My 2 cents on Probiotics

DBwithUC,

I am sorry you took offense, my bad. I did not mean to offend you.

I've been feeling frustated and  a little bent out of shape by the various posts thrashing alternative options and yet in the same breath by the same posters saying "go big pharma"... just a sick and tired of the tirades... I didn't mean to take it out on you.

And I do appreciate your well thought out and well documented citings.

Yes, we both like VSL#3.

But, why is it that whatever comes out of big pharma and associated doctors is touted as "great" whereas herbs, etc... which have been around for decades is looked down upon? I'm not saying you're doing this, but that's pretty much the overview of many on this forum.

And maybe it's time for me to bow out, like another poster said (don't remember who) who got tired of all the negative discourse too...

 

I don't know if folks saw this paper, but it adds more credence to the probiotic story (and counteracts my earlier statement that the VSL#3 folks wouldn't do the study :) ).

Treatment of Relapsing Mild-to-Moderate Ulcerative
Colitis With the Probiotic VSL # 3 as Adjunctive to a
Standard Pharmaceutical Treatment: A Double-Blind,
Randomized, Placebo-Controlled Study

The American Journal of GASTROENTEROLOGY VOLUME 105 | OCTOBER 2010

OBJECTIVES: VSL # 3 is a high-potency probiotic mixture that has been used successfully in the treatment of
pouchitis. The primary end point of the study was to assess the effects of supplementation with
VSL # 3 in patients affected by relapsing ulcerative colitis (UC) who are already under treatment with
5-aminosalicylic acid (ASA) and / or immunosuppressants at stable doses.
METHODS: A total of 144 consecutive patients were randomly treated for 8 weeks with VSL # 3 at a dose of
3,600 billion CFU / day (71 patients) or with placebo (73 patients).
RESULTS: In all, 65 patients in the VSL # 3 group and 66 patients in the placebo group completed the study.
The decrease in ulcerative colitis disease activity index (UCDAI) scores of 50 % or more was higher in
the VSL # 3 group than in the placebo group (63.1 vs. 40.8; per protocol (PP) P = 0.010, confi dence
interval (CI) 95 % 0.51 – 0.74; intention to treat (ITT) P = 0.031, CI 95 % 0.47 – 0.69). Signifi cant results
with VSL # 3 were recorded in an improvement of three points or more in the UCDAI score (60.5 %
vs. 41.4 % ; PP P = 0.017, CI 95 % 0.51 – 0.74; ITT P = 0.046, CI 95 % 0.47 – 0.69) and in rectal bleeding
(PP P = 0.014, CI 95 % 0.46 – 0.70; ITT P = 0.036, CI 95 % 0.41 – 0.65), whereas stool frequency
(PP P = 0.202, CI 95 % 0.39 – 0.63; ITT P = 0.229, CI 95 % 0.35 – 0.57), physician ’ s rate of disease
activity (PP P = 0.088, CI 95 % 0.34 – 0.58; ITT P = 0.168, CI 95 % 0.31 – 0.53), and endoscopic scores
(PP P = 0.086, CI 95 % 0.74 – 0.92; ITT P = 0.366, CI 95 % 0.66 – 0.86) did not show statistical differences.
Remission was higher in the VSL # 3 group than in the placebo group (47.7 % vs. 32.4 % ; PP P = 0.069,
CI 95 % 0.36 – 0.60; ITT P = 0.132, CI 95 % 0.33 – 0.56). Eight patients on VSL # 3 (11.2 % ) and nine
patients on placebo (12.3 % ) reported mild side effects.
CONCLUSIONS: VSL # 3 supplementation is safe and able to reduce UCDAI scores in patients affected by relapsing
mild-to-moderate UC who are under treatment with 5-ASA and / or immunosuppressants. Moreover,
VSL # 3 improves rectal bleeding and seems to reinduce remission in relapsing UC patients.

I had seen this. As one of two clinical trials with VSL that I found in the literature, I wanted to see what dose they used. I had been doing one DS sachet daily and after some initial benefit it seemed to become less effective.

I think it is important to note that in this study, VSL did not significantly improve remission. The p-value is above .05. But it did significantly reduce some symptoms. An earlier study (I posted about both of these studies in some thread) did find a significant increase in remission. SO the evidence is positive, but slightly qualified.

BTW, I decided to do 4 DS sachets/day for 8 weeks (just like the studies). The noticeable benefit returned, but after 4 weeks I was not getting any increased benefit and was getting a lot of gas. I tapered back to 1-2 sachets/day without doing the full 8 weeks.

I recently skipped a few days both of the VSL and of my 2x weekly Rowasa, and I started to get a lot of GI rumbling, bloating, gas, and hourly loose stool and diarrhea - even waking a couple of times a night.

My bad.

I went back to 2 DS sachets daily, and temporarily (I hope) increased my Pred from 7.5mg to 20mg. This seems to have nipped things in the bud, and I am seeing improvement each day. Unfortunately, I was not like the patients who got remission. But, I do enjoy having less symptoms.

