probiotics
prebiotics
metaprebiotics
As interest in natural treatments grows, so does the popularity of probiotics. In 2012, nearly 4 million American adults took probiotics or prebiotics, a fourfold increase from 2007. Probiotics were used in more than 50,000 hospitalizations at 139 U.S. hospitals in 2012. Last year alone, American consumers spent, an estimated $2.4 billion in nutritional supplements .
However, two studies have recently been published in which scientists from Israel question whether such widespread use of probiotics to improve overall well-being and restore intestinal microflora after antibiotic use is really advisable .
The first study showed that bacteria from probiotic microorganisms contained in a dietary supplement are not able to colonize the proper parts of the intestine , and, presumably, they can bypass the gastrointestinal tract without any effect on it. In another study, the same bacteria settled in the intestines after a course of antibiotics, but there was a delay in the restoration of its own microbiota . Both studies, conducted on healthy volunteers, were published in the journal Cell in October 2022.
The term "probiotics" means "live microorganisms that, when administered in an adequate dose, contribute to a health benefit to the host." However, some experts say any evidence of benefit, limited to a small number of indications, is controversial and often of poor quality. A 2022 Cochrane analysis found that data from 10 of 14 systematic reviews of clinical trials were insufficient to determine whether probiotics improve gastrointestinal health .
It would seem that things should be better in patients with diarrhea. Although many studies suggest that probiotic supplementation may prevent or treat antibiotic-associated diarrhea and Clostridium difficile infection, other studies (both children and adults) have shown no benefit for these conditions. The two most recent studies, published late last year in the New England Journal of Medicine, did not show the effectiveness of Lactobacillus rhamnosus probiotics in children with gastroenteritis or stomach flu.
Among scientists and practitioners using bacterial therapies, such uncertainty has "caused a great deal of confusion," says Eran Elinav, MD, PhD, a professor at the Wetzmann Institute in Rehovot, Israel, and lead author of the new study published in Cell. .
Colonization assessment
In 2015, Elinav and his colleague Eran Segal, a computational biologist, demonstrated that the same food can have different effects on blood sugar in different people without diabetes, depending in part on the microflora their intestines.
These scientists developed a method for predicting postprandial blood glucose peaks based on a wide range of clinical and laboratory parameters, including stool microbiota. Predicted changes in blood glucose were used to develop a personalized diet to help reduce postprandial blood glucose peaks. Subsequently, this approach was registered as an innovation in the field of nutrition.
Elinav and Segal, in their latest work, suggest that the most effective means of restoring gut microflora is one that is personalized. In their new study, they, along with Zamir Halpern, chief of internal medicine at the Institute of Gastroenterology at Sourasky Medical Center in Tel Aviv, Israel, revisited key issues that they feel they did not adequately address in their previous studies. works: to what extent do probiotics colonize the human intestine and what effect do they have on it?
In the first study, nineteen healthy volunteers took either a commercially available 11-strain probiotic supplement or a placebo twice daily for 4 weeks. According to Elinav, the supplement included the 4 main genera of bacteria used in probiotics around the world.
Rather than relying solely on stool studies (which is common practice in gut microbiota studies), the researchers also examined sites throughout the gastrointestinal tract, both before and during a course of probiotics. Using colonoscopy and deep endoscopy of the upper digestive tract, the scientists collected samples of the contents and lining of the intestine, and also performed a biopsy of its tissue. The samples were then subjected to extensive genetic sequencing to determine microbiota composition, function, and gene expression of host intestinal cells.
Gut lining samples taken 3 weeks after starting a course of probiotics showed that subjects taking antibiotics could be divided into 2 camps: “susceptible” and “resistant”. Susceptible volunteers demonstrated significant levels of probiotic strains in the intestinal lining, whereas no significant colonization was detected in the intestines of resistant volunteers. Susceptible individuals also showed changes in the indigenous microbiome and gene expression profile throughout the intestine, which was not observed in resistant subjects or in the placebo group.
According to Colleen Kelly, a gastroenterologist and professor at Warren Alpert Medical School at Brown University who was not involved in the study, the work is the first to demonstrate that in some people the intestinal lining is resistant to probiotic colonization , “where all the action happens.” "
The baseline natural gut microbiome of volunteers largely determines whether they will be susceptible or resistant to probiotics. Interestingly, no such difference was found in stool samples: both susceptible and resistant subjects showed comparable amounts of probiotic bacteria, with more bacteria found in the stool of placebo-treated volunteers.
According to Elinav, these results suggest that " our current approach to probiotics is probably wrong ." This variability between individuals means that some people may benefit from taking probiotics and others may not.
This result is not surprising, said Rob K., Ph.D., director of the Innovative Microbiome at the University of California, San Diego, who was not involved in the study. He noted that different people react differently to the same foods, drugs and pathogens “This extends to beneficial organisms,” he said of the study, adding that previous work had found similar variability.
There is a general consensus among doctors and the public that ingesting “good” bacteria can crowd out “bad” bacteria and improve gut health even in a healthy person. Most clinical studies published so far on healthy volunteers have not found significant changes in gut microflora. With the publication of the Weizmann Institute of Science study, the health claims of probiotics are more controversial than ever. Kelly says, " The idea that people take probiotics just to improve their overall health may be a waste of money ."
