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Discussion Starter · #1 ·
I have just read this article, apparently released in December. Perhaps you've discussed it in other threads prior to now, but I am very interested in knowing further thoughts/information in this regard. Apparently there is some evidence that MANY IBS patients are showing intestinal bacteria in common, and this bacteria is being treated, with some significant success fortunately, by antibiotics.What concerns me here is that I have long thought antibiotics to be a CAUSAL FACTOR in IBS and related symptoms. THis would make me nervous and wary of taking antibiotics to cure my IBS ills. HOWEVER, if it is truly giving immense relief, and even overall eradication of symptoms to IBS patients, I of course want to try this...I am just afraid to make matters worse.I do find that probiotics help me...but not always.HEre's the link to the article. I would appreciate any and all commentary and further information on this matter: Thanks! http://biz.yahoo.com/rf/001213/n11406742.html
 

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Joyous, my personal feeling on this.I did not see the whole article.It did not make top news in the Journal it was published in and you would think it would.It may be a subset of IBS patients.I think IBS is more complicated then this points to.I would not rush out and take anti-biotics.First it may be a particular one you need if this is the case.I think we need to read more on this and wait to hear what other doctors think.I do know however that Flux is writting something up on this.Just my opinion.------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com
 

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I personally think there may be two or three main camps of IBS "causes." 1) Primarily anxiety or nerve related; 2) Primarily caused by a bacterial imbalance (for a myriad of reasons possibly); 3) Misc. -- Maybe a mixture of things, maybe food or allergy related, etc. Also, I feel that it may be possible for someone with anxiety or nervous system based IBS to eventually develop a bacterial imbalance; conversely, I feel that it is possible for a person with some other type of IBS to develop a certain amount of anxiety and/or heightened sensitivity to stimuli.I, myself, have a minor propensity toward developing IBS (e.g., I have minor autonomic nervous system dysfunction). I have had little bouts of IBS, aka "spastic colon," in the past. However, for the last 2-1/2 years, I believe I have been suffering primarily from bacteria imbalance. Probiotics do seem to help but not completely. I'm not sure what the complete answer is.So, that's what I think.[This message has been edited by HipJan (edited 01-08-2001).]
 
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Discussion Starter · #5 ·
I really think HipJan is right on the money with the three categories of causes of IBS. (1)Brain/Gut connection (anxiety, etc, or just autonomous nerves malfunctioning) (2)Some kind of bacterial imbalance(3)A combination of the above two, and/or the addition of food allergies and intolerances.I think, from everything I've read, and my own experience, that it usually has a predominant factor that then leads to something else. What I mean is, lets say your IBS is related to anxiety or stress that leads to a problem with the brain-gut connection. So you now have a motility problem. Well, sooner or later that motility problem will probably cause bacteria to become unbalanced, thereby exacerbating your symptoms, and so on. On the other hand your IBS could start after taking some antibiotics or some intestinal infection like travelers D. This changes the bacteria balance in your intestine and then, before the intestinal "flora" gets back into balance, your autonomic nervous system gets out of wack. My personal belief is that most IBS is a combination of things, which is why you get many suggestion on things that can lessen symptoms, but you really don't hear much about cures.Having said that, I also think most "probiotics" and other things work primarily from a placebo effect (which is as good as an actual effect if you ask me). Other things, like calcium, etc.. obviously change stool formation and seem to change motility. I'm going off on tangents here, but I my basic idea here is you have to attack IBS from multiple angles. I would say the single most important one is to get a positive attitude. I think it stands to reason that if stress and anxiety can bring on IBS, then positive thinking and happiness can be a good start in breaking the cycle of IBS.Sorry I got off topic. Good luck.
 

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Seeker -- I feel like I've met myself here on this BB. Are you sure you're not me?!
(Except, I don't think probiotics work as placebos.
)[This message has been edited by HipJan (edited 01-08-2001).]
 
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Discussion Starter · #7 ·
TheSeeker, I just wanted to say that I enjoyed reading your post, as well as Jan's, and that I think you're both right about the multiple causes and contributors...it's a vicious cycle, indeed.I wish to also state that I fully disagree with your suggestion that probiotics work for some, due to a placebo effect...I wholeheartedly disagree there. There are some very clear and concise reasons why probiotics do have a legitimate affect on the intestinal flora, and therefore do create changes in symptoms. That said, sometimes probiotics do not work at all, because they are taken at the wrong time. They cannot, for example, be taken with food in the stomach, and they must be taken with water. Otherwise, they don't survive, and therefore don't work.Placebo, though? No way.As to multiple causes, I agree...and of course, this also leads to there being multiple remedies.Sigh...if only there were that single magic answer.
 
