Enzymes and Probiotics are Keys to Healthy Digestion

By Decker Weiss: NMD & Naturopathic Cardiologist

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• How important are enzymes to digestion?
• What happens if digestive enzymes don’t work adequately?
• What enzymes are involved in the digestion process?
• What is the difference between plant enzymes and animal enzymes?
• What other dietary supplements or enzymes could support digestive health?
• What are probiotics? Why are probiotic bacteria important for digestive health?
• How often should probiotics be taken to ensure optimal support of the digestion system?
• References
• Resources

The gastrointestinal system is a complex network of organs and glands that extract nutrients and water from food we eat so the body can use it.

The food we consume is processed by the gastrointestinal system in six phases:

1. Mental Preparation: prepares the stomach for the meal that will be eaten.

2. Ingestion: taking food into the body (eating).

3. Peristalsis: the movement of food through the gastrointestinal (GI) tract.

4. Digestion: the breakdown of food by both mechanical and chemical processes.

5. Absorption: the passage of digested food from the digestive tract into the vascular and lymphatic systems for distribution to the cells.

6. Elimination: the elimination of indigestible substances and waste products from the body.

Digestion itself is divided into two categories: mechanical and chemical. Mechanical digestion is physical movement that aids chemical digestion. After initial breakdown by chewing, food is churned by the smooth muscles of the stomach and the small intestine, mixing it with enzymes that start the chemical reactions.

Chemical digestion is a series of complex chemical reactions that break down large carbohydrate, lipid, and protein molecules into molecules small enough to enter the blood vessels. Chemical digestion occurs through the action of several different enzymes, such as amylases, proteases, and lipases. For optimal digestion to occur, all these processes must work together in a delicate, synchronized balance. If any part of this complex system under-performs or over-performs, physical problems can result.

How important are enzymes to stomach digestion?

Without enzymes, digestion could not take place and the food we eat could not be absorbed and utilized by our bodies. Enzymes are complex proteins produced by living cells and they start chemical reactions in the body.1

Enzymes are present in the digestive juices. They act upon food, breaking it down into simpler components the body can use for energy.2

What happens if digestive enzymes don’t work adequately?

Inadequate digestion is thought to be a significant cause of food allergies.3

When not digested completely, food can initiate allergic reactions in the body, causing inflammation and immune sensitivity.3 This can lead to chronic inflammatory conditions and certain types of arthritis.

What enzymes are involved in the digestion process?

Many enzymes are part of the digestion process. The three main enzymes involved in digestion are amylase, protease, and lipase. Other enzymes, such as sucrase, lactase, and maltase, have a significant secondary function in digestion.

Amylase breaks down carbohydrates. Saliva contains amylase, which initiates the digestion of dietary starches. Pancreatic secretions also contain amylase. Amylase breaks down starch into several disaccharides (simpler molecules).4

Disaccharides, which include lactose, maltose, and sucrose, are further broken down into simple sugars by the enzymes lactase, maltase, and sucrase respectively. These simple sugars can then be absorbed through the small intestine to help energy production.4

HEALTH FACT: Plant enzymes are able to survive a broader range of pH differences and provide a wider range of activity throughout the gastrointestinal tract. Proteases break down protein. Protein digestion begins in the stomach with the action of the protease, pepsin. The stomach’s acidic environment activates this enzyme. Pepsin is deactivated in the alkaline environment of the intestine.4 However, certain plant based proteases remain active even in more alkaline environments.

Proteins are further broken down by pancreatic enzymes in the alkaline environment of the intestine. Most proteins are ultimately broken down into amino acids, the building blocks of life.4

Lipases break down fat. Fat digestion accelerates in the second part of the small intestine with the action of the pancreatic lipases. These enzymes break down fat into essential fatty acids. The lipase enzymes, along with bile salts, are responsible for the absorption of the fat-soluble vitamins: A, D, E, and K.4

What is the difference between plant enzymes and animal enzymes?

Animal enzymes, particularly porcine-derived enzymes, closely resemble human digestive enzymes. For this reason, many experts believe animal enzymes are effective for specific applications. In general, animal enzymes are more sensitive to pH extremes. To compensate for this pH sensitivity, many of the animal enzyme formulas sold as dietary supplements contain bicarbonates to protect the enzymes from stomach acid.

