Probiotics and prebiotics are two food ingredients that have physiologic effects through the gastrointestinal tract. Once you buy a probiotics supplement, you should refrigerated it to prolong the shelf life.

Enteric coating
Q. I am confused about conflicting information I've read about probiotics. Some sources say you must take enteric-coated capsules so that the probiotics will bypass the stomach and stomach acid (which they say destroys the probiotics) and be released in the intestines. Other sources say that stomach acid does not destroy the probiotics and that enteric-coated capsules are an unnecessarily expensive method of getting your probiotics. Example: Yogurt has worked for
what, centuries, to provide probiotics' health benefits. What is the truth?
   A. I asked Dr. S.K. Dash, President of UAS Laboratories, Inc. and an expert in this field. He responded, "Probiotics are acid and bile resistant. Not only do they pass stomach acid, they implant in the intestine, produce digestive enzymes, vitamins, lactic acid and natural antibiotics. Probiotics do not need enteric coating to be effective."

Enhanced Probiotics System, 60 Vegetarian Capsules
Jarrow Formulas

• Higher Potency 4.4 Billion Organisms per capsules
• • Dairy Free
• Vegetarian
• Enteric Coated!
• Room Temperature Stable! No Refrigeration Required!
• For Intestinal and Immune Health
• Probiotic Supplement
• Individually Blister Sealed

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Jarro-Dophilus enhanced probiotics system is room temperature stable, but preferably refrigerate to safeguard product from heat. Blister packaging each capsule provides extra protection to the bacteria against moister and oxygen. At time of manufacture, each capsule contains approximately 4.4 Billion organisms. Jarro-Dophilus enhanced probiotics system is room temperature stable and enteric-coated, delivering directly into the intestines 8 different species of probiotics representing 4 genera of bacteria: Lactobacilllus acidophillus, Bifidobacterium, Lactococcus and Pediococcus Bifodobacteria longum BB536 (moringa strain) has been shown to colonize, stimulate immune response and suppress intestinal pathogens. L. rhamnosus R0011 is a unique, high producer of polysaccharides, which facilitate colonization and stimulate intestinal immune response. Lactococcus and Pediococcus help reduce spoilage caused by undesirable bacteria in cultured dairy products.

Jarro-Dophilus enhanced probiotics system is ideal for traveling when refrigeration is not readily available. Capsule individually blister packed to help ensure shelf stability.

Probiotics Supplement Facts:
Probiotics Bacteria 4.4 Billion
Organisms
L. rhamnosus R0011 (15.4%) 680 Million
L. casei R0256 (15.4%) 680 Million
L. plantarum R0202 (7.7%) 340 Million
Lactobacillus acidophilus R0052 (15.4%) 680 Million
Bifidobacterium longum BB536 (morinaga strain)(15.4%) 680 Million
Bifidobacterium breve R0070 (7.7%) 340 Million
Pediococcus (15.3%) 670 Million
acidilactici R1001
lactococcus (7.6%) 330 Million
diacetylactis R0100

Usage: Take 1 to 2 probiotics capsules per day, preferably on an empty stomach, though it may also be taken with food, or as directed by your qualified health consultant.

Benefit of prebiotics and probiotics supplements
Probiotics have been defined as live microorganisms that (when ingested) have a beneficial effect in the prevention and treatment of specific medical conditions. These microorganisms are believed to exert biological effects through a phenomenon known as colonization resistance, whereby the indigenous anaerobic flora limits the concentration of potentially harmful (mostly aerobic) germs in the digestive tract. Other modes of action, such as supplying enzymes or influencing enzyme activity in the gastrointestinal tract, may also account for some of the other functions that have been attributed to probiotics.
   Prebiotics are nondigestible food ingredients that benefit host health by selectively stimulating the growth and/or activity of bacteria in the colon. The prebiotic fructooligosaccharide (FOS), is found naturally in many foods, such as wheat, onions, bananas, honey, garlic, or leeks. They can also be isolated from chicory root or synthesized enzymatically from sucrose. Fermentation of FOS in the colon results in a large number of physiologic effects including increasing the numbers of bifidobacteria in the colon, increasing calcium absorption, increasing fecal weight, shortening of gastrointestinal transit time, and possibly lowering blood lipid levels. The increase in bifidobacteria has been assumed to benefit human health by producing compounds to inhibit potential pathogens, by reducing blood ammonia levels, and by producing vitamins and digestive enzymes.

