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Probiotics kill 24 people in The Netherlands
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Frans
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 Posted: Wed Jan 23rd, 2008 16:57

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Hi all,

Something just hit the news here. It seems 24 people woth pancreatic inflammetion died after a research where they were taking probiotics. They say that without the probiotics several of these people would not have died.

The research was done in the University medical center in Utrecht, but shut down now.

Sincerely, Frans

Probiotic prophylaxis in patients with predicted severe acute pancreatitis:

In the experiment, the researchers added probiotics to the patients' dripfeed "in the expectation that it would boost the body's resistance to harmful bacteria", the UMC said in its press release.



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Prof Trevor Marshall
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 Posted: Wed Jan 23rd, 2008 18:12

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Thanks, Frans. Lots of food for thought here. Interesting that they have not published this study result for several years, even though it was not what they expected. I would be interested to know why the results were with-held since 2004/2005, especially with such a clear danger ratio between cohort and placebo.
 
The science tells me that palliation from probiotics probably comes from overloading the innate immune system in the GI tract.

Do you know if the "drip feed" they are talking about is tube-feeding or an IV drip system? Maybe the Dutch-language version is clearer than the English?

 

Last edited on Wed Jan 23rd, 2008 18:27 by Prof Trevor Marshall

jcwat101
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 Posted: Wed Jan 23rd, 2008 19:37

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I suppose there are many possibilities, but as I have described in my progress reports, I find that probiotics increase my immunopathology reaction quite distinctly -- even a serving of yogurt has this effect. 

Their effect on me doesn't seem to depend on being one particular type of probiotic (this happened for both Lactobacillus and for the yeast Saccharomyces).  The increased immunopathology is consistent with the idea that I have bacteria in my intestinal flora that produce VDR blocking substances.  If one displaces them, there could be less VDR blockage and thus more immunopathology.  Other people with different intestinal flora might not observe this effect.

In a situation where the probiotics are given to people in such advanced states of illness, this might be too much immunopathology for some of them to handle all at once without adequate palliation (like from Benicar) or without the other things used with the MP.  Anyway, that is one idea.

Joyce Waterhouse

Last edited on Wed Jan 23rd, 2008 19:39 by jcwat101



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Prof Trevor Marshall
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 Posted: Wed Jan 23rd, 2008 19:55

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Joyce,
Normal probiotics force the innate immune system to challenge them in the GI tract. Inflammatory cytokines are produced, hence the immunopathology. The chemokines will also cause a migration of monocytes to the GI tract, the site of immune challenge. Thus the monocytes will be unable to attack pathogens in the liver, kidney, or even pancreas, as they are being sidelined to the GI tract. More immunopathology, but perhaps a little easier to tolerate in the Gi tract than in the kidney, liver or pancreas.

Unfortunately their patients succumbed to the pancreatic infection :( Oops...
 

coolbeans
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 Posted: Thu Jan 24th, 2008 04:13

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I request clarification please when time allows.

IYO, does this discussion of increased inflammation in the GI tract following injestion of yoghurt/probiotics mean those of us with GI inflammation are better off with yoghurt/probiotics because the challenged immune system attracts attention to the GI tract?

Or

Does this mean those of us with GI inflammation should avoid probiotics in all forms to lessen inflammation in an already inflamed organ and, thereby, let the MP deal with the GI tract more naturally?

TIA, Jan

Prof Trevor Marshall
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 Posted: Thu Jan 24th, 2008 07:48

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Jan,
I haven't stated a position on probiotics. There are many on the protocol who are convinced they are helpful, and I would prefer to concentrate on the key issues that folk really need to solve - No Vit D, plenty of Benicar, and a supportive family/medical environment. Probiotics are a second-order effect, I think (less important).

We now know that the GI tract relies on the innate (Th1) immune system, and the VDR, to deal with intestinal flora. A decade ago it was thought that antibodies (the Th2 system) was involved. So it is certain that ingesting probiotics will place a load on the very part of the immune system already weakened by fighting Th1 inflammation in the major organs. Whether this is good or bad is open to interpretation.

Every time I have personally started to take probiotics I have sensed a setback, rather than a surge forward. Last year I tried "Ultimate Flora - Critical Care - 50 Billion cultures per capsule" just to see what high-dose probiotics would do. I think I took one capsule, maybe two, before discarding the bottle in disgust.

I haven't seen any noticeable changes in intestinal function when I took lesser dose brands, nor did I sense any other benefits (but remember that I have no remaining GI immunopathology for the probiotics to palliate).