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Discussion Starter · #8 ·
Hi HipJan, I've actually been reading this board for a little while now without posting. I thought your post summed up the causes of IBS so well that I had to post a reply. I hope you don't regret getting me to post stuff on here lol.As for the probiotics being placebos, I really believe for the most part that's what happens with those, although I could be wrong. It's just my belief based on what I've read. They've had those probiotics for years, yet I've yet to see a double blind study done with them. With the money they could make on it if it were scientifically proven to be effective I'd think they would have done it by now. I also don't see how dumping a bunch of bacteria that may or may not make it into your intestine, where it certainly wouldn't match the complicated makeup of the bacteria you used to have, would somehow restore someone's intestinal function. Plus, the article that this thread originally refers to is about a Dr who is -killing- bacterial overgrowths in IBS sufferers small intestines. I don't believe he is killing candida or some fungus, but normal intestinal bacteria that has overgrown the small intestine. If that's the case, and lets say this Dr is right, then I'd think that taking probiotics might actually increase the risk of developing more symptoms from overgrowth. So ya got people dumping bacteria in, and others killing it off, who knows what to believe.So, I may be wrong about the placebo effect. Of course, you might be wrong too. That's exactly what the placebo effect is. There's really no way without double blind studies to know. People (including myself) always underestimate the power of the mind. I'm always shocked when I see double blind studies of proven drugs that work, where often the difference between the control group and the group that actually gets the real stuff is not that great. I'm rambling, anyway, like I said, I could be wrong, it's just what I think after everything I've read. Whenever you have desperate people, there's gonna be other people lining up to take their money. In my opinion that's what a lot of the herbal and probiotic companies are doing.
 

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I just want to say there maybe one cause for the clinical defintion of IBS and a multitude of symptoms and subgroups to it, which make it seems like multible causes.Right now the observations made in research indicate that IBS symptoms result from disregulation of intestinal motor,sensory and CNS activity linked through parallel circuits between the central and enteric nervous systems the so called (brain-gut axis.)------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com
 

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eric -- thanks for the reminder for people here about the clinical definition of IBS (we sometimes forget, and some of the newer members may not even be aware of it). you have always been so good about bringing us accurate information!
however, personally, I've always questioned brain-gut nerve dysfunction as "the cause," per se. to me, that may be how IBS is "charactererized" by the medical community (e.g., a description of IBS)... but what is causing that dysfunction in the first place? were we all born with that dysfunction (actually, I may have been, one doctor thinks! I dunno.)? or, has some event or situation come along to temporarily or permanently cause that nerve dysfunction? also, are some people being misdiagnosed as having IBS when they really have, say, bacterial overgrowth -- or, are bacterial overgrowth and "IBS" closely intertwined (for many IBS sufferers)? to me, these are questions we'll still be pondering for a while.I believe we're mostly talking semantics here -- in using the word "cause." (and, that's why I also put "causes" in my first post in quotes. perhaps it would have been better, actually, if I'd said "types" or "varieties." come to think of it, I also don't completely like how I described the "camps" of IBS in my first post...bleaah, and sorry for any confusion!)Seeker -- welcome here, and good points you are making.
(however, I'll still stick with probiotics, myself, for now!
) my understanding, weak that it may be, is that bacterial overgrowth may occur when the "bad bugs" in one's gut for some reason start outnumbering/overpowering the "good bugs" in one's gut. thus, the theory that you put good bugs back in to kill off some of the bad ones. interesting about the lack of double-blind studies (guess that's why many doctors are so reluctant about acidophilus).[This message has been edited by HipJan (edited 01-09-2001).][This message has been edited by HipJan (edited 01-09-2001).]
 
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Discussion Starter · #12 ·
Well, I for one am wholeheartedly against the "placebo" theory where probiotics are concerned. I think Seeker is wrong here, though I also respectfully recognize his right to his opinion. But I can tell you from my own well-worn experience, that I have tried TONS of things to treat my IBS symptoms, and...placebo or not...tons of things have not worked or helped. Probiotics, however, made a drastic difference in my symptoms. So...theoretically speaking...if I were vulnerable to the power of suggestion, and the ensuing placebo effect, due to my "desperation", why wouldn't other things have worked? Different herbs? Other probiotics, even? Nada. Just this one.Seeker's theory doesn't pan out in my book. I think he's just plain wrong. I happen to also be disheartened by allegations of placebo when people truly see relief from a harmless intervention, just by the way. I would submit that Seeker's research has been less than complete if it points to probiotics being nothing but placebos. The full research on this matter does not point to that being the case whatsoever.Pardon the edge to my tone, but I think this is a very important issue.
 

