Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

FODMAP diet and foods: Implications in health and disease

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FODMAP DIET: ROLE IN IRRITABLE BOWEL, LEAKY GUT AND ALTERATION IN INTESTINAL BACTERIA

What is FODMAP and FODMAP Diet (Gibson and Shepherd 2010)

FODMAP is an acronym applied to group of short chain carbohydrates and sugar alcohols comprised of Fermentable Oligo- Di and Monosaccharides And Polyols

Disease associations: High FODMAP diet have been implicated in the rising tide of a variety of disorders.

• Crohn’s disease
• Celiac disease
• Irritable bowel syndrome
• Chronic fatigue syndrome
• Autism

FODMAPs share thee physiological properties:

• Poor absorption in small intestine
• Osmotically active small molecules
• Rapid fermentation by gut flora: the smaller the length of carbohydrate, faster the fermentation

High luminal FODMAP foods undergo rapid fermentation and create metabolic products that predispose to enhanced intestinal permeability, altered intestinal flora, intestinal gases and predispose to small bowel bacterial overgrowth (SIBO).

Examples of high FODMAP foods/diet include:

• Fructose (fruits, honey, high fructose corn syrup)
• Lactose (diary products)
• Fructo-oligosaccharides or fructans (wheat, onions)
• Galacto-oligosaccharides or galactans ( raffinose and stachyose) contained in legumes, beans, cabbage, onions etc.
• Polyols (sorbitol, mannitol, xylitol, maltitol) contained in apples, pears, plums etc. and low calorie sweeteners. Polydextrose and isomalt are frequently used as artificial sweeteners, are poorly absorbed.

What happens when you ingest high FODMAP diet

• Excess intake and delivery of undigested carbohydrates to the colon renders them subject to bacterial fermentation.
• The metabolic fermentation products including increased organic acids (short chain fatty acids), increased surfactant activity, increased gases (hydrogen, carbon dioxide, methane and hydrogen sulfide) and gut distension injure intestinal barrier by in part causing apoptosis.
• Short chain fatty acids (SCAFAs) excess excess has been shown to increase intestinal permeability in animal models.
• The gas content of gut plays an important role in gastrointestinal symptoms.

Problems occur especially when high FODMAP diet is consumed fast:

The process if rapid, can be especially “explosive”. This occurs when large amounts of undigested carbohydrates are exposed to disproportionately high and potentially pathogenic bacteria in gut e.g. small bowel bacterial overgrowth.

Type of food versus speed

• Oligosaccharides (smaller chain length carbs) and sugars are metabolized at a much faster rate than the longer chain length molecules like dietary soluble fiber.
• The speed of bacterial fermentation and generation of metabolic products varies according to substrate (lactulose >inulin> resistant starch)
• FODMAP elimination diet plan requires global and not individual product restriction.

FOMAP drawbacks

• Low FODMAP diet diminishes access to benefits of prebiotics like fiber
• Effects of high fiber/prebiotics

1. Increased bowel fluid by osmotic effects

2. Increased motility

3. Increased generation of short chain fatty acids that serve as food for colonocytes

4. Increase in beneficial strains of bacteria like bifidobacteria.

FODMAP diet and vegetarians

• Legumes and milk products are a major source of nutrition for vegetarians.
• Since the goal of FODMAP strategy is overall reduction, greater cuts need to be made in other categories in order to accomplish the desired goals.  
• Eat good carbs!

Turning harmful effects of FODMAPs into benefits

• A lower proportion of rapidly fermentable carbohydrates along with greater amount of slowly fermentable carbohydrates have potential for ameliorating harmful effects of FODMAPs and shifting the balance towards benefits.
• For example, ingestion of raw potato starch, guar gum and arabinoxylan causes intestinal injury especially involving enzymatic activities. The deleterious effects of these foods do not occur if they are consumed along with slowly fermentable wheat bran.
• Considering the demonstrated potential health benefits of prebiotics, the harm versus benefits may be individual specific based on diet consumed, gastrointestinal flora, rapidity and amount of bacterial fermentation, and presence of comorbid conditions in the context of genetic susceptibility.

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Disclaimer: Everything on this site is for your information only. Do your own due diligence and consult physician. The ads have potential to generate income for the blogger.

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Kid getting infection from day care center? Try probiotics

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There is growing body of literature on benefits of prebiotics and probiotics in reducing risk of infections in elderly as well as in children. Yet, they have not achieved a mainstream acceptance yet for a variety of reasons.