Probiotics and the immune system
Probiotic bacteria such as Lactobacilli or Bifidobacteria are believed to positively affect the immune response by improving the intestinal microbial balance leading to enhanced antibody production and phagocytic (devouring or killing) activity of white blood cells. Bifidobacterium lactis could be an effective probiotic dietary supplement for enhancing some aspects of cellular immunity in the elderly.
   Probiotics enhance systemic cellular immune responses and may be useful as a dietary supplement to boost natural immunity in otherwise healthy adults. Children who take probiotic containing milk often havefewer respiratory infections.

Reduce the incidence of the common cold
A Chinese study indicated small children who drink a mixture of probiotic bacteria mixed in milk twice a day during the winter and spring have fewer colds, need fewer antibiotics, and miss fewer days of school. The study in China involved 326 children, ages 3 to 5 years, who were randomly assigned to three different groups: one given milk with a bacterium called Lactobacillus acidophilus mixed in, another that received the same organism along with a strain of another bacterium, Bifidobacterium animalis, and a third that received just milk with placebo. The test formulas were given twice daily, from November 2005 to May 2006, by school officials during the week and by parents or guardians on weekends. Compared to the placebo group, the Lactobacillus group had 53 percent fewer fevers, 41 percent fewer cough episodes, and 28 percent fewer runny noses. The Lactobacillus/Bifidobacterium group had even larger reductions in symptom rates: 72 percent fewer fevers, 62 percent fewer coughs, and 59 percent fewer runny noses. When children in the test groups did get fevers, coughs or runny noses, they recovered significantly faster. Compared to placebo, the length of illness was decreased by 32 percent with Lactobacillus and by 48 percent with Lactobacillus / Bifidobacterium.The combination probiotic product used in this study is now marketed as "HOWARU Protect" by Danisco in Madison, Wisconsin. Danisco's Dr. Gregory J. Leyer, who headed the study, believes that probiotics may limit the need for medications. Pediatrics, August 2009.

Probiotics and diarrhea
Probiotic supplements may help remedy certain types of diarrhea caused by the use of antibiotics. Probiotics may be used preventively to prevent or reduce symptoms of "traveler's diarrhea."

Australian researchers have modified probiotics microbes -- "good" bacteria -- that may be useful in preventing or treating travelers' diarrhea, an all too common problem during trips to certain countries. The probiotics work against a type of E. coli bacteria that causes diarrhea by producing a chemical that is toxic to intestinal cells. The probiotics carry a molecule that looks a lot like the toxin receptor found on intestinal cells. This mimicry causes the toxin to bind to the microbes instead of the intestinal cells. Lab tests showed that these probiotics could bind and neutralize a significant amount of enterotoxin, according to a report in the medical journal Gastroenterology. Moreover, treatment with these agents conferred significant intestinal protection in rabbits exposed to the toxin. The results suggest that these probiotics could be a useful treatment for traveler's diarrhea caused by E. coli, the researchers state.

Compared with standard formulas, those containing beneficial "probiotics" organisms seem to reduce the number and duration of diarrhea episodes in infants attending childcare centers. Of two types of probiotics tested -- Lactobacillus reuteri and Bifidobacterium lactis -- L. reuteri may be the better supplement, according to the report in the medical journal Pediatrics. Dr. Zvi Weizman, from Soroka Medical Center in Beer-Sheva, Israel, and colleagues assessed various infectious outcomes in 201 infants randomly given formula supplemented with L. reuteri, B. lactis, or no probiotics. All of the infants were healthy and attended childcare centers in Beer-Sheva. In addition to having fewer and shorter diarrhea episodes, infants treated with the probiotic formulas also had fewer episodes of fever. Compared with the other groups, the L. reuteri group also had significantly fewer clinic visits, childcare absences, antibiotic prescriptions, and days with fever. "The present controlled study is the first to compare two different species of probiotics microorganisms and their efficacy in the prevention of common infectious illnesses in childcare infants," Weizman's team states. "In most of the parameters studied, the differences were consistently in favor of L. reuteri," the researchers add. Pediatrics, January 2005.

Inflammatory bowel disease
Probiotics may be helpful in ulcerative colitis and Crohn's disease. Taking a mixture of several probiotic bacteria reduces symptoms in patients with ulcerative colitis that doesn't respond to conventional medications. The probiotic mixture contained four strains of Lactobacillus, three strains of Bifidobacterium and one strain of Streptococcus salivarius -- all well-known species of good bacteria. Researchers from the University of Alberta in Edmonton, Canada enrolled 34 patients with active ulcerative colitis who were treated with the probiotic mixture twice daily for 6 weeks. A variety of standard treatments had been tried on the patients first, with no help. Remission occurred in 53 percent of the patients and an additional 24 percent experienced some degree of improvement in symptoms. A few patients experienced no improvement or worsening of their symptoms. The only apparent side effect from the probiotic mixture was increased bloating. Testing of sampled colonic tissue provided direct evidence that the probiotic bacteria had, in fact, reached the diseased sites of the colon.  American Journal of Gastroenterology, July 2005.

