Sheldon Adelson (1933 - ), the at times controversial billionaire casino developer who made and lost fortunes in the 1960s, rode the tide of the personal computer revolution in the 1980s and 1990s with his computer trade show, and used the revenue to build The Venetian and The Palazzo on the Strip.
The son of a cab driver, Adelson grew up in a lower class section of Boston. He moved to New York for college, and majored in corporate finance and real estate at City College, but never graduated. After entering the U.S. Army in the 1950s, he worked as a courtroom stenographer on Wall Street and started thinking about how to become wealthy there.
By the early 1960s, Adelson had left the Army and attained millionaire status by charging companies fees for showing them how to start selling shares on the stock market. Now wealthy, he moved back to Boston and began investing in companies, eventually owning as many as seventy-five different ones. The price soared for shares of a tour and travel business, the American International Travel Service, his most profitable business. But he lost a fortune when the stock market declined in the late 1960s, and consequently he ran up many debt.
Adelson soon rebounded in the real estate brokerage business by arranging condominium conversions in Boston, and he bought a residential building. But he lost his cash reserve again when the condominium market faltered. Still on the lookout for opportunities, Adelson caught a big break in 1971 when he acquired a majority share of a small company that published magazines, among them a computer-oriented publication, Data Communications User. While attending a trade convention on condominiums in Anaheim, California, Adelson read that a magazine about condominiums had produced the show. He decided that he could use his own publication to produce a show about computers.
His first computer show was in Dallas in 1973. In 1975, he sold his share in the publishing company but held onto the show. He sold his condominium building, launched The Interface Group in Needham, Massachusetts, and concentrated on the computer show. The show grew slowly, garnering only $250,000 in revenues in 1979.
Adelson shifted gears and created the Computer Dealer Expo, also known as COMDEX, which took place at the MGM Grand (now Bally's) in Las Vegas in 1979. The show, intended for small computer dealers, took off, and by 1984, the Interface Group was producing forty shows. COMDEX alone grossed $20 million. COMDEX became the largest trade show produced in Las Vegas, with 100,000 attendees in 1987 and 125,000 in 1988. Adelson's show hit just as IBM, Apple and other brands of personal computers and accessories became a huge international industry. By the late 1980s, his company's net income reached $250 million, and he produced other COMDEX shows in other U.S. cities and in Europe and Japan. Interface succeeded by extracting large fees from exhibitors—as high as $50 a square foot in the Las Vegas Convention Center, for which Interface paid only fifteen cents a square foot.
In the late 1980s, Adelson and his partners from Interface, which also owned two travel companies and several passenger aircraft, decided to look for a resort property to use as a home base in Las Vegas. After overtures to owners of the Dunes, Frontier, and Aladdin hotels, they settled on the Sands, owned by casino developer Kirk Kerkorian. In 1988, Interface bought the venerable but aging Sands for $128 million.
Adelson's redesign scheme for the Sands included a $150 million new resort and shopping mall and a $60 million private convention center for Interface's and other shows. At the time, Adelson, as he would for years to come, had open disputes with the Las Vegas Convention and Visitors Authority (which operated and sold space for the Las Vegas Convention Center), over fees charged for COMDEX. Adelson later complained that the LVCVA's room taxes were too high and its shows unfairly competed with shows in his convention center. He even advocated abolishing the LVCVA, arguing it was no longer needed to promote Las Vegas.
But Adelson's plans hit a snag in 1989, when his hand-picked choice to run the Sands, Henri Lewin, ran into licensing problems with the Nevada State Gaming Control Board. Board members claimed Lewin had not been truthful with them in testimony about a lawsuit brought by a woman who charged that in 1985, he tried to assault her while he was chief executive of the Las Vegas Hilton. The board cited problems with a partner in Adelson's company as well, including past associations with alleged criminals. As for Adelson, the board's investigation revealed many past lawsuits he had filed against creditors to reduce his debts.
But Adelson took advantage of political connections with local and state politicians, who praised Lewin and the Sands project for being good for Las Vegas. While the gaming board voted 3-0 against licensing Lewin, the Nevada Gaming Commission overruled it and agreed to grant Lewin a limited license, with the caveat that he could not run the casino or share in its profits. All five of Adelson's partners received licenses.
Adelson opened the Sands in 1989 and embarked on his building plans. But he soon developed a reputation for being demanding and hard to work with. His association with Lewin quickly soured. Lewin, who said Adelson refused to invest in needed improvements to the Sands' rooms and casino, resigned less than a year later.
In the early 1990s, with the economy at a standstill and money difficult to borrow from banks, Adelson put his expansion plans on hold. He also held back on paying people to whom he owed money. Lewin sued him, alleging Adelson owned him $400,000, and later settled. Adelson's architect for the Sands also sued, and a jury awarded him $1.3 million in 1993.
But in the mid-1990s, the economy and lending markets improved. In 1995, Adelson sold COMDEX to the Japanese firm Softbank for $860 million. Now better able to raise funds from Wall Street, Adelson freed himself of his Interface partners, and built and opened the Sands Expo Center, a 1.2 million square foot convention and show room. In 1996, he demolished the Sands Hotel & Casino to make way for his planned Venice, Italy-themed Venetian, named for the place where he and his second wife had vacationed. The Venetian opened in May 1999.
The hotel proved both controversial, thanks to lawsuits over contractors and Adelson's opposition to the Culinary Union, and wildly successful. Adelson showed that while he was relatively new to the hotel-casino business, he could make big plans with the best of his competitors. Adelson's Sands company reported losses at one point in 2004, despite high revenues, after it granted stock bonuses to executives and paid for the building expenses of a newly planned 3,000-room resort, the Palazzo, north of the Venetian, set to cost $1.8 billion.
Like other Strip developers, Adelson also looked beyond Las Vegas. He became the first American developer to build a casino in Macau, the center of a newly opened, massive Asian gambling market, off the coast of China. The Sands Macau cost $265 million to build and was a big success from its opening in 2004. In Macau, on the so-called Coati Strip, he planned to build seven new casinos, including the $1.8 billion Venetian Macau. Adelson also became the first to win a casino license in Singapore, where he began another casino resort, the $3.5 billion Marina Bay Sands.
More successes led to Adelson's obsession with expansion—he was always looking for new markets, and seeking to outdo his competitors. He took his company, Las Vegas Sands Corporation, public on Wall Street in December 2004. The stock sale was an enormous success—so much so that in 2006, Forbes magazine ranked Adelson, thanks to his profits in Las Vegas and Macau and his Sands stock holdings, as the world's third-richest man, with holdings of $20.5 billion.
Meanwhile, Adelson became prominent in other ways in Las Vegas. His wife, Dr. Miriam Adelson, ran The Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment and Research. Adelson was a major contributor to the local Jewish community and to Israel. He also was heavily involved in politics as a major contributor to the Republican Party.
Monday, December 21, 2009
Saturday, December 5, 2009
Information Analysis and Decision Making
Even in the fully realized Metalibrary, universal accessibility of information does not in itself solve any practical problems. Finding solutions is a multistage process resembling the scientific method that leads from raw data first to knowledge and understanding and then to decisions. Moreover, discovering knowledge and making decisions are not necessarily on the same path, but may often be nearly independent of each other.
The full Metalibrary, like present-day paper libraries, provides material for the first step in the process, by organizing raw data by category and giving users tools to relate the data to other categories, to analyze it, and to record conclusions or argue with those drawn by someone else. All this is done now in scientific journals, though not very efficiently. However it takes place, a community or collective consideration of data is necessary before information can be derived from it. Indeed, it has been in the high density strongly interactive population concentrations that great new ideas took root and flowered in the past, and there is a sense in which the Metalibrary makes the entire population of the Earth into a single city.
When the subject matter can be described in quantitative terms, (chemistry, cell biology, economics, and demographics,) the first step is to establish what are the facts, that is, what data are valid and what information they convey. Expert forums operate through today's journals (and tomorrow's Metalibrary) to achieve consensus on what the facts are, given the data available.
However, managers and other administrators often need to make decisions long before there is a widespread consensus about what the pertinent information means. Ostensibly, such a manager makes decisions on the basis of available information about past history and probable consequences for the future. On the other hand, two people may easily make a different decision under the same circumstances. Here are a few examples:
1. The task is to implement a trial version of a universal data base. The problem is to decide on who should have access to what information. The company hires a lawyer and a computer scientist to advise. Their recommendations flatly contradict each other; one wants a completely open system, and the other desires tight controls.
2. A bank determines that it requires a new computerized billing system for its expanded safety-deposit department. Extensive studies are run, and software is chosen to control the data base. But many compatible machines can run this software, including brand I, brand C, and brand X. Systems from all three vendors are tested and the results charted. Brand C comes out on top in price and performance, with brand I second and X third. The branch manager then overrules the selection committee's recommendation and decides to buy brand I, because the mainframe presently in her office is from the same company and she values brand loyalty higher than price or performance.
3. The Fraser Valley Library acting on recommendations from the Ministry of Human Resources, has decided to build a branch to serve a slum neighborhood of Aldergrove. The only available property is an old park adjacent to a heritage building, formerly the residence of a certain well-known author. Psychologists, social workers, and government officials claim that dramatic improvements in similar slums have always resulted when a library was built. They insist that the house and park ought to be sacrificed. Historians and some local community leaders point to community pride for one of theirs who made good, as well as to the benefits of the park for their children. They do not deny the potential value of the library, but hold that the value of the house and park are greater, intangible though that value may be. The recommendations are again contradictory.
4. During World War II, the British scored a intelligence coup by breaking the German coding scheme and routinely translating military messages from the opposite side. One night, the decoded message contained instructions to bomb the city of Coventry at a particular time. The British prime minister, Winston Churchill, knew that many lives could be saved if he evacuated Coventry. He also knew that this move would reveal to the German High Command that their secrets had been breached, and the codes would immediately be changed. By the time the British could decipher the new ones, many more lives could be lost on the battlefront than could be saved at Coventry. A utilitarian, Churchill did not warn the city; the bombs came, and civilian lives were lost. Clearly, an act-oriented ethics would have dictated the opposite course of action.
The point of these four examples is that the mental filters through which both history and consequences are passed often have more influence on a decision than the facts and probabilities themselves. People do not make decisions on facts; they make them for other reasons. The decision in example two hinges not at all on the data--in fact collecting it turns out to be a wasted effort, for the manager makes the choice irrationally, basing it on emotional familiarity rather than on facts. Business people commonly do decide things emotionally, particularly when it comes to technology--this explains why inferior systems can become commonly used. Such scenarios are normal in any situation where the people making the decision are not personally familiar with the technology; they do not understand the data, or they trust advertising more, so they ignore fact and embrace emotion.
The human element is critical to the outcome of the decision-making process, and the world view (including the ethical view) of the decision maker may well determine the outcome quite apart from (or in contradiction to) the facts. Above the individual's world view, and creating its context, is that person's group culture. Depending on education, peer group, social status, local ideas, organizational outlook, and national goals or prejudices, each person shapes a world view in some degree of conformity with others sharing the same culture. Membership in a given subculture of society will determine whether a person even sees certain data, much less understands it enough to make informed decisions. Thus, even extending decision making to the entire populace would not guarantee that better decisions will be made, or that they will last long in the face of the fickleness of popular opinion.
The full Metalibrary could help with some of these problems, would exacerbate others, and would create some new ones. For instance, it could be used to enforce a requirement that some expertise be demonstrated before participating in a decision. In matters such as the building of libraries or parks, a simple test on the facts of the case could be required to gain voting status. Those living in the affected area would read a selection of the arguments for each course of action, and answer some simple questions to show that the issue is understood. The decision would then be made by the informed and affected people.
Decisions with wider effects and more profound consequences might require a different voting structure, in which the degree of knowledge about the problem would determine each person's share of the vote. If a dam is proposed on the Columbia River, economic benefits would have to be weighed against environmental effects. It might be too much to expect everyone affected to become sufficiently knowledgeable about the proposal and its effects to cast an informed vote--there is too much technical information for non-experts to digest. Moreover, those with the best engineering expertise are not necessarily those most knowledgeable about costs and benefits or about environmental effects. Perhaps a formula could be devised to weigh the votes of those with greater (or multiple) expertise more heavily than those who qualify with less knowledge but are still affected. This would give those with a strong interest a powerful motivation to do some research, and might make it more likely that a consensus on the decision could be reached. However, this particular issue is complicated by the fact that the river in question crosses the Canada U.S. border. How could the relative interests of two entire countries be weighed when one is larger in area and has more environment to affect, and the other has more people and a bigger economy?
The premise behind such electronic participatory democracy schemes is that everyone sufficiently informed would be more likely to come to the same conclusion. This would be a major (and in many cases unjustified) assumption; as has already been indicated, good information is not the only factor in decision making. Such systems would also be a substantial modification of current democratic practice; whether they would be found acceptable or not is another question--especially if they vary in any way the accepted democratic idea of "one person-one vote." It is also important to note that the mere technological enabling of weighted voting is not in itself a reason for implementing such a scheme. Moreover, such a scheme does away with the cherished idea of "one person one vote" and may not therefore be seen as an improvement.
Yet another common supposition is that the existence of comprehensive communications and information facilities such as the Metalibrary would tend to reduce or eliminate differences in culture and world view and thereby promote unanimity in decision making. This would continue a process begun by books, radio, and television and fostered by modern-day population mobility. However, the world of the 1990s was still far from the global village envisioned by some in the 1960s, even though its peoples share far more in common now than for thousands of years. Indeed, though there might gradually be fewer sharply distinct cultures based on geography, and fewer international boundaries as well, there are some very basic conflicts of world views that are unlikely ever to be eliminated. If the fall of the former Soviet Union has taught us anything it is that centuries-old ethnic hatreds such as the ones it brutally suppressed can still survive for generations and be readily be called upon to create new bloodbaths when that repression is removed. In such cases, the availability of more technology merely means that people are killed at a faster rate than before.
Moreover, along with its new kinds of information filters, the Metalibrary could well create new culture and world view conflicts, for not only will people still be able to perceive information differently, but they would also be able to personalize their view of the information to the extent that they will not even have to look at the same data.
An ivy-leaguer with great pride in her type of institution might accept information connection threads only from people at similar schools and choose not to see the threads attached by anyone from smaller or less prestigious universities. Prejudices over spiritual ideas would remain, with some religious people refusing to read certain scientific works and some scientists refusing to read certain religious works. The same applies to those of differing political persuasions. Except when a person placed a foot into the other camp or crossed over altogether, people on one side of any debate could pretend that the other side did not even exist, much as happens today.
When a new link did cause a thread to trail over the self-imposed borders, it would at once be obvious. Denial of recognition would remove the threat and the troubled mind could once again be safely closed. New ideas and the related data would not reach people unless allowed to do so. As is done today with existing information techniques, such denials perpetuate an already well-formed group thinking pattern and increase the possibility that decisions made by such people would be bad ones, because they are not fully informed. Once again we see that automating a bad process (here it is decision making) does not make it better. Rather, it merely produces the bad results faster.
On the other hand, as the pornography issue illustrates, not all information is either useful or beneficial, and it may be a good thing to prevent some of it from entering one's home, or, in such extreme cases, to prevent it from even being available. With a fully implemented Metalibrary, the former may be rather easy, but the latter likely very difficult.
One could suppose that a kind of natural selection (good decisions and advice are more efficient and useful than bad) would gradually reduce the influence of the close-minded as the poor quality of their decisions became evident. However, there is no guarantee that a particular discipline or specialty would not become as rigid and unbending as can now happen using the medium of journal articles. A control belief group has the power to reject new ideas by collectively refusing to look at them. Denial of recognition by the cultural leaders--who may still be termed reviewers or editors--would guarantee that new ideas would not be read. That is, for all its promise as an information utility, the Metalibrary might make it even harder to challenge the control beliefs of a society, for each sub-culture using it would still have unlimited ability to effect intolerance of competing views. A possible way around this difficulty would be to have the Metalibrary rules allow universal visibility to new information links regardless of who makes them, at least until such time as a person reads the item and expressly denies the link. Another possibility would be to create ombuds-reviewers who can make connections that every user will see for at least a certain period of time after the person first reads the new material.
There is no completely satisfactory solution to the problem of intellectual intolerance, however. Everyone filters what they will read and who they will talk to. They must, for there is too much for one person to assimilate. The filters in the Metalibrary will in some senses be more tangible, but they too are necessary. Although the narrowness of specialization may be greatly reduced because much less knowledge will need to be memorized--looking it up will be better--specialties will still remain, and their practitioners will still have difficulty communicating cross-culturally.