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HI To The Days' Most Active Debate Group.May I chime in without fear of decapitation?The line of demarcation between the "clinician" and the "academician" when investigating functional diseases like "actual IBS" always starts to blur and then become volatile around the issues of what is "causal", what is "consequential", thus leading to what are "clinical symptoms or manifestations" (symptoms get reported, manifestations can be observed)and then therapeutically what is "efficacious". Consequently, the definition of "what is clinically efficacious" can get opinionized into "efficacious is as phsyiology proves" (academicians) versus "efficacios is as symptomologic relief demonstrates" (clinicians).So you end up with interesting debates like this. One thing that I think every thinking person who has spent any time objectively working with IBS and looking at the findings as a whole will concde is that there are multiple symptom sets, and that the symptoms are not synonymous with the etiology. Also, the etiology is very likely a multiple-pathway etiology.The gut does not anatomically cause itself to be hyperreactive in all known modes of function anymore than the brain is antomically altered such that its functional links to the gut cause the symptom sets of IBS. Further, the ability to intervene in the reflex links via neurotransimitters does not denote that there are anatomic dysfunctions in the motor or sensory endplates which account for observable alterations in function. These are manifestations of the etiology. So work continues, and as the findings slowly accumulate piece by piece many common chemical origins in the form of gut hormones and the neuroimmune mediators which elicit them are found, and the effect of certain leukotrienes, cytokines, prostaglandins, other neuropeptides on the brain, the nerves, and the smooth muscle tissue itself which keep appearing unexpectedly in unexpected places are well known. So a picture of the interaction of the neuroimmune system and the CNS and how they behave in IBS and related disorders is emerging. And the underlying chemical basis for altered function begins to appear.From there it is not a giant leap to then elucidate where these come from, and then why are they there where they do not belong.But what of therapeutic efficacy of any particular therapy and the possibility of placebo effects? Clinically it is clear beyond a doubt that treating and managing this disorder does not have its own set of rules different from managing any other disease when it comes to constructing programs for optimal outcome. The person has to have each element which is known to effect the symptoms optimized for that patient to achieve the greatest degree of remission.In the case of IBS there are several types of single-mode therapies which have been shown to be efficacious, since they produce measurable clinical relief in a preponderance of the patients when applied.By combining these modes into an integrated program the highest and widest degree of clinical relief can be achieved. This is a fact of medical life regardless of what disease or syndrome one treats. If one therapy helps, and there are other physiologic elements which elicit symptoms, addressing those directly with an additional modality will enhance the outcome to the patient. These things really are not arguable in patient care. What is arguable, as we can see here, is this "placebo" thing. Cut to the chase...any time you give sick people any kind of pill, whether it is pharmacologically active or not, some people's perceived symptoms will be reduced as a result of them taking the pill. This is an unavoidable fact, and is a more a validation of the power of the mind to affect both bodily functions and our PERCEPTIONS of what our body is feeding back to us than it is an indictment. "Pill treatments" have the highest-rate of positive placebo response.This is not unique to pharmaceuticals, to herbals, to probiotics, to any "take a pill" treatment. ANY kind of therapy whereby an expectation is known to the recipient will result in that expectation being perceived in some of the subjects regardless of the actual proven physioloigc effect of the therapy. Psychotherapies, dietary therapies, behavioral therapies, hypnotherapies, nothing is excluded from producing this effect in some percentage of subjects.So all manner of efforts are designed by academicians to use blind and double-blind investigatory techniques with controls. In this way, with some therapies, (pill therapy is the easiest), you can quantify what percentage of patients will experience placebo-based relief...or , in truth, "mind mediated relief". The issue is, in academic investigations this is important when making claims about a modality. But in clinical medicine, the fixation on placebo effect is far less among many practitioners nowadays, except those whose practice remians 100% anchored in the concrete shoes of purely allopathic medicine. By some caregivers the excssive blustering is considered ludicrous when trying to achieve the goals of patient wellness.IF a high percentage of patients experience what is proven to be a placebo effect from a modality, clinically what is evaluated then is some subjective assessment of cost-benefit before condemning the modality.If cancer patients are given a pill where 50% report feeling better after treatment even though it is proven that there is no effect on tumor size or growth rate, and in so doing avoid pursuing therapy which is physiologically effective, the death rate will be considered inexcusable as avoidable mortality is involved and the modality righfully condemned. If the tumor shrank it would be hailed as a breakthrough...by some even if all we did was roll the bones in front of the campfire.If patients with migraine, on the other hand, take a homeopathic remedy which costs $4.95 a week, and their migraines are reduced by 90% thus restoring their quality of life, how far should a clinician go in condemning the therapy? Especially if the only alternative is a pharmaceutical intervention which produces side efects in 30% of the patients? How far should the "academician" ethically pursue his or her campaign to villify the modality and seek to make it unavailable to these patients?Suppose a group of Rome-criteria IBS patients took a probiotic like lactobacillus planterum under controlled conditions for 4 weeks and then were followed up for a year, and another group of IBS patinets took the same thing except there were no lactobacilli in it (placebo) and were followed the same way.Now suppose after a year you found the following: the LB patients had it in their colons after a year, the placebo patients did not, but this had no effect on the other "enterobacteriae" in their cultures from before and after.In the placebo group the enterobacterial counts increased over a year, however.Flatulence was reduced measurably in the LB group, but not in the placebo group. BOTH groups experienced reduced pain one year after the study. Neither group showed any difference in bloating. Now, what does one then say about that? Apparently the test group benefitted in quantifiable measures and in subjective measures (pain), and the placebo group showed no benefit in the quantifiable measures but reported (and experienced) reduced pain.So first the obvious is that patients can benefit from this probiotic regimen...and patients can expereince a reduction of pain perception by taking an inert pill, and it stayed with them for a year (American Journal of Gatsroenterology, May 2000 "Alteration Of Intestinal Microflora Is Associated With reduction In Abdominal Bloating And Pain In Patients With IBS").So the person hotted-up to be an academician will see what he/she wants and the person hotted-up to be a clincian will see what he/she wants. And they will see almost the same thing except that one will harp about the placebo effect while another would see perhaps a validation of the relationship between pain experience versus expectation and the value of manipulating mind-body interraction. In any case this probiotic are was better than the placebo, no?"What is the point of your endless tome MNL?" ...That to me, placebo effect is not some therapeutic damnation in clincial care where mortality and morbidity is not involved....rather one should take the time to evaluate this effect from another perspective...and maybe $20 a month for a bottle of dead bacteria is not such a damnable offense if the patients quality of life is improved by his belief that it will be and how his mind then affects his perceptions and actions. And that just becasue it is a fact that people without exception do exprience so called placebo-affcest from all therapies, it is not worth fighting with each other about and getting our dander up unless some harm is coming to someone along with the experienced benefits.Anyway, that's my story and I'm stickin to it.Now I will not eat up anymore of your bandwidth with my verbosity and poor typing skills.MNL_______________ www.leapallergy.com [This message has been edited by Mike NoLomotil (edited 01-09-2001).]
 

