction in liquid stool consistency in both the groups (p < 0.06), with a slight enhancement in the probiotics group, was observed, but without significant difference (p < 0.522). The incidence of loose-soft stools showed a small decrease in both groups (p < 0.955) and there was an increase in the incidence of normal stool consistency in both the groups (p < 0.01). Our study showed that probiotics have immunostimulatory properties and might be helpful in the treatment of HIV-infected children.

**
Asia Pac J Clin Nutr. 2007;16 Suppl 1:318-22.
Advances in nutrition support for quality of life in HIV+/AIDS.

Suttajit M.

School of Science and Technology, Naresuan University, Phayao Campus, Phayao, Thailand 56000. msuttjit@mail.med.cmu.ac.th

Globally, acquired immunodeficiency syndrome (AIDS) is an epidemic, severe and fatal disease. Along with the etiological factors of human immunodeficiency virus infection (HIV+) and decreased immunity, there are a number of other risk factors including opportunistic infection, malnutrition, wasting syndrome, and oxidative stress. The nutritional problems have been shown to be significant and contribute to health and death in HIV+/AIDS patients. Weight loss, lean tissue depletion, lipoatrophy, loss of appetite, diarrhea, and the hypermetabolic state each increase risk of death. The role of nutrition and how oxidative stress is involved in the pathogenesis of HIV+ leading to AIDS is reviewed. Studies consistently show that serum antioxidant vitamins and minerals decrease while oxidative stress increases during AIDS progression. The optimization of nutritional status, intervention with foods and supplements, including nutrients and other bio-active food components, are needed to maintain the immune system. Various food components may be recommended to reduce the incidence and severity of infectious illnesses by forms of bio-protection which include reduced oxidative stress due to reactive oxygen species which stimulate HIV replication and AIDS progression. Probiotics or lactic acid bacteria and prebiotics are sometimes given on the presumed basis that they help maintain integrity of mucosal surfaces, improve antibody responses and increase white blood cell production. People with HIV+/AIDS can be informed about the basic concepts of optimal nutrition by identifying key foods and nutrients, along with lifestyle changes, that contribute to a strengthened immune system. Moreover, nutritional management, counseling and education should be beneficial to the quality and extension of life in AIDS.

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If you can, eat yogurt daily!
J Clin Gastroenterol. 2008 Mar;42(3):239-43.
Yogurt containing probiotic Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 helps resolve moderate diarrhea and increases CD4 count in HIV/AIDS patients.

Anukam KC, Osazuwa EO, Osadolor HB, Bruce AW, Reid G.

Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Benin, Benin City, Edo State, Nigeria.

HIV/AIDS is changing the human landscape in sub-Saharan Africa. Relatively few patients receive antiretroviral therapy, and many suffer from debilitating diarrhea that affects their quality of life. Given the track record of probiotics to alleviate diarrhea, conventional yogurt fermented with Lactobacillus delbruekii var bulgaricus and Streptococcus thermophilus was supplemented with probiotic Lactobacillus rhamnosus GR-1 and L. reuteri RC-14. Twenty-four HIV/AIDS adult female patients (18 to 44 y) with clinical signs of moderate diarrhea, CD4 counts over 200, and not receiving antiretrovirals or dietary supplements, consumed either 100 mL supplemented or unsupplemented yogurt per day for 15 days. Hematologic profiles, CD4 cell counts, and quality of life was evaluated at baseline, 15 and 30 days postprobiotic-yogurt feeding. There was no significant alteration in the hematologic parameters of both groups before and after the probiotic-yogurt feeding. The probiotic yogurt group at baseline, 15 and 30 days had a mean WBC count of 5.8+/-0.76 x 10(9)/L, 6.0+/-1.02 x 10(9)/L, and 5.4+/-0.14 x 10(9)/L, respectively. However, the mean CD4 cell count remained the same or increased at 15 and 30 days in 11/12 probiotic-treated subjects compared to 3/12 in the control. Diarrhea, flatulence, and nausea resolved in 12/12 probiotic-treated subjects within 2 days, compared to 2/12 receiving yogurt for 15 days. This is the first study to show the benefits of probiotic yogurt on quality of life of women in Nigeria with HIV/AIDS, and suggests that perhaps a simple fermented food can provide some relief in the management of the AIDS epidemic in Africa.

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