Hojsak and colleagues conducted a randomized, double-blind, placebo-controlled trial to examine the efficacy of Lactobacillus GG (LGG) in preventing gastrointestinal and respiratory tract infections in children attending day care centers. The findings were published in the journal Clinical Nutrition.

281 kids were recruited to the study. Study subjects received 10⁹ colony-forming units(CFU) in a fermented milk product for a period of 3 months. Placebo group was administered the same post-pasteurized fermented milk product.

 

Kids taking LGG suffered fewer respiratory infections and those who did develop respiratory infections had a milder shorter course. However, there was no impact on lower respiratory infections. Similarly there was no effect on frequency or severity of gastrointestinal infections.

                                        Listing of some probiotics on market

Do you or someone you know takes probiotics for prevention on a regular basis? If so what has been your experience. Please share your thoughts.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctort. Please consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Yogurt gaining popularity

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Health conscious Americans are increasingly using fermented foods ranging from yogurt to kimchee because of the potential health benefits in a variety of chronic ailments. This was reported by Chicago Tribune/Tribune Media Services (4/28/2010)

Entericoated aspirin, NSAIDs ulcers, dannon yogurt, FDA approved, medical radiation, rotavirus vaccination

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Patients concerned about side effects of aspirin especially the risk of gastrointestinal ulcers often take entericoated formulations of aspirin to avoid such complications.

Though patients often believe these pills pose a lower risk of stomach upset, they actually don’t appear to have much effect on the more serious damage that aspirin can cause.

 

“That’s a huge misunderstanding,” says David A. Johnson, a past president of the American College of Gastroenterology and a professor at Eastern Virginia Medical School. Read more here.

Dannon must pay consumers up to $45 million in damages for falsely advertising the health benefits of its yogurt, under the terms of a class action settlement reached Tuesday in federal court in Cleveland, reports Cleveland.com. The targets of the class action were two Dannon yogurt products -- Activia and DanActive -- pitched in TV ads by actress Jamie Lee Curtis. Read more at dannonsettlement.com.

 The terms "FDA approved" or "FDA registered." are reassuraing while purchasing health care products.  According to Daniel Carpenter, professor of government at Harvard University, and as published in Los Angles Times, these words "FDA approved" or "FDA registered" don't mean as much as consumers often assume. "FDA certification of a product is never a guarantee of safety or effectiveness of anything," Carpenter says.

A House subcommittee heard from various experts calling for standardization of medical radiation to enhance effectiveness and safety as reported in the New York Times, Saying that recent news reports about radiation accidents had “raised huge concerns for me,” Frank Pallone Jr. the chairman of the Energy and Commerce subcommittee on health, said he was shocked that the people who operate radiologic devices need not be licensed in many states and that “the requirements to report errors and the penalties for making errors are basically nonxistent or not enforced.”

The efficacy of the pentavalent rotavirus vaccine was assessed among infants in the United States was studied by Wang et al. from Harward University. A large, national, health insurance claim database was studied. Use of the vaccine resulted in a 66% decrease in acute gastroenteritis related hospitalization and visits to emergency rooms as well as a 74% reduction in costs.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

 

Constipation? what and how to take care of business

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Constipation 

Author: Anil minocha MD of Shreveport, La

Overview

Constipation is the most common digestive complaint in the U.S. and affects predominantly women. It can occur at all ages. Elderly are especially prone to it.  The term obstipation is sometimes used to describe severe constipation.

Diet, medications, sednetary life style, abnormal toileting posture may be involved as causative factors. Many a times, constipation is associated with psychosocial issues and may even be associated with history of physical or sexual trauma.

What ancient medicine thinks about constipation?

Ancient medicine believes that constipation results in alteration of balance of good versus bad bacteria in gut, kinking of colon and accumulation of harmful products due to stool stasis including toxins entering into the body.

In addition to toxins entering the across the intestinal barrier into the body, there can be alterations in fermentation patterns as well as alterations in processing related to altered pattern of the fermenting flora.

Uremic toxins are generated as a result of colonic bacterial fermentation. Such toxins introduced into the body, for example, advanced glycation end products, indoles, phenols may damage a variety of blood vessels in various organs. Prebiotics and probiotics have potential to ameliorate this damage.

If true, this has potential to result in a variety of bodily dysfunction including exacerbation of uremia in kidney disorders.

Strategies for constipation

In addition to modern laxatives and prescription drugs like Amitiza and Miralax, numerous natural products in alternative and complimentary medicine are used to move bowels in patients with constipation.

An overemphasis on evidence-based analysis and aggressive marketing of newly developed laxatives has tilted the recommendations toward more expensive, but not necessarily more effective, agents. There is little shared understanding between patients and professionals about 'normal' bowel function. In addition, there is little consensus on the best treatment strategy for chronic constipation. Many of the natural or ancient bowel cleansing products  have been authenticated by clinical trials. 

