Probiotics

[Georgepds]

For those of us using probiotics I found a good reference. I reproduce table 2 which evaluates many of the commercially available products

A Gastroenterologist’s Guide to Probiotics

The enteric microbiota contributes to gastrointestinal health and its disruption has been associated with many disease states. Some patients consume probiotic products in attempts to manipulate the intestinal microbiota for health benefit. It is important ...

www.ncbi.nlm.nih.gov

Table 2
Common probiotic products specifically tested for gastrointestinal disorders

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Brand Name (Company)	Bacterial Species	Clinical Condition	Effectiveness15,16	Practice Guidelines17–19	Bacteria Count/Dosing	Cost/Quantity
Activia (Dannon, White Plains, NY)	B. lactis DN-173 010, (plus yogurt starters L. bulgaricus, L. lactis and Streptococcus thermophilus)	IBS	C	1b**	4 oz/cup, 1–4 QD	$10–18/24 count
Align (Proctor & Gamble, Cincinnati, OH)	Bifidobacterium infantis 35624	IBS	B	1b**	1 billion/1 QD	$29.99/28 count
BioGaia (Everidis Health Sciences, Saint Louis, MO)	L. reuteri protectis SD2112 (ATCC 55730 or DSM 17928)	Infectious Diarrhea Treatment	A	1a*	100 million QD	$29.99
IBS	C	1b*
Bio-K+ (Bio-K plus International inc., Laval, QC, Canada)	L. acidophilus CL1285 and L. casei LBC80R	AAD Prevention	NS	1b**	50 billion/capsule	$29.99/15 count
CDAD Prevention		1b**	BID
Culturelle (Valio, Helsinki, Finland/Amerifit Brands, Inc., Cromwell, CT)	L. rhamnosus GG (LGG) (LGG also included in Danimals yogurt, Dannon)	AAD Prevention	A	AAP, 1b,1b*	10 billion/1 QD	$18–25/30 count
Infectious Diarrhea Treatment	A	AAP, 1a, 2b*
Infectious Diarrhea Prevention	B	1b, 1b*
CDAD Prevention	B/C
CDAD Prevention of Recurrence	B/C
Crohn’s Disease	C
IBS	B/C (children)	1a,1b*+
Danactive (Dannon. White Plains, NY)	Lactobacillus casei DN-114001	AAD Prevention	A	1b**	3.1 oz/cup	$5.00/8 count
Infectious Diarrhea Prevention		1b*	10 billion/cup
CDAD Prevention		1b**
Florastor (Biocodex, Inc., Creswell, OR)	Saccharomyces Boulardii	AAD Prevention	A	AAP, 1a, 1b*	250 mg/1 BID	$19.99/20 count
Infectious Diarrhea Treatment	A	1a,1b*
Infectious Diarrhea Prevention	B
CDAD Prevention	B/C
CDAD Prevention of Recurrence	B/C	1b**
Crohns	C
Mutaflor (Ardeypharm, Herdecke, Germany)	E.coli Nissle 1917 (ECN)	UC Induction	B		100 mg/capsule/BID	$62–$81/60
UC Maintenance	A	1b**, BSG “A”		Canada#
VSL*3 (Sigma-Tau Pharmaceuticals, Inc., Towson, MD)	Combination Probiotic Product (Streptococcus thermophilus, B. breve, B. longum, B infantis, L. acidophilus, L. plantarum, L. paracasei, L. delbreuckii/bulgaricus	IBS	B/C		122.5 billion/capsule	$86/30 Sachets
UC Induction	B	1b**	450 billion/sachet	$52/60 count
UC Maintenance	A		IBS: ½–1 sachet/day
Pouchitis: Prevention and Maintaining Remission	A	1b**, BSG “B”	Pouchitis: 2–4 sachets/day UC: 1–8 sachets/day

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Effectiveness based on expert panel recommendations where: A=strong, positive, well-conducted, controlled studies in the primary literature, B=some positive, controlled studies but presence of some negative studies or inadequate amount of work to establish the certainty; C=some positive studies but clearly inadequate amount of work to establish the certainty. Practice Guidelines include those of 1) World Gastroenterology Organisation’s global guidelines evidence level assignment17 based on the Centre for Evidence Based Medicine system20:

*pediatrics,

**adults,

+ as part of a multispecies probiotic product 2)American Academy of Pediatrics recommended (AAP)18 3) British Society of Gastroenterology (BSG) guidelines Grade of Evidence19 Grade A indicates consistent results among RCTs, Grade B indicates consistent cohort studies or smaller RCTs.