So I tend to leave it to the individual. Most Th1 patients have severe GI tract involvement, and dealing with that takes just about every tool in their arsenal. If Probiotics seem to help, then who am I to say no? On the other hand, they do not form part of the base protocol, as any benefit is not obvious to me, whether based on personal experience, or biological knowledge.
 

Kas
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 Posted: Thu Jan 24th, 2008 10:14

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This has certainly given me something to think about.

I have been taking high quality probioitcs for years now, and even more so on the MP, as I suffer from really bad yeast and diarrheas whenever I take abx. The jury is still out whether they have been beneficial or not, but I have found that a product called "Florastar"(Saccaromyces boulardii lyo) has made difference. I take 250mg twice daily, and since being on them, I have noticed a GI improvement and the yeast problem, although always present, has become manageable and tolerable. I guess I could stop them altogether and see if there is a change in my IP, and perhaps a little experiment of my own will be in order here, but I am also only one person and we are all different. When I had my colonoscopy two years back - done by a brilliant gastro guy who totally endorsed my being on the MP - he was amazed that my colon was so clear and showed absolutely no inflammation at the time. I was not taking beni back then, but had been on probiotics. Since being on Benicar, my GI symptoms ( other than the stomach bug setback), have been pretty good and I hardly ever need to palliate for reflux any longer. My box of Losec can last me for months. The only changes when on the abx, are bowel ones, but never has C.Diff or parasites/bacteria been found in my samples.

So, for now, I will continue with the Florastar and the organic plain yoghurt and do my best to contain my yeast, take my benicar and abx slowly, and move forward to good health. When and if it is decided that probiotics are contra- indicated on the MP, I will stop, but until then, I think the benefits are outweighing the risks for me.



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 Posted: Thu Jan 24th, 2008 15:43

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I guess I could stop them altogether and see if there is a change in my IP, and perhaps a little experiment of my own will be in order here
Kas, I will bet you a beer (when you have recovered) that you don't have 'yeast', and never have had 'yeast'. Medicine usually doesn't bother to distinguish between inflammation from the Th1 pathogens and a true yeast infection.

Just because yeast can be cultured (did they even bother to do that?) does not mean to say it is causing the inflammation and causing the discomfort. Once the primary innate immune system has been compromised then it is very common for a variety of common pathogens to be present. But that doesn't mean any of them are actually what is making you ill.
 

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 Posted: Thu Jan 24th, 2008 16:04

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 I  bet you would win your beer!

When you ask ' was the yeast cultured?', I have always supposed that is what is done when they take the swabs and send them off to the labs, or is that not so?



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Frans
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 Posted: Thu Jan 24th, 2008 16:09

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Dr Trevor Marshall wrote: Interesting that they have not published this study result for several years, even though it was not what they expected. I would be interested to know why the results were with-held since 2004/2005, especially with such a clear danger ratio between cohort and placebo.
 
The science tells me that palliation from probiotics probably comes from overloading the innate immune system in the GI tract.

Do you know if the "drip feed" they are talking about is tube-feeding or an IV drip system? Maybe the Dutch-language version is clearer than the English?



Trevor, I will have to translate the peace that is on the website of the university hospital here, will come to that tomorrow. It 'explains' why they didn't stop earlier...

The feeding is not entirly clear to me, they use a dutch word which translates to:

- probe  or
- catheter

Does that help?

Sincerely, Frans



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Prof Trevor Marshall
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 Posted: Thu Jan 24th, 2008 16:53

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Frans,
A catheter typically would go into the bloodstream at an elbow. This would have been a really dangerous experiment. A food tube would go down the throat, or maybe just rest in the mouth, depending on how invasive they wanted to be. The key thing to figure out is whether they put these into the bloodstream, or into the mouth:)
 

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 Posted: Thu Jan 24th, 2008 19:02

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"Ultimate Flora - Critical Care - 50 Billion cultures per capsule"

That's the exact same brand I tried a few years ago that gave me RAGING green diahhrea!  It certainly felt like 50 billion of something going on.  :)

I never had any trouble with Theralac but don't even take that anymore.

Last edited on Thu Jan 24th, 2008 19:04 by B R H



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jcwat101
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 Posted: Thu Jan 24th, 2008 19:56

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I have found that I tolerate some brands better than others.  I often have had problems with ones containing FOS/inulin in the base -- in fact one product seemed to have led to a worsening that lasted quite a while.