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Various natural products against constipation include the following:

• Senna: Senna alata (L.) Roxb. is a plant and it is a frequent component of natural bowel moving products. Its laxative activity is supported by scientific findings. Ayurvedic herbal remedy, Miskakasneham has been shown to be effective and safe as Sofsena, a conventional senna-based laxative.
• Aloe: Controlled trials have demonstrated that aloevera when combined with celandin and psyllium group, bowel movements results in more frequent and softer stools while reducing laxative dependence in patients with chronic constipation.
• Cascara Sagrada: It is an anthraquinone-containing stimulant laxative. The dried, aged bark of this tree has been used for thousands of years by both native and immigrant Americans Anthraglycosides are responsible its laxative properties. It acts by increasing intetinal secretions, inducing intestinal peristalsis and promoting bowel evacuation.
• Chinese Rhubarb: Ancient chinese believes in expelling pathogens regardless of hard stool early during course of illness and expelling pathogens with rhubarb is essential.
• Slippery Elm Bark: It is an herbal product with antioxidant properties with potential for reducing inflammation in the gut. In vitro data suggests that it scavenges superoxide dose-dependently and that the oygen radical release from biopsies is reduced after incubation with this herb.
• Olive oil: It is an ancient laxative. One study found that 97.7 percent of subjects with more than three defecations a week had a high intake of virgin olive oil. Oilve oil has also been used as enema in combination with other softeners: like paraffin oil and gycerine mixed with water is effective in difficult cases of constipation.
• Peppermint oil: Peppermint oil is beneficial in improving symptoms of irritable bowel syndrome including abdominal pain.
• Bentonite clay: Randomized controlled trials have shown that treatment beidellitic montmorillonite is effective in constipation predominant irritable bowel syndrome.
• Probiotics: Use of probiotics including Lactobacillus have been shown to be effective in constipation. One double blind pacebo controlled trial in kids with constipation showed that the use of probiotic Lactobacillus casei resulted in a higher defecation frequency, greater rcentage of treatment success, less use of glycerin enema less hard stool as compared to he placebo group.

Do you or someone you know has constipation? What do you think is causing it and how do you treat it? Please share your thoughts.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

IRRITABLE BOWEL SYNDROME

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IBS and how to manage it medically or by complimentary and alternative medicine

Irritable bowel syndrome (IBS) or spastic colon affects 5-20 percent population. It is likely that you or someone you know has irritable bowel syndrome. But what is this irritable bowel syndrome or spastic colon or IBS?

Irritable bowel syndrome

IBS is a symptom based diagnosis of unclear etiology. It should not be confused with diverticulosis or diverticultis. Irritable bowel syndrome is probably is not a single disease. More likely, IBS is comprised of multiple diseases, all lumped into one at the present time for lack of understanding its pathogenesis. Infantile colic is considered by many to be a variant of IBS in infants and kids.

Features of irritable bowel syndrome and Rome criteria

Irritable bowel syndrome is a functional disorder characterized by chronic (at least three months in the preceding one year) abdominal pain and a disturbance of bowel habit. The disturbed bowel habit of IBS may manifest as diarrhea, constipation or alternating diarrhea with constipation. Pain frequently improves with defecation.

A waxing and waning pattern of symptoms is seen in most patients. The precise conglomeration of symptom complex is defined under ROME III criteria.

What causes irritable bowel syndrome?

• The pathogenesis of irritable bowel syndrome remains an enigma and no single etiology fits all cases. IBS is predominantly seen in young females but can be seen in adults of any age and either sex. It is more prevalent among Caucasian Americans than African Americans.
• Motility disorder has been frequently implicated; however no consistent motility pattern can be demonstrated.
•  Visceral hypersensitivity (pain with a stimulus not severe enough to cause pain in healthy subjects) is seen in many patients.
• Autonomic dysregulation has also been implicated. A dysfunction of 5-HT system is supected in many cases. Stress does not cause it but does tend to exacerbate symptoms. Food allergy or intolerance may be present in some cases.
• Many patients attribute the onset of disease to a bout of flu-like illness e.g. viral gastroenteritis, travelers diarrhea.
• Low grade inflammation in the gut can be documented in many cases.
•  Several authors claim small intestinal bacterial overgrowth to be the cause in most cases of IBS although these observations have not been confirmed by others.

