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Probiotics:
Acidophilus, Bifidobacter, and FOS
by Michael T. Murray, N.D.

Probiotics' literally translated "for life" is a term used to signify the health-promoting effects of "friendly bacteria." There are at least 400 different species of microflora in the human gastrointestinal tract. The most important friendly bacteria are lactobacillus acidophilus and Bifidobacterium bifidum. This article shall focus on the principle uses of commercial probiotic supplements containing either or both L. acidophilus and B. bifidum as well as fructo-ol igosaccharides.
Foods fermented with lactobacilli have been, and still are, of great importance to the diets of most of the world's people. Most cultures use some form of fermented food in their diet such as yogurt, cheese, miso, and tempeh. The symbiotic relationship between humankind and lactobacilli has a long history of important nutritional and therapeutic benefits for humans.
At the turn of the century, noted Russian scientist Elie Metchnikoff believed that yogurt was the elixir of life.l His theory was that putrefactive bacteria in the large intestine produce toxins which invite disease and shorten life. He believed that the eating of yogurt would cause the lactobacilli to become dominant in the colon and displace the putrefactive bacteria. For years, these claims of healthful effects from fermented foods were considered unscientific folklore; however, a substantial, and growing, body of scientific evidence has demonstrated that lactobacilli and fermented foods play , a significant role in human health.
Humans are not born with lactobacilli in their gastrointestinal tract. Colonization of gram-positive lactobacilli begins after birth, whereafter there is a dramatic increase in their concentration. B. bifidum is first introduced through breast feeding to the sterile gut of the infant, and large numbers are soon observed in the feces. later, other bacteria (including such beneficial strains as L. case a, L. fermentum, L. salivores, L. brevis, etc.) become established in the gut through contact with the world. Unfortunately, other, potentially toxic, bacteria also eventually cultivate the colon.(2)

Available forms
In order to be beneficial, products containing l. acidophilus and B. bifidum must provide live organisms in such a manner that they survive the hostile environment of the gastrointestinal tract. Several factors, such as species, strain, adherence, growth media, and diet are involved in successful colonization (3,4). Typically, a high-quality commercial preparation will produce greater colonization than simply eating yogurt. One of the key reasons is that yogurt is usually made with L. bulgaricus or Streptococcus thermophilus. While these two bacteria are friendly and possess some health benefits, they are only transient visitors to the gastrointestinal tract and do not colonize the colon.
Proper manufacturing, packaging and storing of the product is necessary to ensure viability, the right amount of moisture, and freedom from contamination. lactobacilli do not respond well to freeze-drying (lyophilization), spray drying, or conventional frozen storage. Excessive temperature during packaging or storage can dramatically reduce viability. Also, unless the product has been shown to be stable, refrigeration is necessary. Some products do not have to be refrigerated until after the bottle has been opened.
While there are a number of excellent companies providing highquality probiotic products, it is difficult to sort through all of the manufacturers' claims of superiority and some products have been shown to contain no active L. acidophilus. In fact, one
study conducted at the University of Washington concluded "Most of the lactobacilli-containing products currently available [1990] either do not contain the. lactobacillus species advertised and/or contain other bacteria of questionable benefit."(5)
I feel most confident when recommending products that have been developed by Professor Khem M. Shahani, Ph.D., of the University of Nebraska. Dr. Shahani is considered the world's foremost expert on probiotics and developer of the DDS-l strain of L. acidophilus-often referred to as the "super-strain" because it exerts benefits far greater than that of the more than 200 strains of L. acidophilus. Dr. Shahani has authored over 190 scientific studies on the role of lactobacilli in human health. Dr. Shahani has personally endorsed several products available through companies supplying health professionals, pharmacies, and health food stores.

Principle uses
The intestinal flora plays a major role in the health of the host.2-4,6 The intestinal flora is intimately involved in the host's nutritional status and affects immune system function, cholesterol metabolism, carcinogenesis, and aging. Due to the importance of L. acidophilus and B. bifidum to human health, probiotic supplements can be used to promote overall good health. There are several specific uses for probiotics, however. The four primary areas of use to be discussed are promotion of proper intestinal environment, postantibiotic therapy, vaginal yeast infections, urinary tract infections, and cancer prevention.

