July 15, 2013

Top 5 Signs of a Healthy Kombucha Brew

Brewing Kombucha at home is a fun and easy process. Like most hobbies, the more you brew, the greater your skillset.
However, to the newbie, the Kombucha brewing process can be fraught with uncertainty, mostly due to lack of information. Oftentimes the mere sight of the culture alone is enough to inspire shudders of revulsion to the uninitiated. With experience comes familiarity but first you must learn to “speak Kombucha.”Heck – you might end up like me, singing to your cultures and calling them your Boochie Babies! Coochie coo Boochie boo!
Since the SCOBY can come in a variety of shapes, sizes and colors, it can be easy to mistake a healthy brew for a science experiment gone awry. However, using the guidelines below, you too will be able to recognize the 5 signs of a healthy Kombucha brew.

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Kombucha smell
Kombucha has its own special smell that longtime brewers will immediately recognize. The signature sweet-sour smell of Kombucha wafting from the brewer is a unique delight. It may take a couple of days for the smell to appear but it is unmistakable once you learn it. Sometimes described as fermented or beerlike, it also has notes of vinegar and a slightly sour pungency that indicates a healthy KT. If you store your KT in a smaller room, you may notice the smell is stronger than when stored in a more open space. 
TRY THIS – Smell your batch everyday and taste it too. You will quickly learn how to detect how much sugar is present with just your nose.
Hannah Crum, the Kombucha Mamma!Kombucha Mamma Sez: “Does your brew smell like rotten eggs? Check your water sourceSome municipal and well water sources may contain sulpher producing bacteria that can create a ‘rotten egg’ smell.

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One of the most obvious signs of a health Kombucha brew is the formation of a new SCOBY (Symbiotic Culture oBacteria and Yeast – often referred to as a “baby”). While SCOBY growth will vary with the seasons due to differences in temperature, air pressure and the like, the culture is hardy and is constantly reproducing as part of its survival strategy. SCOBYs do not miraculously appear fully formed, but grow in gradually until the entire surface area of the brewing vessel is covered. This survival strategy creates a seal which slows down evaporation and allows for the anaerobic fermentation to occur.
Since Kombucha is of nature (as we are) it follows the seasons. In the summer, the Kombucha ferments very quickly and SCOBY growth is more rapid. In the winter when the temperature is cooler, SCOBY growth will still be present but may be much thinner. It can also take longer for the brewing cycle at this time of year.
Hannah Crum, the Kombucha Mamma!Kombucha Mamma Sez: “Remember! Taste is King. Let your tongue be the ultimate tester rather than your eyes because you may have a delicious Kombucha even if there is thin SCOBY growth.”

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Since the culture is a symbiosis of both bacteria (the SCOBY itself) and yeast (the brown strands), it is important that both are in balance. In the early stages, before the culture has fully formed, you may notice yeast congregating at the top of your brew. They look like brown strands or clumps (or a brain!) that eventually attach themselves to the underside of the culture or fall to the bottom of the vessel when they expire. Some confuse the yeast blooms for mold because beneath the newly forming culture they may look bluish or black.
Hannah Crum, the Kombucha Mamma!Kombucha Mamma Sez: “If you still aren’t sure if you have mold or normal culture growth, take a look at these Kombucha mold photos or send a photo to Kombucha Kamp and we will help you identify what you are seeing.”
Again, balance is key – so you want to have some yeast, but not too much. For that reason, it is important to always use starter liquid from the top of your brew where it is bacteria rich. Only using starter from the bottom of your vessel may result in “beery” Kombucha. Check out this article on balancing yeast and bacteria in Kombucha if you suspect yours is out of balance.

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One of the Kombucha culture’s most important defense mechanisms is its low pH. The average pH of properly fermented Kombucha tea is 3.2-2.5. The high acidity prevents other potentially harmful microorganims from colonizing the culture. In fact, the bacteria and yeast work so well together, that they kill other harmful bacteria on contact. Although making Kombucha at home seems daunting, it is actually quite safe.
TIP! Use a pH meter to monitor your brew’s progress.
However, pH will not indicate that your brew is ready to drink as it will often reach the desired pH within the first 3 days of brewing. Therefore, you need to use your taste buds to tell you when your brew is ready. Remember, the longer it ferments, the more sugar is converted and the tarter the flavor. Bottle conditioning will mellow the flavor.
Hannah Crum, the Kombucha Mamma!Kombucha Mamma Sez: “Although Kombucha’s pH is low, once it hits the body’s digestive system, it has an alkalizing effect, like vinegar & lemon juice.”