My opinion: IBS occurs when there is a perfect storm of combination of increased intestinal permeability (Leaky gut) and low grade inetestinal inflammation,  altered gut bacteria and some harmful factor in gut lumen in a patient with genetic predisposition. The role of diet in at least affecting the IBS manifestations can not be emphasized enough.

Note: The leaky gut, inflammation and altered bacteria can affect not only the gut but also systems far away including the brain.

IBS medical consensus

Overall, in the absence of clear cut cause, a bio-psychosocial model for pathogenesis for irritable bowel syndrome has been proposed. This model emphasizes the role of mind-body interactions with the environment.

In this context, it should be noted that there is an increased prevelance of certain chronic pain disorders in IBS patients, e.g. functional dyspepsia, fibromyalgia, chronic fatigue syndrome, interstitial cystitis, chronic back pain etc.

Diagnostic strategy for irritable bowel syndrome

While the diagnosis of irritable bowel syndrome should be positive, physicians frequently perform studies to exclude any treatable cause. The work up for IBS should be individualized and may include complete blood count (CBC), routine chemistries and stool studies. Flexible sigmoidoscopy or colonoscopy may be performed depending upon age and risk for colon cancer and suspicion for alternative diagnosis like inflammatory bowel disease (Crohn's disease and ulcerative colitis).

Celiac sprue should be excluded by antibody testing for anti-tissue transglutaminase antibody. The use of anti-gliadin antibody has recently seen a resurgence with the identification that many IBS patients get relief from gluten free diet.

Lactose hydrogen breath test may be done to exclude lactose intolerance. Small bowel bacterial overgrowth can be excluded by hydrogen breath test or cultures of small bowel aspirate.

Treatment of irritable bowel syndrome

The management of IBS patients follows a step-wise fashion and is largely symptom based. Realistic goals need to be established. Reassurance with a lot of hand-holding goes a long way in helping patient cope with the symptoms of IBS.

Placebo response rate in irritable bowel syndrome may be as high as fifty percent. 

Role of Diet: An often an forgotten factor in management

• High fiber diet and fluid are frequently prescribed as first line of treatment for IBS of all types. Much of positive data about fiber in IBS pertains to Isubghulla type.
• Patients with diarrhea may be helped by lactose-avoidance.
• Patients can frequently identify provoking factors and need to abstain
• Gluten-free diet helps many patients.
• Other exclusion diets are also helpful including the  FODMAP diet.

Role of GI medications

Over the counter laxatives or  prescription medication Zelnorm are used in cases with constipation predominant IBS. Of note, Zelnorm was withdrawn from US market on March 30, 2007 because of unacceptable side-effects. Lubiprostone is available.

Constipating agents like Imodium and Lomotil may be needed in patients with diarrhea predominant IBS. Lotronex is useful for diarrhea-predominant IBS but has high risk for ischemic colitis. Its availability is limited and its use in IBS has largely been abandoned by most physicians in the US.  Its is not to be used for irritable bowel syndrome of constipation type.

Antispasmodic agents e.g. Bentyl are frequently prescribed for abdominal pain associated with irritable bowel syndrome but provide only limited benefit at best.

Peppermint oil, A time proven remedy:

Peppermint oil is effective based on literataure as stated in guidelines by the American College of Gastroenterology.

Probiotics: Multiple studies have now documented beneficial effects of probiotics in IBS. Note, that all probiotics are not created equal and results depend on the species/strain used.

Treat SIBO if present: Small bowel bacterial overgrowth is treated with antibiotics. Rifaximin, a gut selective antibiotic is frequently used. Probiotics have also been shown to heal small bowel bacterial overgrowth and may have less adverse effects overall as compared to antibiotics.

Role of antidepressents in irritable bowel syndrome

Low dose tricyclic antidepressants (e.g. imipramine, desipramine) raise the pain threshold and are frequently prescribed to IBS patients not responding to above strategies; however their side-effects can be problematic.  Although frequently prescribed, there is less data about the use of newer antidepressant agents like SSRIs for management of IBS.

CAM therapies

Several trials have documented positive impact of probiotics in IBS patients. Cognitive behavioral therapy, hypnosis, IBS classes, yoga, Chinese herbal medicine etc have  also been used successfully in irritable bowel syndrome. Limited data points to efficacy of melatonin (over-the-counter sleep-aid) in IBS. A Mayo Clinic (Rochester) study showed that St John's wort does not have beneficial effect.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

What are probiotics and prebiotics and their health benefits

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Intestinal Bacteria, Probiotics and prebiotics

 Pasteur made the prophetic statement that life sans microbes would be impossible. It was Metchnikoff who in 1907 came up with idea of positive role of some bacteria. Lilly & Stillwell coined term probiotic in1965. A 2001 FAO/WHO report defines probiotic as live microorganisms when given in adequate amounts confer benefit to the host.

