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I had the opportunity to listen to a talk given recently by Jon Vanderhoof, a pediatrician from the University of Nebraska. He was talking about the wonders and peculiarities of Lactobacillus GG and its role in digestive health. Lactobacillus rhamnosus GG is a probiotic unlike any other because it has little “hairs”(pili) that helps it stick to the inner lining of the digestive system. It also acts as the good guy which promotes the proliferation of other good bacteria in the neighborhood and it survives stomach acidity, making it likely to reach the intestinal walls where it’s needed the most. Vanderhoof was presenting his clinical experience with the use of Lactobacillus GG in children’s gut problems and he seemed to be very pleased with the results. It was interesting to see how researchers are approaching the role of food allergens and their role in modern diseases, a damage which doesn’t involve the classically allergic mediated reactions and its diagnostic tools with such things as a prick test. In fact, from a strictly mainstream medicine point of view, Vanderhoof explained that a host of inflammatory conditions along the digestive tube were increasingly associated with food intolerances. He gave the example of proctitis (inflammation of the rectum) as a reaction to gluten intolerance and other “idiopathic” diseases as well. He explained that gut motility issues (i.e. constipation) in small children were a result of gut inflammation due to food sensitivities. This is arguably the case for everybody else I should add! He emphasized that he was seeing children constipated as the only reaction to a milk allergy. Other less fortunate little ones were having blood on their stools and vomiting (among other things) in response to their mother’s awful diet. So of course, mothers are instructed to do an elimination diet when they are breastfeeding their babies. Gluten also shows up in mother’s milk contributing thus to colics, failure to thrive, acid reflux, diarrhea, eczema, chronic diaper rash, vomiting, seizures and so forth. For more information see glutenfreesociety.org The classical allergic reaction is IgE mediated (a component of your defense system) and it could send you to the emergency room for a life saving adrenaline shot. It can be that dramatic. But as classical as it may be, it is actually very rare. Most food allergens create great havoc through a non-dramatic but very harmful long-term effect. The most common food allergens are from agricultural-based foods, either GMO or non-GMO. This is one of the reasons why a paleo or ketogenic diet can be very beneficial for a lot of folks with several different conditions or health problems. Anyhow, the take home message is that Lactobacillus GG seems to be unique in its capacity to promote gut health and wellness in general, and that foods from the Agricultural revolution are at the root of mankind’s deteriorating health. Vanderhoof seemed to imply that Lactobacillus GG would increase the chance that a baby would tolerate a certain food allergen better. But if the body reacts to certain foods as it does, it is probably because the food per se is very harmful and was never part of mankind’s natural diet to begin with. Arguably the case for GMOs and the so called Agricultural revolution! For more information see Origins of Agriculture – Did Civilization Arise to Deliver a Fix? Below are some assorted studies and quotes that are relevant to the topic at hand. Share IgE-mediated allergic responses to foods are the most dramatic and perhaps the most easily diagnosed type of food allergy. Non-IgE-mediated food hypersensitivity is more chronic, less acute, less obvious in its clinical presentation, and often more difficult to diagnose. It usually presents in infants between one week and three months of age with vomiting and diarrhea, although irritability, poor feeding, and failure to thrive are not uncommon. A thorough history and physical examination are often key in establishing a diagnosis of food protein hypersensitivity. In non-IgE-mediated disease, skin tests and immunological studies are not helpful. Eliminating the food allergen is the only means of dealing with a food allergy in most patients.[Vanderhoof JA.. Food hypersensitivity in children. Curr Opin Clin Nutr Metab Care. The gut contains a diverse bacterial flora that is acquired at birth and has a number of physiological functions. Administration of prebiotics or probiotics may favourably alter this gut microflora. Prebiotics are poorly digested oligosaccharides that promote the growth of desirable bacteria and may have other beneficial gastrointestinal and systemic effects. Probiotics are “helpful” human bacteria that provide a variety of health benefits when administered exogenously. Probiotics produce beneficial effects in the prevention and treatment of traveller’s diarrhoea, viral diarrhoea, and diarrhoea in day care centres. Moreover, probiotics have been shown to reduce relapses associated with Clostridium difficile, and Lactobacilli are effective in the prevention of antibiotic-associated diarrhoea. Probiotics may