#E. coli Nissle is currently removed from the U.S. market respecting the FDA’s decision on the classification of the product as a “biologic” instead of its former status as a “medical food.”

 

[Georgepds]

Here's another ref, more recent

(PDF) Use of probiotics in gastrointestinal disorders: What to recommend?

PDF | Perturbation of bacterial microflora of the gastrointestinal (GI) tract may play an important role in the pathophysiology of some GI disorders.... | Find, read and cite all the research you need on ResearchGate

www.researchgate.net

One thing that becomes clear, is that each pro biotic helps with a different disease

1 Florastor helps cdiff
2 Align pro helps with some types of IBS

Now you have to dig a little to reach that result ... e.g. the quote

"The imbalance between IL-10 and IL-12, observed in peripheral blood mononuclear cells, was confirmed at the mucosal level in a recent study by Macsharry and colleagues suggesting that this finding may be an underlying phenotype in IBS and a potential biomarker for a subset of IBS patients [Macsharry et al. 2008]. B. infantis was shown to increase IL-10/IL-12 ratio in IBS patients [O’Mahony et al. 2005] suggesting a possible mechanism by which this probiotic may exert its effect."

And the knowledge that align pro contains Bifidobacterium infantis. Gives you statement 2 Align pro helps with some types of IBS

Now.... the problem for someone who has diarrhea is that they poop a lot... they don't know the underlying cause. The hope is a probiotic will help. Well, it might, but the evidence is different bugs (probiotics) work for different diseases.

So, if at first you don't succeed, try try again, but with something different

 

[Georgepds]

And.. from those folks at the ASMBS.. a note saying we told you so.... and probiotics might help.. but might not

Bariatric Surgery: Postoperative Concerns

Download Revised 02/07/2008 | Published: 05/23/2007 Looking for information on life after bariatric surgery? Get the latest information in our Patient Learning Center This information is to be used as…

asmbs.org

"Diarrhea

Diarrhea or loose stools is mainly a potential side effect of Sleeve Gastrectomy with Duodenal Switch (also known as Biliopancreatic Diversion with Duodenal Switch). Diarrhea may be seen with Roux-en-Y Gastric Bypass (RNYGBP), but would not be associated with the Laparoscopic Adjustable Gastric Banding (LAGB).

With the Duodenal Switch (DS), bowel movements are more commonly affected, and the usual alteration is the likelihood of developing soft or loose stools. Frank diarrhea is related to fatty acids passing directly into the colon. These fatty acids would normally have been absorbed in the small intestine. Once in the colon they induce irritation. Diarrhea can also be produced by relatively undigested food passing rapidly through the gastrointestinal tract. A third contributing factor is sorbitol, found in fruits, berries, and also used as an artificial sweetener. Sorbitol is not well absorbed in the GI tract, and when in the colon, it is fermented. This fermentation will result in increased gas and diarrhea.

The average patient after the DS has 2-3 soft bowel movements per day. However, as with most side effects, there is a wide spectrum. At one end of this spectrum are patients who have a single bowel movement a day. At the other end are patients who have more than ten (and sometimes up to twenty) bowel movements a day. For the majority of patients after the DS, the bowel movements are only a mild inconvenience, but for those at the high end of the spectrum the diarrhea can be quite problematic. DS patients may also have a problem with foul-smelling flatus, which can be a serious issue.

Diet is a major influence on bowel movements after a DS. Reducing the amount of fat will usually have a direct beneficial effect on the number and quality of bowel movements a patient may have. Usually, with close questioning, it can be revealed that a patient has not been watching his or her diet as carefully as he or she should. If they can be identified, there are other “trigger” type foods that may induce diarrhea, and the patient should attempt to avoid or minimize these foods.

