The relationship between our bodies and the bacteria that live on them is one of the hottest topics of the decade. Our bodies and our bacteria are a mini ecosystem, the balance of which can easily be disrupted and lead to illness. The ecosystem is called the microbiome and it is kept healthy by maintaining a good balance of beneficial microorganisms, leaving no room for the not so beneficial organisms to colonise the body.
Damaging the Microbiome
The microbiota can be changed by many things. The simplest examples are the effects of medication on the natural balance of bacteria in the gut. A simple change to the pH of the gut by using antacids can increase the percentage of less beneficial bacteria that thrive at a higher pH at the expense of the good bacteria that thrive in the naturally more acid environment. Most antibiotics will decimate the whole population, then it’s a case of first come first served as to who gets to re-colonise the gut afterwards. More often than not, it's the bad guys.
Gut bacteria travel
For a long time it was assumed that the gut bacteria stayed in the gut and did not enter the body. Any imbalance of gut flora was therefore assumed to be responsible for gastrointestinal problems, but little else. In the past few years it has become increasingly evident that these bacteria can cross into the blood stream, and can exert an effect all of the body’s systems. They can affect everything from the health of the brain,right down to the health of the skin under the little toe nail. Keeping the gut bacteria healthy is therefore not just a case of solving an upset tummy.
Prebiotics and Probiotics
Prebiotics are chemicals or substances that create the right environment for bacteria to thrive in, or on, the human body. In the case of the gut they are usually some form of fibre that goes through the gut without being digested. Some body creams are also believed to act in the same way with regard to the bacteria on the skin. Probiotics are food supplements that contain live strains of different bacteria that are beneficial to the gut. Prebiotics and probiotics are usually used together as a treatment.
Controversy over evidence
Sales of probiotics rose by 35% in the Unites States, between 2010 and 2014 and there were similar increases in most EU countries. However a battle rages between the legislators, the scientists and the pharmaceutical companies. Despite new studies being published regularly in the medical journals, the European Food Safety authority continues to state that there is insufficient research on the subject and that a cause-effect relationship has not been sufficiently established in studies. There is clearly an underlying battle going on for the microbiome see Patient QI's The Battle for the Microbiome.
How much research is needed to make the legislators happy?
Over 1,748 studies on probiotics were published in peer reviewed medical journals last year. Of those publications, many were controlled clinical trials carried out in hospital environments by highly qualified doctors, and they showed clear patient benefit. In February this year we reported on a study that showed probiotics reduced respiratory infections in children in hospital on ventilators :Probiotics can prevent penumonia in children on ventilators. In September 2014 we reported on a study that showed antibiotics are associated with an increase in childhood obesity via a disruption of the microbiome: Obesity, another good reason to restrict antibiotic use. And in June 2014 we reported new evidence that mothers taking probiotics reduce the risk of their baby suffering from eczema and allergies: Probiotics in pregnancy can prevent baby eczema.
The legislators are dragging these issues out to extraordinary lengths.
More new evidence for the legislators
An American research team have carried out a meta-analysis, on the use of prebiotics and probiotics in preventing infections in liver transplant patients. The group analysed controlled trials, where the study groups received nutrition and fibre with pre and probiotics, and this was compared to the controlled groups that received only nutrition and fibre. The rate of infection was 35% in the control group, and only 7% in the probiotic group. The probiotic group stayed for a shorter amount of time, both in intensive care and in hospital, and required antibiotics for a shorter amount of time.
Keep the evidence coming!
Sawas et al. Patients receiving Prebiotics and Probiotics Before Liver Transplantatin Develop Fewer Infections than Controls: a systematic Review and Metal-analysis. Clin Gastroenterol Hepatol. June 2015.