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A freshly brewed batch of starter tea can be quite dark, depending on what type of tea you use. Tannins give tea its color and astringency.
As the culture goes about its business of converting sugar into healthy acids, the tannins are also converted. This causes the color of the tea liquor* to gradually lighten, shifting from dark brown to a lighter tan color.
Hannah Crum, the Kombucha Mamma!Kombucha Mamma Sez: “Remember! If you are using green or white tea, the color shift may not be as dramatic but will still be noticeable.”
*Tea liquor is the term used to refer to the liquid created when tea is added to water.
There is no alcohol in tea liquor.

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Learning to “speak Kombucha” is a fun and informative process. Use a notebook to jot down your observations. Remember – Kombucha is a living organism and as such will not behave exactly the same from batch to batch, month to month. Learning to recognize these signs will hel

The amazing health benefits of kombucha

Wednesday, July 03, 2013 by: Dr. David Jockers
Tags: kombuchahealthy drinksSCOBY


Learn more: http://www.naturalnews.com/041051_kombucha_healthy_drinks_SCOBY.html#ixzz2Z8NN5Rj1Kombucha is a symbiotic culture of bacteria and yeast (SCOBY) that forms a zoolgleal mat. This unique beverage has been used for over 2000 years to improve health and fight against infection and chronic disease. The Ancient Chinese called Kombucha the "Immortal Health Elixer" as they revered it for its remarkable health benefits.

Kombucha cultures typically contains many strains of beneficial yeasts that turn sugar into alcohol. One particular strain of bacteria, Gluconacetobacter xylinus ferments the alcohol from the yeast into acetic acid. This lowers the alcohol content in the Kombucha and increases the probiotic metabolite content.

The kombucha mother

The G. xylinum bacterium makes up most of the physical structure of the kombucha mother. The kombucha mother is basically a floating piece of fibrous cellulose with these beneficial microorganisms. The presence of the mother is a sign of an active and alive kombucha. No mother is a sign of pasteurization or processing.

The acidity of the finished kombucha product prevents contamination by airborne mold and bacterial spores. The bacteria and yeasts within the kombucha are also thought to produce antimicrobial defense molecules to protect from contamination as well.

Kombucha is loaded with unique nutrients

Kombucha is loaded with organic acids, active enzymes, amino acids and polyphenol anti-oxidants. The most common components include the various organic acids such as acetic acid, butyric acid, usnic acid, oxalic acid, malic acid, gluconic acid and lactic acid. It also contains active enzymes and probiotics.

Kombucha is typically produced in a sweetened green, white or black tea. The best fermentation process uses an organic evaporated cane juice or honey although too much honey can disturb the stability of the culture. Most of the sugar will be remade into organic acids that blunt the blood sugar response so it is very low glycemic and non-inflammatory.

Improves joint function

Kombucha is rich in glucosamines which helps preserve cartilage structure and prevent joint degeneration. Glucosamines increase hyaluronic acid production within the joint which binds moisture thousands of times its weight in the joint cavity. This provides the joint with structure, moisture, lubrication and flexibility while protecting against free radical damage.

Improves digestion and immunity

Kombucha is loaded with probiotic bacteria and yeast that make their way into the gut and ward off parasites and pathogens. It is particularly good at minimizing Candida and improves digestion and nutrient assimilation. Kombucha enhances immunity by inoculating the gut with healthy microorganisms and providing anti-oxidants and enzymes.

Kombucha helps the body cleanse

This beverage is loaded with enzymes and organic acids that help to detoxify the body. This reduces the load on the pancreas, liver and kidneys and helps the body rid itself of unwanted wastes and destroy cancer cells. Kombucha is rich in glucaric acid which has potent anti-cancer activity.

Nobel Prize winning Russian author Alexander Solzhenitsyn credited drinking kombucha throughout the day, each and every day, helped him beat stomach cancer. This was during his time in the soviet labor camps. President Ronald Reagan was so moved by Solzhenitsyn's testimony that he used kombucha to help him stop the spread of his cancer in 1987.

Sources for this article include:

http://en.wikipedia.org/wiki/Kombucha

http://www.foodrenegade.com/kombucha-health-benefits/

http://drleonardcoldwell.com/2012/10/03/kombucha-health-benefits/

About the author:
Dr. David Jockers owns and operates Exodus Health Center in Kennesaw, Ga. He is a Maximized Living doctor. His expertise is in weight loss, customized nutrition & exercise, & structural corrective chiropractic care. For more information go to www.drjockers.com To find a Maximized Living doctor near you go to www.maximizedliving.com Dr. Jockers is also available for long distance phone consultations to help you beat disease and reach your health goals 

Learn more: http://www.naturalnews.com/041051_kombucha_healthy_drinks_SCOBY.html#ixzz2Z8NK7Jbi

Probiotics are not only powerful gut-healers - they improve bone density, study shows

Thursday, March 07, 2013 by: PF Louis
Tags: probioticsbone densityintestinal health


Learn more: http://www.naturalnews.com/039382_probiotics_bone_density_intestinal_health.html#ixzz2Z7unWhYzA doctor of traditional Chinese medicine (TCM) once told this author that "disease begins in the gut." Ayurvedic medicine also has a similar premise. Bad or sub-optimal digestion leads to all sorts of disease. That includes disease beyond the gastrointestinal (GI) tract.