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You want placebo controlled tests. Here you go. Starting with one on IBS and the rest tend to focus on acute diarrhea, which gets alot more attention because it kills an awful lot of kids in the third worldK.(PS I stopped when I got bored)Title Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Author Nobaek S ; Johansson ML ; Molin G ; Ahrn�e S ; Jeppsson B Address Department of Surgery, Lund University, Lund University Hospital, Sweden. Source Am J Gastroenterol, 95(5):1231-8 2000 May Abstract OBJECTIVE: The influence of the gastrointestinal (GI) microflora in patients with irritable bowel syndrome (IBS) has not been clearly elucidated. This study was undertaken to see if patients with IBS have an imbalance in their normal colonic flora, as some bacterial taxa are more prone to gas production than others. We also wanted to study whether the flora could be altered by exogenous supplementation. In a previous study we have characterized the mucosa-associated lactobacilli in healthy individuals and found some strains with good colonizing ability. Upon colonization, they seemed to reduce gas formation. METHODS: The study comprised 60 patients with IBS and a normal colonoscopy or barium enema. Patients fulfilling the Rome criteria, without a history of malabsorption, and with normal blood tests underwent a sigmoidoscopy with biopsy. They were randomized into two groups, one receiving 400 ml per day of a rose-hip drink containing 5 x 10(7) cfu/ml of Lactobacillus plantarum (DSM 9843) and 0.009 g/ml oat flour, and the other group receiving a plain rose-hip drink, comparable in color, texture, and taste. The administration lasted for 4 wk. The patients recorded their own GI function, starting 2 wk before the study and continuing throughout the study period. Twelve months after the end of the study all patients were asked to complete the same questionnaire regarding their symptomatology as at the start of the study. RESULTS: All patients tolerated the products well. The patients receiving Lb. plantarum had these bacteria on rectal biopsies. There were no major changes of Enterobacteriaceae in either group, before or after the study, but the Enterococci increased in the placebo group and remained unchanged in the test group. Flatulence was rapidly and significantly reduced in the test group compared with the placebo group (number of days with abundant gas production, test group 6.5 before, 3.1 after vs 7.4 before and 5.6 after for the placebo group). Abdominal pain was reduced in both groups. At the 12-month follow-up, patients in the test group maintained a better overall GI function than control patients. There was no difference between the groups regarding bloating. Fifty-nine percent of the test group patients had a continuous intake of fermented products, whereas the corresponding figure for the control patients was 73%. CONCLUSIONS: The results of the study indicate that the administration of Lb. plantarum with known probiotic properties decreased pain and flatulence in patients with IBS. The fiber content of the test solution was minimal and it is unlikely that the fiber content could have had any effect. This type of probiotic therapy warrants further studies in IBS patients. Title Short report: a placebo-controlled study of Lactobacillus GG colonization in one-to-three-year-old Peruvian children. Author Sheen P ; Oberhelman RA ; Gilman RH ; Cabrera L ; Verastegui M ; Madico G Address Asociacion Benefica PRISMA (Proyectos en Informatica Salud, Medicina y Agricultura), San Borja, Lima, Peru. Source Am J Trop Med Hyg, 52(5):389-92 1995 May Abstract A pilot, placebo-controlled study conducted in Peruvian toddlers in a periurban shanty-town community demonstrates that 1) a simple fluorescent antibody test performed on bacteria from colonies grown on solid culture media can be used as a presumptive screening tool for Lactobacillus GG, 2) Lactobacillus GG powder sprinkled on flavored gelatin as a nutritional supplement is well-accepted by infants and mothers in this population, and 3) daily doses of Lactobacillus GG result in efficient colonization of the gastrointestinal tract of Peruvian infants. This study demonstrates that Lactobacillus GG should be evaluated as an adjunct for diarrhea control programs at the community level as well as in hospital-based settings. �� �Title A human Lactobacillus strain (Lactobacillus casei sp strain GG) promotes recovery from acute diarrhea in children. Author Isolauri E ; Juntunen M ; Rautanen T ; Sillanaukee P ; Koivula T Address Department of Pediatrics, Tampere University Hospital, Finland. Source Pediatrics, 88(1):90-7 1991 Jul Abstract To determine the effect of a human Lactobacillus strain (Lactobacillus casei sp strain GG, Gefilac) on recovery from acute diarrhea (82% rotavirus), 71 well-nourished children between 4 and 45 months of age were studied. After oral rehydration, the patients randomly received either Lactobacillus GG-fermented milk product, 125 g (10(10-11) colony-forming units) twice daily (group 1); Lactobacillus GG freeze-dried powder, one dose (10(10-11) colony-forming units) twice daily (group 2); or a placebo, a pasteurized yogurt (group 3) 125 g twice daily; each diet was given for 5 days, in addition to normal full diet otherwise free of fermented dairy products. The mean (SD) duration of diarrhea after commencing the therapy was significantly shorter in group 1 (1.4 [0.8] days) and in group 2 (1.4 [0.8] days) than in group 3 (2.4 [1.1] days); F = 8.70, P less than 0.001. After rehydration, each dietary group maintained a positive weight trend. The urinary lactulose-mannitol recovery ratios (means [95% confidence intervals]) on admission were 0.09 (0.03, 0.24) in group 1, 0.12 (0.07, 0.22) in group 2, and 0.08 (0.04, 0.18) in group 3; no significant alterations in intestinal permeability were observed at retesting after 2 days of realimentation. The result indicates that early nutritional repletion after rehydration causes no mucosal disruption and is beneficial for recovery from diarrhea. It is further suggested that Lactobacillus GG in the form of fermented milk or freeze-dried powder is effective in shortening the course of acute diarrhea.�� �Title Effect of Lactobacillus GG yoghurt in prevention of antibiotic associated diarrhoea. Author Siitonen S ; Vapaatalo H ; Salminen S ; Gordin A ; Saxelin M ; Wikberg R ; Kirkkola AL Address Department of Biomedical Sciences, University of Tampere, Finland. Source Ann Med, 22(1):57-9 1990 Feb Abstract The efficacy of Lactobacillus GG yoghurt in preventing erythromycin associated diarrhoea was studied. Sixteen healthy volunteers were given erythromycin acistrate 400 mg t.i.d for a week. The volunteers were randomly assigned into two groups taking twice daily 125 ml of either Lactobacillus GG fermented yoghurt or pasteurized regular yoghurt as placebo during the drug treatment. Subjects receiving Lactobacillus GG yoghurt with erythromycin had less diarrhoea than those taking pasteurized yoghurt. Other side effects of erythromycin, such as abdominal distress, stomach pain and flatulence, were less common in the GG yoghurt group than in the placebo yoghurt group. The subjects receiving Lactobacillus GG yoghurt were colonized with these bacteria even during erythromycin treatment as measured by faecal counts of total Lactobacillus GG. No Lactobacillus GG was found in the faecal samples of volunteers in the group taking pasteurized yoghurt. Title Probiotic bacteria down-regulate the milk-induced inflammatory response in milk-hypersensitive subjects but have an immunostimulatory effect in healthy subjects. Author Pelto L ; Isolauri E ; Lilius EM ; Nuutila J ; Salminen S Address Department of Biochemistry and Food Chemistry, University of Turku, Finland. Source Clin Exp Allergy, 28(12):1474-9 1998 Dec Abstract BACKGROUND: Probiotic bacteria can influence immune responses both specifically by stimulating antibody production and nonspecifically by enhancing phagocytosis of pathogens and modifying cytokine production. OBJECTIVE: The authors hypothesized that probiotic bacteria can alleviate hypersensitivity by influencing phagocytes. The modulation of phagocytes may be different in healthy subjects compared with hypersensitive subjects. SUBJECTS AND METHODS: In a double-blind, cross-over study, challenges with milk in milk-hypersensitive and healthy adults with or without an intestinal bacterial strain, Lactobacillus GG (ATCC 53103) were performed. The challenge-induced immunoinflammatory response was recorded by measuring the expression of phagocytosis receptors prior to and after the challenge using flow cytometry. RESULTS: In milk-hypersensitive subjects, milk challenge increased significantly the expression of CR1, FcgammaRI and FcalphaR in neutrophils and CR1, CR3 and FcalphaR in monocytes. Milk with Lactobacillus GG prevented the increase of the receptor expression. In healthy subjects, milk challenge did not influence receptor expression while milk with Lactobacillus GG increased significantly the expression of CR1, CR3, FcgammaRIII and FcalphaR in neutrophils. CONCLUSION: Probiotic bacteria appear to modulate the nonspecific immune response differently in healthy and hypersensitive subjects. This is seen as an immunostimulatory effect in healthy subjects, and as a down-regulation of immunoinflammatory response in milk-hypersensitive subjects. �� �Title Lactobacillus GG and acute diarrhoea in young children in the tropics. Author Pant AR ; Graham SM ; Allen SJ ; Harikul S ; Sabchareon A ; Cuevas L ; Hart CA Address Tropical Child Health Group, Liverpool School of Tropical Medicine, UK. Source J Trop Pediatr, 42(3):162-5 1996 Jun Abstract A prospective, placebo controlled, triple blind clinical trial was undertaken in Thailand to determine the effect of Lactobacillus GG on recovery from acute diarrhoea in children. Thirty-nine children (mean age = 8 months) were enrolled and following rehydration received either oral Lactobacillus GG (n = 20) as a freeze-dried preparation or placebo (n = 19) twice daily for 2 days. The clinical characteristics of the study groups were similar. There was no significant difference overall in clinical response detected