Promotion of proper intestinal environment
lactobaci II i have long been noted for the role they play in the prevention of and defense against diseases, particularly those of the gastrointestinal tract and vagina. As part of the "normal flora," they inhibit the growth of other organisms through competition for nutrients, alteration of pH and oxygen tension to levels less favorable to pathogens (disease causing organisms), prevention of attachment of pathogens by physically covering attachment sites, and production of limiting factors such as antimicrobial factors.2-4,6
lactobacilli produce a variety of factors which inhibit or antagonize other bacteria. These include metabolic end products such as organic acids (lactic and acetic acid), hydrogen peroxide, and compounds known as bacteriocinsJ-18 Although some researchers have isolated substances from lactobacilli which they labeled antibiotics, these are probably more accurately described as bacteriocins. Bacteriocins are defined as proteins produced by certain bacteria which exert a lethal effect on closely related bacteria. In general, bacteriocins have a narrower range of activity than antibiotics, but are often more lethal.
Some of the antimicrobial activity of L. acidophilus has been shown to be due to hydrogen peroxide.17,18 However, this reaction requires folic acid and riboflavin, which if in short supply production will reduce H2O2 production. In addition to these direct effects, some researchers believe the antimicrobial activity is also due to immune system stimulation.19-24
The earliest reported therapeutic uses of L. acidophilus in the 1920s suggested that their proliferation was associated with a concomitant decrease in potentially harmful coliform bacteria. This effect has since been confirmed,25-27 However, it is believed that many of the earlier commercial products were less rei iable than those used in later published clinical trials because of inappropriate strains and problems in production, storage, and distribution to consumers,28

Fructo-oligosaccharides
Food components which may help promote the growth of friendly bacteria include fructo-oligosaccharides (FOS). These short-chain polysaccharides are just now entering the United States market; however, in Japan the number of consumer products containing purified FOS reached 450 in 1991 and in 1990 the Japanese market for FOS exceeded $46 million. (29)
FOS is not digested by humans. Instead it feeds the friendly bacteria. Human studies have shown FOS to increase bifidobacteria and lactobacilli while simultaneously reducing the colonies of detrimental bacteria. Other benefits noted with FOS supplementation include: increased production of beneficial short-chain fatty acids like butyrate; improved liver function; reduction of serum cholesterol and blood pressure; and improved elimination of toxic compounds.29,3o
The dosage recommendation for pure FOS is 2,000 to 3,000 mg daily. Natyral food sources of FOS include Jerusalem artichoke, onions, asparagus, and garlic; however, the estimated average daily ingestion of FOS from food sources is estimated to be 800 mg. Thus, the supplementation of FOS may boost FOS intake and promote the growth of friendly bacteria-especially bifidobacteria.3o

Post-antibiotic therapy
Acidophilus supplementation is particularly important for preventing and treating antibiotic-induced diarrhea, candida overgrowth, and urinary tract infections. L. acidophilus has been shown to correct the increase of gram negative bacteria observed following the administration of broad-spectrum antibiotics or as occurs with any acute or chronic diarrhea.2-4,31-33 Similarly, a mixture of Bifidobacterium bifidum and L. acidophilus inhibited the lowering of fecal flora induced by ampicillin and maintained the equilibrium of the intestinal ecosystem)3l
Although it is commonly believed that acidophilus supplements are not effective if taken during antibiotic therapy, research actually supports the use of L. acidophilus during antibiotic administration.31,32 Reductions of friendly bacteria and/or superinfection with antibiotic-resistant flora may be prevented by administering L. acidophilus
!- products during antibiotic therapy. A dosage of at least 15 to 20 billion organisms is required. I would still recommend taking the probiotic supplement as far away from the antibiotic as possible.

