Probiotics Symposium September 21-22, 2012

The annual Probiotics Symposium was held at the fabulous Solamar Hotel downtown San Diego Sept 21-22 2012. It was great venue. The hotel provided healthy meals and excellent service.

The first presenter was Ingrid Kohlstadt, MD who spoke about the systemic manifestations of gastrointestinal dysbiosis.

Probiotics Symposium
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She has a new textbook coming out that we look forward to referencing. She drew our attention to the association of obesity with microbial health... what comes first? Her discussion on the bidirectional & entangled nature of the relationship was very interesting indeed. She reminded us how bacteria provide nutrients essential for metabolism.

She spoke about how gut microbiota adapt to an environment influenced by diet and by altering the gut environment we can achieve meaningful clinical results. When it comes to diet, Kohlstadt had some very sound recommendations:
• Avoid artificial sweeteners
• It is important to ingest fiber & fermented vegetables
• Diversify phyto nutrients like cinnamon, curcumin, berberine, & bitter lemon
• Reduce sugar
• Cook minimally with processed plant fats.
She also reminded us that tropical nuts are high in medium chain saturated fats.

George Halpern, MD spoke about integrative approaches to peptic ulcer disease and helicobacter pylori.

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He told us that there are many microbiota in the saliva that communicate with one another but we don't know yet what it's about.

Gastro esophageal reflux manifests as we get older and the sphincter gets tired, creating weakness after 45 years or so. The symptoms are worse when we lie down. He thinks about Prilosec as a band aid. He suggested use of Melatonin that helps modulate HCL, not for everyone but many are helped by it and it has no side effects.

He recommended Zinc Carnosine which increases mucous in the stomach & is very helpful coating the lining. He also discussed fecal transplant which has become a very topical debate. He reminded us that Michel Simon 1895-1975 was known to eat his feces. He explained that the donor is matched with recipient and the transfer may be prepared through nose, with no surgery or intervention and has shown to work. Whether it will be better to add probiotics, is still to be found out. He questions whether it ought to become routine in debilitating diarrhea.

Mark Pimental, MD is Director of GI motility program at Cedar Sinai Medical Center, gave a very informative presentation on SIBO - Bacterial Overgrowth in the Small Intestine. He explained how different flora in the SI look to those found in the LI.

He discussed IBS at length. He explained how it was always thought that people were emotionally disturbed with IBS and that the symptom of 'bloating' tended to be ignored because there was no medical agent to help it.

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A positive breath test, historically, was thought not to be accurate, but now we know that although we can’t quantitate, it is still informative. So, with the breath test, the patient ingests sugar and the test records the results. He reports that most IBS patients have an abnormal breath test.

He also addressed why IBS patients sometimes have constipation and sometimes diarrhea. He explained that they must have hydrogen to create methane. When methane gas was positive, it is associated with constipation IBS and constipation, in general. Slowing of gut function is associated with methane. He noted that bacteria, fungus, virus, and arcea i.e. old bacteria that is more prevalent than any other bacteria in the gut all produces methane. All these pathogenic organisms may cause SIBO: C Jeuni, E. coli, Salmonella, Shigella.

He suggests that all IBS patients have a toxin in their gut i.e. CDT, Cytolethal Distending Toxin;

The breath test is either 'hydrogen' positive or 'Methane' positive. The one antibiotic that has been found to be effective for SIBO hydrogen positive is Rifaximin. It is found to be 70% effective. It does not affect the microbiota as it is not water soluble. In methane positive SIBO conditions, Rifaximin + Neomycin is recommended.

B Infantis has been shown to be the one probiotic that has shown efficacy for treatment of IBS. Pimental suggests that there may be other factors, like diet, that would influence the outcomes.

Carolyn Dean, MD, also spoke about understanding and managing IBS. She discussed the triggers like food sensitivity, Overgrowth of yeast, use of antibiotics, Stress and Chemicals.