Once again, it becomes evident upon some thought that ideas, like goods and services, (whether cultural or academic) are accepted or rejected by society as a whole in the short run on their perceived merits, not on absolute standards. In their own generation, the guardians of the control ideas and beliefs can always refuse to acknowledge anything else, or even suppress competition. It is only in the longer (historical) run that they come to be evaluated with more global measuring sticks.
Neither will language barriers necessarily be broken down, for eventually the Metalibrary would communicate with users in their own languages. There would therefore be no incentive to learn another tongue, and meeting other people personally might even become more difficult. Spoken communication could suffer and isolationist tendencies increase, balancing off the improvements in written communication.
The full Metalibrary will also be sophisticated enough to allow the use of cultural, religious, or personal values to assist in filtering information and making decisions. Since it will record every data search and every decision, it could record how each person's filters operate and suggest solutions to problems consistent with one's stated values and past decisions. Again, though there would be benefits to this, there would be no incentive to re-examine one's presuppositions periodically, for the Metalibrary could be set to reinforce them.
In any event, the advent of the full Metalibrary would make it clear that everyone has a world view. Each person would construct a reflection of that world view in the process of learning the system, developing the filters, and making decisions at both the information and interpretation levels. Since there would still be "superstars" of each discipline even in this new medium, there would be a demand for the ability to adopt other people's world views (or sets of connecting threads.)
So, in addition to being able to modify one's own personal set of connecting threads to recognize any other person's links, it ought to be possible to rent another's. This is different from incorporating in one's own set the links with that person's name on them, for that does not also add the connections the second person has recognized from other people. Borrowing a whole world view would allow people literally to see things as others do. In this scenario, world views would be a commodity for rent or sale, and would be mergeable with one's own. A person could keep several independent world views on hand and switch between them or revert to an older version of a connection set.
Many scientists who are also writers have remarked that although they can travel in several academic cultures, they seem almost to become different people when they do so. This is an routine phenomenon also, for everyone has different mindsets and vocabularies (called "registers") to communicate with different people. (One vocabulary subset and thinking pattern for the children, another for clients, and other for co-workers, and so on.) The Metalibrary would allow someone to be (intellectually) as many different people as desired, though it is likely that most users would integrate their interests into a single collection. Some people will undoubtedly make their world views available as a public service for anyone to use, others might make a tidy profit selling theirs, much as they now do from books.
All of this would allow for decision making that is potentially more factually informed and that enables the participants to better consider each other's points of view and how these were formed. This does not mean that making decisions will be any easier than it is now or that most (or any) will be unanimous. It does imply broader participation and less bureaucracy, as well as the possibility of more satisfaction with the results. There would still be differences of opinion and there would be more opinions expressed than ever. All opinions could be considered, even though all surely would not be. To put this another way, being better informed may be good in the ethical sense of the word, but it is not clear to what extent that "good" will be sought after. It is even less clear how well it could be enforced.
Yet another problem with an information-based society is the potential to rely too much on machines for the decision making process. When this is done, it is easy to forget that information is more than whatever is stored in or processed by computers. To have meaning, it must be communicable. Assigning and communicating meaning, judging value, and taking action based on informed decisions are all part of the unique province of human activity, and there is as yet no indication that any of these can be automated. It is easy to rely on the neat rows and columns of figures in a spreadsheet, but unless the assumptions behind the formulas used to produce the output are known, the reader cannot make informed human judgement on the information content. There are value judgements behind the process of data collection in the first place; there are value judgements involved in organizing it; and there are value judgements involved in deciding on what meaning to assign to (and what action to take upon) the material in the end. Thus, who decides, and out of what value system, turns out to be what gives information its ultimate quality and meaning. Humans can think about and evaluate their thinking process; machines cannot. This appears to provide an answer for the (ethical) question: who ought to decide for humans--themselves, or machines?
The availability of instant information also creates pressure to make instant decisions. For instance, because it is easy to do so, and the means are at hand, many people respond to electronic mail messages and Internet news postings as soon as they receive them. As users of such systems are well aware, this results in a large volume of intemperate, ill-considered, and impolite mail traffic and news. (Such messages are called "flames".) Likewise, if thought processes and analytical techniques are unsound or if decision makers are so culturally conditioned as to be incapable of considering alternatives, the Metalibrary facility will not help. Computerizing a bad decision-making process does not produce good decisions, it only causes the bad ones to be arrived at in milliseconds instead of days.
As mentioned, prejudice will also remain. That is, irrational dislike of others and refusal to consider things from another person's world view will be as likely then as now. Perhaps the greatest contribution to decision making of instant and universal information availability could be the recognition of legitimate differences among world views as people realize (in the process of automation) how they have been making their decisions. Perceptual and decision-making filters would be obvious instead of hidden; their existence could no longer be denied or ignored. This has the potential to blur the boundaries between sub-cultures, promote communication, broaden specialties, make learning easier, and promote the possibility of sounder decisions. On the other hand, prejudice has stood the test of time as a stronger force in human affairs than any of these potential benefits.
Thus, as for all technologies, the impact of electronic media on knowledge and decision making will be mixed. Great benefits will be available, great abuses will be possible, and for many people there will just be a transfer of their old ways of thinking to a new medium.
The full Metalibrary, like present-day paper libraries, provides material for the first step in the process, by organizing raw data by category and giving users tools to relate the data to other categories, to analyze it, and to record conclusions or argue with those drawn by someone else. All this is done now in scientific journals, though not very efficiently. However it takes place, a community or collective consideration of data is necessary before information can be derived from it. Indeed, it has been in the high density strongly interactive population concentrations that great new ideas took root and flowered in the past, and there is a sense in which the Metalibrary makes the entire population of the Earth into a single city.
When the subject matter can be described in quantitative terms, (chemistry, cell biology, economics, and demographics,) the first step is to establish what are the facts, that is, what data are valid and what information they convey. Expert forums operate through today's journals (and tomorrow's Metalibrary) to achieve consensus on what the facts are, given the data available.
However, managers and other administrators often need to make decisions long before there is a widespread consensus about what the pertinent information means. Ostensibly, such a manager makes decisions on the basis of available information about past history and probable consequences for the future. On the other hand, two people may easily make a different decision under the same circumstances. Here are a few examples:
1. The task is to implement a trial version of a universal data base. The problem is to decide on who should have access to what information. The company hires a lawyer and a computer scientist to advise. Their recommendations flatly contradict each other; one wants a completely open system, and the other desires tight controls.
2. A bank determines that it requires a new computerized billing system for its expanded safety-deposit department. Extensive studies are run, and software is chosen to control the data base. But many compatible machines can run this software, including brand I, brand C, and brand X. Systems from all three vendors are tested and the results charted. Brand C comes out on top in price and performance, with brand I second and X third. The branch manager then overrules the selection committee's recommendation and decides to buy brand I, because the mainframe presently in her office is from the same company and she values brand loyalty higher than price or performance.
3. The Fraser Valley Library acting on recommendations from the Ministry of Human Resources, has decided to build a branch to serve a slum neighborhood of Aldergrove. The only available property is an old park adjacent to a heritage building, formerly the residence of a certain well-known author. Psychologists, social workers, and government officials claim that dramatic improvements in similar slums have always resulted when a library was built. They insist that the house and park ought to be sacrificed. Historians and some local community leaders point to community pride for one of theirs who made good, as well as to the benefits of the park for their children. They do not deny the potential value of the library, but hold that the value of the house and park are greater, intangible though that value may be. The recommendations are again contradictory.
4. During World War II, the British scored a intelligence coup by breaking the German coding scheme and routinely translating military messages from the opposite side. One night, the decoded message contained instructions to bomb the city of Coventry at a particular time. The British prime minister, Winston Churchill, knew that many lives could be saved if he evacuated Coventry. He also knew that this move would reveal to the German High Command that their secrets had been breached, and the codes would immediately be changed. By the time the British could decipher the new ones, many more lives could be lost on the battlefront than could be saved at Coventry. A utilitarian, Churchill did not warn the city; the bombs came, and civilian lives were lost. Clearly, an act-oriented ethics would have dictated the opposite course of action.
The point of these four examples is that the mental filters through which both history and consequences are passed often have more influence on a decision than the facts and probabilities themselves. People do not make decisions on facts; they make them for other reasons. The decision in example two hinges not at all on the data--in fact collecting it turns out to be a wasted effort, for the manager makes the choice irrationally, basing it on emotional familiarity rather than on facts. Business people commonly do decide things emotionally, particularly when it comes to technology--this explains why inferior systems can become commonly used. Such scenarios are normal in any situation where the people making the decision are not personally familiar with the technology; they do not understand the data, or they trust advertising more, so they ignore fact and embrace emotion.
The human element is critical to the outcome of the decision-making process, and the world view (including the ethical view) of the decision maker may well determine the outcome quite apart from (or in contradiction to) the facts. Above the individual's world view, and creating its context, is that person's group culture. Depending on education, peer group, social status, local ideas, organizational outlook, and national goals or prejudices, each person shapes a world view in some degree of conformity with others sharing the same culture. Membership in a given subculture of society will determine whether a person even sees certain data, much less understands it enough to make informed decisions. Thus, even extending decision making to the entire populace would not guarantee that better decisions will be made, or that they will last long in the face of the fickleness of popular opinion.
The full Metalibrary could help with some of these problems, would exacerbate others, and would create some new ones. For instance, it could be used to enforce a requirement that some expertise be demonstrated before participating in a decision. In matters such as the building of libraries or parks, a simple test on the facts of the case could be required to gain voting status. Those living in the affected area would read a selection of the arguments for each course of action, and answer some simple questions to show that the issue is understood. The decision would then be made by the informed and affected people.
Decisions with wider effects and more profound consequences might require a different voting structure, in which the degree of knowledge about the problem would determine each person's share of the vote. If a dam is proposed on the Columbia River, economic benefits would have to be weighed against environmental effects. It might be too much to expect everyone affected to become sufficiently knowledgeable about the proposal and its effects to cast an informed vote--there is too much technical information for non-experts to digest. Moreover, those with the best engineering expertise are not necessarily those most knowledgeable about costs and benefits or about environmental effects. Perhaps a formula could be devised to weigh the votes of those with greater (or multiple) expertise more heavily than those who qualify with less knowledge but are still affected. This would give those with a strong interest a powerful motivation to do some research, and might make it more likely that a consensus on the decision could be reached. However, this particular issue is complicated by the fact that the river in question crosses the Canada U.S. border. How could the relative interests of two entire countries be weighed when one is larger in area and has more environment to affect, and the other has more people and a bigger economy?
The premise behind such electronic participatory democracy schemes is that everyone sufficiently informed would be more likely to come to the same conclusion. This would be a major (and in many cases unjustified) assumption; as has already been indicated, good information is not the only factor in decision making. Such systems would also be a substantial modification of current democratic practice; whether they would be found acceptable or not is another question--especially if they vary in any way the accepted democratic idea of "one person-one vote." It is also important to note that the mere technological enabling of weighted voting is not in itself a reason for implementing such a scheme. Moreover, such a scheme does away with the cherished idea of "one person one vote" and may not therefore be seen as an improvement.
Yet another common supposition is that the existence of comprehensive communications and information facilities such as the Metalibrary would tend to reduce or eliminate differences in culture and world view and thereby promote unanimity in decision making. This would continue a process begun by books, radio, and television and fostered by modern-day population mobility. However, the world of the 1990s was still far from the global village envisioned by some in the 1960s, even though its peoples share far more in common now than for thousands of years. Indeed, though there might gradually be fewer sharply distinct cultures based on geography, and fewer international boundaries as well, there are some very basic conflicts of world views that are unlikely ever to be eliminated. If the fall of the former Soviet Union has taught us anything it is that centuries-old ethnic hatreds such as the ones it brutally suppressed can still survive for generations and be readily be called upon to create new bloodbaths when that repression is removed. In such cases, the availability of more technology merely means that people are killed at a faster rate than before.
Moreover, along with its new kinds of information filters, the Metalibrary could well create new culture and world view conflicts, for not only will people still be able to perceive information differently, but they would also be able to personalize their view of the information to the extent that they will not even have to look at the same data.
An ivy-leaguer with great pride in her type of institution might accept information connection threads only from people at similar schools and choose not to see the threads attached by anyone from smaller or less prestigious universities. Prejudices over spiritual ideas would remain, with some religious people refusing to read certain scientific works and some scientists refusing to read certain religious works. The same applies to those of differing political persuasions. Except when a person placed a foot into the other camp or crossed over altogether, people on one side of any debate could pretend that the other side did not even exist, much as happens today.
When a new link did cause a thread to trail over the self-imposed borders, it would at once be obvious. Denial of recognition would remove the threat and the troubled mind could once again be safely closed. New ideas and the related data would not reach people unless allowed to do so. As is done today with existing information techniques, such denials perpetuate an already well-formed group thinking pattern and increase the possibility that decisions made by such people would be bad ones, because they are not fully informed. Once again we see that automating a bad process (here it is decision making) does not make it better. Rather, it merely produces the bad results faster.
On the other hand, as the pornography issue illustrates, not all information is either useful or beneficial, and it may be a good thing to prevent some of it from entering one's home, or, in such extreme cases, to prevent it from even being available. With a fully implemented Metalibrary, the former may be rather easy, but the latter likely very difficult.
One could suppose that a kind of natural selection (good decisions and advice are more efficient and useful than bad) would gradually reduce the influence of the close-minded as the poor quality of their decisions became evident. However, there is no guarantee that a particular discipline or specialty would not become as rigid and unbending as can now happen using the medium of journal articles. A control belief group has the power to reject new ideas by collectively refusing to look at them. Denial of recognition by the cultural leaders--who may still be termed reviewers or editors--would guarantee that new ideas would not be read. That is, for all its promise as an information utility, the Metalibrary might make it even harder to challenge the control beliefs of a society, for each sub-culture using it would still have unlimited ability to effect intolerance of competing views. A possible way around this difficulty would be to have the Metalibrary rules allow universal visibility to new information links regardless of who makes them, at least until such time as a person reads the item and expressly denies the link. Another possibility would be to create ombuds-reviewers who can make connections that every user will see for at least a certain period of time after the person first reads the new material.
There is no completely satisfactory solution to the problem of intellectual intolerance, however. Everyone filters what they will read and who they will talk to. They must, for there is too much for one person to assimilate. The filters in the Metalibrary will in some senses be more tangible, but they too are necessary. Although the narrowness of specialization may be greatly reduced because much less knowledge will need to be memorized--looking it up will be better--specialties will still remain, and their practitioners will still have difficulty communicating cross-culturally.
Once again, it becomes evident upon some thought that ideas, like goods and services, (whether cultural or academic) are accepted or rejected by society as a whole in the short run on their perceived merits, not on absolute standards. In their own generation, the guardians of the control ideas and beliefs can always refuse to acknowledge anything else, or even suppress competition. It is only in the longer (historical) run that they come to be evaluated with more global measuring sticks.
Neither will language barriers necessarily be broken down, for eventually the Metalibrary would communicate with users in their own languages. There would therefore be no incentive to learn another tongue, and meeting other people personally might even become more difficult. Spoken communication could suffer and isolationist tendencies increase, balancing off the improvements in written communication.
The full Metalibrary will also be sophisticated enough to allow the use of cultural, religious, or personal values to assist in filtering information and making decisions. Since it will record every data search and every decision, it could record how each person's filters operate and suggest solutions to problems consistent with one's stated values and past decisions. Again, though there would be benefits to this, there would be no incentive to re-examine one's presuppositions periodically, for the Metalibrary could be set to reinforce them.
In any event, the advent of the full Metalibrary would make it clear that everyone has a world view. Each person would construct a reflection of that world view in the process of learning the system, developing the filters, and making decisions at both the information and interpretation levels. Since there would still be "superstars" of each discipline even in this new medium, there would be a demand for the ability to adopt other people's world views (or sets of connecting threads.)
So, in addition to being able to modify one's own personal set of connecting threads to recognize any other person's links, it ought to be possible to rent another's. This is different from incorporating in one's own set the links with that person's name on them, for that does not also add the connections the second person has recognized from other people. Borrowing a whole world view would allow people literally to see things as others do. In this scenario, world views would be a commodity for rent or sale, and would be mergeable with one's own. A person could keep several independent world views on hand and switch between them or revert to an older version of a connection set.
Many scientists who are also writers have remarked that although they can travel in several academic cultures, they seem almost to become different people when they do so. This is an routine phenomenon also, for everyone has different mindsets and vocabularies (called "registers") to communicate with different people. (One vocabulary subset and thinking pattern for the children, another for clients, and other for co-workers, and so on.) The Metalibrary would allow someone to be (intellectually) as many different people as desired, though it is likely that most users would integrate their interests into a single collection. Some people will undoubtedly make their world views available as a public service for anyone to use, others might make a tidy profit selling theirs, much as they now do from books.