Plant enzymes are derived from fungal or botanical sources. These enzymes are able to survive a broader range of pH differences and provide a wider range of activity throughout the gastrointestinal tract. Also, plant enzymes may be preferred by people who wish to avoid animal-derived products.

What other dietary supplements or enzymes could support digestive health?

There are many dietary supplements effective at supporting digestive health. Probiotic supplements, in particular, offer a myriad of health benefits.

What are probiotics?

Probiotics are beneficial nontoxic live bacteria that are necessary for life and do not cause disease (non-pathogenic).5 The probiotic bacteria most commonly studied include members of the Lactobacillus and Bifidobacterium group. Because of the Lactobacillus and Bifidobacterium’s ability to break down lactose, these probiotic bacteria are also known as lactic acid bacteria. Both of these probiotic bacteria are well-studied and are available in foods and dietary supplements.5

Why are probiotic bacteria important for digestive health?

Colonies of bacteria in the intestine are called “microflora”. While a normal microflora is associated with good health, changes in intestinal health are associated with weakened immune function. An imbalance in the natural microflora is frequently associated with various disease states such as yeast infections and colon cancer.6

Oral ingestion of probiotic bacteria helps support and modify the composition and metabolic activities of the large intestine microflora.9 Microflora of the large intestine assist digestion through fermentation (lowering the pH of the intestine, making it more acidic and inhospitable to invading species); protect against diseasecausing bacteria; and stimulate the development of certain immune system components.6 Lactic acid bacteria have a central role in the gut flora enabling them to influence the composition of the flora for health benefits.10

HEALTH FACT: Probiotic bacteria need to be ingested regularly for their health-promoting effects to persist.

Probiotic bacteria also have been demonstrated to have anti-cancer properties. In a study, colon cancer patients given L. acidophilus fermented milk showed significantly increased numbers of intestinal Lactobacilli and decreased risk factors associated with colon cancer.8

Lactose is an important sugar that is converted to lactic acid by lactic acid bacteria.11 Lactose intolerance results from an inability to digest lactose, due to the failure of small intestine mucosal cells to produce lactase, an enzyme needed to digest lactose.12 This often results because of genetics, gastrointestinal disease, or because of the decline in the amount of intestinal lactase levels associated with aging.13 Lactase deficient people accumulate nonabsorbed lactose in the gastrointestinal tract, which draws water and electrolytes into the gut and accelerates transit time, leading to bloating, cramping, diarrhea, and malabsorption of nutrients.14 Lactic acid bacteria have been shown to support the breakdown of lactose, specifically by enhancing the activity of lactase (beta galactosidase), which improves lactose digestion and tolerance.15,16

How often should probiotics be taken to ensure optimal support of the digestion system?

Although probiotic bacteria may survive passage through the stomach, they do not permanently colonize in the body and need to be replenished. Therefore, they need to be ingested regularly for their health-promoting effects to persist.

Conclusion

Everything our body has ever been or ever will be is dependent upon nutrition. Every building block, every bone cell, even the sheen of our hair, is the result of the food we eat. But what good does it do to select high quality food if its nutrients are not fully absorbed?

Enzymes that assure greater levels of digestion and absorption of your food, and probiotic bacteria that keep problems in check, can make a huge difference in your health. Try a broad spectrum, plant-based, quality enzyme product with each meal for one week. You will feel an immediate difference.

Couple the enzyme product with a quality probiotic product that contains both Lactobacillus and Bifidobacteria. A product that must be refrigerated is not convenient, especially for people who must spend a lot of time traveling.

How do you know the bacteria are still alive? Look at the bottle. If there is no date stamped, put it down. If it says the company guarantees there was a certain number alive at the time of manufacture, put it down. This means the company is not willing to claim the bacteria are alive when it reaches you. If the product must be constantly refrigerated, put it down.

Find a probiotic that says the bacteria are guaranteed to be alive in the numbers stated on the label until the date printed on the bottle. The bacteria should also be encapsulated in a coating that will protect them from stomach acid so that they reach your intestines alive and ready to go to work. Again, try these two kinds of supplements for even a week. As good as the short-term results are, the long term results are even better.