A pilot trial of Saccharomyces boulardii in ulcerative colitis.
Guslandi M, Giollo P Raffaele University Hosptial, Milan, Italy. Eur J Gastroenterol Hepatol. 2003 Jun;15(6):697-8.
Probiotics can be useful in the treatment of inflammatory bowel disease. In a previous report, the non-pathogenic yeast Saccharomyces boulardii was found to be beneficial in the maintenance treatment of Crohn's disease. The aim of this study was to assess the efficacy of S. boulardii in ulcerative colitis patients. A group of 25 patients with a mild to moderate clinical flare-up of ulcerative colitis received additional treatment with S. boulardii 250 mg three times a day for 4 weeks during maintenance treatment with mesalazine. These patients were unsuitable for steroid therapy. Before and after treatment, Rachmilewitz's clinical activity index was calculated. The probiotic treatment was considered a therapeutic success only when the final score was lower than 6. Of the 24 patients who completed the study, 17 attained clinical remission; this was confirmed endoscopically. Our preliminary results suggest that S. boulardii can be effective in the treatment of ulcerative colitis. Controlled studies with this probiotic agent are warranted.

Probiotics and eczema
Probiotics given during pregnancy to the mother and then post-natally to the child substantially reduce the incidence of eczema in those children at 2 years of life.

Probiotics and irritable bowel syndrome
Probiotics may be helpful in IBS.

Probiotics and chemotherapy drugs
In cancer patients, treatment with the probiotic Lactobacillus reduces the frequency of severe diarrhea and abdominal pain that often comes with 5-fluorouracil (5-FU)-based chemotherapy.

Ulcer relief with Probiotics in Yogurt
Up until recently, peptic ulcer disease was thought to be caused by an imbalance between acid and pepsin secretion, as well as defensive factors such as bicarbonate secretion and gastric mucosal barrier. The isolation of Helicobacter pylori from patients with chronic gastritis and duodenal and gastric ulcers has revolutionized thinking about the causes of ulcers. Current data suggest that persistent infection with Helicobacter pylori may account for peptic ulcer disease. In this study, 59 adult volunteers infected with H. pylori were given Lactobacillus- and Bifidobacterium-containing yogurt (AB-yogurt) twice daily after a meal for 6 weeks. Eleven subjects positive for H. pylori infection were treated with milk placebo as control subjects. H. pylori bacterial loads were determined with use of a breath test, which was performed before and 4 and 8 weeks after the start of AB-yogurt supplementation. Results: Yogurt containing probiotics suppressed H. pylori infection.
     Dr. Sahelian says: When you purchase yogurt, makes sure the label says that it contains these organisms. Or, you may directly supplement with probiotics.

Probiotics and H. Pylori infection
Effects of ingesting Lactobacillus- and Bifidobacterium -containing yogurt in subjects with colonized Helicobacter pylori.
American Journal of Clinical Nutrition, Vol. 80, No. 3, 737-741, September 2004
Evidence suggests that ingesting lactic acid bacteria exerts a suppressive effect on Helicobacter pylori infection in both animals and humans. Supplementing with the probiotics Lactobacillus- and Bifidobacterium-containing yogurt was shown to improve the rates of eradication of H. pylori in humans, a cause of ulcers. Objective: We administered probiotics to subjects with asymptomatic H. pylori to test whether the probiotics yogurt could inhibit H. pylori growth. Design: In an intervention study, 59 adult volunteers infected with H. pylori were given probioitics-yogurt twice daily after a meal for 6 weeks. Eleven subjects positive for H. pylori infection were treated with milk placebo as control subjects. H. pylori bacterial loads were determined with use of the 13C-urea breath test, which was performed before and 4 and 8 wk after the start of probioitics supplementation. Results: Bb12 exerted an in vitro inhibitory effect against H. pylori, whereas La5 did not show an effect. Administration of probioitcs-yogurt decreased the urease activity of H. pylori after 6 wk of therapy. Regular intake of yogurt containing Bb12 and La5 probiotics effectively suppressed H. pylori infection in humans.

