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Probiotic Tips; The Numbers

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Ulcerative Colitis
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Posted 9/28/2007 1:32 AM (GMT 0)
Edits to original post in green...

When it comes to helping UC flares with probiotics you need to have live bacteria and a lot of it the studies are very limited and conclusions from them are in the anecdotal range. For severe flares, these studies show the information posted on the VSL#3 website indicates you need 1800 billion to 3600 billion colony-forming units (CFU) per day. My assumption is you need less for mild flares and even less for maintenance. You can do the math and determine whether the product you're about to buy is a good deal or not. According to my local compound pharmacist and 10 articles I've read it simply costs more to produce a more potent product. 

If your pills contain only 5 billion CFU, as does the Primadophilus Reuteri I bought, then you probably aren't getting a good deal. For $17 I got 90 pills in a container. At 5 billion CFU per pill I needed 360 pills or 4 containers per day--that's $68 per daily dose.

The best deal I've seen thus far is VSL#3 which gives 450 billion live CFU per packet. It's cost is about $160 for 60 packets and each packet delivers 450 billion live CFU. That equates to $10.67 per day for a 1800 billion CFU dose. This is still expensive.

I'm looking for a better deal if anyone knows of one please respond (live bacteria from trusted sources, obviously). I've purchased VSL#3 in the past but would like something less expensive.

I wouldn't get wrapped over the axel about "enteric coated" products. If you did happen to have a highly acidic stomach and were worried about killing a lot of the bacteria then just avoid taking the probiotic on an empty stomach (drinking water will dilute the acid thereby raising the pH). That way your sure to have the bacteria live. Based on the limited amount of information I've read about stomach acidity levels and whether certain bacteria can survive what environment.

Posted 9/28/2007 4:47 AM (GMT 0)
Well I take only one primadophilus reuteri per day and do pretty good with just 5 billion cfu...VSL is apparently the best....that's why it is so expensive.

:)
Posted 9/28/2007 5:14 AM (GMT 0)
You know though when you think about it the health plans should cover and allow pro biotics like prescriptions. If taking them can help the flaring, possible remissions and make for a healthier patient then overall the visits to the Dr, hospitals etc should be reduced resulting in lower costs in the big picture.

I am assuming there are no pro biotics that would fit in to a covered prescription from a doctor that insurance companies cover.
Posted 9/28/2007 11:20 AM (GMT 0)
1 packet of VSL#3 provides 450 billion cfu and costs about $2.67. That's equal to a whole 90 pill bottle of the Primadophilus Reuteri which costs about $17 or more.

If folks have extra money to burn then I suppose paying 6 times or more for the convenience of using pills is worth it but most people like a better deal.

VSL#3 may be a lot better deal than most others but I'm still looking for something better. It's only a matter of time before someone starts really cutting that cost down. VSL#3 makers need some competition.

Posted 9/28/2007 5:36 PM (GMT 0)
Geez Burli what's with the negative attiude toward primadophilus reuteri? I understand you're trying to make a point about the necessary amount of probiotics needed but there are other probiotics that cost alot more and likely don't even have as much as 5 billion cfu in them.

Quite obviously you're looking for something better and cheaper than VSL3 and to date as far as I know there is nothing so don't let your frustrations make you so negative...it's not healthy.

:)
Posted 9/28/2007 6:05 PM (GMT 0)
eyes  
Posted 9/28/2007 6:38 PM (GMT 0)
How many CFU reach the gut after going through all the digestive juices and stuff? I assume that something coated in a pill form would have a better chance than a packet of powder.
Posted 9/28/2007 7:09 PM (GMT 0)
There is also a difference with the probiotics in each brand. L. Reuteri is supposed to be good for UC, but not found in VSL#3. Plus, if you want your probiotics to thrive, you need a good prebiotic (FOS and other stuff), because they divide rapidly. So it not just the numbers, but also which types are present, which could be why certain brands work better for some and not as well for others. Here is the breakdown:

Primadophilus Reuteri contains:
Lactobacillus rhamnosus †
Lactobacillus reuteri †
Lactobacillus acidophilus †