She referred to a very useful FRDQ-7 Yeast Questionnaire to get a very good idea of the prevalence of fungal overgrowth:
1. Have you ever taken broad spectrum antibiotics?
2. Have you taken Tetracycline or other broad spectrum antibiotics for one month or longer?
3. Are you symptoms worse in damp moldy environment?
4. Do you crave sugar?
5. Do you have a feeling of being drained?
6. Do you experience Vaginal or penile - burning, itching or discharge?
7. Do you experience burning, itching, or tearing of eyes?

Dr Dean also addressed Leaky Gut Syndrome.

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She explained that Leaky Gut is an irritation and inflammation of the intestinal lining from infection and exposure to acidic digestive contents. It allows undigested food molecules, yeast byproducts, bacterial byproducts, chemicals, toxins, and poisons to be absorbed into the bloodstream. Yeast organisms may invade the intestinal lining causing a leaky gut and this can lead to an immune system reaction against these foreign substances not only in the GI tract but also in the bloodstream.

She explained how Leaky Gut is not a medically recognized or established diagnosis. However, several research and clinical diagnostic tests do measure permeability of the gut wall through urinary excretion of lactulose and mannitol. Newsweek, in a 1997 article "Gut Reactions," reported that tiny leaks in the lining of the small intestine may play a role in diseases as diverse as asthma and arthritis. Newsweek, November 17, 1997, p. 95-99. She says that medically speaking, there are no drugs to treat Leaky Gut.

She listed the causes of Leaky Gut:
• Antibiotics
• Infections caused by Yeast, Bacteria from food or water, Parasites from any food source and Viruses from infected people
• Caffeine that stimulates excess bile
• Alcohol
• Chemicals in air and water from industry of which there are literally 50,000
• Chemicals in processed food, such as preservatives, colorings
• Corticosteroid drugs that weaken the gut lining
• Hormone replacement therapy that changes the intestinal pH and causes an imbalance of organisms
• Mercury, which is the second most toxic element on the planet and may be from fish, from dental amalgams, or injected as a preservative to the flu vaccine
• Mold and fungus in nuts, grains, flour, and fruit. Mold is a close cousin to yeast
• Non steroidal anti-inflammatory drugs (NSAIDS): All NSAIDS irritate the gut, and one of its main side effects is GI bleeding, even aspirin
• Sugar and flour products that encourage yeast overgrowth

Dr Dean then spoke about the treatment she uses for Leaky Gut Syndrome:
Glutamine, she regards as intestinal cell fuel for maintenance and repair that enhances the barrier function of the gut against viral, bacterial, and food antigens
• Quercitin, a flavonoid, has antioxidant, anti-inflammatory and antihistamine properties
• Herbs like burdock, slippery elm, Turkish rhubarb, sheep sorrel, licorice root and ginger root.

The second day of the Probiotics Symposium began with Trent William Nichols, MD who gave an in depth presentation on Viral Hepatitis and Insulin resistant, Metabolic Syndrome and NAFLD - Nonalcoholic fatty liver disease. He explained that there is known treatment for NAFLD.

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He also mentioned that intestinal permeability - leaky gut - was associated with those suffering with NAFLD as well as a higher prevalence of small bacterial overgrowth.

Dr Nichols mentioned that Liver detox is needed as toxins are stored in fat. He suggested a vitamin regimen to detox liver consisting of Vitamins C, E, B complex, bioflavonoids, glutathione and cysteine.

Russell Jaffe, MD spoke about Diagnosing & Treating Food Allergies, Gluten Sensitivity and Celiac Disease. He says that Digestive is 'the epidemic of epidemics'. The common complaints are heartburn, abdominal pain, gas, bloating, constipation and diarrhea associated with conditions like IBS, Diverticulitis, Crohns Disease, Ulcerative Colitis, Enteropathy, Maldigestion and Dysbiosis.

He spoke about an overloaded immune system that means chronic illness, inflammation, increase in digestive remnants and chronic, degenerative autoimmune disease. He distinguished between acute IgE Histamine Allergy tested using RAST or skin testing and delayed hypersensitivity tested by use of LRA by ELISA that will determine sensitivity to food, food colorings, additives and preservatives, environmental chemicals, toxic minerals, medications, molds, dander’s, hair, and feathers and herbs.