References

1. Enzyme. In: Thomas C, ed. Taber’s® Cyclopedic Medical Dictionary. 14th ed. Philadelphia, PA: F.A. Davis; 1982: 484-6.

2. Lee L., Turner L, Goldberg B. Enzymes. In: The Enzyme Cure. Tiburon, CA: Future Medicine Publishing, Inc.;1998: 19.

3. Food Allergies. In: Murray MT, Pizzorno JE, eds. Textbook of Natural Medicine, Vol 1. 2nd ed. Edinburgh; New York: Churchill Livingstone; 1999: 454.

4. Porth C. Digestion and Absorption. In: Pathophysiology: Concepts of Altered Health States. 5th ed. New York, NY:Lippincott;1998: 715-718.

5. Sanders M. Probiotics. Food Technology. 1999; 11:67-77.

6. Famularo C, Moretti S, Marcellini, De Simone C. Stimulation of immunity by probiotics. In: Fuller, R ed. Probiotics 2 Applications and Practical Aspects. London, England: Chapman & Hall; 1997:133-161.

7. Hilton E, Isenberg HD, Alperstein P, France K, Borenstein MT. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med. 1992;116:353-357.

8. Lidbeck A, Nord CE, Gustafsson JA, Rafter J. Lactobacilli, anticarcinogenic activities and human intestinal microflora. Eur J Cancer Prev. 1992;1:341-53. Abstract.

9. Macfarlane GT, Cummings JH. Probiotics and prebiotics: can regulating the activities of intestinal bacteria benefit health? BMJ.1999;318:999-1003.

10. Fuller R. Introduction. In: Fuller, R ed. Probiotics 2 Applications and Practical Aspects. London, England: Chapman & Hall; 1997:1-9.

11. Lactose. On-line medical dictionary. Available at: http://www.graylab.ac.uk/cgibin/omd?query=lactose& action+Search+OMD. Accessed February 9, 2000.

12. Tortora GJ, Grabowski SR. The digestive system. In: Principles of Anatomy and Physiology. 8th ed. Menlo Park, Calif: HarperCollins College Publishers;1996: 752-805.

13. Marteau P, Vesa T, Rambaud JC. Lactose maldigestion. In: Fuller, R ed. Probiotics 2 Applications and Practical Aspects. London, England: Chapman & Hall; 1997:65-88.

14. Vernia P, Di Camillo M, Marinaro V. Lactose malabsorption, irritable bowel syndrome and self-reported milk intolerance. Dig Liver Dis. 2001;33:234-239.

15. Gismondo MR, Drago L, Lombardi A. Review of probiotics available to modify gastrointestinal flora. Int J Antimicrob Agents. 1999;12:287-292

16. Garman J, Coolbear T, Smart J. The effect of cations on the hydrolysis of lactose and the transferase reactions catalysed by beta-galactosidase from six strains of lactic acid bacteria. Appl Microbiol Biotechnol. 1996;46:22-27.

Resources

Martini MC, Lerebours EC, Lin WJ, et al. Strains and species of lactic acid bacteria in fermented milks (yogurts): effect on in vivo lactose digestion. Am J Clin Nutr. 1991;54:1041-1046.

Jiang T, Mustapha A, Savaiano DA. Improvement of lactose digestion in humans by ingestion of unfermented milk containing Bifidobacterium longum. J Dairy Sci. 1996;79:750-757.

Macfarlane GT, Cummings JH. Probiotics and prebiotics: can regulating the activities of intestinal bacteria benefit health? BMJ. 1999;318:999-1003.

Gismondo MR, Drago L, Lombardi A. Review of probiotics available to modify gastrointestinal flora. Int J Antimicrob Agents. 1999;12:287-292.

Your Digestive System. Mayo Clinic Website. Available at: www.mayohealth.org. Accessed on September 28, 2001.

Porth C. Digestion and Absorption. In: Pathophysiology: Concepts of Altered Health States. 5th ed. New York, NY:Lippincott;1998: 766-769.

Gastric Stable Acidophilus

By Decker Weiss: NMD

Use your browser's back button to navigate this menu.

