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Probiotic Introduction

The Gastro-Intestinal Tract

Gut Flora

Leaky Gut Syndrome

Mucosal Immune System

Stool Analysis

Probiotic & Prebiotic Treatment


Probiotic & Prebiotic Treatment

Probiotic dosage will vary, according to Hanaway, based on the indication for treatment (and/or prevention) and the age of the patient. Strain-specific effects are just beginning to be published and efficacy data on one sub-species or strain may not be applicable to another, even within the same species.

  • Current data suggest that the intestinal flora in Crohns Disease and Ulcerative Colitis - IBD - is not normal, even as we strive to better understand the exact nature of the term "normal flora
  • " 68.
  • Epidemiologic data support the idea that insufficient protective commensal* flora may impair immune system homeostasis
  • 69.
  • Intervention studies are beginning to prove this therapeutic approach. Studies have demonstrated efficacy for maintenance treatment of pouchitis using 450 billion colony-forming units (cfu) per day70. Much higher doses are currently being studied for treatment of Crohns Disease and Ulcerative Colitis - IBD
  • 71.
  • Additional trials have demonstrated efficacy as adjunctive72 and primary
    therapy 73 for ulcerative colitis, using doses of 10-75 billion cfu/day
  • .

Treatment of Irritable Bowel Syndrome - IBS - with probiotics has also been shown to be efficacious in six of eight trials, with response depending upon dosage and strain of probiotic used74. Several studies of Irritable Bowel Syndrome - IBS - treatment with probiotics have utilized doses of 25-75 billion cfu/day of lactobacillus and bifidobacteria, demonstrating decrease in flatus and improvement in quality-of-life symptom scores75-77.

Post-antibiotic therapies have been recommended at 20-25 billion cfu/day to help normalize commensal* flora78. Treatment is usually for 3-4 weeks and can begin during antibiotic treatment, as long as it is not taken concomitantly. Benefit in reducing antibiotic-associated diarrhea has also been demonstrated79.

In addition to studies on strain-specific effects, studies are needed to evaluate the appropriate dosages for various conditions. It has been assumed empirically that higher dosages may be effective for treatment of disease, and lower dosages are useful for health promotion and disease prevention .

A meta-analysis of the utility of Lactobacillus in childhood diarrhea demonstrated its efficacy in reducing diarrhea an average of 0.7 days, with a reduction of bowel movements by 1.6 /day on Day 2. A further evaluation of dose response was performed, demonstrating that the reduction in diarrheal days was directly correlated with dosages above 10 billion (1010) cfu and up to 150 billion (1011) cfu per day80. Synbiotics (the combination of prebiotics and probiotics) seem to be effective at lower dosages81.

A recent review summarizes the evidence that the immuno-stimulatory effect of probiotics extends far beyond the gastro-intestinal tract to distant mucosal surfaces, including the respiratory and genitor-urinary systems82.

Further research has shown that probiotics enhance cell-mediated immunity in elderly patients, particularly in people whose immune systems showed poor response before treatment83.

Probiotics are extremely safe, even at high doses84. No pathogenic or virulence properties have been identified for Lactobacilli or Bifidobacteria85.

Hanaway says that to date, there are no documented cases of septicemia associated with Bifidobacteria. While Lactobacillus has been associated with bacteremia, it has only been documented in severely immuno-compromised patients, with prolonged hospitalization and after surgery86. Data from Finland do not demonstrate any increase in bacteremia over the past 10 years of rapidly increasing probiotic consumption87.

Prebiotic Treatment

Fructooligosaccharides (FOS) may act as a fermentative substrate. Because they particularly favor the Bifidobacteria population in the gut, regular ingestion can help these organisms become predominant. A dose of 4g/day appears sufficient to have this effect in vivo88. Even at a dose five times higher (ie, 20g/d), there is a negligible amount of intact FOS found in the stool, indicating that FOS have been nearly completely fermented in the colon89.


Hanaway say, in conclusion, that it is clear that there is a dynamic relationship involving the gastro-intestinal flora, environmental inputs (food and other nutrients), and the health of the immune system.

Recent research has taught us a great deal about the role of diet and commensal* bacteria in promoting health. It appears that Nobel-laureate Eli Metchnikov may have been correct in his assertion that live bacterial cultures are "the elixir of life." We are unlocking a number of secrets about immune system functioning, but we keep coming back to a simple intervention that has an ever-expanding opus of research to support it, and an extremely low toxicity ratio.

He says that future studies will help us to clarify the best strains and the best dosages for individual patients and specific conditions.

Assessment of commensal* flora and a genomic scan for markers of immunologic dysregulation will be more accurate and more widely available. It appears, however, that the diagnostic and therapeutic tools we have to work with today can make a tremendous difference in reducing the burden of suffering for our patients.

Hanaway proposes that if "form follows function," as Buckminster Fuller was fond of saying, then the form of our immune system may be following the precise functions that our commensal* flora is dictating.

He suggests that we:

  • encourage breastfeeding,
  • decrease unnecessary antibiotic and antimicrobial usage (especially in the first two years of life),
  • improve oral tolerance with a healthy n-6/n-3 fatty acid ratio, and
  • support the development of a healthy commensal* flora.

These actions on behalf of our immune systems will pay dividends for years to come.

*Commensal: Living in a relationship in which one organism derives food or other benefits from another organism without hurting or helping it. Commensal bacteria are part of the normal flora in the gut.