Effectiveness of Saccharomyces boulardii (a probiotic) for antibiotic-associated diarrhea and for C. difficile infection

A good recent review of the effectiveness of probiotics highlights especially the value of Saccharomyces boulardii for diarrhea associated with antibiotic treatments, and for C. difficile infections (a common, and often quite stubborn, gastrointestinal infection). This review, published in 2009, pools data from a number of studies to draw its conclusions. The author first focuses on antibiotic-associated diarrhea, which is a common side effect of many currently used antibiotics, occurring in up to a third of patients being treated. In the second place, the review looks at C. difficile infection and the clinical evidence for the effectiveness of probiotic treatments. In the case of both antibiotic-associated and C. difficile-associated diarrhea, the author concludes that Saccharomyces boulardii has shown effectiveness as a treatment. Among the other findings of this article: probiotic treatments have a very good safety profile and therefore can be recommended widely; and it is very important to treat using probiotics with documented high quality/potency standards in order to insure beneficial outcomes.

Read more about dosage and uses of Saccharomyces boulardii in the NYBC catalog, which now includes two different choices, both from high-quality producers:

Saccharomyces boulardii – Jarrow

and

Florastor – Biocodex

Reference:

McFarland, L. V. Evidence-based review of probiotics for antibiotic-associated diarrhea and Clostridium difficile infections. Anaerobe/Clinical microbiology 15 (2009) 274–280.
Accessed at http://www.idpublications.com/journals/PDFs/ANAE/ANAE_MostDown_1.pdf

Advertisements

Gut Microbiome in HIV

A recent article, technical as usual, looked at the kinds of bacteria found in the intestines of people living with HIV vs those uninfected (and included one long-term non-progressor who has lived 21 years without treatment and no progression). What they found was described beautifully in this post with embedded video.

The idea presented was that perhaps we can help reduce bodywide inflammation by establishing a more healthy bacterial profile in the gut. An idea we have been talking about for decades!! And indeed, this is why we have proposed the use of agents like glutamine (which help the cells lining the gut called villi to turnover), along with probiotics and prebiotics (fiber and/or beta glucans). These are rather blunt tools but do seem to help improve gut function. We do have some data on the use of probiotics in the management of HIV-related diarrhea and for bacterial vaginosis (and our sister organization, FIAR, is working on a meta-analysis on those data). While these kinds of interventions have some benefit, ultimately, understanding what one’s ideal “microbiome fingerprint” is — what is the balance of different types of bacteria that colonize your gut under uninfected conditions — and figuring out how to replace that may provide a substantial improvement in clinical condition, dramatically reducing bodywide inflammation that may persist even under conditions of antiviral suppression.

See the NYBC website for more information on PROBIOTICS

 

HIV and Aging: Living Long and Living Well

By 2015, more than 50% of the United States HIV population will be over 50. There are approximately 120,750 people now living with HIV/AIDS in NYC; 43% are over age 50, 75% are over age 40. Over 30% are co-infected with hepatitis.

What does the future hold for people with HIV and HIV/HCV as they get older?

These statistics and this question furnished the starting point for the New York Buyers’ Club March 28 event HIV and Aging: Living Long and Living Well, presented by Stephen Karpiak, PhD, of the AIDS Community Research Initiative of America (ACRIA).

Dr. Karpiak’s background uniquely positions him to paint the full picture behind the bare statistics, and to provide expert guidance through the complex healthcare challenges faced by the growing population of older people with HIV. After two decades as a researcher at Columbia University’s Medical School, Dr. Karpiak moved to Arizona, where he directed AIDS service organizations through the 1990s, including AIDS Project Arizona (which offered a supplements buyers’ club similar to NYBC’s). In 2002, back in NYC, he joined ACRIA as Assistant Director of Research, and was the lead investigator for the agency’s landmark 2006 study, Research on Older Adults with HIV. This report, the first in-depth look at the subject, surveyed 1,000 older HIV-positive New Yorkers on a host of issues, including health status, stigma, depression, social networks, spirituality, sexual behavior, and substance abuse.

Why are there more and more older people with HIV? The first and principal answer is very good news: HIV meds (HAART), introduced more than 20 years ago, have increased survival dramatically. Secondly, a smaller but still significant reason: older people are becoming infected with HIV, including through sexual transmission. (Older people do have sex, though sometimes healthcare providers don’t seem to acknowledge this reality.)

As Dr. Karpiak noted, HAART prevents the collapse of the immune system, and so it serves its main purpose, to preserve and extend life. And yet, as he reminded the audience, HIV infection initiates damaging inflammatory responses in the body that continue even when viral load is greatly suppressed. These inflammatory responses, together with side effects of the HIV meds, give rise to many health challenges as the years pass. In people with HIV on HAART, research over longer time periods has found higher than expected rates of cardiovascular disease, liver disease, kidney disease, bone loss (osteoporosis), some cancers, and neurological conditions like neuropathy.