VSL#3 contains:
Bifidobacterium breve
Bifidobacterium longum
Bifidobacterium infantis
Lactobacillus acidophilus
Lactobacillus plantarum
Lactobacillus casei
Lactobacillus bulgaricus
Streptococcus thermophilus
Posted 9/28/2007 7:30 PM (GMT 0)
All this talk about probiotics reminded me of a question my GI asked me last visit; she asked me if the probiotics worked for me and in what ways, what evidence did I have (evidence is my word). She was not critical at all just curious and open to my respones. To tell you the truth, I really have no evidence that probiotics work for me, I just take it, have been for years, but I also take a lot of other medications and supplements, so I'm not sure what really is the one thing that's making the difference or a combination? So, does anyone know of any research re: the use of probiotics, trials, evidence type stuff--just curious.
Posted 9/29/2007 4:51 AM (GMT 0)
I got intrigued with probiotics when I heard how well it worked for many different diseases and included IBD (in Digestive Wellness, by Lipski), with apparently some research backing and this was just a month ago.  I was at the bookstore and I noticed another book called the "Probiotics Revolution" by Huffnagle and went immediately to the index, because I'm tired of the cure all diets that do not reference IBD.  Well this guy is a Prof of Internal Medicine, Microbiology, and immunology at Univ. of Mich. Med. Ctr., so he at least has some reputation and I liked that he talked with references, because then I could look them up and he talks like a sensible guy (as a prof. should do).  Here is some stuff to look up:

http://www.vsl3.com/VSL3/research-ulcerative.asp

click on the superscripts for the references.  Here is one that I found:

http://www.amjgastro.com/showContent.asp?Did=4&SessionGUid=007FF116-16C6-421C-AF8E-68F8ECA1F2C4&id=ajg_4179472005&type=abstract

For mild to moderate case of UC in 6wk duration, 77% went into remission (this might be the same as Burli's reference).  VSL3 is also good in treating ileal pouchitis. 

Another and yes it is a probiotic, showed that it worked as well as the mesalazine in retaining remission with nearly identical results. Escherichia Coli Nissle 1917:
http://gut.bmj.com/cgi/content/abstract/53/11/1617

Here is a pilot trial that looks very promising and I am currently taking as of yesterday, with some two-thirds going into remission with this non-pathogenic probiotic yeast:

http://www.florastor.com/client_images/2003_guslandi_a_pilot_trial.pdf

The book I mentioned above lists those probiotics that have a significant number of studies done and is worth looking into (and the specific strain):

L. casei shirota

L. plantarum 299v

L. rhamnosus GG, LGG, (4)

S. boulardii lyo

VSL#3

Very promising research:

B. infantis 35624

L. salivarius UCC118, 433118

The annoying part is that I mentioned some of this to my GI and he's like, "Oh yeah, I know about this."  Is that it?  I guess because much of this is still in the works and not as definitive as a Dr. would need it to be, but it did bother me he didn't get into any of the specifics, as if all I could do is choose from 5-ASA, 6-MP, steriods, remicade, or surgery at this point, otherwise I am on my own.  I am new with taking probiotics this seriously, but all I have is a hope that some of the research will hash out to a path to something good.  Okay, I've gone on long enough, but I hope this information is useful to everyone.

Posted 9/29/2007 5:11 AM (GMT 0)

Here's a link...just scroll to the top of the page when the article loads in to read it from the beginning...

http://www.cbc.ca/health/story/2006/10/12/probiotics.html#skip300x250

:)

Posted 9/30/2007 5:58 AM (GMT 0)
Anyone has personal experience that probiotics helps? Thanks Peter
Posted 9/30/2007 3:57 PM (GMT 0)
Has anyone tried using the VSL#3 "topicly" such as mixing it with a retention enema?  I'm thinking of trying this and was just curious if there's any opinions out there. 
Posted 10/1/2007 1:49 AM (GMT 0)
Have posted this link (below) before several times but I think it very interesting.  None of us can do double blind studies ourselves,  therefore all of our personal experiences are antidotal.  We really don’t know what is working even if we are taking no meds, try probiotics and we go into remission. We may assume it was the probiotics but it could be pure coincidence, as this disease can go into spontaneous remission.  Large scale scientific studies are needed and don’t exist for probiotics. That said, they are definitely worth a try. If you read the info on the link you can see why very large doses of probiotics are probably needed to work and unlike what is being promoted it doesn't matter if they are dead or alive. This study sees a mechanism contrary to what are currently being put forth by the probiotic manufacturers http://tinyurl.com/34m8qr
Posted 10/1/2007 1:18 PM (GMT 0)
Agree.

Thanks, rdm.

My original post is thus updated and, I believe, more accurately stated.
Posted 10/1/2007 5:30 PM (GMT 0)
IndianaUC: I am not sure about a retention enema being better. From the article rdm posted, it appears that it may not matter if it is alive or dead, so it may just be easier if it is just orally taken. Plus, the longer it is in your system, the more opportunity it has to multiply. I don't remember the numbers, but I thought it doubles every half hour or something like that (or maybe ideally). VSL#3 shows strength in numbers and I am curious to know whether that is true for all types of flora.