between the study groups. When only those with acute non-bloody diarrhoea (n = 26) were considered, the mean duration of diarrhoea was significantly shorter in the lactobacillus group (1.9 days) than in the placebo group (3.3 days) (P < 0.055). Stool frequency was less on the second day in the lactobacillus group (P < 0.05). The results suggest that Lactobacillus GG accelerates recovery from acute watery diarrhoea in young children in a tropical setting. Title Lactobacillus GG promotes recovery from acute nonbloody diarrhea in Pakistan. Author Raza S ; Graham SM ; Allen SJ ; Sultana S ; Cuevas L ; Hart CA Address Tropical Child Health Group, Liverpool School of Tropical Medicine, United Kingdom. Source Pediatr Infect Dis J, 14(2):107-11 1995 Feb Abstract A prospective, placebo-controlled, triple blind clinical trial was carried out in Pakistan to determine the effect of Lactobacillus GG on the course of acute diarrhea in hospitalized children. Forty children (mean age, 13 months) were enrolled and after rehydration received either oral Lactobacillus GG (n = 21) or placebo (n = 19) twice daily for 2 days, in addition to the usual diet. The clinical course of diarrhea was followed during the treatment period. Features on admission into the study groups were similar and were characterized by severe diarrhea, malnutrition and inappropriate management before presentation. Response was evident on Day 2 when the frequency of both vomiting and diarrhea was less in the Lactobacillus group. In those who had presented with acute nonbloody diarrhea (n = 32), the percentage of children with persistent watery diarrhea at 48 hours was significantly less in the Lactobacillus group: 31% vs. 75% (P < 0.01). No significant difference was observed by 48 hours in those presenting with bloody diarrhea. The relevance of this finding to the management of diarrhea in the tropics is discussed. �� �Title Lactobacillus reuteri as a therapeutic agent in acute diarrhea in young children. Author Shornikova AV ; Casas IA ; Isolauri E ; Mykk�anen H ; Vesikari T Address University of Tampere, Medical School, Finland. Source J Pediatr Gastroenterol Nutr, 24(4):399-404 1997 Apr Abstract BACKGROUND: Certain strains of lactobacilli may promote recovery from acute diarrhea. Lactobacillus reuteri is of human origin and is a natural colonizer of gastrointestinal tract. In this trial, exogenously administered L. reuteri was studied as a therapeutic agent in acute diarrhea. METHODS: Forty patients between 6 and 36 months of age hospitalized with acute diarrhea (75% rotavirus) were studied. After parental consent, the patients were randomized to one of two treatment groups to receive either 10(10) to 10(11) colony-forming units of L. reuteri or a matching placebo daily for the length of hospitalization or up to 5 days. The clinical outcome of diarrhea and colonization of L. reuteri were evaluated. RESULTS: The mean (SD) duration of watery diarrhea after treatment was 1.7 (1.6) days in the L. reuteri group and 2.9 (2.3) days in the placebo group (p = 0.07). On the second day of treatment only 26% of patients receiving L. reuteri had watery diarrhea, compared with 81% of those receiving placebo (p = 0.0005). Cultures of lactobacilli from stool samples demonstrated that administration of L. reuteri resulted in colonization of the gastrointestinal tract. Lactobacillus reuteri accounted for > 75% of the total lactobacilli found in children fed with this product. CONCLUSIONS: Lactobacillus reuteri is effective as a therapeutic agent in acute rotavirus diarrhea in children. Further studies are warranted to confirm the present finding and to explore the full therapeutic potential of L. reuteri in acute viral diarrhea. Title Prevention of travellers' diarrhoea by Lactobacillus GG. Author Oksanen PJ ; Salminen S ; Saxelin M ; H�am�al�ainen P ; Ihantola-Vormisto A ; Muurasniemi-Isoviita L ; Nikkari S ; Oksanen T ; P�orsti I ; Salminen E ; et al Address Medical Department, Finnair Oy, Vantaa, Finland. Source Ann Med, 22(1):53-6 1990 Feb Abstract A placebo-controlled double-blind study was conducted on the efficacy of Lactobacillus GG in preventing travellers' diarrhoea. Altogether 820 persons travelling on holiday to southern Turkey to two destinations were randomized into two groups receiving either Lactobacillus GG or placebo in identical sachets. On the return flight each participant completed a questionnaire indicating the incidence of diarrhoea and related symptoms during the trip. Of the original group 756 (92%) subjects completed the study acceptably. The overall incidence of diarrhoea was 43.8% (331 cases). The total incidence of diarrhoea in the placebo group was 46.5% and in the Lactobacillus GG 41.0% indicating an overall protection of 11.8%. Protection rates varied between two different destinations with the maximum protection rate reported as 39.5%. Among older age groups there was significantly less diarrhoea when compared to younger travellers. Lactobacillus GG appeared to be effective in reducing the occurrence of travellers' diarrhoea in one of the two destinations with no side effects.
 

