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Diarrhea
By Lindsay Clapp-Hansen
Medical Nutrition Therapy
November 25, 2002
Probiotics
Microbes found in the food supply that
enhance human health.
Criteria: bacteria of human origin, able to
adhere to the intestinal mucosa, have
potential to colonize in the GI tract, can
produce antimicrobial substances, stable
against bile, HCl, and other acids, enzymes,
and oxygen, and determined to be safe and
effective.
Diarrhea Described
Diarrhea is frequent loose stools, along with
an excessive loss of fluid and electrolytes
(K & Na especially), abdominal cramping,
pain, and often presence of a fever.
It can be acute or chronic, and is secondary to
an underlying disease or condition or
pathogenic bacteria within the GI tract.
Types of Diarrhea
1.
2.
3.
4.
Results
1. There was a 11% decrease of diarrhea in
the initial two weeks of probiotic therapy
when comparing the experimental group
to control.
2. By the third week, there was a 30%
decrease difference between the two
groups.
Confounds
The study in 1989 was lacking in clearly quantifiable
values of probiotic dose.
The study that was completed in 1999 was a break
through because there were standardized amounts of
probiotics given. However, the age range of children
does not enable a clear dose per weight determination to
be made.
In all of the studies reviewed concerning antibioticrelated diarrhea, there were one or more of the following
confounds: lack of specific detail of amount and
consistency of diarrhea and the quantity and viability of
the probiotic strains administered. There leaves much to
be researched.
Travelers Diarrhea
It has been estimated that 20-50% of all people
who travel are struck by diarrhea. The frequency
and duration is associated with the destination and
location of the traveler.
Cause: it is presently unknown, but believed to be
due to a change in ingested microbial content and
stress. Pathogenic E. coli is usually protagonist.
Result: unknown, however results in diarrhea.
Infectious Diarrhea
Infectious diarrhea can be induced by any
pathogenic virus or bacteria. Rotaviral diarrhea
will be covered here.
Rotavirus attacks the GI tracts of newborns and
infants, and because of this it can be well isolated
and studied in relation to probiotic dosing.
Rotavirus induces biphasic diarrhea, initially
osmotic and then secretory.
Lactose Intolerance
Lactose intolerance presents in 70-100% of
adults worldwide.
Probiotics function as a lactase isomer.
When probiotics deteriorate, they produce
B-D-galactosidase from the cell wall. This
is an isomer of lactase which then destroys
ingested lactose.
B-D-Galactosidase
In order for the B-D-galactosidase to appear
in the GI tract, the probiotic must be
ingested in a viable state, and then
breakdown.
This means that frozen yogurt and
pasteurized yogurt are not as effective as
fresh yogurt, because they do not produce
the B-D-Galactosidase.
Yogurt Conundrum
So why is pasteurized yogurt tolerated?
One study states that is it the decreased intestinal
transit time, which means that the lactose spends
less time as an undigested molecule within the
large intestine. If the lactase were to spend a longer
period of time in the large intestine, fermentation
and osmotic diarrhea would result.
Other studies state that pasteurized yogurt causes a
delay in gastric emptying and orocecal transit time,
because the probiotics and organic acids they
produce result in a lower osmotic load.
So now what?
There must be more research on how non-viable
(aka pasteurized) probiotics alter the lactose
intolerants GI tract that makes the person able to
consume lactose-containing yogurt.
Over and over again the B-D-galactosidase has been
seen to break down lactose, so non-heat treated
yogurt is acceptable.
Overall, the viable probiotics have been seen to have
a positive effect on lactose intolerant consumption of
dairy. Additionally, there is some manner in which
non-viable microbes are aiding in the acceptability
of lactose in the intolerant individual.
Conclusion
Probiotics are able to decrease the length/incidence
of antibiotic-induced diarrhea through competitive
exclusion.
Probiotics were seen to decrease the severity and
length of travelers diarrhea, especially among the
elderly.
Rotaviral-associated diarrhea cases were
positively altered when oral probiotics were
administered.
Conclusion
Lactose intolerance and probiotics is still
controversial. Viable probiotics clearly have a
positive function. Pasteurized probiotics are an
unknown area at present.
IBD is likely not significantly altered through
probiotic supplementation, however probiotics
could potentially be used instead of antibiotics to
control flare-ups, which may decrease the
incidence of antibiotic-associated diarrhea.
Areas of Research
The correlation between probiotic therapy
and increased production of IgA.
Determining the best strains and the
quantities that are needed to support
intestinal health promotion.
Research that has minimal confounds so
that it will be honored by the scientific
community.