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 Could something as simple as giving a probiotic and a sugar for 7 days prevent sepsis in babies? Sepsis is a life-threatening infection that is a HUGE problem in developing countries such as India. It is a major cause of death in babies throughout the world, even with antibiotic treatment. So this new research (done in India) finding that giving newborn babies a probiotic plus the sugar fructooligosaccharide (FOS) for only one week had the result of lowering the incidence of sepsis and death by 40%, and also infections is huge news. A game changer.

The researchers found that the strain given to the babies was very important. They first tried Lactobacillus GG and Lactobacillus sporogenes, but didn't have success. But a strain of Lactobacillus plantarum was amazingly effective. They gave it together with a sugar - fructooligosaccharide (FOS) - which together worked as a synbiotic. Synbiotics are combinations of probiotics with an FOS supplement that promotes growth and colonization of the beneficial bacteria. FOS (which is naturally found in breast milk and such plants as onion, chicory, garlic, asparagus, banana, artichoke, agave, leeks, wheat, barley), is food for the probiotic bacteria.

It must be pointed out that other studies have tried other probiotics in the prevention of sepsis, but have not been successful. Probiotics that did not work work in other studies were Streptococcus thermophilus, Bifidobacterium infantis, Bifidobacterium lactis, and Bifidobacterium breve. However, they did not also use prebiotic supplements (the FOS) - just the probiotic alone - and studied premature or low birth weight babies (while this study focused on healthy babies of approximately normal weight.) This is why research now needs to be done looking at other groups of babies. From Medical Xpress:

Study shows probiotics can prevent sepsis in infants

A research team at the University of Nebraska Medical Center College of Public Health has determined that a special mixture of good bacteria in the body reduced the incidence of sepsis in infants in India by 40 percent at a cost of only $1 per infant...... The special mixture included a probiotic called Lactobacillus plantarum ATCC-202195 combined with fructo-oligosaccharide (FOS), an oral synbiotic preparation developed by Dr. Panigrahi.

Probiotics are live bacteria and yeasts that are good for your health, especially your digestive system. Synbiotics are combinations of probiotics with an FOS supplement that promotes growth and sustains colonization of the probiotic strain. FOS, naturally found in breast milk and such plants as onion, chicory, garlic, asparagus, banana, artichoke and others, is food for the probiotic bacteria.

Sepsis is a severe complication of bacterial infection that results in around one million infant deaths worldwide each year, mostly in developing countries. It occurs when the immune system stops fighting germs and begins to turn on itself and can lead to tissue damage, organ failure and death. It is estimated that 40 percent of patients with severe sepsis in developing countries do not survive.

The team enrolled more than 4,500 newborns from 149 villages in the Indian province of Odisha and followed them for their first 60 days, the most critical period when they get sick and die. During their first days of life, the newborns were administered the oral preparation for seven days. Results of the randomized, double-blind, placebo-controlled study showed that sepsis and deaths in the first two months of infancy were reduced by 40 percent, more than twice the anticipated reduction of 20 percent. The synbiotic treatment also lowered respiratory tract infections. The effectiveness demonstrated in Dr. Panigrahi's study was so successful the study was halted early. 

An interesting article about this research from The Atlantic: At Last, a Big, Successful Trial of Probiotics

There has been a lot of discussion in the last few years of our gut bacteria (hundreds of species), the microbiome (the community of microbes living within and on a person (gut, nasal cavities, mouth, sinuses, etc.), probiotics, the finding of a link between bacteria and some chronic diseases, and how the modern lifestyle and antibiotics are wiping out our beneficial gut microbes. I am frequently asked how one can improve or nurture the beneficial bacteria in our bodies.

While no one knows what exactly is the "best" or "healthiest" microbial composition of the gut, it does look like a diversity of bacteria is best (may make you healthier and more able to resist diseases). Research also suggests that the diversity and balance of bacteria living in the body can be changed and improved, and changes can occur very quickly. And that the microbial communities fluctuate for various reasons (illness, diet,etc.). Diet seems to be key to the health of your gut microbial community. Prebiotics feed the beneficial bacteria in the gut, probiotics are live beneficial bacteria, and synbiotics are a combination of prebiotics and probiotics. But don't despair - you can improve your gut microbial community starting now. The following are some practical tips, based on what scientific research currently knows.