• How can bacteria be good for us?
• What are probiotics?
• Is there a difference between the probiotic bacteria that is found in yogurt, and in nutritional supplements?
• Where do these probiotic bacteria come from?
• Why are probiotic bacteria important for digestive health?
• How do probiotic bacteria help with digestion?
• What is the difference between digestive enzymes and probiotics? Can they be taken together?
• Is helping to ensure a healthy digestive system the only use for probiotics?
• Then how do I know I am getting what I pay for?
• Why is it important to dissolve only in the intestine?
• How often should probiotics be taken to ensure optimal support of the digestion system?
• If I take a probiotic nutritional supplement, how many bacteria should a good quality supplement contain?
• What does this new coating technology mean to me?
• References

Do you ever think about what goes into your body each day? You should. One of the keys to feeling good and being healthy is eating nutritious food and making sure our gastrointestinal (GI) tract has the tools it needs to optimally digest and absorb nutrients. The GI tract includes of the stomach and intestines, which work to digest food and eliminate waste. A variety of “good” intestinal bacteria help to keep the digestive system running. These “good” bacteria are called probiotic bacteria, or probiotics. Probiotics help digest food, process waste, and keep the “bad” bacteria —which have the potential to cause disease and illness—in check. This issue of Ask the Doctor will look at the probiotic bacteria that play an important role in maintaining our health and wellness: why we need them, what they can do for us, and how to make sure we are getting enough. Also, we will talk about an exciting new process called True Delivery Technology™ that will ensure that probiotic bacteria taken in nutritional supplements survive transport to the intestines, where they set up house and exert their beneficial effects. As we will see, while probiotic supplementation can help prevent and treat many different illnesses, unless the beneficial bacteria reach the intestines alive and active, the supplement is worthless.

I thought bacteria were bad. How can bacteria be good for us?

Some kinds of bacteria do cause illnesses and disease in humans. “Strep” throat is an example of an illness caused by bacteria. However, the majority of bacteria do not cause disease. In fact, there are types of bacteria that are actually beneficial. “Good” bacteria, known as probiotic bacteria, are used in the manufacturing of food and beverages. Some examples of foods that have probiotic food ingredients are buttermilk, yogurt, cheese, sausage, and acidophilus milk.

These same kinds of probiotic bacteria are present in our intestines and help to keep the digestive system running by digesting food and processing waste.

What are probiotics?

Probiotics are live bacteria that are non-toxic and do not cause disease (non-pathogenic).1 Some of the best-understood probiotic bacteria include members of the Lactobacillus and Bifidobacterium groups. Because of the Lactobacillus and Bifidobacterium’s ability to break down lactose, these probiotic bacteria are also known as lactic acid bacteria. Both of these types of probiotic bacteria are well studied and are available in both food and dietary supplements.1

Is there a difference between the probiotic bacteria that is found in yogurt, and in nutritional supplements?

Actually, the bacteria that is in yogurt, our intestine, and most natural supplements are the same types of probiotic bacteria, Lactobacillus acidophilus and Bifidobacterialongum. Because of this, these bacteria are referred in a generic sense as probiotics. So, the term probiotics may refer to the “good” bacteria that are present in food, or that live in our intestine, or that are part of a natural supplement.

Where do these probiotic bacteria come from?

As recently as the middle of the last century, bacteria found naturally in food ingredients were used to make a fermented food product. For example, the lactic acid bacteria found naturally in milk were used to make cheese. This was known as wild fermentation.

Wild fermentations are no longer used. Today, the probiotic bacteria used in food and natural supplements are harvested via a highly controlled fermentation process. This process results in high numbers of bacteria and ensures quality and purity of the bacteria.

Why are probiotic bacteria important for digestive health?

Normal microflora (the term commonly used for intestinal bacteria) is associated with good health. An imbalance in this natural microflora (when the beneficial probiotics are outnumbered by the harmful bacteria) is frequently associated with various disease states such as yeast infections and colon cancer.2 Eating foods or taking a nutritional supplement containing probiotic bacteria can help support and modify the composition of the large intestine microflora.3 Microflora of the large intestine assist digestion through fermentation (by making the intestines more inhospitable to invading bacteria species), protection against disease-causing bacteria, and stimulation of the immune system.2 The probiotics, Lactobacillus and Bifidobacteria, occupy a central role in the intestinal flora and provide health benefits.4

How do probiotic bacteria help with digestion?