Dr. Natasha Campbell-McBride and others in Western medicine have taken this premise beyond physical ailments into the mind-body relationship with GAPS, or Gut and Psychology Syndrome, by treating mental disorders from ADD to Autism.

Their success has come from altering the diet to allow the gut to heal and good bacteria in the intestinal flora to thrive. (http://www.naturalnews.com/033094_gut_health_brain.html)

So there's more to the good bacteria in the gut than most think. Even more than digestion, as important as that is. These supportive bacteria in the gut also signal different parts of the immune system in other areas of the body. It's estimated that up to 80 percent of the immune system is involved with the gut's good bacteria.

The word probiotic means pro-life. These friendly, life-supporting critters are killed off by antibiotics. They're absent in dead foods that comprise the standard American diet (SAD), and are genetically disturbed by GMO transfer genes and viruses.
(http://www.naturalnews.com/031825_GMOs_threat.html)

Yes, GMOs destroy the immune system through the gut and more. And when is the last time you were advised to take probiotic supplements when you were prescribed an antibiotic? That's just not part of the medical monopoly's protocol, despite ongoing research that keeps finding different important aspects of probiotic bacteria.

Mainstream research into probiotic benefits

The study "Probiotic use decreases intestinal inflammation and increases bone density in healthy male but not female mice" was recorded in the Journal of Cellular Physiology late January 2013.

The University of Michigan State researchers fed mice Lactobacillus reuteri for a period of four weeks. Lacobacillus reuteri has been determined from other research to be effective at reducing gut inflammation and effective for treating inflammatory bowel disease.

The fact that inflammation in the gut has been associated with osteoporosis led the researchers to explore what improves gut inflammation as a possible application for bone disease.

The researchers discovered that male mice had improved bone density after ingesting Lacobacillus reuteri, but oddly; female mice did not demonstrate improved bone density. The tacit implication is females may need a variation of the probiotic used.

More research was called upon after discovering this link of probiotics and bone density to determine which probiotics would be the most appropriate for each person to prescribe as a medication for osteoporosis.

Other studies have discovered the importance of probiotics for improving health in different areas.

For example, in 2011 The Cochrane Library reviewed several studies and determined that probiotics such as lactic acid bacteria and bifidobacteria could help resist or resolve upper respiratory tract infection (URTI) from colds, flus, and even pneumonia.

Several studies have confirmed the efficacy of probiotics for prolonged infectious diarrhea among children and irritable bowel syndrome (IBS).

Obviously, the left hand doesn't know what the right hand does as more and more dead food, GMOs, and antibiotics are pushed by the food and medical industry.

You would be wise to stay away from the dead and genetically engineered foods and avoid synthetic antibiotics. At least dose heavily with probiotic supplements if forced into antibiotics.

Some natural antibiotics aren't so selective with what mini-critters they kill too. You may need probiotic supplements more than once in a while.

But for probiotic maintenance, search for raw dairy, create fermented foods, and consume prebiotic superfoods that encourage probiotic bacteria to flourish. (http://www.naturalnews.com)

We all need to get by with a lot of help from our little friends.

Sources for this article include:

http://www.gaps.me/

http://www.huffingtonpost.com

http://onlinelibrary.wiley.com/doi/10.1002/jcp.24340/abstract

http://www.huffingtonpost.com

Learn more: http://www.naturalnews.com/039382_probiotics_bone_density_intestinal_health.html#ixzz2Z7ueWs7f

Probiotics transform emotional response and affect your brain activity

Wednesday, March 27, 2013 by: PF Louis
Tags: probioticsemotional responsebrain activity


Learn more: http://www.naturalnews.com/039661_probiotics_emotional_response_brain_activity.html#ixzz2Z7uOXmRrThe health effects of our friendly bacteria of our gastrointestinal tract are rarely fully understood by most in the medical field, and even less appreciated by the general public.

The population's minority of health conscious consumers do understand the intestinal flora's digestive importance. As important and also under-appreciated as digestion is to our overall health, there is even more to those billions of little critters than digestion alone.