also be efficacious in the treatment of gastroenteritis. Clinical studies of probiotics in inflammatory bowel disease have proved disappointing, but beneficial effects in adults with irritable bowel syndrome have been reported with Bifidobacterium infantis 35624. Lactobacilli GG reduces the incidence of gastrointestinal symptoms and gut permeability in patients with atopic dermatitis, and administration of probiotics reduces the frequency and severity of atopic eczema when administered to pregnant women and then to newborn infants. In conclusion, probiotics are effective in the treatment and/or prevention of a number of conditions, including diarrhoea, irritable bowel syndrome and atopic dermatitis, and the product used should be selected based on the particular indication. [Vanderhoof JA.. Probiotics in allergy management. J Pediatr Gastroenterol Nutr.2008 Nov;47 Suppl 2:S38-40.] “The most extensive studies of the modification of allergic reactions have been reported for atopic eczema with Lactobacillus GG as the probiotic”[…] “Randomized double-blind studies have provided evidence of probiotic effectiveness for the treatment and prevention of acute diarrhea and antibiotic-induced diarrhea, as well as for the prevention of cow milk–induced food allergy in infants and young children. Research studies have also provided evidence of effectiveness for the prevention of traveler’s diarrhea, relapsing Clostridium difficile–induced colitis, and urinary tract infections. There are also studies indicating that probiotics may be useful for prevention of respiratory infections in children, dental caries, irritable bowel syndrome, and inflammatory bowel disease. Areas of future interest for the application of probiotics include colon and bladder cancers, diabetes, and rheumatoid arthritis. The probiotics with the greatest number of proven benefits are Lactobacillus rhamnosus strain GG and Saccharomyces boulardii.” [B.R. Goldin, S.L. Gorbach. Clinical Indications for Probiotics: An Overview. Clin Infect Dis. It is estimated that ventilator-associated pneumonia (VAP) complicates the care of up to 30% of patients receiving mechanical ventilation. Patients with VAP have increased morbidity, mortality, and hospital costs as well as prolonged intensive care unit (ICU) and hospital lengths of stay and increased costs […] Probiotic prophylaxis of VAP using Lactobacillus rhamnosus GG appears safe and efficacious in a select population of patients who are at very high risk for contracting VAP. This therapy may also offer an opportunity to prevent related ICU complications, such as C. difficile and ICU-associated diarrhea. Ultimately, probiotics may fulfill a role in antimicrobial stewardship programs given the reductions in antibiotic consumption[Morrow LE, Kollef MH, Casale TB. Probiotic prophylaxis of ventilator-associated pneumonia: a blinded, randomized, controlled trial. Am J Respir Crit Care Med. APR
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LGG - jedan od najispitivanijih probiotičkih sojeva Klinička primjena Lactobacillus rhamnosus-a GG (LGG) označena je razinom A - klinički dokazana učinkovitost za razne indikacije U novije vrijeme zatrpani smo informacijama o raznim probioticima i njihovim utjecajem na ljudsko zdravlje. Činjenica da našu kožu, probavni i urogenitalni sustav naseljavaju razne dobre bakterije odavno je poznata, ali i dalje nismo sigurni kada posegnuti za probiotikom i, još važnije, koji soj bi odabrani probiotik trebao sadržavati. Lactobacillus rhamnosus GG (LGG) Zadnjih nekoliko godina sve je više istraživanja koja uključuju različite bakterijske sojeve, a jedan od najispitivanijih nesumnjivom je Lactobacillus rhamnosus GG (LGG). Njegova klinička primjena označena je razinom A - klinički dokazana učinkovitost za razne indikacije. Lactobacillus rhamnosus (LGG) su gram-pozitivne, anaerobne bakterije i sastavni su dio čovjekove mikrobiote. Sherwood Gorbach i Barry Golding su ih 1983. godine prvi put izolirali iz crijeva zdravog čovjeka, pa je soj dobio ime prema prvim slovima njihovih imena GG. Lactobacillus rhamnosus GG je soj bakterija koje su rezistentne na kiselinu i žuć, proizvode mliječnu kiselinu, te pomoću pilija dobro prianjaju na crijevni epitel. Upravo su te karakteristike zaslužne za njegovu sve veću upotrebu i sve veći broj kliničlih ispitivanja koja ga uključuju. Kao što smo već spomenuli, broj kliničkih istraživanja koja uključuju probiotike u stalnom je porastu. Godine 2008. izašle su smjernice o upotrebi probiotika koje su revidirane 2011. godine, a prema njima Lactobacillus rhamnosus GG (LGG) spada u najispitivaniji probiotski soj. Njegova klinička učinkovitost višestruko je dokazana, a u daljnjem tekstu navedene su samo neke od indikacija. Indikacije za primjenu Lactobacillus rhamnosus GG (LGG) Akutni gastroenteritis je upalna bolest sluznice želuca, tankog i debelog crijeva. Najčešće je infektivnog porijekla, iako ga mogu uzrokovati i unos različitih lijekova te kemijskih toksina. To stanje ne pogađa samo odrasle osobe, nego i malu djecu. Kada se govori o infektivnom gastroenteritisu kod djece, najčešći uzročnik je rotavirus, iako uzročnici mogu biti i