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

 

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Probiotics, yogurt and gut health in people with HIV

The online information resource for people with HIV, The Body, recently published an article on probiotics, yogurt and gastrointesinal health in people with HIV: A “Cultured” Response to HIV:
Probiotics in Yogurt Could Hold Keys to Optimal Gut Health in HIVers
. Here’s an excerpt:

HIV researchers have known since the early days of the pandemic that HIV can wreak havoc on the gut, which is home to an abundance of CD4 cells. This apparently occurs quite soon after someone is infected with HIV. “It’s almost like the gut is a magnet for the virus early on,” says Bill Critchfield of the University of California at Davis. “[It] becomes compromised in weeks.”

The gut also harbors roughly 100 trillion microorganisms that help with immunity and digestion. HIV infection can upset the balance of healthy bacteria in the gut, allowing “bad” bacteria and fungi to flourish there. Several recent studies have suggested that probiotics — the “friendly bacteria” that turn milk into yogurt and also provide health benefits when eaten — can help restore that balance by repopulating the gut with healthy bacteria or by tuckering out the bad bacteria by competing with them for nutrients.

As Nature Medicine reports, microbiologist Gregor Reid of Lawson Health Research Institute in Ontario, Canada, has been studying the health benefits of probiotics for over 25 years. He’s created his own probiotic, called Lactobacillus rhamnosus GR-1, which he has put into a yogurt that is being used in research involving people with HIV. Reid and others around the world have conducted small studies that show probiotics have a positive effect on CD4 counts, though larger studies are certainly needed to confirm those findings.

The article in the journal Nature Medicine is found at
http://www.lhrionhealth.ca/crdcp/pdf/Nature%20Medicine%20feature.pdf. It looks especially at a pilot study in Tanzania on yogurt, gut health and HIV.

NYBC, like its predecessor supplements buyers’ club DAAIR, has long been interested in probiotics for gut health in people with HIV. See the NYBC entries at Probiotics for detailed recommendations for use.

NYBC’s Quick Guide to Gastrointestinal Health

A number of NYBC members and visitors to our website and blog have asked us to reprint the NYBC “Quick Guide to Gastrointestinal Health,” which first appeared in the Winter 2009 issue of our free newsletter THE SUPPLEMENT:

NYBC’s Quick Guide to Gastrointestinal Health

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.

Below we present various tips, tricks, news and research notes, all designed to help you maintain good gastrointestinal health, or find help when things are not going so well in your digestive tract.

Probiotics. These are “friendly” microorganisms that can re-balance the ecology of your gut. Probiotics are well-known for their benefit to digestive health, and especially for their ability to resolve some types of diarrhea. Here are the major types stocked by NYBC: bifidus (as Bifidus Balance/Jarrow); lactobacillus/bifidus (as Jarrodophilus/Jarrow—needs refrigeration); lactobacillus/bifidus (as Jarrodophilus EPS–needs no refrigeration); and Saccharomyces boulardii (as Florastor from Biocodex—needs no refrigeration).
Some NYBC members find that using Jarrodophilus every other day keeps diarrhea away. (And it’s actually cheaper than getting the probiotics from yogurt—though admittedly not quite so tasty or nutritious.) Another approach: try the green foods supplement Pro Greens (Nutricology), which has a rich variety of nutrients, but also includes a substantial lactobacillus/bifidus component. The BioCodex product Florastor, meanwhile, is most often used for antibiotic-associated diarrhea or to avoid “traveler’s diarrhea” (when started in advance of the trip).

Research note, as reported last year by John James in the online AIDS Treatment News Daily Alerts. The note deals with C. difficile, a diarrhea-producing infection that’s on the rise, and is often a lingering byproduct of antibiotic treatment: “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. […] ‘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 [researcher] Dr. Raymond. ‘When the ‘baby’ C. diff emerge from their spores, they are greeted by a well-colonized gut, rather than an empty playground.’”

Glutamine and other supplements to prevent diarrhea and maintain body weight. In the era of antiretroviral therapy, weight loss has become less of a problem for people with HIV. Yet maintaining muscle mass over time remains a big concern, and one key to that is controlling diarrhea, which deprives the body of needed protein and other essential nutrients.

One frequently used remedy for diarrhea is the amino acid glutamine. It has been studied for leaky gut syndrome, which results when intestinal tissues are damaged, and also has a long history of application to maldigestion in people with HIV. Anecdotally, people with protease-inhibitor diarrhea find relief using 30-40 grams per day. Start with about 15 grams per day and increase the dose until the diarrhea is controlled. A daily maintenance dose is about five grams a day. Note that glutamine is best taken in three daily doses.

Research note: A well-designed study published in the journal Nutrition found that a glutamine-antioxidant regimen was effective at helping HIV+ people with weight loss to regain body weight. The regimen included glutamine (40 g per day), along with vitamin C (800 mg), vitamin E (500 IU), beta-carotene (27,000 IU), selenium (280 mcg), and N-acetylcysteine (2,400 mg). People who took the supplements showed significant weight gain in 12 weeks, while participants taking a placebo did not.