It has often been stated that our gut flora is responsible for at least 60 percent and up to 80 percent of our immune system. More than one study has discovered that "killer cells" are increased, triggered, and unleashed by friendly gut bacteria.

A strong, friendly critter colony also prevents Candida yeast overgrowth and leaky gut syndrome, which leaks digestive toxins into the blood stream before they can be eliminated through the bowels.

Research has shown that a low level of friendly gut bacteria is common among victims of Type II diabetes. (http://www.naturalnews.com)

Just when more are catching on to the importance of friendly gut bacteria for our overall health, along comes a handful of medical mafia renegades discovering that our guts should be considered our second brains. (http://www.naturalnews.com/033094_gut_health_brain.html)

The second brain as gut perspective

A recent early 2013 study conducted in UCLA's Geffen School of Medicine determined that probiotics from fermented milk has positive effects on people's emotional life.

The study used 36 women of normal health and divided them into three sections. One section was fed probiotic enriched fermented milk, another non-fermented milk, and the control group wasn't given any milk.

The researchers use MRIs and other emotional stimulus and analysis systems over a four week period with this conclusion: "Four weeks intake of a fermented milk with probiotics by healthy women affected activity of brain regions that control central processing of emotion and sensation."

The UCLA study involved one of the gut as second brain pioneers, Dr. Emeran Mayer, who is also the Director of the Oppenheimer Center for Neurobiology of Stress. The probiotics contained in the study's fermented milk were: Lactobacillus bulgaricus, Bifidobacterium animalis, Lacotcoccus lactis, and Streptococcus thermophiles.

They observed the fermented milk group demonstrating better task related responses, which corresponded to their instrument monitored increased cortex activity and mid-brain instrument neurotransmitter pathway improvements.

Other research has led to discovering a conduit between the enteric nervous system, located in the abdominal region around the gut, and the central nervous system. Neurotransmitters are produced in the enteric nervous system that connect with the brain stem.

The messages go both ways, from the brain to the gut and vice versa. This explains "butterfly" stomachs from anxiety and that sinking cold feeling in the stomach when dreading a situation or that "I know it in my gut" feeling of certainty.

GAPS or gut and psychology syndrome

From the laboratory of applied clinical healing, UK Dr. Natasha Campbell-Mcbride created a successful therapy for autism spectrum afflictions by bringing her son out of full blown autism.

Here's a quote from an article she wrote to explain GAPS and introduce her book, "Gut and Psychology Syndrome. Natural treatment for autism, ADHD/ADD, dyslexia, dyspraxia, depression and schizophrenia."

"Gut flora is something we do not think much about. And yet the number of functions the gut flora fulfills is so vital for us that if some day our digestive tract got sterilized we probably would not survive."

She has successfully improved the mental and emotional conditions as well as overall health and immunity for many using diet to restore an abundant intestinal flora balance of 85 percent probiotic bacteria to 15 percent pathogenic and/or Candida bacteria.

It's no coincidence that autistic children were brought to gastroenterologist Dr. Andrew Wakefield and his staff for treatment of intensely agonizing inflammatory bowel syndromes. (http://www.naturalnews.com/034629_Andrew_Wakefield_BMJ_Brian_Deer.html)

Sources for this article include:

http://www.drdavidwilliams.com

http://www.ncbi.nlm.nih.gov/pubmed/23474283

http://www.greenmedinfo.com

http://alsearsmd.com.benchmarkmails26.com

http://www.gaps.me/?page_id=20

Learn more: http://www.naturalnews.com/039661_probiotics_emotional_response_brain_activity.html#ixzz2Z7uLvsEA

Can Probiotics Help You Lose Weight?

The promising new research explained.


Probiotics are so hot right now. Every week bring news of another benefit tied to these tiny bacteria, which naturally congregate by the millions in your gut and intestines. Recent research has shown probiotics can aid digestion and ward off illness. And a new study, published in the British Journal of Nutrition, links one probiotic strain to fat loss. But can you trust the weight-reduction claims? 
First, the science: A team of Japanese researchers split 210 overweight people into three groups. While everyone consumed a daily 7-ounce serving of fermented milk, two of the groups drank milk spiked with varying amounts of a probiotic called Lactobacillus gasseri SBT2055, which past research has tied to fat loss. After 12 weeks, people slugging the probiotic milk formulas dropped roughly 8 to 9 percent of their visceral fat—a particularly unhealthy type that builds up around your heart and organs. Both probiotic groups also lost 1 to 3 percent of their belly fat, the study shows.