There are still a lot of questions and probiotic therapy needs more development and I agree it hard to say what is working with all the individual factors to consider, especially without a controlled study. Though there are may not be huge studies in this area (however, the E. coli Nissle 1917 study above involved 327 persons), I believe there are significant ones and hopefully what we try falls into the percentage that it does work for.
Posted 10/2/2007 3:41 AM (GMT 0)
relativelyquantum: you're only on Colazal plus non prescriptions; was this the recipe that took you into remission with previous flares or are you trying less prescriptions? What probiotic are you taking and how much a day?
Posted 10/2/2007 3:51 AM (GMT 0)
I am considering trying VSL#3 and I found from the site that it contains lactic acid bacteria. I just want to ask if it is ok for lactose intolerant people to take this?
Posted 10/2/2007 4:18 AM (GMT 0)
I'm not sure but I know that the primadophilus reuteri actually aids with lactose intolerance (along with high cholesterol which I also had), I was severely lactose intolerant, but since I take the primadophilus daily I no longer have to use lactaid pills/products.

:)
Posted 10/3/2007 1:59 AM (GMT 0)
ach13, the VSL#3 website has the following:

"Can I take VSL#3® if I have an intolerance to dairy products?

Some dairy ingredients are used in the culture medium but are removed during fermentation and concentration. There might be trace amounts at very low levels and, for this reason, VSL#3® is not defined as a dairy-free product but as a non-dairy product. Evidence suggests that probiotics may be useful in the treatment of patients with lactose maldigestion and lactase deficiency. Recent studies have demonstrated that lactose is better digested from yogurt than from milk by lactase-deficient individuals and yogurt ingestion by these patients is paralleled by reduced symptoms. Many patients confirmed that their intolerance was greatly reduced with the use of VSL#3®. If you are lactose intolerant, you may wish to start with a very low intake of VSL#3® to see how you respond before increasing the amount. "

Thus, just as primadolphilus reuteri claims to aid with lactose intolerance, VSL#3 makes a similar claim.
Posted 10/3/2007 2:32 AM (GMT 0)
Thanks. I'm thinking of trying the capsules first since they have lower bacteria count than the packets and are also much cheaper.
Posted 10/3/2007 4:34 PM (GMT 0)
Burli: Honestly I have never been in remission, only in a mild state (3-5 BM/dy) and could handle fairly difficult excercise. Asacol worked wonders at the beginning (3 years ago), then I switched to Colazal and I didn't notice any dramatic improvement and tried prednisone with no improvement. Very gradually I improved by eating far more healthy and taking colazal and excercise. The SCD helped slightly, then it didn't matter. The only probiotics I was taking at the time was yogurt every so often.
Now that I am in the midst of a flare, I've been doing research and probiotics seem hopeful. I did take Entocort not long after the flare, which helped at the beginning, but right now I do not want to go on prednisone and 6-MP or even remecade just yet, until I try this other stuff.
I feel like I'm trying every probiotic and I plan on trying VSL3 in the near future. So far I am taking:
Primadophilus Reuteri
Primal Defense
S. boulardii (250 mg X3/dy, started 1 wk ago)
Pro-Bio
Greens + has probiotics as well
And 2 other types that I can't remember the names. Some I take more often than others per day.
I am new to the probiotic treatment with this kind of tenacity, so I really don't know if it will work, only the research gives me some hope. I am under the impression that either large numbers, a large variety, and/or very specific flora is what is key to improving. One thing I've noticed is that I don't bleed nearly as often, but maybe the chinese herbs are helping as well. I do experiments all the time at work, but it is a different story when you become the experiment.
Posted 10/4/2007 12:44 AM (GMT 0)
ach13: I don't blame ya...It's a lot easier to spend $20 on a bottle of probiotic pills than forking out the money for VSL#3. Who knows, the lower dosage may help. I just wanted folks to know that if they gave probiotics a try and didn't get results, it may have been that they just didn't take enough. I also went the less expensive route the first time.
Posted 3/2/2015 4:26 AM (GMT 0)
Hey pb4...you're still rolling you eyes at me in the post above...since 9/28/2007 and by my calculations that's going on 2 million times.

Anyway, sorry Ifor giving you product of choice a hard time and I was trying to educate.

That bee propolis really did get to me because people say different things help and I just go into that critical/analytical thinking and applying it to me in order to see it's maybe something I would benefit from.

There's of course things like wanting to help others as we all try to do.

Anyway, I just was searching through some old posts and this made me laugh. We cool? cool

Of course since this post they have the VSL#3DS and other stuff.

Hope you're feeling better.
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