Intestinal antiseptics – only against bacteria
Alpha Normis enjoys good reviews.
This group of drugs for treating diarrhea is not effective if the stool disorder is caused by viruses.
Antiseptics are not absorbed through the intestinal walls, do not have side effects such as dysbacteriosis, are effective against bacteria, and have a minimum of contraindications. The most common drugs from this group:
- Enterofuril (stopdiar, nifuroxazide) – does not disrupt beneficial microflora and destroys pathogenic microbes. The drug is not recommended for pregnant women, during lactation, children during the neonatal period, or combined with alcohol consumption.
- Alpha Normix - its effectiveness is even higher than that of the previous drug. Side effects are practically not encountered in practice; it is contraindicated in children under 2 years of age, nursing and pregnant women, and patients with duodenal ulcers.
- Intetrix - most often used for fungal diarrhea and “traveler's diarrhea”. The drug can be used to prevent diarrhea during stay in dangerous regions.
After antibiotics
In their second study, the researchers looked at what happens in the gut when a person takes probiotics after a course of antibiotics. Twenty-one healthy volunteers were treated with broad-spectrum antibiotics (ciprofloxacin and metronidazole) for one week. They then either took the same supplement as in the first study twice daily for 4 weeks, an autologous fecal microbiota graft representing a sample of the subjects' own pre-antibiotic microbiota taken via upper gastrointestinal endoscopy, or nothing. and constituted the control group.
This time, none of the subjects taking probiotics were resistant to colonization. Antibiotics killed most of the natural microbiome, allowing exogenous strains to spread. However, this came at a cost: natural gut bacteria were restored over a longer period in the probiotic group compared to the control group. The return to baseline of host intestinal cell gene expression was also suppressed in the probiotic group during the six-month follow-up period.
Alexander Khoruts, a gastroenterologist and director of the gut microbiota medical program at the University of Minnesota, who was not involved in the study, said he was surprised that the probiotics showed any significant effect at all, even such a small one. It.
Khoruts primarily treats patients with difficult-to-treat C. difficile infections, and nearly all of his patients say they took probiotics. While he's not arguing with them, other than encouraging them to eat more fermentable foods, Khoruts says the evidence supporting the benefits of probiotics is weaker than many people think. “In my literature review (although many may disagree), I did not find any convincing evidence , at least for C. difficile infection, of any beneficial effect of taking probiotics ,” the doctor states.
One significant limitation is the apparent lack of randomized trials providing data on the safety of probiotics, a topic addressed by a systematic review presented in the Annals of Internal Medicine.
Despite the results of the Weizmann Institute of Science study, it is still unknown whether taking probiotics during or after a course of antibiotics actually slows down the restoration of the natural microbiome, and whether such disturbances can cause problems. The composition of the probiotics varies and, according to Knight, the researchers administered an extremely high dose. In addition, the study design did not include analysis of clinical outcomes.
However, long-term impairment after a course of antibiotics is associated with a number of health problems, including infections, obesity, allergies and chronic inflammation, says Elinav. In his opinion, long-term impairment caused by the probiotics his team was studying " could potentially lead to long-term side effects in individuals consuming them ."
Knight notes that the study was conducted on healthy volunteers who were administered antibiotics for research purposes only. In reality, people take antibiotics when they suffer from some disease. Will probiotics slow down the restoration of natural intestinal microflora in this case?
“This study does not address this issue at all,” Knight says. “It discusses the administration of antibiotics to healthy subjects, whose situation may be quite different from the clinical patient population.”
Khoruts believes that the harm from taking most probiotics is likely to be minimal. However, for him “this is quite enough to stop prescribing them and think about what to believe. "I believe the prescribing physician should have a healthy degree of skepticism regarding claims made regarding such products."
Gastrolit and Regidron
Regidron contains 5 components.
The most dangerous consequence of diarrhea is dehydration or dehydration. With frequent bowel movements, the body loses a large amount of fluid.
When this loss exceeds 20%, irreversible consequences occur and the person becomes a victim of death.
The consequences of less significant dehydration may be the formation of blood clots due to blood thickening, metabolic disorders and the process of removing poisoning products from the body.
The first step in such a threat should be to call an ambulance and urgent hospitalization. To minimize the effects of dehydration, in addition to drinking plenty of fluids, it is recommended to use medications such as Gastrolit and Regidron. They include:
- glucose,
- sodium chloride,
- potassium chloride,
- sodium citrate (Rehydron),
- or sodium bicarbonate (Gastrolit).
The drugs are taken only in the absence of vomiting. The contents of the medicine sachet are diluted with cool water, since a warm solution can provoke vomiting. To dilute a bag of Gastrolit you need 200 ml of water, and to dilute Regidron - 1 liter. It is recommended to drink this solution in small sips, little by little, but often.
If diarrhea is profuse, with significant loss of fluid, accompanied by vomiting, the drug may be ineffective and an emergency call will be required.
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