The intestinal bacteria participate in normal functioning of gut:

• Structure and function e.g gut transit is delayed in germ-free animals.
• Biochemical interactions
• Immunology
• Maturation of blood vessels
• Gene expression
• Maintaining body weight

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Potentially helpful mechanisms of actions of bacteria in gut including probiotics 

• Reduce or eliminate pathogens
• Reduce/eliminate toxins/carcinogens
• Release nutrients/antioxidants, growth factors
• Impact on immune function
• Synthesize vitamins (K, FA, B group)

Prebiotics

As mentioned in the book Natural Stomach Care, these are the substances that provide substrate for fermentation by the intestinal bacteria. They are usually undigested food, mostly plant food. They are also known as colonic foods. They involved in the following functions in the intestines.

• Maintain mucosal growth
• Water electrolyte balance
• Provide Energy/nutrients for host/bacteria
• Stimulate growth of flora

Dr. Minocha's article on probiotics for disease prevention

 Clinical studies

Probiotics, prebiotics as well as combined probiotics and prebiotics have been studied in many digestive illnesses like infantile colic, infectious diarrhea, travelers diarrhea, inflammatory bowel disease, antibiotic induced diarrhea, recurrent C. difficile colitis and irritable bowel syndrome.

Studies have also examined the impact of probiotics in non-digestive illnesses like allergic disorders e.g.  atopic dermatitis, dental caries, gingivitis, postoperative infections, infections in liver transplant patients, preventing colds and sickness-related absenteism, baby growth etc.

Many of these studies have been very positive leading to introduction of multiple commercial products into the market. However, each product is different with respect to the type, number of strains and bacterial count.

Note: Just like antibiotics, all probiotics are not created equal. Some probiotics may work in certain situations and not the others.

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Properties of an ideal probiotic

• Ability to survive through gut
• Able to proliferate and colonize gut
• Safe and effective
• Maintain potency for the shelf-life

Myths about probiotics

• Alters the composition  
• Permanent homeliness
• Impact on bowel ecosystem

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Bacteria for your infant's colic?

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Infantile colic is a difficult problem, vexing both to parents and physicians. The cause is thought to be excess intestinal gas. On the lines of irritable bowel syndrome or IBS, new research indicates that probiotic bacteria help in kids with colic.

Probiotics or "good bacteria" that tend to maintain a healthy balance of good versus bad bacteria in the gut. They are being increasingly have been found to be useful for treatment of various illnesses, both gut and non-gut related.

Dr. Savino and colleagues from the University of Turin in Italy conducted a randomized placebo controlled trial to study the effect of Lactobacillus reuteri. Their findings were published in the journal Pediatrics (January 2007).

The study cohort consisted of 90 breast fed babies who were administered either the probiotic or the common over the counter anti-gas medication known as simethicone for 28 days. Mothers refrained from ingesting cow's milk in their diet. Baby crying times were assessed.

The daily median crying time at day 28 was 145 minutes/day in placebo group as compared to only 51 minutes/day in the probiotic group. 95% babies were termed as responders among the probiotic group in contrast to only 7% in the placebo group.

The mechanism of action of the probiotic in such conditions remains to be established. Possible mechanisms include immune-modulation and enhanced peristalsis thus affecting the balance of the gut flora and reduced triggers for abdominal pain.

Do you or someone close to have kids? Do any of them have colicky problems? What remedies have you tried for such episodes?

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Bacteria and obesity: Think infecto-obesity

Secret to body fat is inside you: Infecto-obesity

Let us start on a cheerful note. There is an old saying, all sickness begins in gut. Obesity is no exception. And it is not just related to imbalance between ingestion of excess food and calorie expenditure. And of course obesity cuts down your life span also.

Now that you may have packed some extra-pounds during the holidays, you may be feeling guilty since taking them off is usually not that easy. Worry not! If you can't take them off, it may not be entirely your fault. Even viral infections have been implicated. According to two articles reported in the prestigious journal Nature , the gut bacteria may be playing an important role.

Obesity alters the ecology of the trillions of bacteria present in the gut. Dr. Turnbaugh and colleagues from Washington University in St. Louis, Missouri studied the intestinal bacteria of lean and obese mice as well as humans.

There is an alteration in relative dominance of two types of bacteria (Bacteroidetes and the Firmicutes) in the gut of obese persons. For example, the relative proportion of Bacteroidetes is decreased in obese people as compared to their lean counterparts. This relative proportion increases with weight loss on low-calorie diet.