He spoke about 3 ways to manage food reactivity’s. Firstly substitute reactive foods from the LRA by Elisa, secondly, make use of an alkaline diet plus targeted supplements as well as mental and physical actions to encourage healing and thirdly, a rotation diet.

Dr Jaffe spoke about Celiac Syndrome that is 80+% autoimmune hypersensitivity to gluten. However, there is also a delayed allergy to non-gluten digestive remnants that is often overlooked.

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He recommends keeping track of first urine pH in the morning, evaluating gastro-intestinal transit time, and utilizing Ascorbate C cleansing.

Dr Jaffe ended his presentation with a quote he paraphrased from Hippocrates, "Health is more than the absence of disease, Health is the fullest physical, mental, and spiritual expression attainable by each individual."

Sonia Michail, MD was the next presenter speaking about Pre & Probiotics for Inflammatory Bowel Disease. She explained that prebiotics are defined as a selectively fermented ingredients or indigestible oliosaccharides that result in specific changes, in the composition and/or activity of the gastrointestinal microbiota, thus conferring benefit(s) upon host health.

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She reinforced the antimicrobial and anti-inflammatory nature of probiotics, and how these bacteria can be genetically modified for use as carriers for antigen delivery into diseased sites in the intestine. She reminded us that not all probiotics are created equal, and not all doses of probiotics are effective. Sometimes the probiotic effect in the 'test tube' is different to human subjects.

Dr Michail reported the efficacy of probiotic use in Ulcerative Colitis and Pouchitis, particularly in the use of VSL#3. Interestingly, there were no studies she studied, that showed benefits of probiotic use for Crohns Disease, although Dr Nichols from the audience sited a VSL#3 study that did include benefits in Crohns Disease as well.

Dr Olmstead, in the subsequent panel discussion, suggested that, firstly, only single strain probiotics were tested, VSL#3 or other combinations were not tested and also suggested that perhaps other factors, like dietary changes, were significant in management of Crohns Disease.

Dr Stephen Olmstead, MD concluded the presentations with his discourse on novel approaches to gastrointestinal Candida colonization. He explained that Candida Albicans is the most important fungal pathogen that is commensal in 30-70% of people. It proliferates in opportunistic infections, allergies and autoimmune disease. Chronic Candida Sensitivity symptoms include fatigue, lethargy, abdominal pain, diarrhea, constipation, gas, headaches, psoriasis, hives, eczema, dermatitis, vaginal discharge or purities, dysuria urinary frequency and urgency.

He explained the overlap of polysymptomatic somatic disorders of Chronic Candida, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, Multiple Chemical Sensitivities, and Fibromyalgia. Evidence of Candida colonization is evident in crohns disease, Ulcerative Colitis, gastric ulcer, and duodenal ulcers.

He presented the hypothesis that symptoms of chronic candidiasis sensitivity are the result of an immunological reaction to Candida and possibly other yeasts residing in the GI tract and/or vagina in biofilm communities. Biofilm is described as the gathering of sessile microorganisms, incased in a self-produced matrix.

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It activates resistance genes and difficult to penetrate. It may explain the high recurrence rate post treatment. There are healthy Biofilms that are not adversely affected by probiotics and enzyme treatment.

S boulardii is found to be an effective probiotic for Candida treatment. The proposed protocol to treat Candida Gastrointestinal Biofilm is to initially disrupt the biofilm with Interfase and/or Interfase Plus from Klaire Labs, then kill Candida, using Saccharomyces boulardii 10 billion CFU, oil of oregano, berberine, undecyclenic acid and possible prescription anti-fungals (Nystatin, Fluconazole, or amphotericin). Follow up with enzyme plus antimicrobials fasting, begin with low enzyme dose and titrate up over weeks - duration of treatment is 3 months.

Pamela Nathan, B.A.,L.Ac.
27 September 2012