Your intestines manage the digestion and absorption of the foods you eat, explains study co-author Yukio Kadooka, a researcher with the Snow Brand Company in Japan. And it’s possible the probiotic featured in the study lowers intestinal inflammation and aids digestion, both of which could prevent the buildup of body fat, Kadooka says. 
But here’s the first problem: The probiotic strain highlighted in this research isn’t commercially available in the U.S., Kadooka says. The second problem: Like Kadooka’s study, most of the research linking probiotics to weight loss have been conducted (or funded) by companies who sell products containing those same probiotics. Now, that doesn’t mean the research isn’t valid, says Jeremy Burton, PhD, deputy director of the Canadian Research and Development Centre for Probiotics. “There’s nothing wrong with companies investing in studies, but it’s better when the study is backed up by independent research,” Burton adds.
So far, that independent research is either inconclusive or contradictory. A study published in the International Journal of Obesity found that while some strains of probiotics aid weight loss, others contribute to obesity.  “The research now is premature, and requires more analysis,” says that study’s co-author, Didier Raoult, MD, PhD, a Marseille, France-based microbiologist.
Your takeaway? Probiotics offer benefits “to be sure,” Burton says, and research has supported the digestive-health claims of products like Dannon’s Activia yogurt. But the jury’s still out on probiotics when it comes to weight loss. “There’s definitely a role for probiotics in dieting,” Burton adds. “But were still teasing apart all the mechanisms involved.” So for now, don’t count on a probiotic to replace your treadmill or diet plan. 


Read more: http://www.prevention.com/weight-loss/weight-loss-tips/probiotics-and-weight-loss#ixzz2Z7sdYx2g

Probiotic Therapy for Irritable Bowel Syndrome

George Aragon, MD, Deborah B. Graham, MD, Marie Borum, MD, EdD, MPH, and David B. Doman, MD, FACP, FACGcorresponding author

Abstract

The etiology of irritable bowel syndrome (IBS) is thought to be multifactorial, with several factors (including alterations in gut motility, small-bowel bacterial overgrowth, microscopic inflammation, and visceral hypersensitivity) potentially playing a role. Recent studies have suggested that probiotics may be useful in the treatment of IBS. Although the exact mechanism for how probiotics may aid in the reduction of symptoms commonly found in IBS is unknown, the effects of probiotics on alterations in gut bacteria appear to play a part. This review focuses on recent studies examining the role of probiotics in the treatment of IBS.
Keywords: Irritable bowel syndrome, probiotics, small-bowel bacterial overgrowth
Iritable bowel syndrome (IBS) is a common disorder affecting millions of people worldwide. Over the past few years, there has been an emergence of new concepts related to the pathophysiology of IBS. These concepts include alterations in gut motility, small-bowel bacterial overgrowth, microscopic inflammation, visceral hypersensitivity, and changes related to the brain-gut axis. This changing paradigm may allow for probiotic therapeutic opportunities in IBS. Probiotics are defined as “live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host.”This paper reviews the potential benefits of probiotics in patients with IBS.

Pathophysiology of Irritable Bowel Syndrome

Recent research suggests that IBS has a multifactorial etiology that includes alterations in gut motility, small-bowel bacterial overgrowth, microscopic inflammation, and visceral hypersensitivity. Some of these postulated components of IBS pathophysiology may potentially lend themselves to probiotic therapeutic benefits.

Alterations in Gut Motility

Disorders in gut motility have been observed in the stomach, small intestine, colon, and rectum of IBS patients.- Within the gut, there is a cyclic pattern of motility known as the major migrating complex, which consists of periodic, luminal contractions that propel intestinal contents from the stomach to the terminal ileum. Several studies in the literature have shown that patients with IBS tend to have abnormalities in these contractions. Vassallo and colleagues examined colonic tone and motility by measuring electronic barostat and perfusion manometry in 16 patients to assess for changes in IBS. The study showed that patients with IBS had a greater frequency of high amplitude prolonged contractions and greater preprandial colonic motility, which may account for the increased perception of pain in these patients. Another study, which used radiopaque markers to assess colonic transit times in IBS, showed that patients with diarrhea-predominant IBS had accelerated colonic transit. Although these alterations were seen in patients with IBS, as compared to normal controls, their findings are likely qualitative, rather than quantitative, and lack specificity. Additionally, the alteration in gut motility found in some patients with IBS appears to place them at risk for small-bowel bacterial overgrowth, which is another proposed etiology for IBS.