SOME STEPS TO FEED AND NURTURE YOUR GUT MICROBES:

Eat a wide variety of foods, especially whole foods that are unprocessed or as minimally processed as possible. Eat everything in moderation.

Eat a lot of plant based foods: fruits, vegetables, whole grains, seeds, nuts, and legumes. Think of Michael Pollan's advice: "Eat food. Not too much. Mostly plants."

Eat more washed and raw fruits and vegetables (lots of bacteria and fiber to feed and nurture the bacteria). Some every day would be good.

Eat more soluble and insoluble types of fiber, and increase how many servings you eat every day. A variety of  fiber foods every day, and several servings at each meal, is best. Think fruits, vegetables, whole grains, legumes, nuts, seeds. (See How Much Dietary Fiber Should We Eat? - also has a chart with high fiber foods, and Recent Studies Show Benefits of Dietary Fiber)

Eat as many organic foods as possible. There is much we don't yet know, and pesticides are like antibiotics - they kill off microbes, both good and bad. Somehow I think that lowering the levels in your body of pesticides (as measured in blood and urine) can only be beneficial. Also, organic foods don't contain added antibiotics and hormones. (Eat Organic Foods to Lower Pesticide Exposures).  But even if you can't or won't eat organic foods, it is still better to eat non-organic fruits, vegetables, and whole grains than to not eat them.

Eat some fermented foods such as kimchi and sauerkraut (they contain live bacteria), kefir, and yogurts with live bacteria. Eat other bacteria containing foods such as cheeses, and again a variety is best (different cheeses have different bacteria).

Try to avoid or eat less of mass-produced highly processed foods, fast-foods, preservatives, colors and dyes, additives, partially hydrogenated oils, and high-fructose corn syrup. Read all ingredient lists on labels, and even try to avoid as much as possible "natural flavors" (these are chemicals concocted in a lab and unnecessary). Even emulsifiers (which are very hard to avoid) are linked to inflammation and effects on gut bacteria.

Avoid the use of triclosan or other "sanitizers" in soaps and personal care products (e.g., deodorants). Triclosan promotes antibiotic resistance and also kills off beneficial bacteria. Wash with ordinary soap and water.

Avoid unnecessary antibiotics (antibiotics kill off bacteria, including beneficial bacteria).

Vaginal births are best - microbes from the birth canal populate the baby as it is being born. If one has a cesarean section, then one can immediately take a swab of microbes from the mother's vagina (e.g., using sterile gauze cloth) and swab it over the newborn baby. (See post discussing this research by Maria Gloria Dominguez Bello )

Breastfeeding is best - breastfeeding provides lots of beneficial microbes and oligosaccharides that appear to enrich good bacteria in the baby’s gut.

Live on a farm, or try to have a pet or two. Having pets, especially in the first year of life,  ups exposure to bacteria to help develop and strengthen the immune system, and prevent allergies. Pets such as dogs and cat expose humans to lots of bacteria.

Get regular exercise or physical activity. Professional athletes have more diverse gut bacterial community (considered beneficial) than sedentary people.

Can consider taking probiotics - whether in foods or supplements. They are generally considered beneficial, but not well studied, so much is unknown. The supplements are unregulated, and the ones available in stores may not be those that are most commonly found in healthy individuals. Research the specific bacteria before taking any supplements. Researchers themselves tend to stay away from probiotic supplements and focus on eating a variety of all the foods mentioned above (fruits, vegetables, whole grains, seeds, nuts, legumes, fermented foods) to feed and nurture beneficial bacteria.