Lactose is an important sugar that is converted to lactic acid by lactic acid bacteria.5 Lactose intolerance results from an inability to digest lactose, due to the failure of small intestine mucosal cells to produce lactase, an enzyme needed to digest lactose.6 This often results because of genetics, gastrointestinal disease, or because of the decline in the amount of intestinal lactase levels associated with aging.7 Lactase deficient people accumulate nonabsorbed lactose in the gastrointestinal tract, which draws water and electrolytes into the gut and speeds waste through the intestines, leading to bloating, cramping, and diarrhea.7,8

Approximately 50 million people in the United States have partial to complete lactose intolerance. The following chart illustrates the racial break down of lactose intolerance in this country.9

Prevalence of Lactose Intolerance in the U.S.

• 95% of Native Americans
• 90% of Asian-Americans
• 70% of African-Americans
• 60% of Jewish Americans
• 50% of Mexican Americans
• Less than 25% of Caucasian Americans (non-Jewish, non-Hispanic)

Lactic acid bacteria have been shown to help the breakdown of lactose, specifically by enhancing the activity of lactase (beta galactosidase), which improves lactose digestion and tolerance.8,10 Furthermore, in a randomized, controlled clinical trial, Bifidobacteria longum was shown to assist in the breakdown of lactose and relieve the symptoms of lactose intolerance (flatulence) in people with lactose intolerance.11

What is the difference between digestive enzymes and probiotics? Can they be taken together?

Digestive enzymes, such as protease, amylase, and lipase, act upon food, breaking it down into simpler components that can be used by the body for energy.12 Without enzymes, digestion could not taken place. Therefore, the food that we eat could not be absorbed and utilized by our bodies. Probiotics help the enzymes to digest food and process waste. In essence, probiotic bacteria and enzymes work together to ensure that the digestive tract is running smoothly. When taken together, enzymes assure greater levels of digestion and absorption of your food, and probiotic bacteria aid the enzymes in digestion and keep problems in check.

Is helping to ensure a healthy digestive system the only use for probiotics?

Absolutely not! Probiotic bacteria, such as Lactobacillus acidophilus, have been found to help prevent vaginal yeast infections in women that suffer from these reoccurring infections.13

Approximately 35% of vaginal infections are caused by the yeast, Candida albicans. Candida is a fungus that is a component of the normal gastrointestinal microflora.14 However, Candida must not be allowed to increase in numbers. An overgrowth is associated with adverse health effects like vaginal infections, oral thrush, or even serious systemic yeast infections. Probiotics have been shown to keep levels of Candida in check.14

Probiotic bacteria have also been demonstrated to have anti-cancer properties. In a clinical study, colon cancer patients given Lactobacillus acidophilus fermented milk showed a significant increase in numbers of intestinal Lactobacilli and a decrease in risk factors associated with colon cancer.15

Patients suffering from inflammatory bowel diseases, such as ulcerative colitis and Crohn’s disease, can benefit from probiotic bacteria supplementation. Studies have shown that probiotic bacteria assist in maintaining remission in ulcerative colitis and preventing reoccurrence of Crohn’s disease. Manipulating the intestinal flora may prove to be more effective and better tolerated than the drugs that are conventionally given to treat these diseases.16-20 In one study, Lactobacillus acidophilus was found to improve the intestinal barrier and clinical status in children suffering from Crohn’s disease.16

Probiotics supplementation can also improve and prevent skin diseases, such as eczema. Studies have shown that probiotic bacteria can actually control inflammation associated with skin conditions. 21-23 In one study, infants with eczema who were given probiotic–supplemented formulas showed a significant improvement in skin condition.23 The chart below summarizes some of the diseases and conditions that probiotic bacteria can help prevent and/or improve.

Disease Benefits of Probiotic Supplement

Vaginal yeast infections - Prevents vaginal yeast infections in women.13

Colon Cancer Decreases - risk factors associated with colon cancer.15

Crohn’s Disease - Found to improve the intestinal barrier in patients with Crohn’s disease.16,18-20

Ulcerative Colitis - Helps to maintain disease remission in ulcerative colitis patients.17-20

Eczema - Counteracts inflammatory responses outside the intestinal tract by preventing diseases such as eczema and dermatitis.21-23

How often should probiotics be taken to ensure optimal support of the digestion system?