All of this would allow for decision making that is potentially more factually informed and that enables the participants to better consider each other's points of view and how these were formed. This does not mean that making decisions will be any easier than it is now or that most (or any) will be unanimous. It does imply broader participation and less bureaucracy, as well as the possibility of more satisfaction with the results. There would still be differences of opinion and there would be more opinions expressed than ever. All opinions could be considered, even though all surely would not be. To put this another way, being better informed may be good in the ethical sense of the word, but it is not clear to what extent that "good" will be sought after. It is even less clear how well it could be enforced.
Yet another problem with an information-based society is the potential to rely too much on machines for the decision making process. When this is done, it is easy to forget that information is more than whatever is stored in or processed by computers. To have meaning, it must be communicable. Assigning and communicating meaning, judging value, and taking action based on informed decisions are all part of the unique province of human activity, and there is as yet no indication that any of these can be automated. It is easy to rely on the neat rows and columns of figures in a spreadsheet, but unless the assumptions behind the formulas used to produce the output are known, the reader cannot make informed human judgement on the information content. There are value judgements behind the process of data collection in the first place; there are value judgements involved in organizing it; and there are value judgements involved in deciding on what meaning to assign to (and what action to take upon) the material in the end. Thus, who decides, and out of what value system, turns out to be what gives information its ultimate quality and meaning. Humans can think about and evaluate their thinking process; machines cannot. This appears to provide an answer for the (ethical) question: who ought to decide for humans--themselves, or machines?
The availability of instant information also creates pressure to make instant decisions. For instance, because it is easy to do so, and the means are at hand, many people respond to electronic mail messages and Internet news postings as soon as they receive them. As users of such systems are well aware, this results in a large volume of intemperate, ill-considered, and impolite mail traffic and news. (Such messages are called "flames".) Likewise, if thought processes and analytical techniques are unsound or if decision makers are so culturally conditioned as to be incapable of considering alternatives, the Metalibrary facility will not help. Computerizing a bad decision-making process does not produce good decisions, it only causes the bad ones to be arrived at in milliseconds instead of days.
As mentioned, prejudice will also remain. That is, irrational dislike of others and refusal to consider things from another person's world view will be as likely then as now. Perhaps the greatest contribution to decision making of instant and universal information availability could be the recognition of legitimate differences among world views as people realize (in the process of automation) how they have been making their decisions. Perceptual and decision-making filters would be obvious instead of hidden; their existence could no longer be denied or ignored. This has the potential to blur the boundaries between sub-cultures, promote communication, broaden specialties, make learning easier, and promote the possibility of sounder decisions. On the other hand, prejudice has stood the test of time as a stronger force in human affairs than any of these potential benefits.
Thus, as for all technologies, the impact of electronic media on knowledge and decision making will be mixed. Great benefits will be available, great abuses will be possible, and for many people there will just be a transfer of their old ways of thinking to a new medium.
Should I take probiotics?
"I know that the concept of "friendly" bacteria is attractive, and it is still accepted by the medical community in general.
However, in the last few years scientists have grown to understand that it is the innate immune system which is active in the GI tract, and not adaptive immunity. Because of this, the whole concept of "friendly" bacteria has to be re-examined, and much of it scrapped.
Probiotics are not very 'friendly' at all. The MP will kill the bacteria in the GI tract which have accumulated from the food you eat, and the fluids you drink. You need them to do that in order to recover from chronic disease." ...Trevor.. Mar08
"The science tells me that palliation from probiotics probably comes from overloading the innate immune system in the GI tract.
Normal probiotics force the innate immune system to challenge them in the GI tract. Inflammatory cytokines are produced, hence the immunopathology. The cytokines will also cause a migration of monocytes to the GI tract, the site of immune challenge. Thus the monocytes will be unable to attack pathogens in the liver, kidney, or even pancreas, as they are being sidelined to the GI tract. More immunopathology, but perhaps a little easier to tolerate in the Gi tract than in the kidney, liver or pancreas.
As for disbacteriosis (the absence of good bacteria in the gut), many of the MP folks are taking intestinal flora capsules or tablets (probiotics). I never bothered with that. The intestines become so infected with e-coli, and other L-form species, that flora become a secondary issue to intestinal mis-function, IMO. The pathogens are the key factor, as they inhibit peristalsis, and mess things up in a host of other ways.
I am personally not convinced that probiotics are helpful to the healing process, as their function appears to be via stimulation of the innate immune system in the gut.
So if they work for you, keep using them, but if you are just following what you read in, eg, 'Readers Digest' I would suggest re-evaluating what they are really doing for you
As we begin to understand more about the way the body works, one must question whether probiotics might just be masking the underlying problem. I have not observed any negative effects. They are OK to continue if they seem to be giving some relief from the GI symptoms, as GI mischief is a real nuisance.
Here is a paper by Dave Relman which goes into some other aspects of this issue.
MP folk who are taking multiple antibiotics for year after year, certainly enough abx to kill off any existing flora, still have a functioning GI tract without taking probiotics"
..Trevor..
May 07 Dr. Marshall writes: I will get my head cut off here by somebody but I have seen no convincing evidence that probiotics have any essential function to play in the GI tract.
I think the linkage drawn between probiotics and fungal infection is incorrect, and I think it arose because medicine did not understand how active the innate immune system is in GI function. Stimulating that innate immune system with pathogens (probiotic 'flora') might well increase the production of 'immune system stuff' which would reduce the likelihood of a secondary fungal infection.
Once the MP has gotten your immune system back into balance I would doubt that probiotics would have any useful function to play. Here is some further reading...
http://www.pnas.org/cgi/content/full/103/3/732
June 07: "I am not convinced that any of the microbiota are essential for health. I am still looking for evidence of benefit, I don't see it. The bugs help us grow old, they help us get ill. Maybe there are offsetting positives. I just haven't found any yet
Folk who think they are healthy (but remember everybody is carrying some sort of mix of microbiota) might feel some benefit from using probiotics, but since all they are doing is making their innate immune system work a little harder, I am not sure there is any long-term benefit to be gained from probiotics."
..Trevor..
When you consider the ramifications of autonomic nervous system inflammation, you can see that it may not be as simple as what you are eating or inflammation in the tissues of the GI tract.
July 30, 2007: Would we suffer vitamin deficiencies if all gut bacteria were elminated? We almost have enough data to answer this question, but not quite definitively. My current gut feeling is no- the bacteria may be helpful in several ways but the human body will adapt to their absence. We will have a full answer in another year or two.
The answer will come when more folks on the MP get to full recovery (their own innate immune systems working again) yet they are still taking prophylactic antibiotics (which no longer produce immunopathology). These folks will have no, or very little, gut flora. The few of us in that situation right now are not needing supplements, so it seems the body has adjusted.
..Trevor..
Sept 07 I personally had a very diseased gut until about year 5 into the MP. Bloating, pain, and a host of other symptoms were a constant nuisance. I never found any probiotic to be any use in reducing those symptoms, and I did try a number of probiotics over the years.
Based on how I think probiotics work (increasing the work to be done by the innate immune system in the GI tract) I suspect that any palliative actions would come at the cost of healing elsewhere in the body. But I have no data, and the studies I have seen were all based on a flawed disease model, and therefore of no real help.
..Trevor..
1/24/08
I haven't stated a position on probiotics. There are many on the protocol who are convinced they are helpful, and I would prefer to concentrate on the key issues that folk really need to solve - No Vit D, plenty of Benicar, and a supportive family/medical environment. Probiotics are a second-order effect, I think (less important).
We now know that the GI tract relies on the innate (Th1) immune system, and the VDR, to deal with intestinal flora. A decade ago it was thought that antibodies (the Th2 system) was involved. So it is certain that ingesting probiotics will place a load on the very part of the immune system already weakened by fighting Th1 inflammation in the major organs. Whether this is good or bad is open to interpretation.
Every time I have personally started to take probiotics I have sensed a setback, rather than a surge forward. Last year I tried "Ultimate Flora - Critical Care - 50 Billion cultures per capsule" just to see what high-dose probiotics would do. I think I took one capsule, maybe two, before discarding the bottle in disgust.
I haven't seen any noticeable changes in intestinal function when I took lesser dose brands, nor did I sense any other benefits (but remember that I have no real GI immunopathology for the probiotics to palliate).
So I tend to leave it to the individual. Most Th1 patients have severe GI tract involvement, and dealing with that takes just about every tool in their arsenal. If Probiotics seem to help, then who am I to say no? On the other hand, they do not form part of the base protocol, as any benefit is not obvious to me.
..Trevor..
2/08 A new paper out today shows that probiotics increase Interferon-gamma. That means they create a Th1 reaction, an innate immune reaction.
Researchers report in the British Journal of Sports Medicine, "Probiotic treatment also doubled levels of interferon gamma, a substance secreted by T cells that plays a key role in fighting viral infections."
Interferon gamma (amongst other things) catalyzes the amount of 1,25-D being produced (via CYP27B1). This would imply that healthy people would react differently to probiotics than sick people. Indeed, it confirms that probiotics work on the innate immune system, the Th1 pathways.
I am getting closer to becoming convinced that the mode of action of probiotics is to overload the innate immune system , focus it away from the Th1 pathogens, so as to reduce the patients' symptoms. ..Trevor..
I would caution against any desire for "re-establishment of the normal flora." It is the gut Flavobacter (and other species) that are capable of producing capnine and fueling the Th1 disease process again. Do we really want that? My answer is a resounding NO. Stay away from probiotics. They only suppress proper operation of the innate immune system. As time goes by we will be able to gather data on whether any of them are ultimately beneficial. But now just think of gut flora as unwanted pathogens resulting from our dietary habits (meat-eating, etc).
..Trevor..
See also Pondering probiotics
Members' experiences
-I may note also that I stopped taking probiotics about a week ago and since then I have noticed my immune symptoms have been stronger, such runny nose, irritated throat, scratchy eyes and nose, weakness, sore muscles and especially nausea. ~Jimmy_jimjim
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PROBIOTICS
Lactobacillus acidophilus is a "friendly" strain of bacteria used to make yogurt and cheese. Although we are born without it, acidophilus soon establishes itself in our intestines and helps prevent intestinal infections. Acidophilus also flourishes in the vagina, where it protects women against yeast infections.
Acidophilus is one of several microbes known collectively as probiotics (literally, "pro life," indicating that they are bacteria and yeasts that help rather than harm). Others include the bacteria L. bulgaricus, L. reuteri, L. plantarum, L. casei, B. bifidus, S. salivarius, and S. thermophilus and the yeast Saccharomyces boulardii. Your digestive tract is like a rain forest ecosystem, with billions of bacteria and yeasts rather than trees, frogs, and leopards. Some of these internal inhabitants are more helpful to your body than others. Acidophilus and related probiotics not only help the digestive tract function, they also reduce the presence of less healthful organisms by competing with them for the limited space available. For this reason, use of probiotics can help prevent infectious diarrhea.
Antibiotics can disturb the balance of your "inner rain forest" by killing friendly bacteria. When this happens, harmful bacteria and yeasts can move in and flourish. This can lead to vaginal yeast infections. Conversely, it appears that the regular use of probiotics can help prevent vaginal infections and generally improve the health of the gastrointestinal system. Whenever you take antibiotics, you should probably take probiotics as well, and continue them for some time after you are done with the course of treatment.
Sources
Although we believe that they are helpful and perhaps even necessary for human health, we don't have a daily requirement for probiotic bacteria. They are living creatures, not chemicals, so they can sustain themselves in your body unless something comes along to damage them, such as antibiotics.
Cultured dairy products such as yogurt and kefir are good sources of acidophilus and other probiotic bacteria. Supplements are widely available in powder, liquid, capsule, or tablet form. Grocery stores and natural food stores both carry milk that contains live acidophilus.
Therapeutic Dosages
Dosages of acidophilus are expressed not in grams or milligrams, but in billions of organisms. A typical daily dose should supply about 3 to 5 billion live organisms. Other probiotic bacteria are used similarly. The typical dose of S. boulardii yeast is 500 mg twice daily (standardized to provide 3 x 1010 colony-forming units per gram), to be taken while traveling, or at the start of using antibiotics and continuing for a few days after antibiotics are stopped.
Because probiotics are not drugs, but rather living organisms that you are trying to transplant to your digestive tract, it is necessary to take the treatment regularly. Each time you do, you reinforce the beneficial bacterial colonies in your body, which may gradually push out harmful bacteria and yeasts growing there.
The downside of using a living organism is that probiotics may die on the shelf. In fact, a study reported in 1990 found that most acidophilus capsules on the market contained no living acidophilus.1 The container label should guarantee living acidophilus (or bulgaricus, and so on) at the time of purchase, not just at the time of manufacture. Another approach is to eat acidophilus-rich foods such as yogurt, where the bacteria are most likely still alive.
To treat or prevent vaginal infections, mix 2 tablespoons of yogurt or the contents of a couple of capsules of acidophilus with warm water and use as a douche.
Finally, in addition to increasing your intake of probiotics, you can take fructo-oligosaccharides, supplements that can promote thriving colonies of helpful bacteria in the digestive tract. (Fructo-oligosaccharides are carbohydrates found in fruit. Fructo means "fruit," and an oligosaccharide is a type of carbohydrate.) Taking this supplement is like putting manure in a garden; it is thought to foster a healthy environment for the bacteria you want to have inside you. The typical daily dose of fructo-oligosaccharides is between 2 and 8 g.
Therapeutic Uses
Evidence from many but not all trials suggests that acidophilus and other probiotics may be helpful for preventing traveler's diarrhea and diarrhea caused by antibiotics, chemotherapy, or radiation therapy, as well as preventing and treating infectious viral diarrhea; it may also help irritable bowel syndrome.2–28,109-111, 121-122
Probiotics may also be helpful for preventing or treating eczema,29,30 preventing vaginal yeast infections,31–36 treating ulcerative colitis,37-39 and improving immunity.40–43
The bacteria Helicobacter pylori is the main cause of ulcers in the stomach and duodenum. Antibiotics can kill H. pylori, but more than one must be used at once, and even then the bacteria is not necessarily eradicated. Probiotics may be helpful. Evidence suggests that various probiotics in the Lactobacillus family can inhibit the growth of H. pylori.112-115 While this effect does not appear to be strong enough for probiotic treatment to eradicate H. pylori on its own, preliminary trials, including one double-blind trial,123 suggest that probiotics may help standard antibiotic therapy work better, improving the rate of eradication and reducing side effects.112-113,116-120,123
Preliminary double-blind trials suggest that probiotics might help prevent heart disease by reducing cholesterol levels.44,45,46
Probiotic treatment has also been proposed as a treatment for canker sores and as a preventative measure against colon cancer, but there is no solid evidence that it is effective.
There is some evidence that probiotics can help reduce symptoms of milk allergies when added to milk.49
Finally, probiotics may be helpful in a controversial condition known as yeast hypersensitivity syndrome (also known as chronic candidiasis, chronic candida, systemic candidiasis, or just candida). As described by some alternative medicine practitioners, yeast hypersensitivity syndrome consists of a population explosion of the normally benign Candida yeast that live in the vagina and elsewhere in the body, coupled with a type of allergic sensitivity to it. Probiotic supplements are widely recommended for this condition because they establish large, healthy populations of friendly bacteria that compete with the Candida that is trying to take up residence.
A year-long open trial of 150 women found Lactobacillus probiotics ineffective for preventing urinary tract infections as compared to cranberry juice or no treatment.50
What Is the Scientific Evidence for Acidophilus and Other Probiotics?
Traveler's Diarrhea
According to several studies, it appears that regular use of acidophilus and other probiotics can help prevent "traveler's diarrhea" (an illness caused by eating contaminated food, usually in developing countries).51,52 One double-blind, placebo-controlled study followed 820 people traveling to southern Turkey, and found that use of a probiotic called Lactobacillus GG significantly protected against intestinal infection.53
Other studies using S. boulardii have found similar benefits,54,55,56 including a double-blind, placebo-controlled trial enrolling 3,000 Austrian travelers.57 The greatest benefits were seen in travelers who visited North Africa and Turkey. The researchers noted the benefit depended on consistent use of the product, and a dosage of 1,000 mg daily was more effective than 250 mg daily.
Infectious Diarrhea
Probiotics may also help prevent or treat acute infectious diarrhea in children and adults.