Pretreatment with Lactobacillus- and Bifidobacterium containing yogurt can improve the efficacy of quadruple therapy in eradicating residual Helicobacter pylori infection after failed triple therapy
American Journal of Clinical Nutrition, Vol. 83, No. 4, 864-869, April 2006
Lactobacillus and Bifidobacterium probiotics containing yogurt may suppress Helicobacter pylori. Improvement of the eradication rate by quadruple therapy of residual H. pylori after failed triple therapy is needed. We tested whether prior treatment with probiotics improved the efficacy of quadruple therapy in eradicating residual H. pylori after failed triple therapy. Design: One hundred thirty-eight patients in whom triple therapy failed were enrolled for a culture study of H. pylori to assess antimicrobial resistance. These patients were then randomly assigned in equal numbers to either a yogurt probiotics quadruple therapy group or a quadruple therapy-only group. The patients received 1 wk of quadruple therapy with or without a 4-wk pretreatment with probiotics yoghurt (400 mL/d). A 4-wk pretreatment with probiotics yogurt can decrease H. pylori loads despite antimicrobial resistance, thus improving the efficacy of quadruple therapy in eradicating residual H. pylori.

Probiotics Research study
Workers who took a daily dose of beneficial bacteria, also known as probiotics, were much less likely to call in sick than their colleagues given a placebo. Probiotics have been shown to have a number of positive health effects, helping, for example, to prevent gastrointestinal ills and to boost immune system function. Dr. Py Tubelius and colleagues from Tetra Pak Occupational Health and Safety AB conducted the current study to determine if one probiotic, Lactobacillus reuteri, might help prevent sick leave due to respiratory or gastrointestinal infections. They randomly assigned 262 employees of the company to take a drink containing L. reuteri or a placebo drink every day for 80 days. Twenty-three of the 87 workers on placebo, or about 26%, took sick leave during the course of the study, compared to 10 of the workers taking the probiotic, or 11%. Among the subset of workers on the night shift, none of the 26 taking the probiotic called in sick, compared to 9 of their 27 colleagues, or 33%. Shift workers are known to be more prone to develop stomach ailments, colds and other types of short-term illness leading to sick leave. While the mechanism by which the probiotic might help prevent illnesses isn't clear, the researchers add, it's likely that it helped to strengthen immune function. Environmental Health, Nov 2005.

Probiotics Displace Bad Bacteria in the Nose -- Even though the nose-- with its hairs-- is a filtering system that prevents many harmful bugs, dust, and other undesirable elements from entering the respiratory system, it is also, in some people, a reservoir for harmful bacteria including those that cause staph infections, ear infections, sinus infections, and pneumonia. In those carrying harmful bacteria in their nasal cavities, antiseptic regimens could be crucial for infection control after major operations on or injuries of the head, nasal sinuses, or lungs. Such regimens may also be important for diabetic patients and persons in intensive care units, or with impaired immunity due to various other causes. But, instead of just trying to kill these harmful bacteria with antiseptics or antibiotics, another option may be to displace them with healthy bacteria. Scientists at the Swiss National Accident Insurance Institute, Lucerne, Switzerland tested a possible effect of the ingestion of probiotics on the bacterial flora of the nose. Volunteers were randomly assigned to consume either a probiotic fermented milk drink that included beneficial bacteria such as lactobacilli and bifidobacteria or standard yogurt daily for 3 weeks. At the conclusion of the study, nasal microbial flora were analyzed. There was a 20 % reduction in the occurrence of harmful bacteria in the group who consumed the probiotic drink compared to the group who consumed yogurt.
     Dr Sahelian says: For those who do not wish to drink probiotic fermented milk, capsules of probiotics are available in health food stores. Look for a product that contains several billion bacteria per capsule, including lactobacilli and bifidobacteria. One to three capsules a day should be sufficient.

Probiotics supplements for children
Many infants and children may be lacking beneficial bacteria, and supplements could potentially help them get fewer infections. Compared with standard formulas, those containing beneficial "probiotic" organisms seem to reduce the number and duration of diarrhea episodes in infants attending childcare centers. Of two types of probiotic tested -- Lactobacillus reuteri and Bifidobacterium lactis -- Lactobacillus may be the better supplement, according to the report in the medical journal Pediatrics. Probiotic supplements affect the immune response by improving the intestinal microbial balance leading to enhanced antibody production. Another study indicates that children who take probiotic supplements suffer fewer respiratory infections.