Both the DS and the RNYGBP may unmask previously unidentified lactose intolerance. This can result is diarrhea and gas complaints. An early step in the assessment of diarrhea after surgery is to eliminate dairy products from the diet completely.

Management of diarrhea (provided there is no identifiable pathologic etiology or dietary factor) is varied. A dose of Imodium at bedtime can decrease the number of early morning bowel movements. It may also delay the onset in those who have been previously awakened early in the morning by urgent bowel movements. If beneficial, some patients may stay on a maintenance dose of Imodium® or Lomotil® for long term control.

Many patients will benefit from a course of probiotics. They are a form of natural colonic flora that is administered orally to restore the natural bacterial milieu toward the normal state. Typical probiotic products include Lactobacillus Acidophyllus® and Ultraflora® lactose-free. The more complex and inclusive the product, the better it seems to work. Unfortunately, these products may not be covered by third party payer insurance companies. However, the probiotics usually only need to be taken for a brief period of time to restore the colon to a more normal bacterial state.

In any postoperative patient with especially watery diarrhea, extremely foul flatus, and abdominal cramping, one needs to consider a Clostridium difficile (C. diff.) colitis or antibiotic-associated diarrhea (AAD). This may occur after DS, RYGBP or LAGB. It may manifest itself early after surgery, or it may take 2 or 3 months. Treatment of AAD is with a 10-14 day course of Flagyl®. Not uncommon relapses can be treated with a repeat course of Flagyl® or with oral Vancomycin®. In treating C. diff. colitis, it is important to replenish the colonic flora as the therapy is proceeding with probiotics as described above. Flagyl® is effective in the management of bacterial overgrowth not related to C. diff. infections as well.

Cholestyramine (Questran®) and similar products such as Welchol® and Cholestid® are used to bind bile salts. This may decrease the frequency of diarrhea and the severity of gas. Start with a low dose and gradually increase weekly until a beneficial effect is seen. Cholestyramine has been used to treat C. diff. infections as well, but only with Flagyl® not Vancomycin®.

Rarely, with the above management strategies a patient may continue to have an unacceptably high frequency of bowel movements. It is reasonable to give the bowel time to compensate and adapt, so that fat absorption increases. This will allow diarrhea to improve. If after one year there is no improvement in diarrhea, then the situation requires intervention. Surgical lengthening of the common channel can be entertained. This is usually a relatively straightforward surgical procedure that may be done laparoscopically with an overnight hospital stay. Subsequently, diarrhea will be controlled without causing significant weight regain.

Before making changes in diet, vitamins and medications, be sure to consult your physician.

 

[Georgepds]

So, on a more personal note, probiotics are working for me.We 'll see if that continues, but I welcome the relief, and the freedom.

For now, it's mostly Florastor and Primal defense ultra, but I hope to get it down to just PDU.

I hope the gal who gave up on dating so long ago finds a solution.

 

[DianaCox]

I do one PDU in the AM, and a Culturelle at night.

 

[Georgepds]

Is the rationale the more diverse the better?

 

[JackieOnLine]

probiotics are working for me.We 'll see if that continues, but I welcome the relief, and the freedom.

I'm glad for you!

this may be a dumb question, but remember I haven't had a DS, can you eat fermented foods and get probiotics that way? kefir if you can do dairy, sauekraut and so on?

because I know in the non WLS world, absolutely the more diverse the better but also MORE

Loads of beneficial bacteria (probiotics) – including a greater variety and up to100 times more good bacteria per serving than probiotic supplements!

from the link
why fermented foods are all the rage

 

[Georgepds]

Well.. yes I can, but with care. Any abrupt change seems to invite the flood waters. It's pretty clear to me there is a spectrum of response among DS patients. More people have these kind of problems than "normies", and some people with DS have more problems than others.

In the year between the VSG and the duodenal switch, I had no/few GI problems, and was able to wear those lovely boxer shorts without fear. To me this says the intestine resection is the likely source of the problem.

Also, at least for me, the problems come and go, if not they would drive me totally batty.

