Chicago Daily Herald
Not all bacteria are bad guys.
Some of the trillions of bacteria living in our guts keep pathogens at bay. Others break down molecules for digestion. Some boost our immune systems.
In the best of conditions, these so-called "friendly" bacteria coexist peacefully in the digestive tract in a symbiotic relationship with their host. When something goes wrong - an infection, a virus, even some antibiotics - the natural flora go AWOL, and we end up in misery.
Enter probiotics, a word that means "for life." Scientists are learning that probiotics, taken as supplements, can treat a host of disorders by restoring those beneficial bacteria.
Probiotics have been used successfully to treat children's diarrhea for decades. Now doctors are seeing an explosion of interest in similar treatments for adults. In the past five years, researchers have published hundreds of studies examining probiotics' effectiveness.
"It's no longer a snake oil or some alternative treatment," said Gregor Reid, a microbiologist at the University of Western Ontario in Canada and a prominent researcher in the field. "There is growing, exciting science in probiotics."
Several factors are driving this interest, according to Reid. The public is clamoring for more natural cures and is increasingly wary of the dangers of over-reliance on antibiotics.
This demand is supported by new science that suggests probiotics can alleviate gastrointestinal upsets and other ailments.
Some strains of Lactobacillus and Bifidobacterium - the heavyweights among our friendly microorganisms - have been shown in some clinical studies to alleviate symptoms of inflammatory bowel diseases such as ulcerative colitis and Crohn's disease.
In a study of 40 patients who had surgery for ulcerative colitis, those taking high doses of a probiotic called VSL-3 had a lower chance of relapse than patients in a control group. Only three patients on probiotic therapy saw their symptoms return, compared to everyone taking the placebo.
A study in Finland found that allergy-prone mothers who swallowed capsules of benign bacteria during pregnancy were less likely to have children suffering from eczema. Only 23 percent of the children exposed to the Lactobacillus GG bacteria developed skin allergies, compared to 46 percent of the control group.
The effect of the benign bacteria remained four years later.
This and other research supports the "dirt hypothesis" that suggests our immune systems form around early exposures to bacteria.
At birth, the human gastrointestinal tract is sterile. The organisms that colonize first tend to dominate the system. For much of human history, babies got their first gulp of bacteria - usually Lactobacilli and Bifidobacteria - from their mother's birth canals and breast milk.
Babies born in the hospital or via C-section are exposed to different bacteria, such as Streptococci and Clostridia. With the wrong programming, the immune system is more prone to overreaction.
Likewise, women with autoimmune diseases SUCH AS might not have the "right" bacteria, which could affect their children, according to the researchers in the Finnish study.
Help for diarrhea
Other studies suggest probiotics might reduce the risk of some cancers, bacterial vaginosis and even high cholesterol.
The best-documented benefit is for the treatment of diarrhea. In numerous studies, strains of Lactobacillus reuteri reduced the duration of diarrhea from the rotavirus by a day or more. Some studies have also suggested probiotics provide protection from traveler's diarrhea.
Dr. Hector Hernandez, a pediatric gastroenterologist at Advocate Lutheran General Hospital in Park Ridge, said some patients suffer prolonged diarrhea after taking a broad-spectrum antibiotic.
Such drugs can wipe out not only the bad bacteria causing an infection, but also most of the good bacteria that aid in digestion and keep pathogens in check. In their absence, bugs not killed by the antibiotic can multiply and wreak havoc in your colon.
That's what happened to Marie Mazzotta, a 2-year-old from Oswego. After taking an antibiotic for a urinary tract infection, the little girl was diagnosed with an infection of Clostridium difficile, a stubborn bacteria that is usually present but subdued in our gastrointestinal tract.
If it grows out of control, C. difficile can cause severe, life- threatening diarrhea. A course of the powerful antibiotic Flagyl appeared to halt Marie's infection. But it returned as soon as Marie stopped taking the Flagyl.
"I was teaching her to ride a bike," remembers her mother, Michelle Mazzotta, who has since moved with her family to Texas. "It was one of those rare nice days in March in Chicago. I put her down for a nap at 1, and she woke up at 1:30 screaming, throwing up, fever.
"It just came back with a vengeance."
At Advocate Lutheran General, Marie spent weeks hooked up to feeding tubes, catheters and other support systems when the C. difficile infection mutated into toxic megacolon, a rare and often lethal complication of inflammatory bowel disease.
Doctors added Vancomycin, an antibiotic reserved for the most dangerous infections. This time, Hernandez also gave Marie doses of Florastor™ (www.florastor.com), which contains the beneficial yeast Saccharomyces boulardii.
The diarrhea disappeared for good. Now Mazzotta uses probiotics any time Marie, now 4, or her younger sister requires antibiotics for an infection.
"People are so blase about antibiotics," Mazzotta said, "but there are some negative side effects."
So far, no standard guidelines exist for using probiotics to treat disease. The federal government treats probiotics like vitamins or supplements, and does not regulate them for quality.
Many products do not identify the particular strain of bacteria, making it impossible for consumers to verify whether they've proven effective in clinical studies. Worse, researchers have found some products do not even contain the bacteria listed on the label, or that the bacteria are, in fact, dead and therefore useless.
"Unfortunately, in the literature, quite a few papers show many probiotics are all hype," Reid said. "Many people in the medical community have been cynical, and that cynicism is I believe justified when you look at some products."
Only a handful of bacterial strains have undergone rigorous scientific testing. More research is needed, particularly in terms of dosing, said Dr. Sunanda Kane, a gastroenterologist and assistant professor of medicine at the University of Chicago.
"We don't have a lot of good, randomized, controlled trials with set doses and outcomes," she said. "There are recommended doses, but no one has come up with the best one. There are no strict guidelines."
Nonetheless, Kane does recommend probiotics to her patients, and is setting up a clinical trial replicating a German study on ulcerative colitis.
In the absence of detailed information, pharmacists find themselves recommending products on a case-by-case basis.
Pharmacist Bob Listecki, owner of Glen Ellyn Pharmacy, relies on asking detailed questions to figure out what probiotic might help a patient, based on what has worked for other clients.
"I started realizing everything is not from the pharmaceutical industry that has answers," Listecki said.
Patients being treated for gastrointestinal disorders or who take antibiotics for chronic infections might find relief from probiotics, Kane said.
"They certainly are not harmful, and they may help with symptoms like gas, bloating, diarrhea," she said. "It's a very encouraging area of research right now. We're excited we could potentially use good bacteria to change the way people feel, but it's really early in the story."
So far, it appears their benefits are transitory. Probiotics taken as supplements don't colonize the gastrointestinal tract, so to retain their benefits the patient must continue to consume new bacteria.
And then there is the question of queasiness. In other parts of the world, probiotics are so well accepted that some countries add them to infant formula. In the United States, successive generations have been raised on the belief germs ought to be shot on sight.
"The whole story has been, 'Bacteria are bad for you, wipe them out,' " Reid said. "How do you change that? It's going to take a lot of persuading to convince someone bacteria are good for them."