After posting yesterday "Probiotic Misconceptions", I was pleasantly surprised that today's NY Times had an article (by Jane Brody) raising similar concerns. What was good is that she wrote about supplements not being regulated. She also left out that probiotic beneficial organisms are found in more than the gut. A case in point being the sinuses - because healthy sinuses also have Lactobacillus sakei (according to the Abreu et al study of 2012), and which has been the basis for my family's successful kimchi treatment for sinusitis (see Sinusitis treatment link for the method). From the NY Times:

Probiotic Logic vs. Gut Feelings

The label on my bottle of Nature’s Bounty Advanced Probiotic 10 says it contains 10 probiotic strains and 20 billion live cultures in each two-capsule dose. The supplement provides “advanced support for digestive and intestinal health” and “healthy immune function.” I have no way to know if any of this is true. Like all over-the-counter dietary supplements, probiotics undergo no premarket screening for safety, effectiveness or even truth in packaging. 

To be sure, lay and scientific literature are filled with probiotic promise, and I am hardly the only consumer who has opted to hedge her bets. The global market for probiotic supplements and foods is expected to reach $32.6 billion this year,with a projected annual growth of 20 percent or more.

 Beneficial micro-organisms have since been shown to inhabit three main locations in the digestive tract: the stomach, the lower part of the small intestine and the large intestine. To better understand the current enthusiasm for enhancing the body’s supply of these micro-organisms, some definitions are needed.

Prebiotics are nondigestible carbohydrates that stimulate the growth and activity of beneficial micro-organisms (that is, probiotics) in the gut. They are found naturally in oats, wheat, some fruits and vegetables (bananas, onions, garlic, leeks, asparagus, soybeans, honey and artichokes), and in breast milk, and they are added to some infant formulas.

Probiotics are defined by the World Health Organization as “live micro-organisms which when administered in adequate amounts confer a health benefit on the host.” The ailments that probiotics are said to benefit range from infection-caused diarrhea, inflammatory bowel diseases and irritable bowel syndrome to asthma, allergy and Type 1 diabetes.

Synbiotics are a combination of prebiotics and probiotics. They are found in so-called functional foods like yogurt and kefir, fermented foods like pickles and some cheeses, and in some supplements.

That probiotic organisms are important to health is not questioned. As researchers at the Institute for Immunology at the University of California,Irvine have written intestinal micro-organisms play “an important role in the development of the gut immune system, digestion of food, production of short-chain fatty acids and essential vitamins, and resistance to colonization from pathogenic microorganisms.”

Dr. Walker has explained that probiotics enhance defensive action by the cells that line the gut. When a person takes antibiotics, especially the broad-spectrum antibiotics most often prescribed, many of these beneficial microbes are destroyed along with the disease-causing bacteria. Patients on antibiotics are often told to consume yogurt with active cultures to replenish the beneficial organisms.

In an extensive review of the evidence published in 2010 in the journal Pediatrics, an expert committee concluded that probiotics might limit the course of virus-caused diarrhea in otherwise healthy infants and children. But the committee said there was not sufficient evidence to justify routine use of probiotics to prevent rotavirus-caused diarrhea in child care centers. Nor did the committee endorse taking probiotics during pregnancy and nursing or giving them to infants to prevent allergic disorders in those at risk.

Only a small percentage of probiotic foods and supplements have the backing of peer-reviewed published research. They include Dannon’s Activia yogurt and DanActive drink and the supplements Culturelle and Align. Although kefir contains even more probiotic strains than yogurt, clinical studies have not shown it to be effective in preventing or treating infectious diarrhea.

The challenge in taking probiotics is to get the microbes past the stomach, where most are killed by gastric acid, said Robert Dunn, a biologist at North Carolina State University. Once in the intestines, they must compete effectively with the microbes already present.

Dr. Dunn, author of "The Wild Life of Our Bodies," says there is good reason to remain skeptical of probiotics“There are hundreds of kinds of prebiotics and probiotics in stores,” he said. “As a consumer, it’s almost impossible to figure out what is best. What are the specific species in your intestines, and how will what you take compete with them?” Still, he added, taking them doesn’t seem harmful. 

There is growing evidence for the role of the appendix in restoring a healthful balance of microbes in the body. Though long considered an expendable, vestigial organ, the appendix is now being looked at as “a storehouse of good bacteria,” Dr. Dunn said. In a study of recovery rates from Clostridium difficile, which causes a severe form of infectious diarrhea, often following antibiotic therapy, patients whose appendixes had been removed were more likely to have a recurrent infection than those who still had appendixes.