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Frans
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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.

Prof Trevor Marshall
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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 17:27 by Prof Trevor Marshall

jcwat101
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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 18:39 by jcwat101

Prof Trevor Marshall
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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...
 

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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

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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.
 

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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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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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 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?

Frans
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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

Prof Trevor Marshall
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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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"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 18:04 by B R H

jcwat101
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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 18:58 by jcwat101

Frans
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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 09:04 by Frans

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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.

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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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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

Prof Trevor Marshall
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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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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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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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Interesting cause I have IP like crazy, and have not been able to tolerate ABX very well between the interstitial cystitis, U colitis, Asthma and MCS issues. 

I wonder if taking the 1,000mg of ceftin daily for 4 years also added insult to injury causing a high bacteria load.  I know my initial 1,25D was only in the low 40's, but lets face it, as sick as I was, is it possible that my immune response was not a true reading, (that it should have been on the higher side).  Some that I have spoken to who were not as sick as myself, and also for a much shorter period of time had WAY higher 1,25D levels then I, when tested. (I assume that their immune response was better then mine in showing the 1,25D level).

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I am just about to enter into phase ll and find this topic very interesting. I had a bout of Gerd, Reflux, indigestion (whatever you want to call it) a few day ago.  First I took two acidophillus and waited a bit w/o relief.  Then I took the Prevacid my gastro doc gave me and then just in the event it was an IP, I chewed an extra Benicar.  Sat up for a while at the computer and in about 45 minutes, I realized that the burning, churning, turning was gone.  My mind says it was the Prevacid.  If that is true, is the Prevacid contraindicated on MP.  I hope it was IP because the relief was so fast. I don't even know what the classification of Prevacid is.  I only know I have been off and on it for years.  It cured an ulcer I had.  I also have a hiatal hernia.  Does that ever repair itself? My questions may seem dumb, but I am new at this and very much interested. I never did think that acidophillus or lactobacillus was of any help.  Thanks for letting me put my two cents worth in.  Dolores

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I want to throw out this question.  Those who did not do well with, or do not seem to have the need for probiotics, are they mostly those who do not have U. colitis, IBS, food intolerances, etc?

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Dr. Marshall, Is what you are saying about the probiotics possibly triggering a Th1 response the same as someone eating more than a low carb diet?  That is, do the carbs in the diet divert the innate immune system?  I ask this because at this moment in time, I cannot handle the low carb diet (my IP becomes intolerable), and I was told to increase my carbs.  I've tried lowering them twice now, and I'm hoping in time I will be able to lower them.

Lori, my 1,25D was 48 and I was very sick pre-MP (and having a very difficult time of it); I also have IBS.  However, if I take pro-biotics (even only 1billion), I end up with terrible constipation, feel bloated, and just plain miserable.

Claire

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Claire,
Have you tried Colase or Fiberone. These work wonders for me.

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Lori, Claire,
Most of us have some degree of GI tract problems. I hate to describe the degree of those problems with a diagnosis tag - whether it be IBS, or whatever, as one doctor might give that diagnosis to exactly the same degree of illness that another doctor may feel is still 'normal.'

Sugars do affect the immune system profoundly. You are describing that they seem to de-activate your immune system, and that is not surprising. Juggling your level of immunopathology might be possible by changing the antibiotic dose, as well as changing the sugars.

I never found Probiotics to be helpful. But I never took them for long enough to become dependent upon the immunosuppression they apparently offer. If given a choice, I would avoid probiotics during the MP.
 
Constipation is certainly changed by the level of carbs in your diet. Drugs such as Colace, docusate sodium, used to work well for me and are OTC. Don't use them any more than you need, it is better to rely on Milk of Magnesia. This suggestion comes with the usual disclaimers about making sure you ask Doc before you change anything...
 

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Well, I tried to lower my usual dose of probiotics again in the past day and a half.  Bingo, on the verge of diarrhea again.  When I stay on my usual dose of 4 total probiotics a day, I am fine.  It has also taken me 6 weeks just to have the ability to get the meds increased.  My inability to up the ABX even on only a 2 combo instead of the 3 combo, is still very slow. 

I never fit the norm in the mainstream of things, and apparently with the MP as well.

Not a problem cause I have progressed with improvement, VERY slow and steady. (again for me I am superwomen now, but so very far from normal.) Thanks for all the info here.

Take Care,   Lori

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Hi all, I have been following this thread and thinking a lot about this subject, but a lot of things about probiotics sound very odd.

Here in the Netherlands they say it improves our bowelmovement. Now there are two things about that that strike me as odd.

First of all, they do not explain why this impaired bowelmovement happens in the first place. I would like to know and inderstand what is wrong that so many people seemingly enjoy beneficial effects from this. Are they all sick in some way?

Another remark about this is that if one needs to improve bowelmovement, try eating a piece of raw chicken. Believe me, you will be running to the toilet in no time...

This sounds stupid, but when one looks at the paper Trevor posted about these athletes, this is exactly what seems to be happening. These people's immune systems are antagonized, period.

This sure makes one wonder if these so-called good bacteria, that are purported to be 'accepted' by our bodies are maybe actually not 'accepted'. Our immunesystem clearly isn't accepting them.

Dave Relman's paper (Trevor has mentioned this paper several times in the past) on the gut microbiota is rather telling in that respect, or at least it should make one wonder.

http://tinyurl.com/37upu8

What Relman's group found that the microbiota in the first months of life differs from that of the 'normal adult microbiota'.

Now, off course the question is, why do some species survive and some don't. It is clear that probiotics trigger an immune response, so perhaps the ones surviving in our bodies have figured out a way to avoid destruction by the immune system?

Maybe the whole thing is even simpler. Our innate immunity is non-specific, meaning it targets parts of bacteria, viruses, etc, regardless of what species.