Small-Bowel Bacterial Overgrowth

Small-bowel bacterial overgrowth has emerged as a possible cause of IBS. In 1977, Vantrappen and associates described a reduction in the major migrating complex in patients with bacterial overgrowth.Further studies have confirmed this finding in patients with IBS and abnormal lactulose breath testing.However, studies showing the presence of small-bowel bacterial overgrowth in patients with IBS have been conflicting. A large study of 202 patients with IBS found that 78% of these patients had evidence of bacterial overgrowth via breath testing. In the study, 25 of 47 patients experienced eradication of bacterial overgrowth on follow-up after treatment with antibiotics. Analysis of this subset of patients revealed that those who were successful in the eradication of bacterial overgrowth reported improvement in their IBS symptoms. Another study, which was conducted by Pimentel and coworkers, looked at 111 patients with IBS and found that 84% had abnormal breath testing. These patients were randomized to neomycin or placebo for a total of 7 days. A follow-up questionnaire revealed that patients in the neomycin group reported a 35% reduction in symptomatology as compared to 11.4% in the placebo group. More recently, Peralta and colleagues assessed 97 patients who met Rome II criteria and found that 56% of these patients had positive lactulose breath tests. Fifty-four patients with positive tests were treated with a 7-day course of rifaximin (Xifaxan, Salix). Follow-up after 3 weeks revealed that 50% of patients had a subsequent negative lactulose breath test and a statistically significant improvement in their IBS-related symptoms. These results were similar to those found in a recent study by Majewski and associates, in which a 4-week course of rifaximin led to improvement in IBS-related symptoms and a negative breath test in patients who previously had positive tests. Although these results are encouraging, further research is needed in this area.

Microscopic Inflammation

Interest has recently emerged regarding the possibility of microscopic inflammation as a cause of IBS.Several studies have shown that patients with IBS have low-grade inflammation throughout the small bowel and colon.- It has been postulated that the release of certain inflammatory mediators, including interleukins and histamine, may affect nearby enteric nerves, causing alteration in gut function and sensory perception., Although this theory shows promise, efforts to treat low-level inflammation to improve symptoms have been disappointing. A study of 29 patients with postinfectious IBS who were randomized to either prednisolone 30 mg daily versus placebo showed that, although T lymphocytes decreased by 22% as compared to 11.5% in the placebo group, no improvement was noted in IBS symptoms.

Visceral Hypersensitivity

Visceral hypersensitivity has been recognized as one of the potential contributing etiologies of pain associated with IBS. It has long been known that patients with IBS have poor tolerance to rectal distention.- Other studies have confirmed that increased perception in visceral stimuli in patients with IBS can also be seen throughout the length of the gastrointestinal tract.- Interestingly, however, compliance and wall tone are similar in patients with IBS and in healthy control patients.Although increases in the perception of pain are common in patients with IBS, hypersensitivity has not been found to be a consistent indicator of disease. In fact, some studies show that only 60% of IBS patients perceive hypersensitivity to bowel distention., An additional confounder is that patients with IBS may be hypervigilant to pain, which may act as a potential bias in these studies.
Psychological factors have long been known to exacerbate symptoms of patients with known IBS. Although the exact effects of stress, depression, and anxiety on the gut remain unclear, serotonin appears to play a role. Serotonin is known to regulate secretory, motility, and sensory events in the gut; thus, changes in its concentration may contribute to the sensorimotor function in IBS. This mechanism provides the rationale for the use of selective serotonin reuptake inhibitors in the treatment of IBS.

Physiologic Benefits of Probiotics in Irritable Bowel Syndrome

Probiotics are live microorganisms with a vast array of therapeutic potential for gastrointestinal disease. They have been studied and used in many gastrointestinal disorders, with growing evidence for use in pouchitis, Clostridium difficile colitis, antibiotic-associated diarrhea, inflammatory bowel disease, and IBS. The emerging multifactorial pathophysiologic paradigm of IBS may create adjunctive probiotic therapeutic opportunities.
Probiotics have a beneficial effect on intestinal mucosa via several proposed mechanisms that include suppression of the growth and binding of pathogenic bacteria, improvement of the barrier function of the epithelium, and alteration of the immune activity of the host., Probiotics secrete short chain fatty acids, an action that results in decreased luminal pH and production of bactericidal proteins.Butyric acid, a byproduct of bacterial fermentation of fiber, has been shown to nourish colonic enterocytes, enhancing mucosal integrity., The DNA of probiotic organisms has also been shown to inhibit apoptosis of epithelial cells., In addition, probiotics may improve bowel dysmotility.
A study by Desbonnet and coworkers investigated the probiotic Bifidobacterium infantis on rats that were chronically subjected to a stressor (a forced swim test) for 14 days. The results were reductions in the levels of tumor necrosis factor alpha, interferon gamma, and interleukin 6 after stimulation of peripheral blood monocytes. Plasma levels of tryptophan and kynurenic acid were also significantly increased in the rats treated with B. infantis compared to controls. There was no improvement in performance during the stressor, though B. infantis may have had a role as an antidepressant by increasing the levels of tryptophan, a serotonergic precursor, and reducing pro-inflammatory markers. These raised levels of tryptophan can potentially reduce depressive overlay and aberrant enteric nervous system effects in IBS.