As for the "probiotics story", I don't think there is any doubt in the colitis research community that there is dis-regulation of the gut micro-flora with IBD. There is some confusion of whether the autoimmune leads to dysbiosis, or dysbiosis leads to IBD. There is also evidence that whichever comes 1st, the influence goes back and forth over time. Science did a special edition on the Gut Microbiota in the June 8 2010 edition. (www.sciencemag.org/site/special/gut_micro/index.xhtml

I really recommend the article discussing the bidirectional influence of immune system and gut microbes:

the website: said...
Published Online June 6 2012
Science 8 June 2012:
Vol. 336 no. 6086 pp. 1268-1273
DOI: 10.1126/science.1223490

Review

Interactions Between the Microbiota and the Immune System

Lora V. Hooper1,*,
Dan R. Littman2,
Andrew J. Macpherson3

Abstract

The large numbers of microorganisms that inhabit mammalian body surfaces have a highly coevolved relationship with the immune system. Although many of these microbes carry out functions that are critical for host physiology, they nevertheless pose the threat of breach with ensuing pathologies. The mammalian immune system plays an essential role in maintaining homeostasis with resident microbial communities, thus ensuring that the mutualistic nature of the host-microbial relationship is maintained. At the same time, resident bacteria profoundly shape mammalian immunity. Here, we review advances in our understanding of the interactions between resident microbes and the immune system and the implications of these findings for human health.

Post Edited (DBwithUC) : 8/13/2012 1:17:17 PM (GMT-6)

laurar said...
What are people's thoughts on VSL #3 sachets vs. VSL #3 capsules? Which is better in terms of getting the organisms to actually reach your colon?

I'm willing to try out the sachets (if I move up to DS) but at the same time, capsules work in a great way to release at a specific time, rather than hoping loose powder should make its way down to the colon.

stereofidelic89 said...

laurar said...
What are people's thoughts on VSL #3 sachets vs. VSL #3 capsules? Which is better in terms of getting the organisms to actually reach your colon?

I'm willing to try out the sachets (if I move up to DS) but at the same time, capsules work in a great way to release at a specific time, rather than hoping loose powder should make its way down to the colon.

I have had the capsules, and they are just plain gelatin capsules. They disolve pretty quickly in the stomach, and shouldn't offer any advantage in regards to specific time/location relaease.

I woudl be interested in an enterically coated VSL capsule. I am sure some of the organisms are being killed inthe stomach and 1st part of the small intestine.

I would like to throw my two cents in for Mutaflor, which is manufactured in Germany and contains the non-pathogenic e.coli strain Nissle 1917. Those if you in Canada or Europe, and those in the US like myself who are willing to travel to Canada to pick it up (the FDA has declared it a biologic drug and thus effectively have banned it unless it undergoes US drug trials) would be advised to throw it into the mix too. It is as expensive as VSL3 but It seems to finally be breaking the back of my latest flare. I do take VSL3 and a number of other brands as well. mutaflor, however, is one of the few , along with VSL3, with excellent double blind studies supporting it.

Post Edited (Probiotic) : 8/13/2012 4:54:50 PM (GMT-6)

I take two Mutaflor daily (contains 2.5 x 10 to the 8th)viable cells each. Since I started taking them soon after I started my 5ASA, I really don't know if they're making a difference. Seems like it might be chancey to back off and start up again.

Do any of you take more than 1 type of probiotic at once, or know if it's a good idea (or not).

InSoFla, I hope you keep putting your 2 cents in, I find your comments helpful.

about the acronym soup on the first page of this thread, what does OP stand for? I know, DQ (dumb question )

Lodi- yes many of us take more than one probiotic at once- I take a couple dozen of different strains daily, in about 5 different brands. Nothing wrong with that- remember, fecal bacteriotherapy implants hundreds (or more) strains of bacteria.

Re. the questionof what is better, VSL3 capsules or the DS satchets- From a probiotic standpoint it makes no difference if the numbers of colony firming units is equal. A DS satchet contains around 900 billion CFU and a capsule contains 125 billion, so with 7 capsules a day for example, one would get the sAme as 1 satchet... Price-wise I have calculated that they are roughly comparable , unless one actually gets an insurance discount on the DS (my insurer does not so it makes no difference)... But I have now find it more cost effective to not take huge doses of VsL3 but instead just a smaller dose and to save my money and soend it on mutaflor. Oh, I think I do better on VSl capsules than the satchets becAuse the latter contain sugar (maltose)- why they have to put that garbage in there is beyond me- if I need flOring I can add that myself, sheesh.

I failed to include the name of a probiotic that I have talked about on a different thread. It is Benebiotics, an enteric coated pill that has billions of good things. They are also very inexpensive compared to the VSL#3's, pills or packets. Just google Benebiotics. However, for me they are an OTC so are not covered where the VSL#3 DS packets are covered. My cost will be $4 for a month's supply.

Great information! I've been wanting to try more probiotics, so this is great confirmation for me to start. I'll plan to start with VSL#3, hopefully I'll find it at the pharmacy but I can see I can also order it online.

I am so amazed at how helpful everyone is here. I feel like I'm on a good track.