SEPTEMBER 15, 2007


For infant diarrhea, probiotics work wonders

New study finds L rhamnosus knocks days
off illness, protects gut

The probiotic L rhamnosus cuts babies' diarrhea duration by nearly two days, according to an Italian study in the August 18 British Medical Journal. Looking at kids between the ages of three and 36 months, the study found probiotics — good bacteria — successfully reduced the time infants suffered from acute diarrhea.

At first glance, the number seems small but it represents as much as half the length of the affliction, says Dr Sunita Vohra, the director of the University of Alberta's Complementary and Alternative Research and Education Program. "That's two days less suffering and losing fluid for the child, and a two-day earlier return to work for the parents."

Besides, dealing with runny stool and cranky babies are not the only hazards of this illness — diarrhea can lead to serious dehydration and kills more than 400 babies a year in the US and Canada.

Diarrhea can be caused by a virus or a bacteria but in kids the real culprit is often an antibiotic prescription. The drugs kill off the good bacteria in the kid's gut along with the bad ones, leaving the patient vulnerable to other harmful organisms.

Treatment for diarrhea has traditionally been to keep the child hydrated. Docs rely mostly on an oral, glucose-based rehydration solution to replace the kid's body fluids. But that helps neither the symptoms nor the duration of the diarrhea.

Enter probiotics. They include the many good bacteria from the ones in yogurt to the ones that help digest dairy products. The friendly living organisms help by staging a sort of sit-in — they colonize the gut and prevent harmful bacteria from setting up shop until the colon's supply of normal bacteria is replenished.

As research proliferates, probiotics are becoming more and more popular with pediatricians in the fight against infants' diarrhea. "The evidence on probiotics is exciting and very promising," says Dr Vohra. "They have a reassuring safety profile in a normal host."

But there is a catch. The new study's authors, from the University of Naples, point out that not all probiotics are created equal. "In most countries, micro-organisms purported to have probiotic properties are considered food additives rather than drugs," study authors write. Therefore, only safety is closely examined before marketing — not efficacy. Parents can buy them over the counter and most don't bother checking with the pediatrician to see which one works best.

"There are multiple sources for those probiotic recommendations," Dr Vohra agrees. "Not the least of which is the internet. Parents google medications and treatments they think would help their kids." Sometimes kids even end up in the emergency room because they've used natural health products without the advice of a physician, Dr Vohra notes. Other times, these products are harmless but entirely useless. Some don't work at all against diarrhea, while others work extremely well.

The study showed that the L rhamnosus GG strain not only lopped off almost two days of diarrhea, it reduced the number of stools per day and improved their consistency. Another preparation that proved equally effective was a cocktail of four bacterial strains — L debrueckii, S thermophilus, L acidophilus and Bifidobacterium bifidum. Neither treatment had any side effects.

Patients should be cautioned not to take probiotics (or give them to their children) unless a doctor recommends they do so, Dr Vohra warns. "You're giving a living organism, so there's always a fear of infection," she says. Chances of infection are slim, she concedes, but a kid whose immune system is down because of illness or another infection might not be able to handle even a friendly bacteria. "You have to consider how much potential benefit versus how much risk. That's what parents should discuss with the doctor," she explains.

Although many physicians are unfamiliar with probiotics, with mounting evidence to support their use and increasing patient interest Dr Vohra says they'll have to get more comfortable answering probiotics questions. "It's about familiarity with usage and knowing what side effects to watch out for, among other things," she says. "Once family physicians undertake learning more about this, it'll become part of their routine practice."



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