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Larry Newman is the Chief Operating Officer, Technical and Regulatory Affairs of Kirkman Group, Inc. (Kirkman). Contact Kirkman at 1-800-245-8282; 6400 Rosewood St., Lake Oswego, OR.

Monday, January 10, 2011

Probiotics 101

By Larry Newman

How Probiotics Work

There is a growing appreciation in scientific circles that the human body relies on armies of “friendly” bacteria to promote good health.

Probiotics are the good flora that can counter balance harmful bacteria to provide protection from illness and support other functions essential to a healthy gut and immune system.

“Probiotic” means "for life."  Technically, probiotics are live, beneficial bacteria which 
benefit the host by improving the intestinal flora ratio of good to harmful organisms.

There are 10 times more bacteria (approximately 10 trillion microorganisms) in the human gut than all other types of cells in the human body. These varied bacteria species generate intense metabolic activity and are of key importance to human health.

A healthy gastrointestinal tract contains a balance of both friendly bacteria as well as harmful strains of bacteria.  Friendly bacteria keeps the harmful bacteria in check, however, there are numerous ways in which friendly bacteria can be destroyed or depleted including:

•    Use of broad spectrum antibiotics
•    Stress
•    Environmental toxins/chemicals
•    Improper diet or nutrient deficiencies
•    Food allergies and sensitivities
•    Yeast, bacterial or viral overgrowths

Probiotic supplementation can restore balance for healthy gut and immune functions.

The Benefits of Kirkman’s Probiotics

Kirkman’s probiotics
were developed specifically for our customers’ special dietary requirements.

All probiotics offered under Kirkman's label are casein and gluten free.*  In addition, all of Kirkman’s probiotics are free from other common allergens including wheat, gliadin, eggs, soy, processed sugars, palmitates, MSG, artificial colors and flavorings, salicylates and preservatives.

In addition, many customers of Kirkman® require high-strength probiotics for effectiveness.  Kirkman® offers varying potencies of high-strength probiotics, up to 75 billion CFUs per capsule.

The probiotic strains used in Kirkman’s products have been extensively researched in many clinical trials and studies that document the potential health benefits that our customers require including:

•    Ability to adhere to the GI mucosal membrane
•    Positive affects on controlling bacterial, yeast and vital overgrowths
•    High tolerance for stomach acids and bile salts
•    Ability to strengthen the intestinal tract’s immunological barrier
•    Production of anti-microbial substances that are active against many forms of harmful bacteria.
•    Clinically proven effectiveness in controlling diarrhea and constipation
•    Assistance in regulating intestinal mobility and normalizing bowel function
•    Ability to enhance the uptake of important nutrients including calcium, magnesium and zinc.

Importantly, Kirkman's blends, encapsulates and packages all of Kirkman’s probiotics in-house which means that we can impose the strictest standards of quality control in each step of the manufacturing process.  At Kirkman®, probiotic cultures are kept frozen at -20 degrees C. until used and are subsequently subjected to exacting temperature and humidity controls to ensure potencies and long-term stabilities.

In addition, only glass bottles are used for packaging Kirkman’s probiotics, which ensure imperviousness to moisture. To maintain the stability of the probiotics’ live organisms, Kirkman® uses amber glass bottles with special desiccants to provide the highest standard for packaging of live bacteria.

Probiotics are usually anaerobic organisms, which means that they live in the absence of oxygen.  Kirkman® takes the extra step of nitrogen flushing which replaces the oxygen in the bottle, thereby improving stability.

Off-the shelf probiotics are usually weakened because they loose potency under normal temperatures and while on store shelves.  Kirkman® ships our probiotics direct to you, packaged with ice so you can be assured that the product you receive lives up to its stated potency.

Kirkman® is a distributor of Culturelle™ and ThreeLac™ both of which contain traces of casein.  

FAQs About Probiotics
What Parents Want to Know

Q-Why would I consider giving my child probiotics?
A-    Probiotics are good insurance for maintaining healthy intestinal flora which in turn supports a healthy gastrointestinal tract.  Specific health symptoms which might indicate a need for probiotics include abdominal pain, gas, bloating, bacterial or yeast overgrowth, constipation or excessively loose stools.

Q-What is the definition of a probiotic?
A-    Probiotics are live strains of beneficial bacteria which promote gastrointestinal health.

Q- What are the functions of probiotics?
A-    Probiotics promote intestinal growth and colonization of the healthy beneficial strains they deliver, which in turn helps to crowd out harmful bacteria or yeast.