Only once did I have a benefit from them and that was when I was on a high dose antibiotic for Lyme prior to the MP.  At that time, Nutrition Now's PB8 got rid of my antibiotic associated diarrhea.  That was the first time I had benefited and was surprised when it helped. 

I stopped taking them fairly early in the MP, as I did not find any benefit from them.  But it is true some people swear by them and I agree with Trevor about leaving it up to the individual.

But perhaps the conclusion from all this is one should not assume one is better taking them just because there are articles that recommend them.

Joyce Waterhouse

Last edited on Thu Jan 24th, 2008 19:58 by jcwat101



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 Posted: Sat Jan 26th, 2008 10:02

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Hi all,

Well, they used a tube going via the mouth directly into the bowels as far as I can tell.

Furthermore, the reason why they did not stop earlier is because the total of the placebo group (6% died) and the actual supplemented groups (16% died) 'almost' equalled the 'normal' statistical death rate (10%). 16 + 6 / 2 = 11%...

Only after seperating these two, they found that the rate in the supplemented group was too high and that of the placebo group lower than statistics.

They state that the law and medical yada yada forbid them to control these two groups against statistics seperately during the experiment. A rather fatal flaw in methodology I think...

Hope this helps...

Sincerely, Frans

Last edited on Sat Jan 26th, 2008 10:04 by Frans



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 Posted: Wed Jan 30th, 2008 02:37

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For clarification tube feeding in pancreatitis is sometime done with a nasal-jejunal tube and other times a tube (catheter) is surgically placed directly though the wall of the abdomen into the jejunum. Feeding though the stomach or duodenum is avoided, and patients are kept NPO (nothing per mouth). In some total parenteral nutrition (TPN) through a central venous line is required.   No study would ever put probiotics into a central venous line in humans, so it most likely would have been the jejunal feedings they were looking at. Since probiotics as part of the human food supply usually go thought the stomach and duodenum before reaching the jejunum it would seem like they were taking a leap of faith to even try introducing microbes into the jejunum.

best, P.B.

Prof Trevor Marshall
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 Posted: Wed Jan 30th, 2008 02:45

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That's a good way to put it, PB - a "leap of faith."

I would have used a much different terminology, like 'reckless'. But you are correct.

Rather too much medicine is practiced as "faith" rather than "science" or "understanding"...
 

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 Posted: Fri Feb 15th, 2008 01:53

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Hi all,

I ran into a paper that seems to be related to the issue at hand.

PMID: 18268332.

What they found was that mice without the 'good' gut bacteria (microbiota) seemed to have less inflammatory pain

An explanation could be that their immune systems just worked much better because of the absence of bacteria in the gut.

Any comments/thoughts about this?

Sincerely, Frans



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 Posted: Fri Feb 15th, 2008 06:21

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Frans, mice have a different innate immune system to man. Results from murine models do not necessarily translate to man. This is especially so when considering gut microbiota.
 

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 Posted: Tue Feb 19th, 2008 16:48

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Interesting topic.  I have been using probiotics now for the past 7 years.  When I first started, it was like Joyce, due to high levels of ABX for Lyme.  I was on Zith 500mg and Ceftin 1,000mg a day for 4 years.  I know, don't even want to think about the ABX I was on, now having MP info, it makes me crazy!

I have tried several times during the MP to take less of the probiotics, but continue to have issues with U. Colitis, when I monkey around.  Just tried it again after reading this topic.  So, I assume, I still have the need for them.  Waiting for the day that I don't.

My dose is: 2 of Vital 10 & Bifidiolife, twice a day. I used to take a third one, but was able to stop that a few months into the MP.

Of all my issues, my colon/intestines have dictated my ability to progress with the MP ABX.

Take Care,   Lori



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 Posted: Tue Feb 19th, 2008 18:49

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Lori,
A new paper out today shows that probiotics increase Interferon-gamma. That means they create a Th1 reaction, an innate immune reaction. I am getting closer to becoming convinced that the mode of action of probiotics is to overload the innate immune system , focus it away from the Th1 pathogens, so as to reduce the patients' symptoms.

Here is the Reuter summary of that study:
"Probiotics help distance runners stay healthy"
http://www.reuters.com/article/healthNews/idUSKIM96896120080219

"Probiotic treatment also doubled levels of interferon gamma, a substance .. that plays a key role in fighting viral infections."

Interferon-gamma catalyses the production of 1,25-D.  You can see it in Figure 1 of my new paper, to the left of CYP27B1.
 


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