razne bakterije. Karakteristike i intenzitet simptoma su promjenjivi, ali većinom uključuju mučninu, povraćanje, kruljenje i grčeve u trbuhu te dijareju. Prema ESPGHAN-u, u tim slučajevima ključna je rehidratacija. Uz nju, preporučuje se primjena dokazano učinkovitih probiotika, točnije sojeva Lactobacillus rheuteri GG (LGG) i Saccharomyces boulardii. Koncentracija Lactobacillus rhamnosus GG (LGG) koja se koristi u te svrhe, mora iznositi više od 1010 CFU/dan, a terapija mora trajati barem 5 do 7 dana. Upravo tu koncentraciju Lactobacillus rhamnosusa GG (LGG) osigurava BebiCol. Dijareja uzrokovana primjenom antibiotika također se često pojavljuje kod male djece. Antibiotici svojim djelovanjem ne uništavaju samo patogene bakterije, nego i bakterije koje su dio ljudske crijevne mikrobiote, što rezultira disbalansom između patogenih i dobrih bakterija. Sve to dovodi do pojave dijareje. Lactobacillus rhamnosus GG (LGG) učinkovit je u prevenciji pojave dijareje uzokovane antibioticima i zato je izrazito značajno da se primjena započne već od prvog dana antibiotske terapije. Svakako valja naglasiti da je jedna od najispitivanijih indikacija upravo sprječavanje pojave infekcije kod djece. Studije su pokazale da Lactobacillus rhamnosus GG (LGG) preventivno djeluje i na pojavu resporatornih i gastrointestinalnih nozokomijalnih infekcija kod djece. Jedna od dokazanih kliničkih indikacija tog probiotika je i prevencija virusnih infekcija gornjih dišnih puteva djece mlađe životne dobi, koje se javljaju kod djece koja pohađaju dječji vrtić. Dojenačke kolike Pod pojmom dojenačkih kolika podrazumijevamo pojavu učestalih i iznenadnih bolova, te jakog i neutješnog plača kod inače zdravog dojenčeta. To se obično javlja u poslijepodnevnim i večernjim satima, svakodnevno, tijekom nekoliko tjedana, i to između 3. tjedna i 3. mjeseca života. Kolike ne predstavljaju problem samo za dijete, nego i za roditelje koji su iscrpljeni neutješnim plakanjem svoga djeteta. Lijeka za kolike nema, a roditeljima se preporučuje niz nefarmakoloških mjera koje uključuju dovoljno odmora za majku i dijete, prikladnu njegu i hranjenje, prekidanje hranjenja barem 2 do 3 puta da bi dijete izbacilo višak zraka, dizanje djeteta nakon hranjenja u uspravan položaj (potom se stavlja na bok), masiranje trbušćića i dr. Također, preporučuje se i primjena probiotika. Studija je pokazala da crijevna mikrobiota djece koja imaju kolike sadrži manju količinu soja Bifidobacterium. Djeci koja su koristila Lactobacillus rhamnosus GG (LGG) broj bifidobakterija je narastao. I roditelji su potvrdili da su se broj sati plakanja kao i broj dana s epizodama plača smanjili u odnosu na kontrolnu skupinu koja je primala placebo. Zaključak Lactobacillus rhamnosus GG (LGG) jedan je od najkorištenijih probiotskih sojeva u kliničkim ispitivanjima. Označen je razinom A – klinički dokazane učinkovitosti za različite indikacije, i to za: - akutni gastroenteritis - infektivnu dijareju - prevenciju antibioticima uzrokovane dijareje - prevenciju respiratornih infekcija djece mlađe životne dobi koja pohađaju kolektve - prevenciju respiratornih i gastrointestinalnih nozokomijalnih infekcija. BebiCol, BebiCol Forte i Bebicol s cinkom sadrže koncentraciju Lactobacillus rhamnosusa GG (LGG) potrebnu za navedene indikacije, te predstavljaju prvi izbor kod odabira odgovarajućeg probiotika. Literatura: Hojsak I, Abdovic S, Szajewska H, Milosevic M, Krznaric Z, Kolacek S. Lactobacillus GG in the prevention of nosocomial gastrointestinal and respiratory tract infections. Szajewska H, Wanke M, Patro B. Meta-analysis: the effects of Lactobacillus rhamnosus GG supplementation for the prevention of healthcare-associated diarrhoea in children. Aliment Pharmacol Ther 2011;34:1079-87 Hojsak I, Snovak N, Abdovic S, Szajewska H, Misak Z, Kolacek S. Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers: a randomized, double-blind, placebo-controlled trial. Szajewska H, Kotowska M, Mrukowicz JZ, Armanska M, Mikolajczyk W. Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants. Agostoni C, Axelsson I, Braegger C i sur. Probiotic bacteria in dietetic products for infants: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2004;38:365-74 Szajewska H, Setty M, Mrukowicz J, Guandalini S. Probiotics in gastrointestinal diseases in children: hard and not-so-hard evidence of efficacy. J Pediatr Gastroenterol Nutr 2006;42:454-75 FAO/WHO (2001) Health and Nutritional Properties of Probiotics in Food including Powder Milk with Live Lactic Acid Bacteria. Report of a Joint FAO/WHO Expert Consultation on Evaluation of Health and Nutritional Properties of Probiotics in Food Including Powder Milk with Live Lactic Acid Bacteria 8.Hojsak I, Shamir R. Safety of Probiotics. World Review of Nutrition and Dietetics; 2013. Submited Szajewska H, Skorka A, Ruszczynski M, Gieruszczak-Bialek D. Meta-analysis: Lactobacillus GG for treating acute diarrhoea in children. Aliment Pharmacol Ther 2007;25:871-81 Pärtty A, Lehtonen L, Kalliomäki M, Salminen S, Isolauri E. Probiotic Lactobacillus rhamnosus GG therapy and microbiological programming in infantile colic: a randomized, controlled trial. ABELA PHARM PROMO