That brings us to “multi-morbidity management”—a term we weren’t enthused about at first, since it sounded more like medical-speak than the plain talk our NYBC event had promised. But Dr. Karpiak gave us a simple definition: dealing with three or more chronic conditions at the same time (and HIV counts as one). He then made the case that this is a critical concept to grasp if older people with HIV are going to get optimal care. Multi-morbidity management, he explained, is a well-accepted healthcare concept in geriatric medicine, which recognizes that older people may have several conditions and will benefit from a holistic approach in order to best manage their health. Treating one condition at a time, without reference to other co-existing conditions, often doesn’t work, and sometimes leads to disastrously conflicting treatments.

And here’s where Dr. Karpiak warned about “polypharmacy”–another medical term worth knowing. “Polypharmacy” can be defined as using more than five drugs at a time. Frequently, it comes about when healthcare provider(s) add more and more pills to treat a number of conditions. But this approach can backfire, because, as a rule of thumb, for every medication added to a regimen, there’s a 10% increase in adverse reactions. That’s why adding more and more drugs to treat evolving conditions may be a poor approach to actually staying well.

In closing, Dr. Karpiak focused especially on a finding from ACRIA’s 2006 study: the most prevalent condition for older people with HIV, aside from HIV itself, was depression. Over two-thirds of those surveyed had moderate to severe depression. Yet while depression can have serious conse-quences–such as threatening adherence to HIV meds–it has remained greatly under-treated. It may seem an obvious truth, but as Dr. Karpiak underlined, psychosocial needs and how they’re met will play a big role in the health of people with HIV as they age. What social and community supports are available becomes a big medical question, and how healthcare providers and service organizations respond to it can make for longer, healthier lives for people with HIV.

And now we come back to NYBC’s contribution to the discussion on HIV and Aging. While NYBC doesn’t keep track of such information in a formal way, we do recognize that quite a few of our members have been using supplements since the days of our predecessor organization DAAIR–going back 20 years now. That’s a lot of accumulated knowledge about managing symptoms and side effects among people with HIV! To accompany the March 28 presentation, our Treatment Director George Carter drew up a pocket guide to complementary and alternative approaches: HIV and Aging – Managing and Navigating. Partly derived from his long experience, and partly drawn from a 2012 Canadian report, the guide ranges over those kinds of “co-morbidities” that Dr. Karpiak spoke of, including cardiovascular, liver, kidney, bone, and mental health conditions. Interventions or management strategies include supplements, but also diet and exercise recommendations, as well as psychosocial supports (counseling, support groups, meditation, and activism).

NYBC has also updated several info sheets from its website and blog, offering these as a way to address some of the most common healthcare issues facing people with HIV as they get older: cardiovascular topics; :digestive health; NYBC’s MAC-Pack (a close equivalent to K-PAX®); key antioxidants NAC and ALA and their potential to counter inflammatory responses; and supplement alternatives to anti-anxiety prescription drugs. These info sheets, together with the HIV and Aging – Managing and Navigating pocket guide, are available on the NYBC website and blog.

We hope that our HIV and Aging: Living Long and Living Well event has been useful to all. Special thanks to our audience on March 28, many of whom brought excellent questions to the session. Now let’s continue the conversation…

To your health,

New York Buyers’ Club

NYBC_March282013

Omega-3 fatty acids (especially DHA) may protect against ulcerative colitis

Omega-3 fatty acids (for example, the EPA and the DHA in your fish oil supplements) have an anti-inflammatory effect, of interest to researchers in a recent study of inflammatory bowel disease, specifically ulcerative colitis. This large study, which focused on people from 45 to 74 years old, found that those with the highest consumption of DHA (410 mg to 2,000 mg per day) had a 77% reduction in the risk of developing ulcerative colitis over an average period of four years than those consuming the lowest amount (up to 110 mg per day). On the basis of their research, the study authors suggest that higher intake of omega-3 fatty acids, especially DHA, could have a protective effect against development of ulcerative colitis.

For more information on DHA, EPA and other fatty acid supplements, see the NYBC category:
Fatty acid supplements
Note that NYBC stocks a variety of these supplements, both from fish oil (Nordic Naturals and Jarrow), and from vegetarian (algae) sources.

Reference:
John, S et al. Dietary n-3 polyunsaturated fatty acids and the aetiology of ulcerative colitis: a UK prospective cohort study. Eur J Gastroenterol Hepatol. 2010 May; 22(5):602-6

Glutamine for the Gut

We’re reprinting information on the use of Glutamine for Inflammatory Bowel Disease (ulcerative colitis and Crohn’s disease) and for HIV/AIDS. These excerpts are from the University of Maryland Medical Center’s Complementary Medicine web resource, which provides an extensive and generally up-to-date database on nutritional supplements and their applications.