Studies on Probiotics

There is a limited amount of quality evidence for the empiric use of probiotics in IBS. The randomized controlled trials that have been performed are typically small and are limited by publication bias. Previous trials have typically included strains of Lactobacillus species, Bifidobacterium species, andPropionibacterium species, along with different probiotic combinations such as VSL#3 and SCM-III.

VSL#3

Kim and colleagues performed two double-blind, pla-cebo-controlled trials examining VSL#3 for the treatment of IBS symptoms., VSL#3 is a combination of probiotics that contains live bacteria including Bifidobacterium (B. longum, B. infantis, and B. breve); Lactobacillus (L. acidophilus, L. casei, L. delbrueckii ssp. bulgaricus, and L. plantarum); and Streptococcus salivarius ssp. thermophilus. The first trial by Kim, in 2003, evaluated the effect of VSL#3 on gastrointestinal transit and symptoms of diarrhea-predominant IBS. Twenty-five IBS patients were randomized to receive VSL#3 or placebo for 8 weeks. With VSL#3, the decrease in bloating was borderline significant, but there was no effect on gastrointestinal transit or other individual symptoms of IBS. Kim and associates performed a second placebo-controlled trial studying VSL#3 and its effects on IBS symptoms and colonic transit in 48 IBS patients, with abdominal bloating as the primary endpoint. VSL#3, as compared to placebo, led to a reduction in flatulence and a delay in colonic transit.

SCM-III

SCM-III is another probiotic combination of 3 different strains (L. acidophilus, Lactobacillus helveticus,and Bifidobacterium sp.), which was evaluated by Tsuchiya and coworkers in a study of 68 IBS patients. The study participants were randomly assigned to receive SCM-III or placebo for 12 weeks. There was an improvement in overall efficacy in 80% of patients at 12 weeks (P<.01), as well as improvement in bloating, abdominal pain, and bowel habits at different time intervals throughout the 12-week period. However, the limitations of this study included its single-blinded design, small study population, and use of pseudo-randomization.

Lactobacillus and Bifidobacterium Species

Saggioro performed a study with 70 IBS patients, randomizing them to 3 different treatment groups for assessing improvements in abdominal pain and severity scores of 7 IBS symptoms. These treatment arms included Group 1 (L. plantarum LP01 and B. breve BR0); Group 2 (L. plantarum LP01 and L. acidophilus LA02); or placebo. Both treatment cohorts showed significant decreases in abdominal pain and severity scores at 2 and 4 weeks; however, the major limitation of this study was the inability to perform statistical evaluation due to its small number of patients and its short duration of follow-up.
O’Mahony and associates performed a study in 77 patients diagnosed with IBS (based upon Rome II criteria) and grouped them into 3 different treatment arms. The patients received Lactobacillus salivarius UCC4331, B. infantis 35624, or placebo for a total of 8 weeks and then were assessed for the cardinal symptoms of IBS (abdominal pain/discomfort, bloating/distension, and difficulty of bowel movement), quality of life, and blood sampling for interleukin-10 and -12. Those patients randomized to the B. infantis 35624 arm showed a significant reduction in composite symptom score as well as a reduction in each individual symptom, with the exception of bowel movement frequency and consistency. The interleukin-10/-12 ratio, which is abnormal in IBS patients in the proinflammatory state, was normalized in the B. infantis 35624 arm, suggesting that the mechanism of action of this particular probiotic may have an immune-modulating effect. The limitations of this trial, as with other trials involving probiotics, include its small size and lack of power calculation; otherwise, it was a well-designed trial. The authors concluded that additional larger, randomized, controlled trials studying B. infantis 35624 are needed, along with further research regarding the mechanism of immune regulation in IBS patients.
A larger study by Whorwell and coworkers evaluating different doses of B. infantis 35624 was performed in 362 women diagnosed with IBS. The study participants were randomized to low or high doses of B. infantis or placebo and were followed for a total of 4 weeks. In the treatment group, there was a significant decrease in abdominal pain/discomfort (the primary endpoint) at 4 weeks, along with improvement in the secondary endpoints of bloating/distension, sensation of incomplete evacuation, passage of gas, straining, bowel habit satisfaction, and a reduction in composite symptom score. These benefits were only noted in the high-dosing group containing 1 × 10 CFU/mL of B. infantis, and not 1 × 10 CFU/mL of B. infantis. The authors concluded that the discrepancy in the efficacy of the higher and lower concentrations may have been secondary to the methods that the different formulations use to release the active agent within the intestine.
A study by Guyonnet and colleagues assessed 274 constipation-predominant IBS patients and randomized them to placebo or fermented milk yogurt (Activia, Dan-non), which containsBifidobacterium animalis (regularis) DN-173 010 for 6 weeks. In the treatment group, the health-related quality-of-life discomfort score improved, as well as bloating symptoms (both of which were primary endpoints), and there was an increase in stool frequency in patients with fewer than 3 stools per week. This yogurt (ie, B. regularis) may have promotility benefits for the alleviation of IBS bowel dysmotility and may shorten intestinal transit time.
Past studies involving the Lactobacillus species as either a single probiotic agent or in combination with other probiotics have been less impressive. A 6-month double-blind, placebo-controlled study by Kajander and associates evaluated 103 patients with IBS and randomized them to a probiotic mixture containing Lactobacillus rhamnosus GG, L. rhamnosus LC705, B. breve Bb99, and Propionibacterium freudenreichii ssp. shermanii JS, or to placebo and then followed them for 6 months. A 44% reduction in the symptom score (consisting of abdominal pain, distension, flatulence, and borborygmi) was seen in the probiotic group at the end of the trial. A recent meta-analysis by Moayyedi and coworkers reviewed 4 trials evaluating single strains of Lactobacillus and found no significant benefit in alleviating IBS symptoms in 200 patients.,-,,
Nine trials evaluated different probiotic combinations (most often including Bifidobacterium, Lactobacillus, and Streptococcus) in 772 patients and showed a significant effect in improving IBS symptoms.,-,,- Two trials involving Bifidobacterium, conducted by O’Mahony and associates and Whorwell and colleagues (both of which were previously mentioned in this article), were included in this meta-analysis and showed a trend toward improving IBS symptoms in 379 patients.,
Brenner and coworkers conducted a meta-analysis in 2009 that included 16 randomized controlled trials evaluating the efficacy, safety, and tolerability of probiotics in IBS patients. B. infantis 35624 was the only probiotic that showed any significant benefit in the composite symptom score of IBS patients.Bifidobacterium likely has a beneficial effect in the symptom relief of IBS either as a single agent or in combination with other probiotics, though the available data are inadequate and further well-designed trials are still needed.