Back to your helpful question, I started eating kéfir ( like liquid yogurt, I like cherry flavor) and, sometimes, fermented sauerkraut ( you have to get the fermented kind, there is another way to make it with vinegar that has no bugs)

Like you say, I'm working under the theory the more diverse the bugs the better. The thing I'm not sure if any of the bugs in kéfir or sauerkraut make it alive to the gut.. but what the hell.. they taste good..at least eaten seperately

So what I don't really understand is what happens to the microbiota when the gut , and transit time , is shortened. The theory is the microbiota community is disturbed, and the bugs that promote GI problems ( like Diarrhea) become more prominent. The act of taking the probiotic introduces a fresh community of beneficial microbes into the gut, but only temporarily. Hence the need to take a daily pill.

I get the broad strokes, but when I try to get a deeper understanding I face the problem that the symptoms have multiple causes. I'm sure whatever is ailing me is exacerbated by the DS, but that may be only the trigger.

 

[DianaCox]

Is the rationale the more diverse the better?

Yes.

 

[southernlady]

My rationale as to which one to take was if I remembered to take it, I was ahead of the game. Nothing requiring refrigeration was in that category so for Charles and I, a chewable gummy was our choice. Not the best but better than none at all.

 

[Georgepds]

My rationale as to which one to take was if I remembered to take it, I was ahead of the game. Nothing requiring refrigeration was in that category so for Charles and I, a chewable gummy was our choice. Not the best but better than none at all.

My understanding is PDU does not need refrigeration

Reading about probiotics, I came across some that argued against refrigeration because of the high humidity

But I'm with you... the first task is to take it

 

[Georgepds]

Follow up.... well.. probiotics helped me

It's been a while since I started his screed. I now take Primo defense ultra 2 or 3 times a day, and that helps, a lot.

Whew... to the casual observer it seems like a bad joke, but to not be able to take a long walk, or go to town for a coffee, can make you blue, or crazy.

Time to take up swing again at the Kittery dance hall ....

 

[JackieOnLine]

probiotics helped me

so glad for you!

and, seriously? I always wanted to learn Swing Dancing and have taken a few lessons in the past. I stink at it but want to do it again anyway. good for you!

 

[Georgepds]

More follow-up.. On the small chance it might help someone else, I want to share my solution to the DS gastro set of FUD problems ( Farting, Uncontrolled bowel movements, and Diarrhea)

Wait for it.... lima beans.. one can a night.. Goya is my choice . I microwave a can in its' own liquid, and then drain the liquid. Add a bit of Olivio and salt, and it's a major snack

I know it's weird, but I chalk it up to the soluble fiber in the beans. I still do the probiotics ( primo defense ultra ), but less now. Call the beans a prebiotic

I really don't know why kidney beans. Baked beans, e.g., will set me into gastric distress. Other beans, and peas, don't seem to help as much

On the plus side, you might live a little longer. Lima beans are legumes, and in horizontal longevity studies across countries, legumes are the only dietary feature that add life, no matter what the cultural eating norm.

What's more, you are about half way there to meeting the recommended amount of fruits and vegetables a day (~2 cups of each). Who knows what amount is good for the DS population, but if you can eat it without regaining weight, so much the better

And think, a life without FUD.. what a thought

And it helps the dancing too, no more MIF (Movement Induced Farts )

Legumes: the most important dietary predictor of survival in older people of different ethnicities - PubMed

To identify protective dietary predictors amongst long-lived elderly people (N= 785), the "Food Habits in Later Life "(FHILL) study was undertaken among five cohorts in Japan, Sweden, Greece and Australia. Between 1988 and 1991, baseline data on food intakes were collected. There were 785...

pubmed.ncbi.nlm.nih.gov

 

[JackieOnLine]

I know it's weird, but I chalk it up to the soluble fiber in the beans. I still do the probiotics ( primo defense ultra ), but less now. Call the beans a prebiotic

whatever works! I think people forget about prebiotics, but you need to eat them to feed the probiotics.

I need to eat more beans, it's easy enough to add any kind to a salad and I just forget.