A review of the literature published in 2001 found 13 double-blind, placebo-controlled trials on the use of probiotics for acute infectious diarrhea in infants and children; 10 of these trials involved treatment, and 3 involved prevention.109 Overall, the evidence suggests that probiotics can significantly reduce the duration of diarrhea and perhaps help prevent it. The evidence is strongest for the probiotic Lactobacillus GG, and for infection and with a particular virus called rotavirus.
For example, one double-blind, placebo-controlled trial of 269 children (age 1 month to 3 years) with acute diarrhea found that those treated with Lactobacillus GG recovered more quickly than those given placebo.58 The best results were seen among children with rotavirus infection (rotavirus is a virus that can cause severe diarrhea in children). Similar results with Lactobacillus GG were seen in a double-blind study of 71 children.59
In addition, a double-blind study evaluated the possible benefits of the probiotic L. reuteri in 66 children with rotavirus diarrhea.60 The study found that treatment shortened the duration of symptoms, and the higher the dose, the better the effect.
A double-blind, placebo-controlled study of 81 hospitalized children found that treatment with Lactobacillus GG reduced the risk of developing diarrhea, particularly rotavirus infection.61 A double-blind, placebo-controlled study found that Lactobacillus GG helped prevent diarrhea in 204 undernourished children.62
Other studies indicate that the probiotics B. bifidum, Streptococcus thermophilus,L. casei, Lactobacillus LB, and S. boulardii - both individually and combined with L. reuteri and L. chamnosus - may also help prevent or treat diarrhea in infants and children.63–68, 121-122 One study found that bacteria in the B. bifidum family can kill numerous bacteria that cause diarrhea.69
Keep in mind that diarrhea in young children can be serious. If it persists for more than a day, you should take your child to a physician.
A large (211 participant) double-blind, placebo controlled study found that adults can benefit from probiotic treatment as well.26
Antibiotic-Related Diarrhea
The results of many but not all double-blind and open trials suggest that probiotics, including S. boulardii and Lactobacillus GG, may help prevent or reduce antibiotic-related diarrhea.70–79 One study evaluated 180 people, who received either placebo or 1,000 mg of saccharomyces daily along with their antibiotic treatment, and found that the treated group developed diarrhea significantly less often.80 A similar study of 193 people also found benefit.81 However, a study of 302 people found no benefit with Lactobacillus GG.82
Other Forms of Diarrhea
Preliminary evidence suggests that probiotics may be helpful for reducing diarrheas and other gastrointestinal side effects caused by cancer treatment (radiation or chemotherapy).83,84
Small double-blind studies suggest S. boulardii might be helpful for treating chronic diarrhea in people with HIV, hospitalized patients being tube-fed, and people with Crohn's disease.85–88
Inflammatory Bowel Disease (Ulcerative Colitis and Crohn’s Disease)
The conditions Crohn’s disease and ulcerative colitis fall into the family of conditions known as Inflammatory Bowel Disease. Chronic diarrhea is a common feature of these conditions.
A double-blind trial of 116 people with ulcerative colitis compared probiotic treatment against a relatively low dose of the standard drug mesalazine.89 The results suggest that probiotic treatment might be equally effective as low-dose mesalazine for controlling symptoms and maintaining remission. Evidence of benefit was seen in other trials as well.90
Another study found S. boulardii helpful for the diarrhea of Crohn’s disease.87
Probiotics might be useful for people with ulcerative colitis who have had part or all of the colon removed. Such people frequently develop a complication called "pouchitis," inflammation of part of the remaining intestine. A 9-month double-blind trial of 40 people found that a combination of three probiotic bacteria could significantly reduce the risk of a pouchitis flare-up.91 Participants were given either placebo or a mixture of various probiotics, including four strains of Lactobacilli, three strains of Bifidobacteria, and one strain of Streptococcus salivarius. The results showed that treated people were far less likely to have relapses of pouchitis.
Irritable Bowel Syndrome
People with irritable bowel syndrome (IBS) experience crampy digestive pain as well as alternating diarrhea and constipation and other symptoms. Although the cause of irritable bowel syndrome is not known, one possibility is a disturbance in healthy intestinal bacteria. Based on this theory, probiotics have been tried as a treatment for IBS.
In a 4-week, double-blind, placebo-controlled trial of 60 people with IBS, treatment with L. plantarum reduced intestinal gas significantly.92 The benefits persisted for an additional year after treatment was stopped.
In another 4-week, double-blind trial, 40 people with IBS again received either L. plantarum or placebo.110 The results showed improved overall symptoms in the treated group as compared to the placebo group.
A small 6 week trial using L. acidophilus also found indications of benefit.93 However, in a double-blind, placebo-controlled crossover study of 24 people with irritable bowel syndrome, use of Lactobacillus GG failed to produce any noticeable benefit.111
Eczema
Use of probiotics during pregnancy and after childbirth may reduce risk of childhood eczema. In a double-blind, placebo-controlled trial that enrolled 159 women, participants received either placebo or Lactobacillus GG capsules beginning 2 to 4 weeks before expected delivery.94
After delivery, breast-feeding mothers continued to take placebo or the probiotic for 6 months; formula-fed infants were given placebo or probiotic directly for the same period of time. The results showed that use of Lactobacillus GG reduced children's risk of developing eczema by approximately 50%.
According to two-double blind trials, infants who already have eczema may benefit from probiotics as well.95,96
Vaginal Yeast Infections
A review of the many studies on the use of oral and topical acidophilus to prevent vaginal yeast infections concluded that it may be effective, but more study is needed.97,98
Immunity
A number of studies suggest that various probiotics can enhance immune function; however, most of them were not double-blind.99 One 12-week, double-blind, placebo-controlled trial evaluated 25 healthy elderly people, half of whom were given milk containing a particular strain of Bifidobacterium lactis, the others milk alone.100 The results showed various changes in immune parameters which the researchers took as possibly indicating improved immune function. Another double-blind, placebo-controlled study of 50 people using B. lactis had similar results.101
In addition, a 7-month, double-blind, placebo-controlled study of 571 children in day-care centers in Finland found that use of milk fortified with Lactobacillus GG reduced the number and severity of respiratory infections.102
Cholesterol
An 8-week, double-blind, placebo-controlled trial of 70 overweight people found that a probiotic treatment containing S. thermophilus and Enterococcus faecium could reduce LDL ("bad") cholesterol by about 8%.103 Similarly positive results were seen in other trials of the same or other probiotics.104–107 However, a 6-month double-blind, placebo-controlled trial found no long-term benefit.108 Researchers speculate that participants stopped using the product regularly toward the later parts of the study.
Safety Issues
There are no known safety problems with the use of acidophilus or other probiotics. Occasionally, some people notice a temporary increase in digestive gas.
Interactions You Should Know About
If you are taking antibiotics, it may be beneficial to take probiotic supplements at the same time, and to continue them for a couple of weeks after you have finished the course of drug treatment. This will help restore the balance of natural bacteria in your digestive tract.
Last reviewed January 2003 by HealthGate CAM Medical Review Board
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What They Are:
Probiotic supplements contain helpful bacteria that assist in balancing the levels of indigenous microorganisms in the human body. Probiotics are available in varied forms such as yogurt and other foods, capsules, tablets, beverages, and powders. Probiotics should not be confused with prebiotics, which are complex sugars (such as inulin and other fructo-oligosaccharides) that are ingested as fuel for bacteria already present in the gastrointestinal tract; although prebiotics and probiotics are sometimes combined in the same product and termed synbiotics.
What They Do:
The normal human gastrointestinal tract contains hundreds of different species of harmless bacteria, referred to as intestinal flora. When the normal balance of these bacteria is disturbed by illness or antibiotic treatment, the most common effect is diarrhea. Probiotics work by colonizing the small intestine and crowding out disease-causing bacteria, thereby restoring balance to the intestinal flora. They may also produce substances that inhibit pathogenic bacteria, compete for nutrients with them, and stimulate the body's own immune system.
Antibiotics often lower the numbers of beneficial bacteria in the body along with their intended targets, and probiotics can replace these beneficial bacteria and lessen some negative side effects of antibiotics. Saccharomyces boulardii, Enterococcus faecium and Lactobacillus have been clinically proven to prevent antibiotic-caused diarrhea. Successful clinical trials have also been conducted using Lactobacillus to treat H. pylori infection and Lactobacillus plantarum to treat irritable bowel syndrome. Lactobacillus GG (a strain of L. rhamnosus) and Lactobacillus reuteri have been shown to reduce the duration of diarrhea due to certain infections in infants and young children.
Studies using probiotics (Lactobacillus, Bifidobacterium, Streptococcus, and Saccharomyces species) to treat traveler's diarrhea, however, have not shown definitive results. Although the evidence isn't clear-cut, probiotics have been studied as a treatment for many other conditions and their side effects; including, lactose intolerance, respiratory and GI problems resulting from cystic fibrosis, Crohn's disease, cancer prevention, high blood cholesterol, tuberculosis, eczema, canker sores, milk allergies, vaginal and urinary tract infections, and prevention of respiratory infections in children.
See ConsumerTips™: What to Consider When Using for dosage information and, for more information, see the Probiotics article in the Natural Product Encyclopedia on this Web site.
Quality Concerns and What CL Tested For:
Neither the FDA nor any other federal or state agency routinely tests probiotics for quality prior to sale. However, quality issues for probiotic supplements can include the following:
· The viability of bacteria in the product — how many organisms are alive when the consumer purchases it? Some products make no claim at all and others only claim the amount at the time of manufacture.
· The types of bacteria in the product — the product should contain the bacterial species that it claims on the label, and potentially pathogenic microorganisms should not be present.
· Enteric protection of the product — Some types of bacteria can't survive as they pass through stomach acid and into the small intestine where the bacteria would attach and grow (see ConsumerTips™: What to Consider When Buying for more information). Ideally the product should contain bacteria that research shows can survive passage through the stomach or it should be enteric coated. Products in tablets should also be able to properly disintegrate so as to release the probiotic bacteria and not pass through the body intact.
ConsumerLab.com, as part of its mission to independently evaluate products that affect health, wellness, and nutrition, purchased many leading probiotic products sold in the U.S. and tested them to determine whether 1) they possessed the claimed amount of viable bacteria or, if not listed on the label, at least 1 billion live organisms per maximum suggested daily serving, 2) they were free of contamination with yeast, mold, and types of bacteria with disease-causing potential, and 3) tablets disintegrated properly so that their contents would be released, or if enteric-coated, their contents would be released after passing through the stomach. (See Testing Methods and Passing Score for more information).
What CL Found:
ConsumerLab.com purchased 25 probiotic products: 19 were for use by the general population, 3 were specifically marketed for use by children, and 3 were yogurts. Among these, eight products claimed from 1 billion to 6 billion live organisms per daily serving. Thirteen other products claimed specific numbers of live organisms (some as high as 60 billion) but only as of the time of manufacture — not indicating the number that would be in the product at the time of use. The yogurts and one supplement did not specify bacterial counts (see How Products were Selected and What to Consider When Buying for more information).
On testing, ConsumerLab.com found that 8 of the products contained less than 1% of the claimed number of live bacteria or of the expected minimum of 1 billion. In fact, six products had only a few thousand live bacteria — one-ten thousandth of the amount claimed or expected. Interestingly, products that did not claim a specific number of live bacteria at the time of use were much more likely to have been low, while 7 of the 8 products that gave expected numbers at the time of use (not limited to the time of manufacture) met these counts. It is quite likely that products that were low in bacteria may not work. Some clinical studies have shown that products with even tens of millions of live bacteria may be ineffective, as opposed to those having one billion or more live bacteria.
None of the products were contaminated with pathogenic bacteria, mold, or fungus. All tablet products disintegrated properly so that their bacteria would be released in the body. The one enteric-coated capsule passed special testing that confirmed its ability to pass through the stomach and deliver its bacteria to the intestine. See Testing Methods and Passing Score for more information about the testing and criteria.
Products That Passed Testing:
Listed alphabetically below by name the products that passed ConsumerLab.com's independent testing of Probiotic Supplements and Foods. Also shown are the claimed types and numbers of live bacteria per suggested daily serving (or the minimum expected number if not claimed).
CONSUMERLAB.COM APPROVED QUALITY PROBIOTIC PRODUCTSClick on for additional information on the productTo find retailers that sell some of the listed products click here.
Product Name(Pill Type or Form) Manufacturer/Distributor Number of ProbioticBacteria in Maximum SuggestedDaily Serving* (Billions of Cells) Types of Organisms Claimed
Supplements for General Population Use:
Country Life® Hypoallergenic, Milk-Free Power-Dophilus™ Dietary Supplement (vegetarian capsule) Dist. by Country Life® 1 (E) Lactobacillus rhamnosus, Lactobacillus acidophilus,Bifidobacterium lactis (bifidum),Bifidobacterium longum
Enzymatic Therapy Natural Medicines® Acidophilus Pearls™ with Patented True Delivery™ Technology (enteric-coated "pearl" capsule) Dist. by Enzymatic Therapy, Inc. 1 (C) Lactobacillus acidophilus and Bifidobacterium longum
Flora Source™ Super Potency Probiotic Cultures (vegetarian capsule) Dist. by MBA Company 1 (E) Lactobacillus rhamnosus, Bifidobacterium bifidum, Lactobacillus acidophilus, Bifidobacterium infantis, Bifidobacterium longum, Streptococcus thermophilus, Lactobacillus plantarum, Lactobacillus salivarius, Lactobacillus casei, Lactobacillus bulgaricus, Lactobacillus acidophilus DDS-1, Lactobacillus sporogenes, Lactobacillus lactis, Lactobacillus paracasei, Bifidobacterium lactis, Lactobacillus brevis
Nature Made®, Recommended By Pharmacists, Acidophilus Dietary Supplement, 500 Million Live Cells Per Tablet Dist. by Nature Made Nutritional Products 1 (C) L. acidophilus
Nutrilite® IntestiFlora Dietary Supplement (powder) Dist. by Access Business Group International LLC 1 (C) Bifidobacterium longum, Lactobacillus acidophilus
Puritan's Pride® Inspired By Nature™ Milk Free Acidophilus, 2.4 Billion Live Cells Per Capsule, 50% More Live Cells (vegetarian capsule) Mfd. by Puritan's Pride®, Inc. 1 (E) Lactobacillus Acidophilus, Lactobacillus Rhamnosus, Lactobacillus Bifidum
Puritan's Pride® Inspired By Nature™ Potent Acidophilus Supplement with Pectin (capsule) Mfd. by Puritan's Pride®, Inc. 1 (E) Lactobacillus acidophilus, L. brevis, L. salivarius, L. helveticus, L. bulgaricus, Bifidobacterium bifidum
The Premier Probiotic Culturelle™ with Lactobacillus GG, Patented Maximum Potency (capsule) Dist. by CAG Functional Foods 20 (C) Lactobacillus GG
Trader Darwin's™ For the Survival of the Fittest LiveBac® Acidophilus, 1 Billion Organisms per Caplet at Time of Manufacture (caplet) Dist. by Trader Joe's 1 (E) Lactobacillus acidophilus, Lactobacillus bulgaricus, Bifidobacterium bifidum, Streptococcus thermophilus
Vital Life Vital-Immune Biotic Probiotic Supplement, Complete Non-Dairy Combination of Microorganisms (vegetarian capsule) Dist. by Klaire Laboratories, Inc. 6 (C) Lactobacillus rhamnosus, Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum
Vitamin World® Naturally Inspired™ Milk Free Acidophilus, 2.4 Billion Live Cells Per Capsule, 50% More Live Cells (vegetarian capsule) Mfd. by Vitamin World®, Inc. 1 (E) Lactobacillus Acidophilus, Lactobacillus Rhamnosus, Lactobacillus Bifidum
Supplements for Use by Children:
GNC Natural Brand™ Children's Chewable Acidophilus, Grape Flavor (tablet) Dist. by General Nutrition Corporation 1 (C) L. acidophilus
Nature's Way® Once Daily Powdered Primadophilus® for Children (powder) Dist. by Nature's Way Products, Inc. 1.5 (C) Lactobacillus rhamnosus, Bifidobacterium infantis, Bifidobacterium longum, Lactobacillus acidophilus
UAS Labs DDS® Junior, Bifidus, Acidophilus, FOS, 2 Billion CFU/g, Non Dairy Powder Dist. by UAS Laboratories 1 (E) B. infantis & L. acidophilus
Yogurts:**
Breyers® 99% Fat Free Fruit on the Bottom Lowfat Yogurt, 1% Milkfat, Black Cherry Dist. by Kraft Foods North America, Inc. 1 (E) Made with active yogurt cultures with L. acidophilus
Colombo® Classic Lowfat Yogurt, 1% Milkfat, Vanilla Dist. by Colombo®, Inc, 1 (E) Made with active yogurt cultures including L. acidophilus.
