Most people do not understand that we live in a sea of bacteria. There are bacteria, and related organisms called Archea, at the bottom of the sea and probably deep into the earth. The vast majority of these bacteria do us no harm and, in fact, some are necessary for health and even life. For example, if a patient has been taking antibiotics for several weeks, their blood clotting may be seriously impaired. This is because vitamin K is manufactured in the gut by bacteria, which are killed off by antibiotics.
Antibiotics have another undesirable effect on bacteria in the gut. The bacteria which are sensitive to that antibiotic are killed off and this leaves room for more dangerous bacteria, which are resistant to the antibiotic, to take up residence. My professor of surgery had a theory, which I have not seen proven, that harmless bacteria are the best adapted for life in the gut. If they are killed off by antibiotics and replaced by pathogenic organisms, removal of the antibiotics will allow the harmless organisms to reestablish themselves, displacing the pathogenic strains. I saw evidence of this in his and my own patients.
He kept a pure culture of Escherichia coli, a common colon bacterium, in the hospital lab. This strain was sensitive to all antibiotics so would be quickly killed off in their presence. Many of his elective surgery patients would come in for surgery with highly antibiotic resistant organisms in their colon. This was because they had been taking antibiotics, usually for diverticulitis. If these patients developed an infection postop, most common antibiotics would be useless. What he did was to stop all antibiotics and give the patient a dose of the lab E. coli in a malted milkshake. On admission, we would take a culture of the patient’s stool and have the lab check sensitivity to the common antibiotics. Usually, we found that the stool organisms were resistant. A couple of days after the dose of sensitive E coli had been given (I never asked the patients if they knew what was in the milkshake), the stool culture was checked again. In almost all cases, we found that the resistant organisms had been replaced by sensitive ones.
The residents at the County Hospital used a variant of this method on elective colon surgery patients. Since the lab was not about to keep a culture of sensitive organisms for us, we used an alternate source for them. Patients coming in for simple surgeries, like hernia repairs, who had not been on antibiotics and who had not been around hospitals, had a stool sample taken. That stool specimen was mixed with a malted milkshake and given to the colon surgery patients. Needless to say, they were not told the contents of the milkshake. We were less able to test the effect because the labs were very uncooperative with any of these exotic concepts. Still, I think it worked although we now know that the bowel flora is actually not what we thought it was in the 1960s. The anerobic organisms, like Clostridia, were not well understood and Bacteroides had not been discovered. It is now known that 90% of colon organisms are anerobic, meaning they cannot survive in an oxygen containing atmosphere. Many species have not been discovered because they cannot be cultured. They also produce nutrients, like fatty acids, that are essential for the health of the colon mucosa. There is even a disease called “diversion colitis” that is due to diversion of the fecal stream, by a colostomy usually, from the lower colon.
Why am I bringing up these old war stories ? There is a lot of interest right now in how colon bacteria affect normal health. Irritable Bowel Syndrome is much in the health news. There is a theory that it is caused by bacteria in the bowel that produce too much gas and cause other irritating conditions.
Researchers have built a strong case that bacteria may be the actual culprit. Mark Pimentel, M.D., a colleague of mine at Cedars-Sinai Medical Center who heads the GI Motility Program, has spent the last decade studying IBS, specifically the role bacteria may play in causing the condition. He and his colleagues unveiled the results of a large clinical study during Digestive Disease Week earlier this year in New Orleans. This study showed an antibiotic is effective in providing long term relief of IBS symptoms – excellent news for a large number of IBS sufferers.
If an antibiotic is helpful, what about other bacteria that may not cause the irritation ? WE hear a lot the past few years about “probiotics” on the radio. What are they ?
Our bodies are a complicated ecosystem full of flora. In fact, the bacteria outnumber our own cells by 10 times. There are around 10 trillion cells that make up the human body, and we have around 100 trillion bacteria cells in our digestive tracts.