NYBC stocks two forms of Glutamine. And, by the way, we’ve just noticed that our bulk Glutamine powder (1 kilogram) is about HALF THE PRICE of a “discounted” Glutamine powder offered by a chain of vitamin/supplement stores! (GNC…sssshhh)

Read these entries for dosage recommendations:

Glutamine as a bulk powder (1 kilogram)

and

Glutamine capsules 500mg/100.

Glutamine is the most abundant amino acid (building block of protein) in the bloodstream. It is considered a “conditionally essential amino acid” because it can be manufactured in the body, but under extreme physical stress the demand for glutamine exceeds the body’s ability to synthesize it.

Inflammatory Bowel Disease (IBD)
Glutamine helps to protect the lining of the gastrointestinal tract known as the mucosa. Because of this, some experts speculate that glutamine deficiency may play a role in the development of IBD, namely ulcerative colitis and Crohn’s disease. These conditions are characterized by damage to the mucosal lining of the small and/or large intestines, which leads to inflammation, infection, and ulcerations (holes). In fact, some preliminary research suggests that glutamine may be a valuable supplement during treatment of IBD because it promotes healing of the cells in the intestines and improves diarrhea associated with IBD.

HIV/AIDS
Individuals with advanced stages of human immunodeficiency virus (HIV) often experience severe weight loss (particularly loss of muscle mass). Some studies of individuals with HIV have demonstrated that glutamine supplementation, along with other important nutrients including vitamins C and E, beta-carotene, selenium, and N-acetylcysteine, may reduce the severe weight loss associated with this condition.

Florastor/ Saccharomyces boulardii

Here’s the NYBC summary of recent research on Saccharomyces boulardii, which is available under the tradename Florastor:

Saccharomyces boulardii, sometimes abbreviated Sac. boulardii or S. 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 among probiotics for antibiotic-associated diarrhea, C. difficile colitis, and “traveler’s diarrhea.” It can also help with irritable bowel syndrome, ulcerative colitis and Crohn’s disease. Here are some recent research highlights:

-Harvard Medical School researchers have identified specific pathways by which Saccharomyces boulardii decreases intestinal inflammatory responses; their 2006 report helps explain the broad range of protective effects that this probiotic exerts in a variety of gastrointestinal disorders. (Sougioultzis S, et al. 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.)

-A 2006 meta-analysis (combined analysis of multiple individual studies) found that Saccharomyces boulardii was the only probiotic studied that was effective against Clostridium difficile disease, a common form of antibiotic-associated diarrhea. (McFarland L V. 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.)

-A 2008 study found that Crohn’s patients receiving Saccharomyces boulardii treatment showed significant improvements in intestinal function compared with those given a placebo. (Garcia Vilela E, et al. Influence of Saccharomyces boulardii on the intestinal permeability of patients with Crohn’s disease in remission. Scand J Gastroenterol. 2008;43(7):842-8.)

-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 the lining of the lungs, and a main component of the body’s protective mechanism against pathogens. Thus Saccharomyces boulardii may now be credited with an ability to enhance immune function in general. (Flaviano S. et al. Comparative study of Bifidobacterium animalis, Escherichia coli, Lactobacillus casei and Saccharomyces boulardii probiotic properties. Archives of Microbiology, Volume 191, Number 8 / August, 2009.)

See the NYBC entry for more details, including recommended dosages:

http://nybcsecure.org/product_info.php?products_id=217

Jarro-Dophilus EPS

Jarrow Formulas advertises this product as the number one selling probiotic supplement on the US market, and, at least in this case, we tend to think that’s a sign that it is a worthwhile supplement, helpful for people dealing with malabsorption or various gastrointestinal disturbances that prevent adequate digestion.

Here’s the product review from the NYBC website:

Jarro-Dophilus EPS (Jarrow) Each bottle, 60 capsules. Each capsule contains 4.4 billion probiotic organisms, including various species of Lactobacillus, Bifidus, Pediooccus acidilactici and Lactococcus diacetylactis. These capsules are enterically-coated to preserve them without refrigeration, which makes this an ideal product for use while travelling. However, if at home, refrigerate anyway, just to preserve them as well. Blister packed. Suggested use is 1-2 capsules per day, if possible, without food. Dairy-free and vegetarian formulation. Also contains potato starch, magensium stearate and ascorbic acid.

Note: A 2006 consumerlab.com report evaluated several brands of acidophilus-containing products. This Jarrow product passed all of their tests!

Further information on this and other probiotic supplements can be found on the NYBC website:

http://nybcsecure.org/index.php?cPath=27