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thanks, kmottus!!
also, thanks, as usual, Mike (though, also as usual, could take quite a bit of time to read through everything you've posted!
)![This message has been edited by HipJan (edited 01-09-2001).]
 

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HI JAN.LOL. I understand. I think that SpecialK and I must have the same "pile-of-files-of- abstracts".I think the point can be summarized as follows...my point anyway...numerous investigations have shown probiotics to be effective in certain symptoms sets, but indeed there are patients who (when using subjective criteria, even validated questioniares) will experience placebo-induced symptomatic relief.My comment is it does not bother me from a clinical care standpoint since they are cheap and can do no harm, if some patients only get a pain reduction from it that is cheaper and safer than giving drugs for pain. Just be sure to get capsules fresh out of cold storage if possible...alot of the stuff on the shelves of HF stores is so old there are few live bacteria left, so all you will get is the placebo component.(**I think I am gonna set up a separate board and have a cut and paste contest with SpecialK and see who can go faster and farther...but there has to be an incentive...a nice Enterococcus Stew for grand prize perhaps?)Have a DFDMNL_____________ www.leapallergy.com
 

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BwahahahaI have access to Medline and I know how to use it.I've actually seen papers where they discuss the ethical use of placebos. Make the same suger pills, but in different colors with different scientific sounding names for each disease, and use them as the first line for just about everything. Do the... Well we have this drug for that, it doesn't have any bad side effects, and it really helps an awful lot of people with your problem. Let's try it for a month, and we'll see you for a follow up... Fits the do no harm part of the oath, but some people see it as too unethical.K.[This message has been edited by kmottus (edited 01-09-2001).]
 

