A Medical Student Blog

Unofficial thoughts on medicine and medical school

Youtube Summary of Probiotics

Here below, you will see my amateur bad attempt to try to make this topic a little more fun to digest.

Main point #1: clostridium difficile is a serious, bacterial problem in the U.S., that can cause death.

Just today (4/30/07) our professor was telling us how four people died in the hospital of this infection last year. Usually it’s treated with antibiotics, but sometimes they fail — at which point, the outlook is grim for the patient. There is good news though! Patients could be potentially treated with probiotics (although a funkier version of probiotics). With Dr. Aas, he’s reported much success with this form of treatment when patients can’t fight off C. difficile with metronidazole or vancomycin (these are the common antibiotic treatments).

Main Point #2: Von Niel argues that probiotics should be considered a mainstream therapy (see the Von Niel reference).

There are enough randomized controlled trials out there to support such a statement. But it is slow to catch on in the U.S., possibly because it usually takes 17 years for new scientific discoveries to get widely disseminated (Balas & Boren, 2000).  For safety information on which strains are safe and who can take probiotics:http://www.ajcn.org/cgi/content/abstr… The authors noted: “We found that probiotics are safe for use in otherwise healthy persons, but should be used with caution in some persons because of the risk of sepsis.” 

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Probiotics (from Von Neil, 2005)

We definitely know it works for:

Acute infectious diarrhea
Prevention of antibiotic-associated diarrhea Conditions that are potentially treatable by probiotics:Chronic diarrhea
Inflammatory bowel disease
Irritable bowel syndrome
Food allergyConditions that are potentially preventable:Traveler’s diarrhea
Necrotizing enterocolitis
Urogenital infections
Atopic disease
Dental cariesFuture applications proposed for:
Cystic fibrosis
Rheumatoid arthritis
Cancers

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What is clostridium difficile? (from JG Bartlett, 2006)

It’s a nasty bacteria.

Who gets it?

If you’ve taken antibiotics, are of advanced age, or in the hospital or recently came from the hospital.

What’s the significance of this problem?

A new epidemic strain of C. difficile has emerged that causes more frequent and more serious disease.

What are some symptoms?

“Clinical disease and C. difficile toxin are present almost exclusively in patients with recent antibiotic exposure, with rare exceptions.” So if you’ve taken antibiotics, that increases your risk. Clinical expression of infection almost always includes diarrhea, but symptoms vary widely.

Common findings in patients with infection: 1) colitis (inflammation of the colon) with cramps, 2) fever 3) abdominal pain 4) fecal leukocytes (white blood cells in the stool) 5) and inflammation on colonic biopsy (if you do a biopsy of the colon).

Pseudomembranous colitis (a type of infection of the colon) represents an advanced stage of disease, and although considered “nonspecific,” it is nearly diagnostic of C. difficile infection.  The disease is almost always restricted to the colon.

A recent report implicates gastric acid–suppressive agents as a risk for disease, but this has not been consistently observed.

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How come my microbiology professor doesn’t think probiotics work?

“Frequently, years or even decades are required for laboratory discoveries to reach clinical practice. It takes an estimated average of 17 years for only 14% of new scientific discoveries to enter day-to-day clinical practice” (Balas & Boren).

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Why the Healthcare System Should Care

Based upon their hospital’s rate of CDAD (clostridium difficile associated diarrhea) in 0.7% of discharges,they estimated that the total excess in US healthcare costs attributable to CDAD was likely >$1.1 billion.– from the Center for Disease Control.  Emerging Infectious Diseases • http://www.cdc.gov/eid • Vol. 12, No. 3, March 2006 

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References

Aas et al., 2003. Recurrent Clostridium difficile Colitis: Case series involving 18 patients treated with donor stool administered via a nasogastric tube. Clinical Infectious Diseases 2003; 36: 580-5

Balas EA, Boren SA. Yearbook of Medical Informatics: Managing Clinical Knowledge for Health Care Improvement. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH; 2000

Bartlett, JG. Narrative review: the new epidemic of Clostridium difficile-associated enteric disease. Ann Intern Med. 2006 Nov 21;145(10):758-64. Review.

Savino et al., (Randomized controlled trial talking about probiotics and cholic) Pediatrics 2007;119;e124-e130

Van Niel Pediatrics 2005; 115; 174-177

Weisman et al., (talking about randomized controlled trial looking at probiotics and infections in day care centers) Pediatrics 2005;115;5-9

August 8, 2007 - Posted by | Health news, Youtube Summary | , , ,

6 Comments »

  1. you’re awesome.

    Comment by abbie | April 11, 2008 | Reply

  2. Dear Jeff,
    You are great. It is so great to see a medical student reach out and teach the world about Omega-3’s. I went to HMS and then into psychiatry where I got involved in Omega-3 research in mood disorders. I fell in love with with the science of Omega-3 and especially EPA and DHA. There was no true omega-3 for the public then just fish oils which were awful. People were emailing that there was nothing they could take. Listening to them I thought I can make what they want and make it even better by making the fist high EPA omega-3 for the public. So in 1998 I set out to create the first high concentrate, high EPA omega-3 made at pharmaceutical quality and created OmegaBrite. Your statements on quality and science decribe exactly how I felt.. I wanted it to make not only a true omega-3 but the quality to be pristine with every batch tested and pure with no oxidation. Now OmegaBrite is in countries all around the world. It was fairly radical for a Harvard doc to do as you can imagine. That’s why your videoblog really made my day because now it is full circle- HMS’r talking about Omega-3. How great is that.
    Thank you.
    check out at OmegaBrite,com mid way down the page the handwriting improvement for a person with huntingtons disease. http://www.omegabrite.com/why/success_stories.html

    HD patient William, #22 in the EPA Study, begain taking OmegaBrite for 2 grams of EPA/day.
    This is pretty moving.

    Also a YouTube on Liam gets ripped on OmegaBrite I just found is very cool. His mom is a pediatrician.

    You made my day.
    Best,
    CAL

    Comment by Carol Locke, MD | June 23, 2008 | Reply

  3. Hey, great job! You have made a medical topic a little more fun and that’s not easy. The more people that know the better! I know I’ve been helped by probiotics.

    Comment by probiotics 12 plus | October 7, 2008 | Reply

  4. Отличный блог, интересное и полезное содержание!

    Comment by Futslewster | April 10, 2009 | Reply

  5. I can tell that this is not the first time at all that you mention this topic. Why have you chosen it again?

    Comment by How to Get Six Pack Fast | April 15, 2009 | Reply

  6. Being a former crohns disease sufferer I’m glad to see someone in med school looking in another direction than the traditional give the patient a drug, or radiate them on get out the knife. My irritable bowel problems were only made worse with the traditional drugs, so that left me on my own and I found relief with nutrition. Keep up the good work and know that there are others who feel the same way.
    There is some research being done that has shown that many of the ibd’s are caused by yeast infections/candida albicans
    and many sufferers have found relief with anti fungal treatment and diet.

    Comment by Gerald Boykin | September 27, 2010 | Reply


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