Q- What are the mechanisms by which probiotics deliver their beneficial effects?
A-    The probiotics deliver live, colony forming units, to the intestines.  Generally speaking, Lactobacillus strains work predominately in the small intestine while Bifidobacterium strains are more active in the large intestine.  When reaching the intestines, the colony forming units begin multiplying thereby crowding out and making it more difficult for harmful bacteria to survive.

Q- What are the different functions of the different strains?
A-    There are certain strains of probiotics which are particularly effective in crowding out specific strains of harmful bacteria such as Clostridia or Klebsiella.  Unless your doctor has positively identified the harmful strains via a stool culture, however, most individuals who use probiotics don’t actually know which harmful bacterial strains are present in the intestines and rely on a multi-strain probiotic to increase the beneficial flora while crowding out the undesirable flora.  If you doctor has done a stool test and identified a particular pathogenic bacteria, he can prescribe a specific strain of probiotic particularly effective  for that organism.

Q- Is there any one strain – or a couple – that is more advantageous than others?
A-    If a stool test has identified a particular pathogenic bacteria, then a probiotic specifically effective on that bacteria would be desirable.  If not, then a combination of Lactobacillus strains and Bifidobacterium strains have been shown to be very effective.

Q- Do I need to start out slowly?
A-    Yes.  Each individual needs to find out their optimum dose for their own ideal gastrointestinal health.  Some individuals need only low doses to correct intestinal issues while others need more therapeutic dosages.

Q- Is the dosage dependent on the patient’s weight or age?
A-    It can be but not necessarily.  Each individual needs to find that “ideal” dose.  Sometimes once daily is enough, while in others, multiple dosing per day is needed.

Q- What is the rate at which you should increase the dosage?
A-    A good rule of thumb is to start out with ¼ of a capsule for a few days, and then increase to ½ capsule if no negative effects (such as loose stools) are seen.  After another few days, increase to a full capsule.  If improvement is noticed, but not yet optimal, then multiple dosing per day or multiple capsules can be tried.  The most common symptoms of overdosing with a probiotic are excessively loose stools or excess gas.  If that occurs, back the dosage down.

Q- What kind of beneficial effects have some people seen with probiotics?
A-    Reduced abdominal pain, less gas, improved regularity, firmer stools, less odorous stools, and better food digestion.  Sometimes improvement in skin tone is also seen.

Q- Are there any sorts of effects which appear negative?
A-    Only if the product is overdosed in which case loose stools and excessive gas could result or if there is a die off reaction resulting from harmful bacteria  releasing toxins  as they die.  This is known as the herxheimer reaction which causes the individual to feel “sick” or uncomfortable for a few days.  This die off reaction usually resolves in a week to ten days. 

Q- What do you do if you see these effects?
A-    If you see positive effects, try to find the ideal dose and maintain that dosing regimen.  If the above negative results occur, back the dosage down until the right dose is determined or in the case of a die off reaction, reduce the dose until the situation resolves.

Q- Although probiotics are not intended to diagnose, treat, or cure any disease, for what reasons have some people started taking probiotics?
A-    Specific health issues which might indicate a need for probiotics include intestinal or abdominal pain, gas, bloating, bacterial or yeast overgrowth, constipation or excessively loose stools.

Q- How long will it take to see positive results?
A-    Often, positive results will be seen within a day or two.  In some individuals, it may take a week or two.

Q- Is it possible to overdose on probiotics?
A-    Yes.  Excessive probiotics usually result in loose stools and/or excess gas.

Q- How do you work with the dosage/administration for a child who has trouble tolerating probiotics?
A-    A child who has difficulty tolerating probiotics could have a sensitivity to something in the product or could be experiencing a die off reaction.  If it appears to be a sensitivity type allergic reaction, try a hypoallergenic form.  If it appears to be die off, reduce the dose and be patient.  Die off usually resolves within a week.

Q- How far do probiotics survive in their journey down the gastrointestinal tract?
A-    Kirkman’s probiotic strains are stabilized with a protective polymer which coats the probiotic cells to protect them from stomach acids.  Most of the cells reach the intestines alive and are ready to go to work.  This may not be true of many other brands.  Unstabilized strains can be killed off by the acidic conditions of the stomach.

Q- How should Kirkman's probiotics be stored?
A-    Kirkman's probiotics are shipped on ice.  When received by the customer, they should be stored in the refrigerator.

Q- How long can Kirkman's probiotics be out of the refrigerator (at room temperature) and still be effective?
A-    They can be left at room temperature not exceeding 75° F for a day or two.   In excess of 75° F, however, the integrity of the product can be compromised within about two hours.  The hotter the temperature, the quicker cells are killed off.  The best scenario is to keep refrigerated in which case, label potency is guaranteed through the best buy date on the label.