Stonyfield Farm® French Vanilla Nonfat Yogurt Dist. by Stonyfield Farm® Yogurt 1 (E) S. thermophilus, L. bulgaricus, L. acidophilus, Bifidus, L. casei, and L. reuteri
* (C) = Claimed at Time of Use; (E) = Expected Minimum if Not Claimed
** Results for yogurts based on an 8-ounce (1 cup) serving.
Unless otherwise noted, information about the products listed above is based on the samples purchased by ConsumerLab.com for this Product Review. Manufacturers may change product ingredients and information at any time, so be sure to check labels carefully when evaluating the products you use or buy. If a product's ingredients differ from what is listed above, it may not necessarily be of the same quality as what was tested. It also cannot be assumed that other products from a Manufacturer or Distributor listed above are of equal quality to those listed.
ConsumerTips™: What to Consider When Buying:
When probiotic supplements are properly labeled, it is easy to determine what types of bacteria are present. Bacterial organism's names should be listed in italics, with the genus name capitalized and listed first. The genus name may also be abbreviated with its first letter (e.g., Lactobacillus acidophilus or L. acidophilus). The species most commonly seen in probiotics and that have been tested in laboratory and clinical studies are Lactobacillus acidophilus, L. bulgaricus, L. casei, L. gasseri, L. plantarum, Bifidobacterium bifidum, B. lactis, B. longum, Enterococcus faecium, and Saccharomyces boulardii (a yeast). Other species that can be used as probiotics but have less accompanying research are L. johnsonii, L. reuteri, L. rhamnosus, B. breve, B. infantis, E. faecalis, and Streptococcus salivarius. Some probiotic bacterial strains have been patented and are accompanied by substantial research into their effects. L. casei GG (a strain of Lactobacillus rhamnosus found in Culturelle capsules), L. casei in Actimel (Dannon), and LC1 (Nestle) are three examples. Some research has shown that it may be more effective to take a probiotic supplement that contains a mixture of bacterial strains rather than a single bacterial species.
While many products make claims regarding the number of organisms in the product, these typically refer to the numbers at the time manufacture — which can be very different from the amount still viable at the time of purchase. Exposure to heat, moisture, and oxygen can all negatively affect survival of probiotics in a product, so the expiration date is especially important to consider when buying products. Some products have an enteric coating, because certain probiotic bacteria need protection in order to survive exposure to gastric fluid. In general, Lactobacillus, Bifidobacterium, and Streptococcus species do not need enteric coating as they can survive passage through the stomach. However, L. bulgaricus and S. thermophilus, as well as Leuconostoc and Lactococcus species, cannot survive passage through the stomach. These bacteria are commonly found in yogurt because they are used as starters for dairy products. However, they do not colonize the intestinal tract; so they are likely to have little effect as probiotics. Some bacteria naturally sporulate ("hibernate" within a protective coating) when they are exposed to harsh conditions, and some researchers postulate that sporulated bacteria are more resistant to the harsh conditions found in the intestinal tract. Consequently, another delivery method is to manufacture probiotics in the form of bacterial spores — this is most often used for bacteria of the genus Bacillus.
What to Consider When Using:
The recommended daily intake for probiotic supplements is 1 billion units (sometimes referred to as colony forming units, or CFU's) to 10 billion units per day. These amounts may be written on the label as 1 x 109 or 109 for one billion units, and 1 x 1010 or 1010 for ten billion units.
For the treatment of diarrhea, it is recommended to start taking probiotic supplements as soon as symptoms appear. However, if symptoms persist for several days, see a physician. Following antibiotic treatment, take probiotic supplements for 2 weeks. Probiotics are sometimes taken before travel in an attempt to prevent traveler's diarrhea. To gain probiotic benefits from yogurt or other dairy foods, look for products labeled "contains live cultures" or "active cultures". Some yogurts may also state the species of bacteria they contain.
For treating vaginal bacterial infections, vaginal suppositories containing approximately 1 billion Lactobacillus organisms are typically used.
If you are taking antibiotics, it may be advisable to take them at least 2 hours apart from taking a probiotic, as the antibiotic could potentially kill the organisms.
Although not always a requirement, it is advisable to keep probiotic products refrigerated to prolong their shelf life. Interestingly, all of the products that specifically suggested that they be kept refrigerated passed this review — possibly because they were maintained under more favorable conditions during their storage and distribution.
Concerns and Cautions:
There are no known safety issues with probiotic bacteria, but occasionally, some people notice a temporary increase in digestive gas.
In a few cases among severely ill or immunocompromised individuals, probiotic use has caused bacteremia (presence of bacteria in the blood) or pathological infections resulting in severe illness. However, when taken at appropriate doses in healthy people, they are very safe. Even HIV-positive adults have taken probiotics for up to 3 weeks without side effects.
To further assist consumers, ConsumerLab.com is licensing its flask-shaped CL Seal of Approved Quality (see The CL Seal) to manufacturers for use on labels of products that have passed its testing. ConsumerLab.com will periodically re-evaluate these products to ensure their compliance with ConsumerLab.com's standards.
Consumers should inform their healthcare providers of the dietary supplements they take.
For probiotics, the key for me is to get it in enteric coated capsules. I can quickly tell the difference in my digestion. The normal capsules and powders never helped me like the enteric coated capsule type. Solaray Multidophilus 12 has been the best brand for me. slowmo
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The brand name is NOW, it is Acidophilus Two Billion Highest Quality 100 capsules. It has no additivies. It cost $6.99 plus tax. I have had no bloating or cramping and it has helped me get along with the antibiotics of MP, both of them. I am in Phase 2. Barney
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I have also had terrible bloating caused by some probiotics. I've tried different brands, and the one that doesn't bother me is Nature's Day Once Daily Primadophilus and Bifidus, enteric coated. It's in the fridge at the health food store. It costs $17.99 for 90 caps. Expensive but it's been helpful, and without causing trouble.
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I have found Culterelle and Bifa-15 to be excellent probiotics. Lonestartick
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There is one on the market made by Genestra called HMF forte. It stands for human microflora and according to my doctor it is superior to any probiotic on the market. All of the other probiotics come from animal sources.
Lisa66
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In Australia we have a product available from Blackmore's brand called FORBIOTIC. They claim that this strain of probiotic bacteria has been specifically bred to be antibiotic resistant. Clever, yes?
I don't know if a similar product is available overseas, but I can tell you that the Blackmore's brand is one of the "Best" & most trusted brands. Also, I have tried it out in yoghurt-making - and it set up the milk very well, so there must be plenty of live culture in it. Claudia
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There is another type of probiotic that I wonder if you have tried. I heard about it from a very respected doctor, who mentioned it at a conference (CIIN). From what he said, t's a soil based organism that was developed into a probiotic because it produced a substance that killed Candida quite effectively.
When I took it, I had a Candida die-off reactions that was just as strong as what I had on Diflucan. I have not used it extensively, since I become sensitive to just about everything and became sensitive to this product too (and my Candida problem lessened), but I thought you might consider it worth looking into. The SBO (soil based organism) product I used is the most hypoallergenic one I found (and was the one recommended by the doctor mentioned above) and it is called Flora-Balance. You can find out more by doing a Internet search (the company I order from generally is http://needs.com ). It could be used in a douche as well.
However, in the last few years scientists have grown to understand that it is the innate immune system which is active in the GI tract, and not adaptive immunity. Because of this, the whole concept of "friendly" bacteria has to be re-examined, and much of it scrapped.
Probiotics are not very 'friendly' at all. The MP will kill the bacteria in the GI tract which have accumulated from the food you eat, and the fluids you drink. You need them to do that in order to recover from chronic disease." ...Trevor.. Mar08
"The science tells me that palliation from probiotics probably comes from overloading the innate immune system in the GI tract.
Normal probiotics force the innate immune system to challenge them in the GI tract. Inflammatory cytokines are produced, hence the immunopathology. The cytokines will also cause a migration of monocytes to the GI tract, the site of immune challenge. Thus the monocytes will be unable to attack pathogens in the liver, kidney, or even pancreas, as they are being sidelined to the GI tract. More immunopathology, but perhaps a little easier to tolerate in the Gi tract than in the kidney, liver or pancreas.
As for disbacteriosis (the absence of good bacteria in the gut), many of the MP folks are taking intestinal flora capsules or tablets (probiotics). I never bothered with that. The intestines become so infected with e-coli, and other L-form species, that flora become a secondary issue to intestinal mis-function, IMO. The pathogens are the key factor, as they inhibit peristalsis, and mess things up in a host of other ways.
I am personally not convinced that probiotics are helpful to the healing process, as their function appears to be via stimulation of the innate immune system in the gut.
So if they work for you, keep using them, but if you are just following what you read in, eg, 'Readers Digest' I would suggest re-evaluating what they are really doing for you
As we begin to understand more about the way the body works, one must question whether probiotics might just be masking the underlying problem. I have not observed any negative effects. They are OK to continue if they seem to be giving some relief from the GI symptoms, as GI mischief is a real nuisance.
Here is a paper by Dave Relman which goes into some other aspects of this issue.
MP folk who are taking multiple antibiotics for year after year, certainly enough abx to kill off any existing flora, still have a functioning GI tract without taking probiotics"
..Trevor..
May 07 Dr. Marshall writes: I will get my head cut off here by somebody but I have seen no convincing evidence that probiotics have any essential function to play in the GI tract.
I think the linkage drawn between probiotics and fungal infection is incorrect, and I think it arose because medicine did not understand how active the innate immune system is in GI function. Stimulating that innate immune system with pathogens (probiotic 'flora') might well increase the production of 'immune system stuff' which would reduce the likelihood of a secondary fungal infection.
Once the MP has gotten your immune system back into balance I would doubt that probiotics would have any useful function to play. Here is some further reading...
http://www.pnas.org/cgi/content/full/103/3/732
June 07: "I am not convinced that any of the microbiota are essential for health. I am still looking for evidence of benefit, I don't see it. The bugs help us grow old, they help us get ill. Maybe there are offsetting positives. I just haven't found any yet
Folk who think they are healthy (but remember everybody is carrying some sort of mix of microbiota) might feel some benefit from using probiotics, but since all they are doing is making their innate immune system work a little harder, I am not sure there is any long-term benefit to be gained from probiotics."
..Trevor..
When you consider the ramifications of autonomic nervous system inflammation, you can see that it may not be as simple as what you are eating or inflammation in the tissues of the GI tract.
July 30, 2007: Would we suffer vitamin deficiencies if all gut bacteria were elminated? We almost have enough data to answer this question, but not quite definitively. My current gut feeling is no- the bacteria may be helpful in several ways but the human body will adapt to their absence. We will have a full answer in another year or two.
The answer will come when more folks on the MP get to full recovery (their own innate immune systems working again) yet they are still taking prophylactic antibiotics (which no longer produce immunopathology). These folks will have no, or very little, gut flora. The few of us in that situation right now are not needing supplements, so it seems the body has adjusted.
..Trevor..
Sept 07 I personally had a very diseased gut until about year 5 into the MP. Bloating, pain, and a host of other symptoms were a constant nuisance. I never found any probiotic to be any use in reducing those symptoms, and I did try a number of probiotics over the years.
Based on how I think probiotics work (increasing the work to be done by the innate immune system in the GI tract) I suspect that any palliative actions would come at the cost of healing elsewhere in the body. But I have no data, and the studies I have seen were all based on a flawed disease model, and therefore of no real help.
..Trevor..
1/24/08
I haven't stated a position on probiotics. There are many on the protocol who are convinced they are helpful, and I would prefer to concentrate on the key issues that folk really need to solve - No Vit D, plenty of Benicar, and a supportive family/medical environment. Probiotics are a second-order effect, I think (less important).
We now know that the GI tract relies on the innate (Th1) immune system, and the VDR, to deal with intestinal flora. A decade ago it was thought that antibodies (the Th2 system) was involved. So it is certain that ingesting probiotics will place a load on the very part of the immune system already weakened by fighting Th1 inflammation in the major organs. Whether this is good or bad is open to interpretation.
Every time I have personally started to take probiotics I have sensed a setback, rather than a surge forward. Last year I tried "Ultimate Flora - Critical Care - 50 Billion cultures per capsule" just to see what high-dose probiotics would do. I think I took one capsule, maybe two, before discarding the bottle in disgust.
I haven't seen any noticeable changes in intestinal function when I took lesser dose brands, nor did I sense any other benefits (but remember that I have no real GI immunopathology for the probiotics to palliate).
So I tend to leave it to the individual. Most Th1 patients have severe GI tract involvement, and dealing with that takes just about every tool in their arsenal. If Probiotics seem to help, then who am I to say no? On the other hand, they do not form part of the base protocol, as any benefit is not obvious to me.
..Trevor..
2/08 A new paper out today shows that probiotics increase Interferon-gamma. That means they create a Th1 reaction, an innate immune reaction.
Researchers report in the British Journal of Sports Medicine, "Probiotic treatment also doubled levels of interferon gamma, a substance secreted by T cells that plays a key role in fighting viral infections."
Interferon gamma (amongst other things) catalyzes the amount of 1,25-D being produced (via CYP27B1). This would imply that healthy people would react differently to probiotics than sick people. Indeed, it confirms that probiotics work on the innate immune system, the Th1 pathways.
I am getting closer to becoming convinced that the mode of action of probiotics is to overload the innate immune system , focus it away from the Th1 pathogens, so as to reduce the patients' symptoms. ..Trevor..
I would caution against any desire for "re-establishment of the normal flora." It is the gut Flavobacter (and other species) that are capable of producing capnine and fueling the Th1 disease process again. Do we really want that? My answer is a resounding NO. Stay away from probiotics. They only suppress proper operation of the innate immune system. As time goes by we will be able to gather data on whether any of them are ultimately beneficial. But now just think of gut flora as unwanted pathogens resulting from our dietary habits (meat-eating, etc).
..Trevor..
See also Pondering probiotics
Members' experiences
-I may note also that I stopped taking probiotics about a week ago and since then I have noticed my immune symptoms have been stronger, such runny nose, irritated throat, scratchy eyes and nose, weakness, sore muscles and especially nausea. ~Jimmy_jimjim
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PROBIOTICS
Lactobacillus acidophilus is a "friendly" strain of bacteria used to make yogurt and cheese. Although we are born without it, acidophilus soon establishes itself in our intestines and helps prevent intestinal infections. Acidophilus also flourishes in the vagina, where it protects women against yeast infections.
Acidophilus is one of several microbes known collectively as probiotics (literally, "pro life," indicating that they are bacteria and yeasts that help rather than harm). Others include the bacteria L. bulgaricus, L. reuteri, L. plantarum, L. casei, B. bifidus, S. salivarius, and S. thermophilus and the yeast Saccharomyces boulardii. Your digestive tract is like a rain forest ecosystem, with billions of bacteria and yeasts rather than trees, frogs, and leopards. Some of these internal inhabitants are more helpful to your body than others. Acidophilus and related probiotics not only help the digestive tract function, they also reduce the presence of less healthful organisms by competing with them for the limited space available. For this reason, use of probiotics can help prevent infectious diarrhea.
Antibiotics can disturb the balance of your "inner rain forest" by killing friendly bacteria. When this happens, harmful bacteria and yeasts can move in and flourish. This can lead to vaginal yeast infections. Conversely, it appears that the regular use of probiotics can help prevent vaginal infections and generally improve the health of the gastrointestinal system. Whenever you take antibiotics, you should probably take probiotics as well, and continue them for some time after you are done with the course of treatment.
Sources
Although we believe that they are helpful and perhaps even necessary for human health, we don't have a daily requirement for probiotic bacteria. They are living creatures, not chemicals, so they can sustain themselves in your body unless something comes along to damage them, such as antibiotics.
Cultured dairy products such as yogurt and kefir are good sources of acidophilus and other probiotic bacteria. Supplements are widely available in powder, liquid, capsule, or tablet form. Grocery stores and natural food stores both carry milk that contains live acidophilus.
Therapeutic Dosages
Dosages of acidophilus are expressed not in grams or milligrams, but in billions of organisms. A typical daily dose should supply about 3 to 5 billion live organisms. Other probiotic bacteria are used similarly. The typical dose of S. boulardii yeast is 500 mg twice daily (standardized to provide 3 x 1010 colony-forming units per gram), to be taken while traveling, or at the start of using antibiotics and continuing for a few days after antibiotics are stopped.