Probiotic bacteria do not permanently colonize in the body. They need to be replenished by the consumption of foods containing probiotic bacteria or by taking a probiotic natural supplement. Whatever form you choose to replenish the intestinal probiotics, they need to be ingested daily for their health-promoting effects to continue.

If I take a probiotic nutritional supplement, how many bacteria should a good quality supplement contain?

The critical factor is not how many bacteria that a supplement contains, but rather how many bacteria reach the intestines healthy, vigorous, and ready to work.

A good quality supplement will deliver at least 1 billion living, healthy probiotic bacteria per dose to your intestines. The bacteria in the probiotic natural supplement should be a mixture of both Lactobacillus and Bifidobacteria.

Again, the critical key to a good quality probiotic supplement is that the bacteria must be alive to work. Only living probiotic bacteria can colonize in the intestines. A good quality probiotic nutritional supplement will have GUARANTEED levels of live bacteria at the point of consumption. Inferior brands will merely state levels of live bacteria at the point of manufacture. Recently, a private laboratory tested various probiotic nutritional supplements in the marketplace, including one utilizing True Delivery Technology™. These supplements were best selling brands, two of the supplements were enteric coated, and all had label guarantees about potency. The lab counted the levels of living bacteria found and compared these findings to the bacterial levels claimed by each manufacturer. The chart below right illustrates that most probiotic supplements do not deliver the number of living bacteria that they claim on their labels.

Then how do I know I am getting what I pay for?

First, look for a product that has a “use by” date or an “expiration“ date clearly stated on the package. It is also important to look for a probiotic supplement that does not require refrigeration. Probiotic supplements that require refrigeration often have been subjected to warm temperatures during shipment and storage that will inevitably kill off some or all of the bacteria.

It is also important that the product label guarantees live bacteria at the time of purchase, not at the time of shipment or manufacturing. However, from the laboratory test discussed to the right, we see that sometimes these written guarantees are not worth the paper they are written on.

There is one scientifically validated process—True Delivery Technology™— that assures live and vigorous bacteria are delivered to the intestine. This process suspends the probiotic bacteria in a moist paste and immediately seals the bacteria in a perfectly seamless spherical gelatin ball. This bacterial paste is completely protected from air and dryness so that the bacteria are alive until the specialized gelatin dissolves – in the intestines.

Why is it important to dissolve only in the intestine?

Lactic acid bacteria are not very resistant to the acids of the stomach. The harsh environment of the stomach destroys the majority of these bacteria.

This new coating process technology protects bacteria from the stomach acid. The sphere is specially developed to only dissolve in the alkaline environment of the intestines. As we see in the chart below, enteric coating is not enough as it does nothing to protect the bacteria while they wait for purchase on a shelf.

What does this new coating technology mean to me?

This specialized process is an expensive processing step, but it has many advantages to you.

The gelatin spheres actually “seal” the bacteria in the capsule, which protects them from air. Probiotic bacteria are anaerobic, meaning they do not require oxygen to live. In fact, the presence of oxygen can actually injure or kill probiotic bacteria. In addition, the special coating’s ability to seal the bacteria in the capsule eliminates the need for the nutritional supplement to be refrigerated though they can be kept in the refrigerator, if desired.

By protecting the bacteria on the shelf and in the stomach, the probiotic bacteria successfully reach the intestine. As a result, there will be a greater number of healthy, intact bacteria that can colonize in the intestine.

Conclusion

Many health care practitioners believe all health issues are related in some way to the process of digestion. Probiotics play a crucial role in improving our digestive health, which, in turn, is interconnected to every single function in our bodies.

Taking a probiotic supplement is an excellent way to replenish the good bacteria in your intestinal microflora. A quality probiotic product contains two different types of bacteria from Lactobacillus and Bifidobacteria species with at least one billion live bacteria per dose. But how do you know the bacteria are still alive? Look at the package. If there is no date stamp, put it down. If it says the company guarantees there was a certain number alive at the time of manufacture, put it down. That means that the company is not willing to claim the bacteria are alive when delivered to the target site, the intestine. If the product must be constantly refrigerated, put it down. How do you know it didn’t sit in a truck for two days, or was in a warehouse before it was shipped to the health food store? Find a probiotic that says the bacteria are guaranteed to be alive in the numbers stated on the label until the date printed on the bottle. Find a product using unique, cutting edge science to deliver the probiotic bacteria in a form new to the United States – a form that uses spherical, sealed, double coating to protect the bacteria. That company has gone to extra time and expense to make sure you reap the benefits that probiotics can offer.