Q- Are Kirkman’s probiotics casein and gluten free?
A-    All probiotics manufactured by Kirkman® are tested and certified to be casein, gluten and soy free.  Kirkman® also distributes, but does not manufacture other brands of probiotics.  These other brands are not always free of casein and gluten.

Q- Which of Kirkman’s probiotics are SCD legal?
A-    The SCD original diet required only Lactobacillus strains to be used.  Bifidobacterium strains were not SCD legal.  Using that strict definition, only Kirkman’s Lactobacillus acidophilus product would be considered SCD legal.  Many doctors, however, realized the need for some Bifido strains when on that diet and asked Kirkman to come up with an inulin free Pro Bio Gold® formulation.  We have done that and doctors using that philosophy also consider that product SCD legal.

Q- I’ve heard negative things about Bifidum bacteria – one probiotic strain.  Are there any particular strains that might cause problems?
A-    Kirkman® believes that the negative reports on bifidum strains are unfounded.  It is well established that infants have a very high concentration of Bifidum strains and infant probiotics are usually primarily Bifidum based.  Adults, however, also need some Bifido bacteria in balance with Lactobacillus strains for good gastrointestinal health.  The literature indicates that multi strain combinations of Lactobacillus and Bifium strains are more effective than single strains unless a particular bacteria is being targeted.

Q- Do probiotics help the immune system?
A-    Yes.  Probiotics stimulate the production and activity of immune cells located in the tissues that line the gastrointestinal tract, respiratory system and urinary tract.  These are known as mucosal tissues and a significant percentage of the body’s immune capacity may reside in these tissues.  Probiotics also contain varying amounts of DPPIV enzyme which stimulates immune response on the brush border of the gastrointestinal tract.

Q- What is the role that probiotics play when a patient has been prescribed antibiotics?
A-    Antibiotics are not specific to harmful bacteria.  They also kill off the beneficial flora in the gastrointestinal tract often resulting in severe stomach cramping and diarrhea.  By using a probiotic concurrently with antibiotics, beneficial flora can be preserved resulting in minimal side effects from the antibiotic.

Q- How far apart should probiotics and antibiotics be spaced so that both are effective and helpful?
A-    The probiotics should be given half way between the antibiotic doses so the two do not come in direct contact with each other.  For example, if your antibiotic is to be given every four hours, give the probiotic two hours after the antibiotic.  If the antibiotic is to be given every eight hours, give the probiotic four hours after the antibiotic.

Q- Should probiotics be taken before or after any given dose of antibiotics?
A-    No, the probiotic should be given as far apart from the antibiotic as possible.

Q- Have people who have colitis, Crohn’s Disease, or irritable bowel syndrome reported good effects with probiotics?
A-    Yes, considerable literature indicates that probiotics can improve and positively support the above conditions.

Q- Is there a best time of day to take probiotics?
A- There are two schools of thought on this subject.  Some experts suggest taking them on an empty stomach so implantation is more effective, while other experts suggest taking them with meals so that less stomach acid is encountered.    Kirkman® recommends taking them at the very beginning of a meal which limits the degree of acidity the probiotic encounters.

Q- Should probiotics be taken apart from digestive enzymes?
A-    Probiotics can be partially digested by digesting enzymes such as protease and amylase.  For this reason Kirkman recommends separating them to some degree.  When both products are being used by a patient, we recommend taking the enzyme at the very beginning of the meal followed by the probiotic about 30 minutes later.  That way they do not come into direct contact with each other.

Q- Should probiotics be taken apart from any herbs, spices, or herbal supplements?
A-    Many herbs contain inherent immune supporting ingredients which can kill living cells such as probiotics.   For that reason, herbal products should be given separated from probiotics by an hour or two.

Q- Do probiotics help with nutrient absorption?
A-    Intestinal inflammation and/or bacterial overgrowth can interfere with nutrient absorption.  When these conditions are present, probiotics can help.

Q- Are different potencies of probiotics generally used in different situations?
A-    Generally speaking, one should use the dose of probiotics necessary to maintain good gastrointestinal health.  Some people do well on low potency products such as 20 billion colony forming units, while others require in hundreds of thousands of colony forming units.  Individuals must find the dosage that is right for their bodies.  Also, when significant bacterial overgrowth is present in an unhealthy gut, sometimes therapeutic dosages are needed initially, followed by a maintenance dosage after the overgrowth is reduced.