Because probiotics are not drugs, but rather living organisms that you are trying to transplant to your digestive tract, it is necessary to take the treatment regularly. Each time you do, you reinforce the beneficial bacterial colonies in your body, which may gradually push out harmful bacteria and yeasts growing there.
The downside of using a living organism is that probiotics may die on the shelf. In fact, a study reported in 1990 found that most acidophilus capsules on the market contained no living acidophilus.1 The container label should guarantee living acidophilus (or bulgaricus, and so on) at the time of purchase, not just at the time of manufacture. Another approach is to eat acidophilus-rich foods such as yogurt, where the bacteria are most likely still alive.
To treat or prevent vaginal infections, mix 2 tablespoons of yogurt or the contents of a couple of capsules of acidophilus with warm water and use as a douche.
Finally, in addition to increasing your intake of probiotics, you can take fructo-oligosaccharides, supplements that can promote thriving colonies of helpful bacteria in the digestive tract. (Fructo-oligosaccharides are carbohydrates found in fruit. Fructo means "fruit," and an oligosaccharide is a type of carbohydrate.) Taking this supplement is like putting manure in a garden; it is thought to foster a healthy environment for the bacteria you want to have inside you. The typical daily dose of fructo-oligosaccharides is between 2 and 8 g.
Therapeutic Uses
Evidence from many but not all trials suggests that acidophilus and other probiotics may be helpful for preventing traveler's diarrhea and diarrhea caused by antibiotics, chemotherapy, or radiation therapy, as well as preventing and treating infectious viral diarrhea; it may also help irritable bowel syndrome.2–28,109-111, 121-122
Probiotics may also be helpful for preventing or treating eczema,29,30 preventing vaginal yeast infections,31–36 treating ulcerative colitis,37-39 and improving immunity.40–43
The bacteria Helicobacter pylori is the main cause of ulcers in the stomach and duodenum. Antibiotics can kill H. pylori, but more than one must be used at once, and even then the bacteria is not necessarily eradicated. Probiotics may be helpful. Evidence suggests that various probiotics in the Lactobacillus family can inhibit the growth of H. pylori.112-115 While this effect does not appear to be strong enough for probiotic treatment to eradicate H. pylori on its own, preliminary trials, including one double-blind trial,123 suggest that probiotics may help standard antibiotic therapy work better, improving the rate of eradication and reducing side effects.112-113,116-120,123
Preliminary double-blind trials suggest that probiotics might help prevent heart disease by reducing cholesterol levels.44,45,46
Probiotic treatment has also been proposed as a treatment for canker sores and as a preventative measure against colon cancer, but there is no solid evidence that it is effective.
There is some evidence that probiotics can help reduce symptoms of milk allergies when added to milk.49
Finally, probiotics may be helpful in a controversial condition known as yeast hypersensitivity syndrome (also known as chronic candidiasis, chronic candida, systemic candidiasis, or just candida). As described by some alternative medicine practitioners, yeast hypersensitivity syndrome consists of a population explosion of the normally benign Candida yeast that live in the vagina and elsewhere in the body, coupled with a type of allergic sensitivity to it. Probiotic supplements are widely recommended for this condition because they establish large, healthy populations of friendly bacteria that compete with the Candida that is trying to take up residence.
A year-long open trial of 150 women found Lactobacillus probiotics ineffective for preventing urinary tract infections as compared to cranberry juice or no treatment.50
What Is the Scientific Evidence for Acidophilus and Other Probiotics?
Traveler's Diarrhea
According to several studies, it appears that regular use of acidophilus and other probiotics can help prevent "traveler's diarrhea" (an illness caused by eating contaminated food, usually in developing countries).51,52 One double-blind, placebo-controlled study followed 820 people traveling to southern Turkey, and found that use of a probiotic called Lactobacillus GG significantly protected against intestinal infection.53
Other studies using S. boulardii have found similar benefits,54,55,56 including a double-blind, placebo-controlled trial enrolling 3,000 Austrian travelers.57 The greatest benefits were seen in travelers who visited North Africa and Turkey. The researchers noted the benefit depended on consistent use of the product, and a dosage of 1,000 mg daily was more effective than 250 mg daily.
Infectious Diarrhea
Probiotics may also help prevent or treat acute infectious diarrhea in children and adults.
A review of the literature published in 2001 found 13 double-blind, placebo-controlled trials on the use of probiotics for acute infectious diarrhea in infants and children; 10 of these trials involved treatment, and 3 involved prevention.109 Overall, the evidence suggests that probiotics can significantly reduce the duration of diarrhea and perhaps help prevent it. The evidence is strongest for the probiotic Lactobacillus GG, and for infection and with a particular virus called rotavirus.
For example, one double-blind, placebo-controlled trial of 269 children (age 1 month to 3 years) with acute diarrhea found that those treated with Lactobacillus GG recovered more quickly than those given placebo.58 The best results were seen among children with rotavirus infection (rotavirus is a virus that can cause severe diarrhea in children). Similar results with Lactobacillus GG were seen in a double-blind study of 71 children.59
In addition, a double-blind study evaluated the possible benefits of the probiotic L. reuteri in 66 children with rotavirus diarrhea.60 The study found that treatment shortened the duration of symptoms, and the higher the dose, the better the effect.
A double-blind, placebo-controlled study of 81 hospitalized children found that treatment with Lactobacillus GG reduced the risk of developing diarrhea, particularly rotavirus infection.61 A double-blind, placebo-controlled study found that Lactobacillus GG helped prevent diarrhea in 204 undernourished children.62
Other studies indicate that the probiotics B. bifidum, Streptococcus thermophilus,L. casei, Lactobacillus LB, and S. boulardii - both individually and combined with L. reuteri and L. chamnosus - may also help prevent or treat diarrhea in infants and children.63–68, 121-122 One study found that bacteria in the B. bifidum family can kill numerous bacteria that cause diarrhea.69
Keep in mind that diarrhea in young children can be serious. If it persists for more than a day, you should take your child to a physician.
A large (211 participant) double-blind, placebo controlled study found that adults can benefit from probiotic treatment as well.26
Antibiotic-Related Diarrhea
The results of many but not all double-blind and open trials suggest that probiotics, including S. boulardii and Lactobacillus GG, may help prevent or reduce antibiotic-related diarrhea.70–79 One study evaluated 180 people, who received either placebo or 1,000 mg of saccharomyces daily along with their antibiotic treatment, and found that the treated group developed diarrhea significantly less often.80 A similar study of 193 people also found benefit.81 However, a study of 302 people found no benefit with Lactobacillus GG.82
Other Forms of Diarrhea
Preliminary evidence suggests that probiotics may be helpful for reducing diarrheas and other gastrointestinal side effects caused by cancer treatment (radiation or chemotherapy).83,84
Small double-blind studies suggest S. boulardii might be helpful for treating chronic diarrhea in people with HIV, hospitalized patients being tube-fed, and people with Crohn's disease.85–88
Inflammatory Bowel Disease (Ulcerative Colitis and Crohn’s Disease)
The conditions Crohn’s disease and ulcerative colitis fall into the family of conditions known as Inflammatory Bowel Disease. Chronic diarrhea is a common feature of these conditions.
A double-blind trial of 116 people with ulcerative colitis compared probiotic treatment against a relatively low dose of the standard drug mesalazine.89 The results suggest that probiotic treatment might be equally effective as low-dose mesalazine for controlling symptoms and maintaining remission. Evidence of benefit was seen in other trials as well.90
Another study found S. boulardii helpful for the diarrhea of Crohn’s disease.87
Probiotics might be useful for people with ulcerative colitis who have had part or all of the colon removed. Such people frequently develop a complication called "pouchitis," inflammation of part of the remaining intestine. A 9-month double-blind trial of 40 people found that a combination of three probiotic bacteria could significantly reduce the risk of a pouchitis flare-up.91 Participants were given either placebo or a mixture of various probiotics, including four strains of Lactobacilli, three strains of Bifidobacteria, and one strain of Streptococcus salivarius. The results showed that treated people were far less likely to have relapses of pouchitis.
Irritable Bowel Syndrome
People with irritable bowel syndrome (IBS) experience crampy digestive pain as well as alternating diarrhea and constipation and other symptoms. Although the cause of irritable bowel syndrome is not known, one possibility is a disturbance in healthy intestinal bacteria. Based on this theory, probiotics have been tried as a treatment for IBS.
In a 4-week, double-blind, placebo-controlled trial of 60 people with IBS, treatment with L. plantarum reduced intestinal gas significantly.92 The benefits persisted for an additional year after treatment was stopped.
In another 4-week, double-blind trial, 40 people with IBS again received either L. plantarum or placebo.110 The results showed improved overall symptoms in the treated group as compared to the placebo group.
A small 6 week trial using L. acidophilus also found indications of benefit.93 However, in a double-blind, placebo-controlled crossover study of 24 people with irritable bowel syndrome, use of Lactobacillus GG failed to produce any noticeable benefit.111
Eczema
Use of probiotics during pregnancy and after childbirth may reduce risk of childhood eczema. In a double-blind, placebo-controlled trial that enrolled 159 women, participants received either placebo or Lactobacillus GG capsules beginning 2 to 4 weeks before expected delivery.94
After delivery, breast-feeding mothers continued to take placebo or the probiotic for 6 months; formula-fed infants were given placebo or probiotic directly for the same period of time. The results showed that use of Lactobacillus GG reduced children's risk of developing eczema by approximately 50%.
According to two-double blind trials, infants who already have eczema may benefit from probiotics as well.95,96
Vaginal Yeast Infections
A review of the many studies on the use of oral and topical acidophilus to prevent vaginal yeast infections concluded that it may be effective, but more study is needed.97,98
Immunity
A number of studies suggest that various probiotics can enhance immune function; however, most of them were not double-blind.99 One 12-week, double-blind, placebo-controlled trial evaluated 25 healthy elderly people, half of whom were given milk containing a particular strain of Bifidobacterium lactis, the others milk alone.100 The results showed various changes in immune parameters which the researchers took as possibly indicating improved immune function. Another double-blind, placebo-controlled study of 50 people using B. lactis had similar results.101
In addition, a 7-month, double-blind, placebo-controlled study of 571 children in day-care centers in Finland found that use of milk fortified with Lactobacillus GG reduced the number and severity of respiratory infections.102
Cholesterol
An 8-week, double-blind, placebo-controlled trial of 70 overweight people found that a probiotic treatment containing S. thermophilus and Enterococcus faecium could reduce LDL ("bad") cholesterol by about 8%.103 Similarly positive results were seen in other trials of the same or other probiotics.104–107 However, a 6-month double-blind, placebo-controlled trial found no long-term benefit.108 Researchers speculate that participants stopped using the product regularly toward the later parts of the study.
Safety Issues
There are no known safety problems with the use of acidophilus or other probiotics. Occasionally, some people notice a temporary increase in digestive gas.
Interactions You Should Know About
If you are taking antibiotics, it may be beneficial to take probiotic supplements at the same time, and to continue them for a couple of weeks after you have finished the course of drug treatment. This will help restore the balance of natural bacteria in your digestive tract.
Last reviewed January 2003 by HealthGate CAM Medical Review Board
All HealthGate health and medical information found on this site is accredited by URAC. URAC's Health Web Site Accreditation Program requires compliance with 53 rigorous standards of quality and accountability, verified by independent audits.
What They Are:
Probiotic supplements contain helpful bacteria that assist in balancing the levels of indigenous microorganisms in the human body. Probiotics are available in varied forms such as yogurt and other foods, capsules, tablets, beverages, and powders. Probiotics should not be confused with prebiotics, which are complex sugars (such as inulin and other fructo-oligosaccharides) that are ingested as fuel for bacteria already present in the gastrointestinal tract; although prebiotics and probiotics are sometimes combined in the same product and termed synbiotics.
What They Do:
The normal human gastrointestinal tract contains hundreds of different species of harmless bacteria, referred to as intestinal flora. When the normal balance of these bacteria is disturbed by illness or antibiotic treatment, the most common effect is diarrhea. Probiotics work by colonizing the small intestine and crowding out disease-causing bacteria, thereby restoring balance to the intestinal flora. They may also produce substances that inhibit pathogenic bacteria, compete for nutrients with them, and stimulate the body's own immune system.
Antibiotics often lower the numbers of beneficial bacteria in the body along with their intended targets, and probiotics can replace these beneficial bacteria and lessen some negative side effects of antibiotics. Saccharomyces boulardii, Enterococcus faecium and Lactobacillus have been clinically proven to prevent antibiotic-caused diarrhea. Successful clinical trials have also been conducted using Lactobacillus to treat H. pylori infection and Lactobacillus plantarum to treat irritable bowel syndrome. Lactobacillus GG (a strain of L. rhamnosus) and Lactobacillus reuteri have been shown to reduce the duration of diarrhea due to certain infections in infants and young children.
Studies using probiotics (Lactobacillus, Bifidobacterium, Streptococcus, and Saccharomyces species) to treat traveler's diarrhea, however, have not shown definitive results. Although the evidence isn't clear-cut, probiotics have been studied as a treatment for many other conditions and their side effects; including, lactose intolerance, respiratory and GI problems resulting from cystic fibrosis, Crohn's disease, cancer prevention, high blood cholesterol, tuberculosis, eczema, canker sores, milk allergies, vaginal and urinary tract infections, and prevention of respiratory infections in children.
See ConsumerTips™: What to Consider When Using for dosage information and, for more information, see the Probiotics article in the Natural Product Encyclopedia on this Web site.
Quality Concerns and What CL Tested For:
Neither the FDA nor any other federal or state agency routinely tests probiotics for quality prior to sale. However, quality issues for probiotic supplements can include the following:
· The viability of bacteria in the product — how many organisms are alive when the consumer purchases it? Some products make no claim at all and others only claim the amount at the time of manufacture.
· The types of bacteria in the product — the product should contain the bacterial species that it claims on the label, and potentially pathogenic microorganisms should not be present.
· Enteric protection of the product — Some types of bacteria can't survive as they pass through stomach acid and into the small intestine where the bacteria would attach and grow (see ConsumerTips™: What to Consider When Buying for more information). Ideally the product should contain bacteria that research shows can survive passage through the stomach or it should be enteric coated. Products in tablets should also be able to properly disintegrate so as to release the probiotic bacteria and not pass through the body intact.
ConsumerLab.com, as part of its mission to independently evaluate products that affect health, wellness, and nutrition, purchased many leading probiotic products sold in the U.S. and tested them to determine whether 1) they possessed the claimed amount of viable bacteria or, if not listed on the label, at least 1 billion live organisms per maximum suggested daily serving, 2) they were free of contamination with yeast, mold, and types of bacteria with disease-causing potential, and 3) tablets disintegrated properly so that their contents would be released, or if enteric-coated, their contents would be released after passing through the stomach. (See Testing Methods and Passing Score for more information).
What CL Found:
ConsumerLab.com purchased 25 probiotic products: 19 were for use by the general population, 3 were specifically marketed for use by children, and 3 were yogurts. Among these, eight products claimed from 1 billion to 6 billion live organisms per daily serving. Thirteen other products claimed specific numbers of live organisms (some as high as 60 billion) but only as of the time of manufacture — not indicating the number that would be in the product at the time of use. The yogurts and one supplement did not specify bacterial counts (see How Products were Selected and What to Consider When Buying for more information).
On testing, ConsumerLab.com found that 8 of the products contained less than 1% of the claimed number of live bacteria or of the expected minimum of 1 billion. In fact, six products had only a few thousand live bacteria — one-ten thousandth of the amount claimed or expected. Interestingly, products that did not claim a specific number of live bacteria at the time of use were much more likely to have been low, while 7 of the 8 products that gave expected numbers at the time of use (not limited to the time of manufacture) met these counts. It is quite likely that products that were low in bacteria may not work. Some clinical studies have shown that products with even tens of millions of live bacteria may be ineffective, as opposed to those having one billion or more live bacteria.
None of the products were contaminated with pathogenic bacteria, mold, or fungus. All tablet products disintegrated properly so that their bacteria would be released in the body. The one enteric-coated capsule passed special testing that confirmed its ability to pass through the stomach and deliver its bacteria to the intestine. See Testing Methods and Passing Score for more information about the testing and criteria.
Products That Passed Testing:
Listed alphabetically below by name the products that passed ConsumerLab.com's independent testing of Probiotic Supplements and Foods. Also shown are the claimed types and numbers of live bacteria per suggested daily serving (or the minimum expected number if not claimed).
CONSUMERLAB.COM APPROVED QUALITY PROBIOTIC PRODUCTSClick on for additional information on the productTo find retailers that sell some of the listed products click here.