Other supplements have also been used to counteract malabsorption and diarrhea associated with HIV and/or HIV medications:

Calcium: two Canadian studies from 2004 and 2005 re-affirm the thinking that calcium carbonate can be useful in controlling protease inhibitor-related diarrhea. Calcium supplements have long been used for this purpose by buyers’ club members; see the recommendations under “Digestive Maintenance” on the NYBC website for details.

Soluble fiber such as apple pectin, oat bran, and flax seed. For some people, soluble fiber can help food stay in the digestive tract for longer periods of time, increasing the amount of nutrients that are absorbed, and lessening bowel frequency.

Traditional botanicals/remedies for gastrointestinal health. NYBC stocks two formulas produced by the well-regarded California-based developers of herbals, Health Concerns and Pacific BioLogic. Both formulas are derived from traditional schools of herbal medicine (Chinese or Tibetan), but are also informed by modern clinical practice. Here are the indications for use supplied by the manufacturers:

Quiet Digestion (Health Concerns). 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.

GI Tract: Gastro Regulator (formerly Digest Ease) from Pacific BioLogic. Derived from a Tibetan medicine formula, it is designed to help the function of the gastrointestinal tract, helping to optimize the course of digestion and colonic function, particularly problems arising from bad dietary habits. There may be a brief period of diarrhea or constipation at the beginning of using this product.

Recently an NYBC member called our attention to Mastic Gum, a resin traditionally used in the Eastern Mediterranean as a remedy for heartburn, and generally to protect the stomach and duodenum. Now there’s intriguing new research supporting use of mastic for gastrointestinal health and perhaps additional purposes as well:

1. A study published in 2007 found evidence that mastic could help prevent or manage prostate cancer. This prostate-protective effect may be achieved via an inhibition of nF-KB–interestingly, that’s a cellular protein that HIV also hijacks to help produce more of itself.

2. Another recent study looked at use of 2.22 grams of mastic/day among patients with Crohn’s disease (a chronic, debilitating bowel disorder). Not only did this dosage help in this small pilot study, but two markers of inflammation were significantly reduced: interleukin-6 and C-reactive protein. Again, it’s of interest that both markers are also often elevated in HIV disease.

TheBody.com booklet: “The HIVer’s Guide to Coping with Diarrhea & Other Gut Side Effects.” NYBC recommends this thorough and easy-to-read booklet, which has been reviewed by HIV specialist physicians, and also includes case studies of people with HIV who have worked through some typical gastrointestinal problems. It can be read online, or ordered from thebody.com at http://www.thebody.com/content/art13137.html.
Here’s a capsule summary of the 29-page booklet:

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 remedies, including over-the-counter drugs, supplements, prescription meds, or changing your diet or your HIV drug regimen.

For further information, please also see individual product entries in the “Digestive Maintenance” section of the NYBC catalog. In addition to the items mentioned above in our “Quick Guide,” you’ll also find here our recommendations in the category of digestive enzymes:

DIGESTIVE MAINTENANCE

Probiotics and immune function

Probiotics such as bifidus, lactobacillus and saccharomyces boulardii are known first of all for their benefit to digestive health, and especially for their ability to help resolve various types of diarrhea (from antibiotic-associated diarrhea to “traveler’s diarrhea”).

But as they promote gastrointestinal tract health and good digestion, probiotics also support immune function and increase the body’s resistance to infection. This is because probiotic organisms produce compounds like lactic acid, hydrogen peroxide and acetic acid that increase the acidity of the intestine and slow the reproduction of many harmful bacteria. It’s also been discovered that probiotics produce substances called bacteriocins, which act as natural antibiotics to kill undesirable bacteria.

One example of recent research on probiotics and immune function: a double blind trial that looked particularly at supplementation with Bifidobacterium lactis showed that it significantly enhanced immune function in a group of healthy elderly people. This study, reported in 2000, showed immune function enhancement after six weeks of supplementation.

For further information on individual probiotics, see the NYBC entries:

Probiotics

Saccharomyces boulardii (as Florastor/Biocodex)

Bifidus (as Bifidus Balance/Jarrow)

Lactobacillus/Bifidus (as Jarrodophilus/Jarrow)

Lactobacillus/Bifidus (as Jarrodophilus EPS–needs no refrigeration)

See also the entry for the green foods supplement Pro Greens (Nutricology), which includes a substantial lactobacillus/bifidus component.

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References:
–De Simone C, Vesely R, Bianchi SB, et al. The role of probiotics in modulation of the immune system in man and in animals. Int J Immunotherapy 1993.
–Barefoot SF, Klaenhammer TR. Detection and activity of Lactacin B, a Bacteriocin produced by Lactobacillus acidophilus. Appl Environ Microbiology 1983.
–Arunachalam K, Gill HS, Chandra RK. Enhancement of natural immune function by dietary consumption of Bifidobacterium lactis. Eur J Clinical Nutrition 2000.