So maybe, just maybe, our bodies have actually evolved to destroy everything that gets in it, period.

Bacteria (and viruses eg) don't belong in our bodies, none of them. The human body (innate immunity) just seems designed that way.

Just some thoughts, Frans

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Hi Frans,

IMHO - I think the answer has to do with the fact that a "typical" bowel motion consists of a large proportion of dead bacteria. It also contains "dead cells from the bowel lining" which may be important to factor in for people who are sick with gut disease. So when we are told that probiotics improve bowel motions, it may refer mainly to improving the consistency (bulk)of bowel motions for people who are constipated. A diet with probiotics provides lots of the kind of bacteria (lactobacillus) which our bodies can easily kill off. Milk is our first food and lactobacilli are "safe" for babies' guts to "deal with". I think we have evolved a preference, so to speak, for such bacteria. Obviously, it makes demands on our immune system, but on balance, a healthy person's gut is happy doing this.

Probiotics may also displace (overgrow) any bad bacteria and in that respect, help prevent diarrhea. So that is an "improvement" as well. It is a balancing act.

Dr Marshall says (correct me if I am wrong,) he doesn't think we even need any bacteria in our gut, but of course it is impossible to live in a sterile world, so we are always going to be exposed to bacteria. Better to have some of the "good guys" than let the bad ones take over. I think this is the idea behind the probiotics promotion.  

If we eat sufficient amounts of fibre and stay hydrated, our bowel motions should be fine, once we are healthy, without additional probiotics.

Claudia

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hi.

just a story i thought would be of relevance:

our mum does not have pancreas problems, and yet last week after taking a quarter capsule of a new abx mum experienced severely debillitating non-relenting pain near the bottom of her ribcage on the left side (location of pancreas.)

it was so severe our doctor did an emergency blood test and came out four times after for checkups.

after reading and discussing this story in the netherlands, we realised mum had taken probiotics leading up to and after the dose of meds. (see below for details)

just thought you should know.
Angelina

the following is an excerpt from her post

last week sun night took  acidophilus capsule (US brand): 1x L. rhamnosus, Lcasei, L. plantarum, L. acidophilus, B. longum (morinaga strain), B. breve, Pediococcus acidilactici, Lactococcus lactis ssp. Lactis. (new from the US had taken before and was no prob.)
 On mon night took 1x lactobacillus acidophilus + bifidobacterium lactis  to prepare for Tue night abx (read about gutproblems) and wedn another acidophilus (US brand))

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Just wondering...

My doc thinks my RUQ pain is due to my gallbladder. I am not so sure. I don't throw up nor do I have any diarrhea. After a bit of research I am leaning toward my pancreas. Probiotics have never seemed to have any good or bad effect on me (as far as I have been able to assertain), but the idea that the probiotics could potentially have a bad effect on my pancreas, if that is the case, is VERY scary, and I think, very dangerous!

Gail
"It is never too late to be what you might have been." -George Eliot :cool:

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I think this article sheds some light  on the kind of thing that is going on, but obviously it is just one  part of a hugely complicated interaction:

http://www.eurekalert.org/pub_releases/2008-05/hms-ibp052208.php

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Here is an article about how there is another dimension to how probiotics have the effects they reputedly do, by altering the adhesive ability of pathogenic bacteria:

http://tinyurl.com/ScienceDirect-Probiotics

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Something new from New Zealand.

http://www.nzherald.co.nz:80/health/news/article.cfm?c_id=204&objectid=10542787

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I attended the "Beneficial Microbes" conference, run by the American Society for Microbiology, about 3 weeks ago.

None of the people who talked in terms of "Beneficial Microbes" have the expertise to understand that the bacteria which they believe have beneficial effects are also likely to carry harmful genes into the human body. It is ignorance of the worst kind. They assume that the body is sterile, except for those bacteria which they can identify in teeth, gut, etc, and they have no concept of a metagenome. Sigh...

Hence my keynote at Gene 2008 in China:
"Understanding Disease Requires Study of a Metagenome, not just the Human Genome"

http://www.bitlifesciences.com/wcg2008/
 

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NickBowler,

It appears PSA acts as an immunosuppressant. So using PSA to treat IBD would not be a very good idea (since it could encourage the proliferation of pathogens). Using one species of bacteria to drive out a more pathogenic species may have some value. However, reactivating an impaired immune system via the MP so it can better manage the gut microflora in the way the body has evolved to do seems like the safest approach to me.

As someone with Crohn's disease I prefer to follow Dr. Marshall's cautious view on probiotics.

Ken

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Ken,

It does seem as though palliation of symptoms by modifying the immune response so that it produces fewer inflammatory cytokines, adding species which compete with more pro-inflammatory ones either by producing specific chemicals or by physical interference, or even by the diversion of inflammation from distant organs to the gut as Amy surmised, is the main purpose of probiotic supplementation. Whether or not that could be supportive of the MP is not clear yet but most people will no doubt take the view that it is not, as the long term goal of the MP is to reduce bacterial load.

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I found it particularly disturbing that the article (from NZ) mentioned adding probiotics (i.e. live bacteria) to BABY FORMULA.  Scary stuff, especially considering they already add "vitamin D".

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There is already a product marketed for babies from Natren. When I first saw it, I didn't think anything of it. Knowing what I know now... I am not so calm about the thought!

beeletcher
inactive member
 

Joined: Wed Apr 16th, 2008
Location: Dawson Creek, British Columbia Canada
Posts: 90
Status:  Offline
Hi Trevor,

Good luck in China! Is there anything in the forecast for Canada next year, Autoimmunity or otherwise?

Do you know of any states, cities, provinces, where MP members get together?

Brenda



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