Product Name(Pill Type or Form) Manufacturer/Distributor Number of ProbioticBacteria in Maximum SuggestedDaily Serving* (Billions of Cells) Types of Organisms Claimed
Supplements for General Population Use:
Country Life® Hypoallergenic, Milk-Free Power-Dophilus™ Dietary Supplement (vegetarian capsule) Dist. by Country Life® 1 (E) Lactobacillus rhamnosus, Lactobacillus acidophilus,Bifidobacterium lactis (bifidum),Bifidobacterium longum
Enzymatic Therapy Natural Medicines® Acidophilus Pearls™ with Patented True Delivery™ Technology (enteric-coated "pearl" capsule) Dist. by Enzymatic Therapy, Inc. 1 (C) Lactobacillus acidophilus and Bifidobacterium longum
Flora Source™ Super Potency Probiotic Cultures (vegetarian capsule) Dist. by MBA Company 1 (E) Lactobacillus rhamnosus, Bifidobacterium bifidum, Lactobacillus acidophilus, Bifidobacterium infantis, Bifidobacterium longum, Streptococcus thermophilus, Lactobacillus plantarum, Lactobacillus salivarius, Lactobacillus casei, Lactobacillus bulgaricus, Lactobacillus acidophilus DDS-1, Lactobacillus sporogenes, Lactobacillus lactis, Lactobacillus paracasei, Bifidobacterium lactis, Lactobacillus brevis
Nature Made®, Recommended By Pharmacists, Acidophilus Dietary Supplement, 500 Million Live Cells Per Tablet Dist. by Nature Made Nutritional Products 1 (C) L. acidophilus
Nutrilite® IntestiFlora Dietary Supplement (powder) Dist. by Access Business Group International LLC 1 (C) Bifidobacterium longum, Lactobacillus acidophilus
Puritan's Pride® Inspired By Nature™ Milk Free Acidophilus, 2.4 Billion Live Cells Per Capsule, 50% More Live Cells (vegetarian capsule) Mfd. by Puritan's Pride®, Inc. 1 (E) Lactobacillus Acidophilus, Lactobacillus Rhamnosus, Lactobacillus Bifidum
Puritan's Pride® Inspired By Nature™ Potent Acidophilus Supplement with Pectin (capsule) Mfd. by Puritan's Pride®, Inc. 1 (E) Lactobacillus acidophilus, L. brevis, L. salivarius, L. helveticus, L. bulgaricus, Bifidobacterium bifidum
The Premier Probiotic Culturelle™ with Lactobacillus GG, Patented Maximum Potency (capsule) Dist. by CAG Functional Foods 20 (C) Lactobacillus GG
Trader Darwin's™ For the Survival of the Fittest LiveBac® Acidophilus, 1 Billion Organisms per Caplet at Time of Manufacture (caplet) Dist. by Trader Joe's 1 (E) Lactobacillus acidophilus, Lactobacillus bulgaricus, Bifidobacterium bifidum, Streptococcus thermophilus
Vital Life Vital-Immune Biotic Probiotic Supplement, Complete Non-Dairy Combination of Microorganisms (vegetarian capsule) Dist. by Klaire Laboratories, Inc. 6 (C) Lactobacillus rhamnosus, Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum
Vitamin World® Naturally Inspired™ Milk Free Acidophilus, 2.4 Billion Live Cells Per Capsule, 50% More Live Cells (vegetarian capsule) Mfd. by Vitamin World®, Inc. 1 (E) Lactobacillus Acidophilus, Lactobacillus Rhamnosus, Lactobacillus Bifidum
Supplements for Use by Children:
GNC Natural Brand™ Children's Chewable Acidophilus, Grape Flavor (tablet) Dist. by General Nutrition Corporation 1 (C) L. acidophilus
Nature's Way® Once Daily Powdered Primadophilus® for Children (powder) Dist. by Nature's Way Products, Inc. 1.5 (C) Lactobacillus rhamnosus, Bifidobacterium infantis, Bifidobacterium longum, Lactobacillus acidophilus
UAS Labs DDS® Junior, Bifidus, Acidophilus, FOS, 2 Billion CFU/g, Non Dairy Powder Dist. by UAS Laboratories 1 (E) B. infantis & L. acidophilus
Yogurts:**
Breyers® 99% Fat Free Fruit on the Bottom Lowfat Yogurt, 1% Milkfat, Black Cherry Dist. by Kraft Foods North America, Inc. 1 (E) Made with active yogurt cultures with L. acidophilus
Colombo® Classic Lowfat Yogurt, 1% Milkfat, Vanilla Dist. by Colombo®, Inc, 1 (E) Made with active yogurt cultures including L. acidophilus.
Stonyfield Farm® French Vanilla Nonfat Yogurt Dist. by Stonyfield Farm® Yogurt 1 (E) S. thermophilus, L. bulgaricus, L. acidophilus, Bifidus, L. casei, and L. reuteri
* (C) = Claimed at Time of Use; (E) = Expected Minimum if Not Claimed
** Results for yogurts based on an 8-ounce (1 cup) serving.
Unless otherwise noted, information about the products listed above is based on the samples purchased by ConsumerLab.com for this Product Review. Manufacturers may change product ingredients and information at any time, so be sure to check labels carefully when evaluating the products you use or buy. If a product's ingredients differ from what is listed above, it may not necessarily be of the same quality as what was tested. It also cannot be assumed that other products from a Manufacturer or Distributor listed above are of equal quality to those listed.
ConsumerTips™: What to Consider When Buying:
When probiotic supplements are properly labeled, it is easy to determine what types of bacteria are present. Bacterial organism's names should be listed in italics, with the genus name capitalized and listed first. The genus name may also be abbreviated with its first letter (e.g., Lactobacillus acidophilus or L. acidophilus). The species most commonly seen in probiotics and that have been tested in laboratory and clinical studies are Lactobacillus acidophilus, L. bulgaricus, L. casei, L. gasseri, L. plantarum, Bifidobacterium bifidum, B. lactis, B. longum, Enterococcus faecium, and Saccharomyces boulardii (a yeast). Other species that can be used as probiotics but have less accompanying research are L. johnsonii, L. reuteri, L. rhamnosus, B. breve, B. infantis, E. faecalis, and Streptococcus salivarius. Some probiotic bacterial strains have been patented and are accompanied by substantial research into their effects. L. casei GG (a strain of Lactobacillus rhamnosus found in Culturelle capsules), L. casei in Actimel (Dannon), and LC1 (Nestle) are three examples. Some research has shown that it may be more effective to take a probiotic supplement that contains a mixture of bacterial strains rather than a single bacterial species.
While many products make claims regarding the number of organisms in the product, these typically refer to the numbers at the time manufacture — which can be very different from the amount still viable at the time of purchase. Exposure to heat, moisture, and oxygen can all negatively affect survival of probiotics in a product, so the expiration date is especially important to consider when buying products. Some products have an enteric coating, because certain probiotic bacteria need protection in order to survive exposure to gastric fluid. In general, Lactobacillus, Bifidobacterium, and Streptococcus species do not need enteric coating as they can survive passage through the stomach. However, L. bulgaricus and S. thermophilus, as well as Leuconostoc and Lactococcus species, cannot survive passage through the stomach. These bacteria are commonly found in yogurt because they are used as starters for dairy products. However, they do not colonize the intestinal tract; so they are likely to have little effect as probiotics. Some bacteria naturally sporulate ("hibernate" within a protective coating) when they are exposed to harsh conditions, and some researchers postulate that sporulated bacteria are more resistant to the harsh conditions found in the intestinal tract. Consequently, another delivery method is to manufacture probiotics in the form of bacterial spores — this is most often used for bacteria of the genus Bacillus.
What to Consider When Using:
The recommended daily intake for probiotic supplements is 1 billion units (sometimes referred to as colony forming units, or CFU's) to 10 billion units per day. These amounts may be written on the label as 1 x 109 or 109 for one billion units, and 1 x 1010 or 1010 for ten billion units.
For the treatment of diarrhea, it is recommended to start taking probiotic supplements as soon as symptoms appear. However, if symptoms persist for several days, see a physician. Following antibiotic treatment, take probiotic supplements for 2 weeks. Probiotics are sometimes taken before travel in an attempt to prevent traveler's diarrhea. To gain probiotic benefits from yogurt or other dairy foods, look for products labeled "contains live cultures" or "active cultures". Some yogurts may also state the species of bacteria they contain.
For treating vaginal bacterial infections, vaginal suppositories containing approximately 1 billion Lactobacillus organisms are typically used.
If you are taking antibiotics, it may be advisable to take them at least 2 hours apart from taking a probiotic, as the antibiotic could potentially kill the organisms.
Although not always a requirement, it is advisable to keep probiotic products refrigerated to prolong their shelf life. Interestingly, all of the products that specifically suggested that they be kept refrigerated passed this review — possibly because they were maintained under more favorable conditions during their storage and distribution.
Concerns and Cautions:
There are no known safety issues with probiotic bacteria, but occasionally, some people notice a temporary increase in digestive gas.
In a few cases among severely ill or immunocompromised individuals, probiotic use has caused bacteremia (presence of bacteria in the blood) or pathological infections resulting in severe illness. However, when taken at appropriate doses in healthy people, they are very safe. Even HIV-positive adults have taken probiotics for up to 3 weeks without side effects.
To further assist consumers, ConsumerLab.com is licensing its flask-shaped CL Seal of Approved Quality (see The CL Seal) to manufacturers for use on labels of products that have passed its testing. ConsumerLab.com will periodically re-evaluate these products to ensure their compliance with ConsumerLab.com's standards.
Consumers should inform their healthcare providers of the dietary supplements they take.
For probiotics, the key for me is to get it in enteric coated capsules. I can quickly tell the difference in my digestion. The normal capsules and powders never helped me like the enteric coated capsule type. Solaray Multidophilus 12 has been the best brand for me. slowmo
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The brand name is NOW, it is Acidophilus Two Billion Highest Quality 100 capsules. It has no additivies. It cost $6.99 plus tax. I have had no bloating or cramping and it has helped me get along with the antibiotics of MP, both of them. I am in Phase 2. Barney
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I have also had terrible bloating caused by some probiotics. I've tried different brands, and the one that doesn't bother me is Nature's Day Once Daily Primadophilus and Bifidus, enteric coated. It's in the fridge at the health food store. It costs $17.99 for 90 caps. Expensive but it's been helpful, and without causing trouble.
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I have found Culterelle and Bifa-15 to be excellent probiotics. Lonestartick
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There is one on the market made by Genestra called HMF forte. It stands for human microflora and according to my doctor it is superior to any probiotic on the market. All of the other probiotics come from animal sources.
Lisa66
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In Australia we have a product available from Blackmore's brand called FORBIOTIC. They claim that this strain of probiotic bacteria has been specifically bred to be antibiotic resistant. Clever, yes?
I don't know if a similar product is available overseas, but I can tell you that the Blackmore's brand is one of the "Best" & most trusted brands. Also, I have tried it out in yoghurt-making - and it set up the milk very well, so there must be plenty of live culture in it. Claudia
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There is another type of probiotic that I wonder if you have tried. I heard about it from a very respected doctor, who mentioned it at a conference (CIIN). From what he said, t's a soil based organism that was developed into a probiotic because it produced a substance that killed Candida quite effectively.
When I took it, I had a Candida die-off reactions that was just as strong as what I had on Diflucan. I have not used it extensively, since I become sensitive to just about everything and became sensitive to this product too (and my Candida problem lessened), but I thought you might consider it worth looking into. The SBO (soil based organism) product I used is the most hypoallergenic one I found (and was the one recommended by the doctor mentioned above) and it is called Flora-Balance. You can find out more by doing a Internet search (the company I order from generally is http://needs.com ). It could be used in a douche as well.
Lactobacillus
U.S. Brand Names
Bacid® [OTC]; Culturelle® [OTC]; Dofus [OTC]; Flora-Q™ [OTC]; Kala® [OTC]; Lactinex™ [OTC]; Lacto-Bifidus [OTC]; Lacto-Key [OTC]; Lacto-Pectin [OTC]; Lacto-TriBlend [OTC]; Megadophilus® [OTC]; MoreDophilus® [OTC]; Superdophilus® [OTC]
Canadian Brand Names
Bacid®; Fermalac
Mexican Brand Names
Lacteol Fort
Pharmacologic Category
Dietary Supplement; Probiotic
Reasons not to take this medicine
• If you have an allergy to Lactobacillus or any other part of this medicine.
• Tell healthcare provider if you are allergic to any medicine. Make sure to tell about the allergy and how it affected you. This includes telling about rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other symptoms involved.
What is this medicine used for?
• This medicine is used to treat diarrhea.
• This medicine is used to relieve excess gas in the gastrointestinal tract.
How does it work?
• Lactobacillus maintains the normal balance of bacteria and yeast in the gastrointestinal tract.
How is it best taken?
Tablets and capsules:
• Take this medicine with or without food. Take with food if it causes an upset stomach.
• Swallow capsule whole. Do not chew or crush.
• You may sprinkle contents of capsule on soft food or liquid.
Bacid® [OTC]; Culturelle® [OTC]; Dofus [OTC]; Flora-Q™ [OTC]; Kala® [OTC]; Lactinex™ [OTC]; Lacto-Bifidus [OTC]; Lacto-Key [OTC]; Lacto-Pectin [OTC]; Lacto-TriBlend [OTC]; Megadophilus® [OTC]; MoreDophilus® [OTC]; Superdophilus® [OTC]
Canadian Brand Names
Bacid®; Fermalac
Mexican Brand Names
Lacteol Fort
Pharmacologic Category
Dietary Supplement; Probiotic
Reasons not to take this medicine
• If you have an allergy to Lactobacillus or any other part of this medicine.
• Tell healthcare provider if you are allergic to any medicine. Make sure to tell about the allergy and how it affected you. This includes telling about rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other symptoms involved.
What is this medicine used for?
• This medicine is used to treat diarrhea.
• This medicine is used to relieve excess gas in the gastrointestinal tract.
How does it work?
• Lactobacillus maintains the normal balance of bacteria and yeast in the gastrointestinal tract.
How is it best taken?
Tablets and capsules:
• Take this medicine with or without food. Take with food if it causes an upset stomach.
• Swallow capsule whole. Do not chew or crush.
• You may sprinkle contents of capsule on soft food or liquid.
Irritable Bowel Syndrome
Related Terms:
• Spastic Colon
Principal Proposed Natural Treatments
• Flaxseed, Peppermint Oil, Probiotics, Traditional Chinese Herbal Medicine
Other Proposed Natural Treatments
• Acupuncture, Avoidance of Allergenic Foods, Coleus forskohlii, Digestive Enzymes (Including Bromelain and Other Proteolytic Enzymes ) , Fructo-oligosaccharides, Glutamine, Hypnotherapy, Melatonin, Relaxation Therapy, Slippery Elm
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Principal Proposed Natural Treatments
Other Proposed Natural Treatments
References
The term IBS is used to describe chronic colon problems that occur in the absence of an identifiable medical cause. Common symptoms include alternating diarrhea and constipation, excess intestinal gas, intestinal cramping, uncomfortable bowel movements, abdominal discomfort following meals, and excessive awareness of the presence of stool in the colon. Despite all these distressing symptoms, in IBS, the intestines appear to be perfectly healthy when they are examined. Thus the condition belongs to a category of diseases that physicians call “functional.” This means that while the function of the bowel seems to have gone awry, no injury or disturbance of its structure can be discovered. (The analogous problem in the stomach is called dyspepsia , and the two conditions frequently overlap.)
Because the cause of IBS is not understood, conventional medical treatment of IBS is highly inadequate. One drug that had shown promise, Zelnorm, was withdrawn from the market for safety issues. Another, Lotronex, was temporarily withdrawn, and then re-approved, but only under strict limitations. Other medical treatment approaches for IBS include increased dietary fiber, drugs that reduce bowel spasm, and drugs to address constipation or diarrhea as needed. In addition, various forms of psychotherapy, including hypnosis, have been tried, with some success. 1-6
Principal Proposed Natural TreatmentsPeppermint
Peppermint oil is widely used for IBS. While the research evidence is a bit inconsistent, 9 out of 13 placebo-controlled studies found peppermint oil more effective than placebo. 7-12,34,49 However, most studies were small.
For more information, including dosage and safety issues, see the full Peppermint article.