Probiotics products
Some probiotics supplements sold over the counter may not contain enough live bacteria to be effective. "There's a chance that you may be buying dead bacteria unless you shop very carefully," says Dr. Tod Cooperman, president of ConsumerLab.com. The analysis by ConsumerLab.com included 13 brands of probiotics. Consumer Lab found just 9 contained at least 1 billion viable organisms per dose, the amount considered necessary for effectiveness. Brands that fell short of the billion mark included DDS Acidophilus; Flora Source; Nature's Secret Ultimate Probiotic 4-Billion; and Rite Aid Acidophilus, Milk Free. Advocare Probiotic Restore did contain the 1 billion minimum, but claimed on its label to pack 30 billion per dose. ConsumerLab.com

Probiotics supplement questions
Q. Are homeostatic soil organisms supplement preferable to probiotics for gastrointestinal disorders?
   A. Since I have not seen any independent published studies with homeostatic soil organisms, and none comparing homeostatic soil organisms to a probiotic supplement, it is not possible for me to say with any degree of certainty.

Q. Can probiotics supplements be taken the same day as curcumin, turmeric, and serrapeptase?
   A. Probably but I have not seen any research regarding these combinations.

Q. Is a daily dose of a probiotic supplement recommended for everyone or is it specifically for people who are taking anti-biotics or have intestinal issues?
   A. Each person is unique in their benefit from probiotic supplements. Some people may consume yogurt on a regular basis or have developed good intestinal flora throughout life. Others may have a shortage of good bacteria or have taken antibiotics in the past. Therefore, it is difficult to make a firm recommendation regarding wholesale advice on taking probiotics. As a general rule, it would seem prudent and reasonable for many people to take a probiotic supplement a few times a week or a few times a month.

My Mother got clostridium difficile toxin after a six week course of Ertapenum. She was taking Jarrow Dophilus probiotic during this course. Finished antibiotic, was without probiotic for 4 days and developed CDT. Does now want to take Flagyl. She is back on Jarrow Dophilus and then we added Saccharomyces boulardii. This seemed to be too much and she goes to the bathroom frequently. She does not have diarrhea but just goes often. Although it isn't watery it does not look normal. She has some stomach cramps. My question is - How long do we give the probiotic to get her back to normal before further steps need to be taken. I have read under the Mayo Clinic that it is possible to treat this with probiotics. When should she start to feel normal if this is actually working?
    It is impossible for me to know since I would have to review the whole medical history, lab results, and physical exam in order to have a better understanding of the situation.

Dear Dr. Sahelian: There is so much conflicting information about probiotics that I thought I would ask you for clarification. Several years ago, I attended a lecture sponsored by Pharmax, with Dr. Nigel Plummer as the speaker. He said that probiotics would stay well in a freezer. Now I read that freezing could compromise the bacteria. What do you say? And second, at another seminar, Dr. Michael Wald shared that taking a probiotic at the same time as an antibiotic, the probiotic would enhance the efficiency of the drug. I have never been able to find any information to corroborate either of these two assertions. Whatever information you have about these two areas of confusion, would be greatly appreciated. Thank you for your attention in this matter. Sincerely, Gina Liberti, MS, DTR, MS ED, Adjunct Professor, Functional Nutrition, SUNY Rockland Community College.
    As far as I know, freezing or more practically keeping the bottles in the non-freezer section of a refrigerator helps with the longevity of the bacteria. I have not seen much reliable research in regards to taking antibiotics with probiotics. There are dozens of different antibiotics and many types of beneficial bacteria, and it would seem that each combination has to be studied by itself in various dosages as a treatment of various conditions. Therefore, making a blanket statement that probiotics would enhance the efficacy or efficiency of the antibiotic seems simplistic. It is probably a lot more complicated than that.

I have noticed that moderate to high doses of probiotics started after a long break can cause significant sinus congestion in myself and others. It is as if the probiotics are kicking out the candida all at once and the result can be significant congestion. A friend restarted her probiotics-laiden green shake after 12-18 months off at her earlier dosage and ended up needing sinus surgery because of blockages formed in upper sinus cavities. What have you heard or read about such side effects? It may be that only some people get this effect - I believe that I have had chronic candida for years - at a level of suppressing my immune system. Chronic sinus "infections" and years of anti-biotic usage. I have fought back over the past four years by eliminating most gluten and sugars from my diet and using accupressure to improve my sinus drainage and immune system. No antibiotics now the four years but I have insomnia that repeatedly wakes me at 3 or 4 AM as if I have a harsh adrenalin jolt - very difficult to get back to sleep. Sweaty chest. Blood sugar crash? I am 42, professional, wife, and a mother of 3 children ages 10, 6 and 2. Yes, there is significant stress in our lives, though sleepness is certainly a contributing factor!
    I have not heard of these friendly bacteria products causing sinus problems.