This altered bacterial flora results in the alteration of bacterial metabolism. For example, bacterial flora in obese facilitates extraction of greater amount of energy from the diet. Data also showed that it might not be a static phenomenon. For example, the transfer of the "obese" bacterial flora to the lean animals results in induction of obesity in the lean ones!

Above findings in no way diminish the fact that obesity is directly related to the net balance between in amount of calories ingested and the calories consumed by the body as energy expenditure. It just means that the pathogenesis of obesity has a bacterial component.

Do you have a weight problem? Do you have difficulty taking off excess body weight? Have you been on yo-yo diet? Your thoughts are welcome.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Fermented soy prevents obesity

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Does probiotic soy have benefit against obesity?

<As the health care costs keep rising on account of the epidemic of obesity, scientists are looking at more and more unconventional strategies to combat the curse of extra weight.

Dr. Manzoni and colleagues from Brazil studied the effect of a soy product fermented by two probiotics (Enterococcus faecium and Lactobacillus jugurti) in rats. The rats were fed a chow diet or Soy diet as above. The results were published in the journal Nutrition .

They found that the soy had beneficial effect on fat pads in the body. This was likely due to the fact that the fat cell size was significantly smaller in the rats fed fermented soy diet. In addition, the data showed that the fermentation of probiotic was responsible for enhancing the anti-fat effects of the soy diet on the fat cells.

The authors concluded that this fermented soy diet might be another option to pursue for obesity prevention.

While this study was done in rats, the results look very promising. The soy products and probiotics have many beneficial effects on health and it would be a coup if these results can be duplicated in humans.

What are your thoughts on soy or probiotics? Do you take soy or any probiotics for any reason? Feel free to share your thoughts.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Probiotic fermented soy to prevent weight gain

Probiotics de-stress gut dysfunction

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An article written by Dr. Anil Minocha, Shrevport, La

It is well documented that chronic stress makes the gut barrier hyperpermeable or leaky. This can allow the harmful substances including bacteria to leak across the gut wall and absorbed into the body causing disease.

 Dr. Zareie and colleagues from Hospital for Sick Children, Canada sought to examine if this leakiness of the gut could be prevented by administration of a probiotic regimen in rats under chronic stress.

Study: Chronic psychological stress was induced in rats by a test called water avoidance stress (WAS) which is known to make gut leaky. These rats were subjected to water avoidance stress or sham stress intermittently over a period of days. Animals were given supplementation of probiotics Lactobacillus acidophilus and L. rhamnosus in the drinking water prior to stress. Animals remained healthy for the duration of the study. Rats were sacrificed after the study and the gut as well regional lymph nodes were studied.

Results: Chronic stress caused a intestinal barrier dysfunction (Leaky gut) in both small and large intestine along with increased bacterial stickiness to the lining of the gut wall as well as penetration across the gut wall. Over two-thirds of rats were found to have bacterial translocation to mesenteric lymph nodes.

While probiotic pretreatment alone had no effect on intestinal barrier function in controls, the treatment reduced gut barrier dysfunction; in addition, it completely blocked the bacterial stickiness to the gut wall as well their translocation across the gut wall into the body.

Conclusions: These results further lend support to hypothesis that certain probiotics can prevent chronic stress-induced intestinal abnormalities and, hence have potential to reduce the potential for sicknesses e.g. irritable bowel syndrome and inflammatory bowel disease like Crohn's disease and ulcerative colitis.

Implications in humans: While it may be a big leap to jump to conclusions from a study involving rats, it should be noted that there is evidence suggesting that probiotics help in some patients with irritable bowel syndrome as well as ulcerative colitis in humans.

NOTE: All probiotics are not created equal!

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Common cold? Probiotics to rescue!

Literature is gradually accumulating that the long-term ingestion of certain probiotics is protective against a variety of infections. In the current study, Doctors DeVrese and colleagues from Federal Research Center of Nutrition and Food in Germany looked at the role of probiotic ingestion on prevention of upper respiratory infections (common cold, influenza). They published their findings in the journal Vaccine.

These investigators studied the effect of long term consumption of probiotics lactobacilli and bifidobacteria in a randomized controlled fashion during two winter/spring periods. 479 subjects participated in the study. All subjects received vitamins plus minerals with or without probiotics.

The authors found that while the incidence of viral respiratory infection was not affected, the duration were markedly reduced in the probiotic group. In fact, the probiotics reduced the duration of sickness almost 2 days (average 7.0 days versus 8.9 days). There was also reduction in severity of symptoms.