Probiotics
Numerous double-blind trials indicate that various probiotics ("friendly" bacteria) may be helpful for IBS. 15,16,25,27,28,35,47,50,51,54-56,61
For example, in a 6-week, double-blind, placebo-controlled trial of 274 people with constipation-predominant IBS, in which constipation is a more significant symptom than diarrhea, use of a probiotic formula containing Bifidobacterium animalis significantly reduced discomfort and increased stool frequency. 50 In another randomized trial, 266 women with constipation who consumed yogurt containing Bifidobacterium animalis and the prebiotic fructo-oligosaccharide twice daily for two weeks experienced significant improvement in their symptoms compared to women consuming regular yogurt as a placebo.60Prebiotics are substances that encourage the growth of beneficial bacteria in the colon.
Another study examined the effects of 4 weeks treatment with L. plantarum on intestinal gas in 60 people with IBS. This study found benefits that persisted for an entire year after treatment stopped. 15
Benefits were seen in five other small, double-blind trials as well, using L. plantarum , 25, 27L. acidophilus , 16,55Lactobacillus rhamnosus , 47L. salivarus , 51 and Bifidobacterium , 51 as well as proprietary probiotic combinations including various strains. 28,35,54
However, there have been a number of negative studies as well.26,36,57
Two studies that pooled previous randomized trials on the use of probiotics for IBS came to similar conclusions: probiotics appear to offer some benefit, most notably for global symptoms and abdominal discomfort. However, these two studies were unable to determine which probiotic species were most effective.58,59
For more information, see the full Probiotics article.
Flaxseeds
In a double-blind study, 55 people with chronic constipation caused by IBS received either ground flaxseed or psyllium seed (a well-known treatment for constipation) daily for 3 months. 17 Those taking flaxseed had significantly fewer problems with constipation, abdominal pain, and bloating than those taking psyllium. The flaxseed group had even further improvements in constipation and bloating while continuing their treatment in the 3 months after the double-blind study ended. The researcher concluded that flaxseed relieved constipation more effectively than psyllium.
For more information, see the Flaxseed article.
Chinese Herbal Medicine
Chinese herbal medicine is traditionally practiced in a highly individualized way, with herbal formulas tailored to the exact details of each person’s case. In a double-blind, placebo-controlled trial, 116 people with IBS were randomly assigned to receive individualized Chinese herbal treatment, a “one-size-fits-all” Chinese herbal formulation, or placebo. 29 Treatment consisted of 5 capsules 3 times daily, taken for 16 weeks. The results showed that both forms of active treatment were superior to placebo, significantly reducing IBS symptoms. However, the individualized treatment was no more effective than the “generic” treatment. Similar results were seen in another study as well. 44
For more information on this complex medical system, including important safety issues, see the Traditional Chinese Herbal Medicine article.
Other Proposed Natural TreatmentsOne study found evidence that pancreatic digestive enzymes (including proteolytic enzymes plus other enzymes called lipases) might be helpful for reducing the flare-up of IBS symptoms that may follow a fatty meal. 30
Three small studies suggest that use of the supplement melatonin might reduce symptoms of IBS; 38-39,46 it has been suggested that the hormone melatonin may have an effect on the nervous system in the digestive tract.
An herbal combination containing candytuft , matricaria flower , peppermint leaves , caraway , licorice root , and lemon balm has shown some promise for IBS. 37
In one double-blind trial, a combination of lemon balm , spearmint, and coriander showed some promise for reducing symptoms of diarrhea-dominant IBS. 45
The herbs Coleus forskohlii and slippery elm as well as the supplement glutamine are also sometimes recommended for IBS, but there is no meaningful evidence as yet that are helpful.
One double-blind study failed to find either the herb fumitory or an herbal relative of turmeric helpful for IBS. 40
The prebiotic supplement fructo-oligosaccharides has been advocated as a treatment for IBS. However, research results are currently inconsistent at best. For example, a s6-week, double-blind study of 105 people with mild irritable bowel syndrome compared 5 g of fructo-oligosaccharides daily against placebo, and returned conflicting results. 52 According to some measures of symptom severity employed by the researchers, use of FOS led to an improvement in symptoms; however, according to other measures, FOS actually worsened symptoms. 19 Conflicting results, though of a different kind, were also seen in a 12-week, double-blind, placebo-controlled study of 98 people. 41 Treatment with FOS at a dose of 20 g daily initially worsened symptoms, but over time this negative effect wore off. At no time in the study were clear benefits seen, however. On a positive note, one study did find benefit with a combination prebiotic-probiotic formula. 42
Food allergies may play a role in IBS, and diets based on identifying and eliminating allergenic foods might offer some benefit. 18-24,48
Hypnotherapy has shown some promise for IBS, 31 as has relaxation therapy . 53,54
Acupuncture has been proposed as a treatment for IBS. However, study results have thus far failed to show it effective. For example, a 13-week study of 60 people with IBS found fake acupuncture just as beneficial as traditional acupuncture. 32 Two other studies also failed to find benefit. 33,43
• Spastic Colon
Principal Proposed Natural Treatments
• Flaxseed, Peppermint Oil, Probiotics, Traditional Chinese Herbal Medicine
Other Proposed Natural Treatments
• Acupuncture, Avoidance of Allergenic Foods, Coleus forskohlii, Digestive Enzymes (Including Bromelain and Other Proteolytic Enzymes ) , Fructo-oligosaccharides, Glutamine, Hypnotherapy, Melatonin, Relaxation Therapy, Slippery Elm
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References
The term IBS is used to describe chronic colon problems that occur in the absence of an identifiable medical cause. Common symptoms include alternating diarrhea and constipation, excess intestinal gas, intestinal cramping, uncomfortable bowel movements, abdominal discomfort following meals, and excessive awareness of the presence of stool in the colon. Despite all these distressing symptoms, in IBS, the intestines appear to be perfectly healthy when they are examined. Thus the condition belongs to a category of diseases that physicians call “functional.” This means that while the function of the bowel seems to have gone awry, no injury or disturbance of its structure can be discovered. (The analogous problem in the stomach is called dyspepsia , and the two conditions frequently overlap.)
Because the cause of IBS is not understood, conventional medical treatment of IBS is highly inadequate. One drug that had shown promise, Zelnorm, was withdrawn from the market for safety issues. Another, Lotronex, was temporarily withdrawn, and then re-approved, but only under strict limitations. Other medical treatment approaches for IBS include increased dietary fiber, drugs that reduce bowel spasm, and drugs to address constipation or diarrhea as needed. In addition, various forms of psychotherapy, including hypnosis, have been tried, with some success. 1-6
Principal Proposed Natural TreatmentsPeppermint
Peppermint oil is widely used for IBS. While the research evidence is a bit inconsistent, 9 out of 13 placebo-controlled studies found peppermint oil more effective than placebo. 7-12,34,49 However, most studies were small.
For more information, including dosage and safety issues, see the full Peppermint article.
Probiotics
Numerous double-blind trials indicate that various probiotics ("friendly" bacteria) may be helpful for IBS. 15,16,25,27,28,35,47,50,51,54-56,61
For example, in a 6-week, double-blind, placebo-controlled trial of 274 people with constipation-predominant IBS, in which constipation is a more significant symptom than diarrhea, use of a probiotic formula containing Bifidobacterium animalis significantly reduced discomfort and increased stool frequency. 50 In another randomized trial, 266 women with constipation who consumed yogurt containing Bifidobacterium animalis and the prebiotic fructo-oligosaccharide twice daily for two weeks experienced significant improvement in their symptoms compared to women consuming regular yogurt as a placebo.60Prebiotics are substances that encourage the growth of beneficial bacteria in the colon.
Another study examined the effects of 4 weeks treatment with L. plantarum on intestinal gas in 60 people with IBS. This study found benefits that persisted for an entire year after treatment stopped. 15
Benefits were seen in five other small, double-blind trials as well, using L. plantarum , 25, 27L. acidophilus , 16,55Lactobacillus rhamnosus , 47L. salivarus , 51 and Bifidobacterium , 51 as well as proprietary probiotic combinations including various strains. 28,35,54
However, there have been a number of negative studies as well.26,36,57
Two studies that pooled previous randomized trials on the use of probiotics for IBS came to similar conclusions: probiotics appear to offer some benefit, most notably for global symptoms and abdominal discomfort. However, these two studies were unable to determine which probiotic species were most effective.58,59
For more information, see the full Probiotics article.
Flaxseeds
In a double-blind study, 55 people with chronic constipation caused by IBS received either ground flaxseed or psyllium seed (a well-known treatment for constipation) daily for 3 months. 17 Those taking flaxseed had significantly fewer problems with constipation, abdominal pain, and bloating than those taking psyllium. The flaxseed group had even further improvements in constipation and bloating while continuing their treatment in the 3 months after the double-blind study ended. The researcher concluded that flaxseed relieved constipation more effectively than psyllium.
For more information, see the Flaxseed article.
Chinese Herbal Medicine
Chinese herbal medicine is traditionally practiced in a highly individualized way, with herbal formulas tailored to the exact details of each person’s case. In a double-blind, placebo-controlled trial, 116 people with IBS were randomly assigned to receive individualized Chinese herbal treatment, a “one-size-fits-all” Chinese herbal formulation, or placebo. 29 Treatment consisted of 5 capsules 3 times daily, taken for 16 weeks. The results showed that both forms of active treatment were superior to placebo, significantly reducing IBS symptoms. However, the individualized treatment was no more effective than the “generic” treatment. Similar results were seen in another study as well. 44
For more information on this complex medical system, including important safety issues, see the Traditional Chinese Herbal Medicine article.
Other Proposed Natural TreatmentsOne study found evidence that pancreatic digestive enzymes (including proteolytic enzymes plus other enzymes called lipases) might be helpful for reducing the flare-up of IBS symptoms that may follow a fatty meal. 30
Three small studies suggest that use of the supplement melatonin might reduce symptoms of IBS; 38-39,46 it has been suggested that the hormone melatonin may have an effect on the nervous system in the digestive tract.
An herbal combination containing candytuft , matricaria flower , peppermint leaves , caraway , licorice root , and lemon balm has shown some promise for IBS. 37
In one double-blind trial, a combination of lemon balm , spearmint, and coriander showed some promise for reducing symptoms of diarrhea-dominant IBS. 45
The herbs Coleus forskohlii and slippery elm as well as the supplement glutamine are also sometimes recommended for IBS, but there is no meaningful evidence as yet that are helpful.
One double-blind study failed to find either the herb fumitory or an herbal relative of turmeric helpful for IBS. 40
The prebiotic supplement fructo-oligosaccharides has been advocated as a treatment for IBS. However, research results are currently inconsistent at best. For example, a s6-week, double-blind study of 105 people with mild irritable bowel syndrome compared 5 g of fructo-oligosaccharides daily against placebo, and returned conflicting results. 52 According to some measures of symptom severity employed by the researchers, use of FOS led to an improvement in symptoms; however, according to other measures, FOS actually worsened symptoms. 19 Conflicting results, though of a different kind, were also seen in a 12-week, double-blind, placebo-controlled study of 98 people. 41 Treatment with FOS at a dose of 20 g daily initially worsened symptoms, but over time this negative effect wore off. At no time in the study were clear benefits seen, however. On a positive note, one study did find benefit with a combination prebiotic-probiotic formula. 42
Food allergies may play a role in IBS, and diets based on identifying and eliminating allergenic foods might offer some benefit. 18-24,48
Hypnotherapy has shown some promise for IBS, 31 as has relaxation therapy . 53,54
Acupuncture has been proposed as a treatment for IBS. However, study results have thus far failed to show it effective. For example, a 13-week study of 60 people with IBS found fake acupuncture just as beneficial as traditional acupuncture. 32 Two other studies also failed to find benefit. 33,43
Probiotics: dead or alive?
Counting the studies that have been done on probiotics is like counting the organisms in a gram of yoghurt.
Probiotics are live microbial ingestible supplements that can benefit the host (ingesting) organism by favourably altering its intestinal microbial balance.1 Given the assumption that these microbial supplements must be living, substantial research and development has been dedicated to processes and agents that can prolong their stability and viability throughout the food, beverage and dietary supplements value chain. These include cryo-preservation; prebiotics; microencapsulation; and novel delivery vehicles such as protein-based microparticles, and sausages, along with strain selection.2,3,4,5
But do the organisms need to be alive to be effective?
A number of basic and clinical research studies have been conducted with a heat-killed, freeze-dried, human gut-derived strain (LB) of Lactobacillus acidophilus (Lacteol Fort, Homdan, France, first isolated in 1907) with a fermented culture medium. Earlier studies conducted among paediatric and adult populations showed efficacy in acute diarrhoeal episodes.6,7 A double-blind, placebo-controlled crossover trial in a population of 18 inflammatory bowel disease patients revealed significant clinical efficacy with a daily dose of 10 billion organisms taken twice daily.8 Although a research-validated symptom score was not used, the crossover design (with a two-week washout) augments the rigor of the trial.
A more recent study among 73 paediatric patients (ages 3-24 months) with acute watery diarrhoea and mild to moderate dehydration revealed that a dose of 10 billion LB cells, taken as Lacteol Fort (twice daily), produced significant reductions in the duration of diarrhoea, especially among infants who had not received prior antibiotic therapy.9 The LB strain/culture medium that comprises Lacteol Fort exhibits gut cell adhesive and pathogen excluding properties, which appear to be thermostable.10,11
Collectively, these data demonstrate a 'probiotic' effect with dead organisms. The ideal assessment would be a head-to-head comparator study assessing a heat-killed strain against a live probiotic strain.
One study did just that. It was a multi-centre, randomised, open-label four-week study that assigned 137 adults with chronic diarrhoea to receive Lacteol Fort (10 billion organisms twice daily) or a live Lactobacillus acidophilus chewable tablet that contained 400mg of skimmed fermented milk per tablet (five tablets thrice daily; strain not specified and viability not validated; Lacidophilin brand, Tai Ge Pharma, China).12,13 The Lacteol group showed significantly superior efficacy in symptom scores and overall efficacy.
The obvious major weaknesses of this study include the complete lack of characterisation of the 'live' probiotic strain, the absence of a placebo control, and the lack of blinding. A definitive and rigorous head-to-head comparator study is warranted, including assessment of the efficacy of the Lacteol Fort fermented culture medium alone.
Probiotics are live microbial ingestible supplements that can benefit the host (ingesting) organism by favourably altering its intestinal microbial balance.1 Given the assumption that these microbial supplements must be living, substantial research and development has been dedicated to processes and agents that can prolong their stability and viability throughout the food, beverage and dietary supplements value chain. These include cryo-preservation; prebiotics; microencapsulation; and novel delivery vehicles such as protein-based microparticles, and sausages, along with strain selection.2,3,4,5
But do the organisms need to be alive to be effective?
A number of basic and clinical research studies have been conducted with a heat-killed, freeze-dried, human gut-derived strain (LB) of Lactobacillus acidophilus (Lacteol Fort, Homdan, France, first isolated in 1907) with a fermented culture medium. Earlier studies conducted among paediatric and adult populations showed efficacy in acute diarrhoeal episodes.6,7 A double-blind, placebo-controlled crossover trial in a population of 18 inflammatory bowel disease patients revealed significant clinical efficacy with a daily dose of 10 billion organisms taken twice daily.8 Although a research-validated symptom score was not used, the crossover design (with a two-week washout) augments the rigor of the trial.
A more recent study among 73 paediatric patients (ages 3-24 months) with acute watery diarrhoea and mild to moderate dehydration revealed that a dose of 10 billion LB cells, taken as Lacteol Fort (twice daily), produced significant reductions in the duration of diarrhoea, especially among infants who had not received prior antibiotic therapy.9 The LB strain/culture medium that comprises Lacteol Fort exhibits gut cell adhesive and pathogen excluding properties, which appear to be thermostable.10,11
Collectively, these data demonstrate a 'probiotic' effect with dead organisms. The ideal assessment would be a head-to-head comparator study assessing a heat-killed strain against a live probiotic strain.
One study did just that. It was a multi-centre, randomised, open-label four-week study that assigned 137 adults with chronic diarrhoea to receive Lacteol Fort (10 billion organisms twice daily) or a live Lactobacillus acidophilus chewable tablet that contained 400mg of skimmed fermented milk per tablet (five tablets thrice daily; strain not specified and viability not validated; Lacidophilin brand, Tai Ge Pharma, China).12,13 The Lacteol group showed significantly superior efficacy in symptom scores and overall efficacy.
The obvious major weaknesses of this study include the complete lack of characterisation of the 'live' probiotic strain, the absence of a placebo control, and the lack of blinding. A definitive and rigorous head-to-head comparator study is warranted, including assessment of the efficacy of the Lacteol Fort fermented culture medium alone.
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