Yeast infections
L. acidophil us has been shown to retard the growth of Candida albicans--the major yeast involved in vaginal yeast infections)4 Clinical studies have suggested that the introduction of yogurt or lactobacilli to the vagina can assist in clearing up and preventing recurrent vaginal yeast infections as well as bacterial vaginosis.35
L. acidophilus is a normal constituent of the vaginal flora, where it contributes to the maintenance of the acid pH by fermenting vaginal glycogen to lactic acid)6-39 Suppression of L. acidophilus by broad spectrum antibiotics leads to the overgrowth of yeast and other bacteria.4o
Re-establishment of normal vaginal lactobacilli can be accomplished by douching twice a day with an acidophilus containing solution. The solution is best prepared by using a high quality acidophil us supplement or activeculture yogurt. Dissolve enough of either choice in 10 ml of water to provide 108 live organisms per ml. Use a syringe to douche the material into the vagina. Since lactobacilli are normal inhabitants of the vaginal flora, the douche can be retained in the vagina as long as desired.

Urinary tract infection
One of the problems with antibiotic therapy for urinary tract infections (i.e., bladder infections) is that the disturbance in the bacterial flora which protects against urinary tract infections leads to recurrent infections. The insertion of lactobaccilli suppositories into the vagina of women after they had been treated with antibiotics has been shown to significantly reduce the recurrence rate.41 Women given antibiotics should routinely re-establish proper vaginal flora by following the guidelines given above for vaginal infections, or insert active cultures of L. acidophilus into the vagina. Oral therapy is also a good idea.

Cancer
A series of population studies has suggested that the consumption of high levels of cultured milk products may reduce the risk of colon cancer.42 L. bulgaricus, the primary lactobacilli used for yogurt, has demonstrated potent anti-tumor activity.43 Feeding milk and colostrum fermented with L. acidophilus DDS1 has been reported to result in a 16% to 41 % reduction in tumor proliferation in animal studies.44 In human studies, ingestion of L. acidophilus resulted in reduced activity of bacterial enzymes associated with the formation of cancer-causing compounds in the gut.45 The beneficial effects of lactobacilli against cancer appear to extend well beyond the colon. In a double-blind trial conducted in 138 patients surgically treated for bladder cancer, patients were stratified into three groups: (A) with primary multiple tumors; (B) with recurrent single tumors, and (C) with recurrent multiple tumors.46 In each group, patients were randomly allocated to receive the oral Lactobacillus casei preparation (LCP) or placebo. LCP showed a better effect than placebo in preventing cancer recurrences in subgroups A and B; however, no significant effect was noted in group C. These results indicate that Lactobaci II us preparations are safe and effective in preventing recurrence of superficial bladder cancer as long as they are not recurring multiple tumors.
L. acidophilus preparations are also of value in cancer patients receiving chemotherapy drugs or radiation therapy involving the gastrointestinal tract. In one study, 24 patients scheduled for internal and external irradiation of the pelvic area for gynecological cancers were selected for a controlled study to test the prevention of intestinal side effects by administration of L. acidophilus.47 The test group received 150 ml per day of a fermented milk product supplying them with live L. acidophilus bacteria in a 6.5% lactulose substrate. Prevention of radiotherapy-associated diarrhea was achieved.

Dosage
The dosage of a commercial probiotic supplement is based upon the number of live organisms. The ingestion of 1 to 10 billion viable L. acidophilus or B. bifidum cells daily is a sufficient dosage for most people. Amounts exceeding this may induce mild gastrointestinal disturbances, while smaller amounts may not be able to colonize the gastrointestinal tract.

Safety
Probiotics are extremely safe and
are not associated with any side effects.

Interactions
L. acidophilus and B. bifidum are negatively affected by alcohol and antibiotics.48 Although there is no evidence that the organism interferes with the activity of most antibiotics, the metabolism of sulfasalazine, chloramphenicol palmitate, and phthalylsulfathiazole is affected by L. acidophilus.49

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Michael T. Murray, N.D. is a leading researcher and author in the field of natural medicine. He is co-author of A Textbook of Natural Medicine, the definitive textbook on naturopathic medicine for physicians, and sole author of several books, including Natural Alternatives to Over-the-Counter and Prescription Drugs, The Healing Power of Herbs and his newest, Natural Alternatives to Prozac. Dr. Murray serves on several editorial boards and advisory panels. As well as maintaining a private medical practice, Dr. Murray is an accomplished educator and lecturer. In addition to his many books, he has written thousands of articles, appeared on hundreds of radio and TV programs, and lectured to over 100,000 people nationwide.

American journal of Natural Medicine

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