Future Directions

Probiotics will likely have an emerging adjunctive therapeutic role in treating IBS. The studies to date simultaneously provide interesting observations and raise fundamental questions. Overall, many of the studies involved were small in size, of short duration, and had significant design flaws, but there is growing evidence that B. infantis is becoming the frontrunner for treatment of IBS. If larger, well-controlled studies involving other strains of probiotics are performed, we may begin to have other options regarding different probiotic species and for the treatment of more specific subsets of IBS symptoms.
Additional issues that still need to be determined include the most effective probiotic strain, dose, and duration of therapy; whether patients should be treated for specific IBS symptoms only; and whether there is a role for maintenance IBS therapy or only IBS therapy on an as-needed basis. In addition, cost-effectiveness analysis and safety profiles still need to be addressed in large, well-designed trials. As probiotics are not considered pharmaceutical drugs, they are not currently regulated by the US Food and Drug Administration, which would promote standardization for consistent clinical trials in the future.
Probiotics may have a role as a delivery vehicle for therapeutic payloads that are released at targeted areas of inflammation throughout the intestinal tract. The majority of this research has involved probiotics in the treatment of inflammatory bowel disease, but these studies may translate into future studies for IBS. One such example is the study conducted by Steidler and Neirynck in which recombinant Lactococcus lactis, engineered to secrete interleukin-10, was administered to mice with experimental inflammatory bowel disease, which showed that the probiotic was similar to steroids.
A recent systematic review performed by the American College of Gastroenterology Task Force on the management of IBS concluded that Lactobacillus does not appear to be effective in single organism studies and studies involving combinations of probiotics, though Bifidobacterium demonstrates some efficacy (Grade 2C evidence). Future avenues of research should focus on treating subtypes of IBS; evaluation of patients according to the Rome III criteria; safety, dosing, and concentrations of certain probiotics; and duration of treatment.

Contributor Information

George Aragon, Drs. Aragon and Graham are Gastroenterology Fellows at the George Washington University School of Medicine in Washington, DC.
Deborah B. Graham, Drs. Aragon and Graham are Gastroenterology Fellows at the George Washington University School of Medicine in Washington, DC.
Marie Borum, Dr. Borum serves as Professor of Medicine and Director of the Division of Gastroenterology.
David B. Doman, Dr. Doman serves as Clinical Professor of Medicine.

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