As more people become increasingly aware of the importance of this “good bacteria,” hundreds of products in recent years have attempted to catch our eye by promising to help our troubled stomachs. Probiotics, defined as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host,” have become a big business. During a casual flip through the television channels, I frequently encounter commercials filled with attractive women gushing that their digestion has never been more regular thanks to certain yogurts or other products.
There may be something to some of those claims.
Probiotics include both yeastlike members of the saccharomyces group and teria, which usually come from two groups: Lactobacillus or Bifidobacterium. Probiotics are sold as capsules, tablets and powders, as well as in a growing number of foods. Among them, yogurt, yogurt drinks, kefir, miso, tempeh, as well as some juices and soy beverages. Sometimes the bacteria were present originally, and sometimes they are added during the preparation of the foods.
I have for many years prescribed yogurt and lactobacillus containing milk, available in the supermarket, for my patients recovering from conditions in which they took antibiotics.
Despite its narrow range of participants, the study confirmed that probiotic yogurt aided many of those involved. “We have shown that simply giving a probiotic drink to elderly patients who are prescribed antibiotics reduces their risk of getting diarrhea,” says Mary Hickson, a research dietician at Imperial College in London and the lead author of the study.
Gastrointestinal illness is a common side effect in an antibiotic’s battle against bacterial infection. Antibiotics don’t just go after the bad guys — they also kill some of the beneficial or neutral place-holding flora in our digestive tracts. This collateral damage allows deleterious organisms to establish themselves, often inflicting abdominal distress and discomfort as a result. Yogurt, like other “probiotic” foods, helps to promotes the growth of favorable bacteria in our digestive tracts. These microorganisms assist us in absorbing nutrients from our food and also occupy valuable real estate so that pathogens cannot proliferate and make us sick.
It’s nice to see the theory catch up with practices that I and others have been using for 40 years. Those patients who got the fecal milkshakes never knew how advanced the therapy they were getting really was.
Tags: health care, medicine, science
Interesting.
My ex-wife had Crohn’s disease (allegedly) at the end of her first marriage and during our marriage. She seemed able to turn the symptoms on and off to fit the emotional landscape. She had very poor eating habits: erratic schedules, almost a binge-fast type of diet.
The divorce seemed to have cured her.
Crohns is interesting. When I was in medical school, almost 50 years ago, there was a theory that it was caused by atypical tuberculosis organisms. Now, the common theory is some sort of autoimmune disease but the tb theory is still in play. During my time in medical school it was often referred to as the “bitch syndrome” but that has long been considered sexist and a few other things.
A search using the terms crohns disease and tuberculosis still yields 591 articles.
This is very timely, for me, since I am getting over a horrible bout of gastro-enteritis that struck Sunday night. I lost *everything* and ended up in the hospital where they put in 4+ liters of fluid. They also discovered a UTI so now I’m on Cipro..I am glad you approve of the yogurt regime because I’m taking 2 servings a day.
What amazed me is that ER showed no curiosity about what I may have eaten that day, and no one ever told me exactly what else I had besides the UTI, despite several blood cultures, stool sample etc.
The ER had probably seen 100 people that day with the same symptoms. They conclude that it is a virus going through the community. I don’t know about the cipro. There is no point eating yogurt until you are off the cipro.
fecal milkshakes-yuk! I can’t help but think some Dr’s may have enjoyed giving this secret punishment to a few of their challenging patients.
Nobody complained.
I have heard that certain bacteria in your gut can even provide a more restful and deeper sleep.
Well, it’s better than diarrhea.
Ahh, clindamycin. Dentists love it, especially when you’re getting an implant. I have been told it’s an anaerobic antibiotic. I know this: it took me about 3 months of Walgreen’s Probiotic to get straight after a course of this antibiotic. Before I figured out what to do, all the unpleasantries of colon problems were there. It also caused, for me at least, the worst heartburn I have ever experienced. I won’t be taking it again.