Remember however, not every type of probiotic bacteria works against everything. They are specific just like antibiotics for infections.

Of note, Dr. Minocha's article on preventative benefits from probiotics was published in the journal Nutrition in Clinical Practice.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

Yogurt has probiotics for positive health and disease prevention

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All Yogurts are not created equal

As stated in the book, "Natural Stomach Care", by Anil Minocha MD of Shreveport, La, an average American eats four to six pounds of yogurt per year. The commercial market for yogurt exceeds $2.2 billion in the US and the popularity of yogurt continues to grow.

A big advantage of yogurt over milk and its other products is that it may be tolerated by those with deficiency of the enzyme lactase manifesting as lactose intolerance.

Probiotics play an improtant role in disease prevention.

As per regulations, yogurt must have two types of "friendly" bacteria to qualify as yogurt. These are Lactobacillus acidophilus bulgaricus and Streptococcus thermophilus, but their beneficial effect especially in doses seen in usual yogurt is controversial. Some brands subject yogurt to further heat treatment resulting in killing of bacteria in an attempt to boost the shelf life. This step gets rid of any potential benefits of these bacteria.

A brand of yogurt containing live cultures has a logo/seal (in the form of A C which stands for active cultures) on the container. Thus, yogurt may be made by active cultures but may or may not have the bacteria depending upon the brand.

Note however, that the seal is voluntary and its presence implies that the yogurt contains atleast 100 million bacteria per gram at the time of manufacture.

Health-oriented yogurt brands tend to contain one or more bacteria in addition to the two outlined above. In addition, the number of bacteria per serving is much higher so that enough bacteria can survive to the colon and exert their beneficial effects to the highest potential.

A word of caution: I recommend avoiding frozen or sweetened yogurts and those with fruit if your goal is the highest health benefit.

Do you like or eat yogurt? Did you learn any unique things from your mom or grandma about yogurt? Would the above information change your dietary habits in any way? Please let me know what you think.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. Do your own due diligence. Talk to your doctor for advice. Ads have potential to generate income for the blogger.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

 

Doctor, I have bacteria in stomach!

Helicobacter pylori

Despite the popular myth, the stomach despite its acidity is not completely sterile. The most common type of bacteria is known as Helicobacter pylori (Hp).

Ever since the then controversial publication by Nobel laureates Warren and Marshall correlating these bacteria with gastritis and ulcers, this bacterium has been a subject of countless research papers as well as speculation. It has been linked to controversial conditions like coronary artery disease and short stature

H. pylori is a ubiquitous organism and may be present in as many as 40-50% of the population. In some developing countries, the prevalence may be as high as 90 percent. In most humans, it does not appear to cause any health problems.

PROVEN ASSOCIATIONS

1. Gastritis
2. Duodenal ulcer and gastric ulcer
3. Gastric adenocarcinoma (World Health Organization classifies Helicobater pylori as Class I carcinogen)
4. MALT-lymphoma

Preliminary data suggests the association with the following:

1. Iron deficiency anemia
2. Idiopathic thrombocytopenic purpura
3. Urticaria

DIAGNOSIS

The diagnosis of Helicobacter pylori can be made by a variety of means including testing the biopsy specimen obtained on upper GI endoscopy. Other methods include breath test and stool test. The above tests look for evidence of actual presence of the H. pylori bacteria. A simple indirect screening test involves testing the blood for antibodies against the Helicobacter pylori. However, the latter can't be used for testing for results of eradication therapy since the antibodies may persist in the blood long time (months to years) after the Helicobacter pylori has been eradicated.

TREATMENT

Helicobacter pylori is a very resistant organism. As such, multi-drug regimens usually taken for 2 weeks are the rule. Variety of drug combinations comprising of 3-4 drugs are available. Dosepacks are also available, e.g. PrevPac and Helidac. Dosepacks improve compliance. Probiotics may help reduce the severity of side-effects due to treatment.

Paradoxically, some studies suggest that Helicobacter pylori is protective against gastroesophageal reflux disease or chronic heartburn.

TREATMENT SUCCESS

Success rates vary and depend on multiple factors including the drug regimen and compliance etc. Re-infection rates are low in developed countries (less than 5%) but may be as high as 20% in developing countries.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

Intestinal bacteria in health and disease

Home Shreveport page                 Facebook Anil Minocha This article has been authored by Anil Minocha, Shreveport, La

Altered bacterial flora increases risks to health

Living in this wide-world and even bigger universe, we sometimes forget that there is a different form of universe within each of us. In fact, there are trillions of bacteria in each one of us. Did you know that the number of bacteria in our gut actually exceeds the number of cells in human body by 10 fold.