References

1. Sanders M. Probiotics. Food Technology. 1999; 11:67-77.

2. Famularo C, Moretti S, Marcellini, De Simone C. Stimulation of immunity by probiotics. In: Fuller, R ed. Probiotics 2 Applications and Practical Aspects. London, England: Chapman & Hall; 1997:133-161.

3. Macfarlane GT, Cummings JH. Probiotics and prebiotics: can regulating the activities of intestinal bacteria benefit health? BMJ. 1999;318:999-1003.

4. Fuller R. Introduction. In: Fuller, R ed. Probiotics 2 Applications and Practical Aspects. London, England: Chapman & Hall; 1997:1-9.

5. Lactose. On-line medical dictionary. Available at: http://www.graylab.ac.uk/cgibin/ omd?query=lactose&action+Search+OMD. Accessed February 9, 2000.

6. Tortora GJ, Grabowski SR. The digestive system. In: Principles of Anatomy and Physiology. 8th ed. Menlo Park, Calif: HarperCollins College Publishers;1996: 752-805.

7. Marteau P, Vesa T, Rambaud JC. Lactose maldigestion. In: Fuller, R ed. Probiotics 2 Applications and Practical Aspects. London, England: Chapman & Hall; 1997:65- 88.

8. Gismondo MR, Drago L, Lombardi A. Review of probiotics available to modify gastrointestinal flora. Int J Antimicrob Agents. 1999;12:287-292.

9. Garman J, Coolbear T, Smart J. The effect of cations on the hydrolysis of lactose and the transferase reactions catalysed by beta-galactosidase from six strains of lactic acid bacteria. Appl Microbiol Biotechnol. 1996;46:22-27.

10. Martini MC, Lerebours EC, Lin WJ, et al. Strains and species of lactic acid bacteria in fermented milks (yogurts): effect on in vivo lactose digestion. Am J Clin Nutr. 1991;54:1041-1046.

11. Jiang T, Mustapha A, Savaiano DA. Improvement of lactose digestion in humans by ingestion of unfermented milk containing Bifidobacterium longum. J Dairy Sci. 1996;79:750-757.

12. Lee L., Turner L, Goldberg B. Enzymes. In: The Enzyme Cure. Tiburon, CA: Future Medicine Publishing, Inc.;1998: 19.

13. Hilton E, Isenberg HF, Alperstein P, France K, Borenstein MT. Ingestion of yogurt containing Lactobacilluys acidophilus as prophylaxis for candidal vaginitis. Ann Intern med. 1992;116:353-357.

Probiotics and irritable bowel syndrome: rationale, putative mechanisms, and evidence of clinical efficacy.

By M. Camilleri, Mayo Clinic College of Medicine

The irritable bowel syndrome (IBS) follows an acute, presumably infectious diarrheal illness in approximately 15% of patients. There may be a persistent, mild inflammatory state with changes in mucosal function or structure. Changes in the colonic bacterial flora reported in IBS seem related to predominant bowel. Colonic bacteria normally metabolize nutrients with the formation of gas and short chain fatty acids. The latter may induce propulsive contractions and accelerate colonic transit or they may enhance fluid and sodium absorption in the colon. This review addresses the mechanisms, rationale and current evidence for the efficacy of probiotics, including Lactobacilli, Bifidobacteria, and VSL#3, in the treatment of IBS. The mechanisms influenced by probiotics include immune function, motility, and the intraluminal milieu. Probiotics may suppress the low-grade inflammation associated with IBS or restore normal local immune function. Lactobacilli and Bifidobacteria subspecies are able to deconjugate and absorb bile acids, potentially reducing the colonic mucosal secretion of mucin and fluids that may contribute to functional diarrhea or IBS with diarrhea. Therapeutic trials show the potential benefit of Bifidobacteria or Lactobacilli species alone or in the specific probiotic combination, VSL#3, on symptoms in IBS. Colonic transit was retarded in IBS patients treated with VSL#3 without induction of significant changes in bowel function. In summary, probiotics are promising therapies in IBS.

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