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LOL x2...and I can fly through PUBMED fast as you can say OPEN WINDOW HIGHLIGHT COPY CLOSE WINDOW OPEN WINDOW PASTE SAVE FILECould make a Jackie Chan type movie of med- eggheads banging on medical databases, furiously-flying-duets-of fingers madly banging and clipping and WHOOOPPPPS!!! My soft underbelly is accidentally exposed....yes, >sob< 'tis true. I am a 2-finger clipper...like you can't tell from the persistent typos...can you imagine if I could actully type with all ten fingers?Jeff would have to pull my plug (HEY! I heard that remark!)MNL
 
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Hi folks. I'm the person who mentioned off hand that it was my personal belief that a lot of probiotic type relief was placebo in nature. It was a tangent I went off on, and had no idea people read so much into it. I wasn't saying that if you got relief from it that it was from the placebo effect. Nor did I say that probiotics are all fake and worthless. My point was that I didn't think the majority of people taking them were getting relief from actually changing their "flora." I just find all the probiotic talk a little misleading and it's my belief that a lot of relief people get from them is placebo. But as one person pointed out, that's true for anything people try. In fact, if you look at Mike's tapes, they are almost like a treatment and a placebo wrapped in one. When you think of something aimed at the mind, where a guy is telling you "you will feel better," over and over, I'm not sure how you could separate that from it. It's one of the reasons I like Mike's tapes so far, at least it's doesn't hide from the mental issue.As for all those Medline articles, I gotta tell you that for all the talk about probiotics, and all the companies out there producing that stuff, I'm rather surprised that's all there was. Most of it was about people suffering from D that I think is a little different from what we think of as IBS D. I think it was more like dysentery D. The first study was the strongest, but even there I think it mentioned 60 people total. I don't have time right now to figure out exactly what the study is saying, but I really don't see too much. "number of days with abundant gas production, test group 6.5 before, 3.1 after vs 7.4 before and 5.6 after for the placebo group" out of how many days? in a month? the two weeks? the four weeks? Then you have the interestingly quick statement of "Abdominal pain was reduced in both groups." Hmmm, I wonder if maybe it was reduced slightly more maybe in the placebo group? I'm not saying it was, but I find it interesting how they leave out the numbers there, and you know both groups abdominal pain reductions can't be exactly equal. Kinda makes one wonder. Then you have "At the 12-month follow-up, patients in the test group maintained a better overall GI function than control patients." That's a hopeful sign. Although again, why no numbers on this one, but numbers on the gas production?? All this says is the test group maintained better overall GI function, the difference could have been miniscule.Then you have "There was no difference between the groups regarding bloating." Guess that speaks for itself.And finally "Fifty-nine percent of the test group patients had a continuous intake of fermented products, whereas the corresponding figure for the control patients was 73%." I have to admit I'm a little lost on this one. Are they saying the test group ate less fermented products? That might help GI function I might think. Again, not sure what they meant there. Bottom line though, if that's the best stuff they have on probiotics, I personally find it pretty meager. In no way am I saying it might not help people or whatever. I'm just very skeptical of all this probiotic stuff.One last thing. I find it sort of interesting that all these studies that were cited were from places like Sweden, Finland, and Pakistan. Why wouldn't a US company that makes probiotics sponsor a decent study of IBS in the US? Maybe they have. I'd like to be proven wrong. I hope they do discover that probiotics are as wonderful as the people who sell them make them out to be. It's just my opinion that they aren't. You know what they say about opinions though, they're like assh****, everybodys got one. (LOL, sorry, this being an IBS board, I couldn't resist). [This message has been edited by TheSeeker (edited 01-09-2001).]
 

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placebos, probiotics, bad flora blah, blah, blah. So many opinions, so much research. So how come Lotronex worked for so many of us. Doesn't the answer lie in the chemical makeup of lotronex - what does it fix? There would be your answer to the mysterious IBS. (IBS-D)
 
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