BACTERIAL PATTERNS IN BODY

While the total number of bacteria in each body is about 100 trillion, the number of species encountered is only 500-1000. In fact, 99% of flora is made up by 30-40 species. Each individual human being has a unique, specific and stable pattern of the types of bacteria present. This uniqueness is controlled by physiologic and immunologic uniqueness of each one of us. For example, bacterial flora in monozygotic twins follows a similar pattern

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CLASSIFICATION

The intestinal bacteria may be auto- or allochthonous. Autochthonous bacteria means that these species are detected consistently suggesting that there has been long term association. They are stable in population as well as size and presumably have a demonstrable ecological function.

For example, in case of broiler chickens raised under commercial conditions, lactobacilli become established in their gut soon after hatching and persist throughout life despite common and frequent use of antibiotics. These lactobacilli influence pH of intestinal contents which in turn inhibits proliferation of harmful bacteria (a demonstrable function).

Allochthonous bacteria are found at a site other than where they are formed i.e. delivered by food. As such, they are aliens to the gut. Various mechanisms determine how long they can stay. For example, competition with the native bacteria, also known as Niche exclusion principle.

NICHE EXCLUSION PRINCIPLE

The Niche principle states that two types of species with similar ecological/functional niche cannot live together and survive in same place. The major reason for vast biodiversity of microflora in the gut is the immensely heterogeneous environment that exists in relation to nutrients and spatial arrangement. As such, scores if not hundreds of niches need to co-exist with different types of bacteria favored by each.

SYMBIOTIC RELATIONSHIP

There is also a possibility of symbiosis; which means benefit to both the bacteria and the host. It is clear that bacteria get benefit with nutrients; the benefit to host (i.e. human) has not been well demonstrated since people can live in germ free environs. On the other hand, we know that the overall microflora does affect the intestinal physiology and metabolic functions.  Thus the entire gut flora may be considered one organism for the purpose of symbiosis although individually it consists of commensals.

EFFECT OF ALIEN BACTERIA

At the same time, under certain circumstances, the arrival of alien bacteria can degenerate into host-parasite in which host is injured. Example is sepsis caused by anaerobes in normal flora.

VARIATION OF BACTERIAL SPECIES IN GUT
Different parts of digestive tract have different quantities of bacteria. In fact, even within colon, the different parts have different species. In inflamed colon, the inflamed colon has different species than the healthy one.

CHANGES DURING LIFE
From the time of birth, the flora changes with time till established into a stable pattern. The flora depends on numerous factors. For example, in a neonate, the type of bacteria present are different depending upon hospital or home delivery, country, method of delivery (vaginal delivery versus C-section), small family size and maternal diet etc. Lack of exposure to certain species or use of antibiotics at critical time of maturation of immune system may alter the ultimate flora and impact on health.

EFFECT OF DIET
The human diet has also evolved over millions of years and so have the gut flora. The paleolithic diet did not contain grain or cow's milk. Most food was well fermented, as it was stored in soil for weeks or even months. There was less salt, sugar and fat. On the other hand, minerals (x2), plant fiber (x10), antioxidants (x20) and bacteria (x billions) were contained in abundance. Research suggests that the beneficial bacteria tolerate western diet poorly.

EFFECT OF STRESS AND DISEASE
Intestinal bacterial patterns change during stress and disease. For example in pancreatitis, the good bacteria disappear in 4-6 h resulting in overgrowth of pathogens and translocation of these harmful bacteria across the gut wall within 6 hours.

When a person is admitted to an intensive care unit, the good lactic acid bacteria are lost after a short stay. The examination of gut bacteria in astronauts reveals that the good lactic acid bacteria are reduced to as low as zero accompanied by an overgrowth of pathogenic bacteria.

USEFULNESS OF GUT BACTERIA
The intestinal bacteria serve a lot of functions in the gut. The animals of bacteria raised in germ-free conditions have deranged gastrointestinal system. Their gastric emptying is delayed, intestinal transit is prolonged and the colon may be dilated.

MANIPULATING GUT FLORA
Pasteur stated that life sans microbes is impossible. In 1907, Metchnikoff came up with idea of positive role of some bacteria. It was Lilly & Stillwell who coined the term "probiotic" in 1965. Severl studies have documented the benefits of probiotics and prebiotics in digestive (irritable bowel syndrome, inflammatory bowel disease, infectious diarrhea) as well as non-digestive illnesses (common cold, obesity).

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Disclaimer: Everything on this site is for your information only. Do your own due diligence and consult physician. The ads have potential to generate income for the blogger.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger