What Nurses Need to Know About Probiotics

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What Nurses Need to Know About Probiotics

Yogurt may indeed be a wonder food.

By Elizabeth Hanink, RN, PHN, BSN
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Rows, furrows and crevices; sucking tentacles, all oozing slime. Liquid sloshing back and forth, sometimes in a trickle, sometimes in a flood. Add a flamboyant riot of bacteria, parasites, viruses and some yeast, and that’s what the surface of your gut is like. If you’re normal, everything works in harmony. But let one aspect get out of balance, and all sorts of chaos can follow.

Consider that 80 percent of your body’s immune function is located in your intestines. Consider also that the number of microorganisms — those same bacteria, viruses and yeasts — number more than your total body cell count.

Now keep in mind that there isn’t room for everybody at the bug fest; there isn't sufficient food either. That means there are always winners and losers. The good news is you can, in most cases, determine which will triumph. Biologically, you get what you eat (and breathe). But you, not what you eat, plan the menu.

For instance, everybody harbors yeast in their lower tract, along with E. coli, Clostridium, and the like. In small portions, this is quite ordinary. But let certain strains of any of these get the upper hand, and any nurse worth her stethoscope can tell you what will happen: major havoc, major distress.

How to Keep It All in Balance?

More and more, scientists are beginning to think that something called probiotics might be the answer. Just what are they? One definition, set by the World Health Organization, is “live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host.”

Why, you ask, is it necessary to add something extra to our food? Today’s diet has eliminated many sources of healthy bacteria that used to be an ordinary part of life. Most people don’t consume a variety of fermented foods, although a traditional Japanese diet always features a large quantity. Many weight control efforts eliminate milk products like cheese, and then there are all the people who are milk-intolerant. Several fermented foods seem too high in sodium, and food manufacturing processes extending shelf life further dilute the amount of helpful bacteria in food.

The widespread use of antibiotics is also to blame. One researcher, Gary Huffnagle, Ph.D., of the University of Michigan Medical School, writes that an ordinary two-week regimen of antibiotics for, say an ear infection, can devastate most of the normal microbes in the gut. He further states that meat and water expose us to lower but more frequent levels of antibiotics.

So probiotics are something you need to work to include. Simple enough, but which live organisms and what adequate amount? Enter the hard slogging of detailed scientific studies. Every day, more and more are published, and some of the researchers are nurses. For instance, the GRACE Project, conducted through the Yale University School of Nursing, was started in order to study the effectiveness of probiotics on the rate of recurrent candidiasis in HIV-positive women.

So far, scientists have studied only a few organisms closely, including strains of Lactobacillus and Bifidobacterium. But there’s strong evidence that other probiotics help protect against, or mitigate the effects of, ailments as different as the common cold and infant colic. Add to these the whole range of nasty autoimmune diseases, and you have a significant group of illnesses that might be remedied by simply restoring the normal micro flora of the body.

How Much Do You Need?

It depends. A serving or two daily of a fermented milk product like yogurt, kefir, and aged cheese is a good place to start. Add fermented sauerkraut, pickles and olives once in awhile, along with a variety of fresh fruits and vegetables, and the average person will get a sufficient supply of probiotics to confer tangible health benefits.

For those who wish to target specific problems, more knowledge is needed. To be effective, the amount of probiotics will probably require a supplement in pill or capsule form and every effect is, at least as far as is known now, strain-specific. One Lactobacillus is not like another. PubMed, a service of the U.S. National Library of Medicine, offers access to scientific and medical journals that have an ever-growing list of articles summarizing specific research findings and correlating individual disease states with specific strains of microbes.

In all cases, diligence is required. Different manufacturing processes greatly affect the concentration of live organisms actually available for consumption. For instance, all yogurts, by definition, are made by starting with active Lactobacillus bulgaricus and Streptococcus thermophilus. But many manufacturers, including some of the most well-known, then heat or pasteurize the yogurt, which obliterates the bacteria. It’s still yogurt, and you will still get your calcium, but you won’t get any beneficial probiotics.

Look for the seal of the National Yogurt Association that says "Live & Active Cultures." That means at least 100 million cultures per gram (sometimes listed as CFU, colony forming units) are present at manufacture. For maximum benefit, then look for a product that contains three or more specific strains. Frozen products still contain active cultures but in far fewer numbers, usually in the 10 million range. Yogurt-coated pretzels and raisins do not. It’s the live bacteria that make it possible for some of the lactose-intolerant to handle yogurt with ease.

Look in the refrigerated section for nondairy fermented foods like pickles and sauerkraut because they lack the preservatives that kill off the good organisms. Foods should be packed in brine, not vinegar. Miso, kimchee and tempeh are other good sources.

What About Supplements?

We need to be even more rigorous in buying supplements, however no set guidelines exist. Natasha Trenev, author of Probiotics, Nature’s Internal Healers, a nonmedical, nonacademic approach to probiotics, recommends the “holy trinity,” for general benefit, a combination of Lactobacillus acidophilus, Lactobacillus bulgaricus and Bifidobacterium bifidum.

Don't forget to read labels. For one thing, it's not guarantee you'll get it at a price that please the pocketbook. Second, the FDA treats these products as food items and does not scrutinize them as it does drugs.

Trade names confuse the issue. Contaminants are common, and so are suboptimal levels of beneficial organisms. Fortunately, some manufacturers follow the stricter drug guidelines, and some submit products for independent testing. If you’re going to go this route, check out the company and be highly selective. The usual amount of active microbes should be in a range of one to 10 billion per dose to justify the expense. And “active” is used loosely here.

The organisms are freeze dried and become active only in the body’s moist environment. High-tech manufacturers thus imitate the clever immigrants who, unable to get through Ellis Island with fresh yogurt, hid cultures in handkerchiefs that had been dipped in starter, then dried and folded as clean linen; once through immigration and ashore, the hankies were dipped in warm milk. Hurrah! A fresh source of microorganisms was safely established in the New World.

Some supplements and, of course, foods, also provide a rich source of probiotics, nondigestible food ingredients that stimulate the growth and activity of beneficial organisms. Pectin and inulin are examples. Storage is critical, and expiration dates really matter.

What sorts of ailments might respond to a complementary or alternative approach such as probiotics? The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, reports that there is encouraging evidence that the use of probiotics can help the following: diarrhea, especially if caused by rotavirus; infections of the female urinary and genital tract; irritable bowel syndrome and intestinal infections caused by Clostridium difficile; ileal pouchitis; and atopic dermatitis in children.

NCCAM also reports that it’s sponsoring research to see if undernourished children with diarrhea in a developing countries respond to probiotics (Tulane); whether probiotics can prevent kidney stone formation by decreasing targeted substances in the urine (Mayo); and whether antibiotic-resistant bacteria found in the elderly, hospitalized, and those with weakened immune systems will respond (Tufts-New England Medical Center).

Sounds nifty, doesn’t it? One word of caution is in order. Although probiotics in large doses aren’t harmful, they should be used carefully. Supplement strength doses should not be taken by the elderly, the very young, and the immune-suppressed without medical guidance. Even though there’s good evidence that these populations might derive benefit from probiotics, care is required.

Elizabeth Hanink, RN, PHN, BSN, is a freelance writer in Los Angeles with extensive hospital and community-based nursing experience.

This article is from workingnurse.com.

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