Advanced probiotic strategies for exceptional patient outcomes

Approximately 70% of your patients immune system is found in the GI tractYour patients health begins with the health of their GI microflora

Specific strains of probiotic bacteria have demonstrated clinical benefit

Beneficial for irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) Helps to protects against infection by pathogens including yeastDecreases side effects of antibiotic therapy such as diarrhea

Promotes normal intestinal functions and may help reduce constipationHelps to reduce harmful bacteria and stimulates improved immune functionMay help control urogenital infectionsImproves the digestion of lactose

Only a handful of probiotic strains are responsible for the lions share of the clinical research. Some of these include:L. plantarum 299VL. acidophilus NCFMS. boulardii

Genus, Species and Strain CharacterizationAlthough many strains are commercially available, very few have supporting clinical data

GENUS

SPECIES

STRAIN

S. boulardii

LACTOBACILLI

BIFIDOBACTERIA

SACCHAROMYCES

L. acidophilus

L. casei

L. bulgaricus

L. plantarum

L. rhamnosus

NCFM

B. infantis

B. lactis

B. longum

B. adolescentis

S. cerevisiae

BI07

DDS 1

33200

HN001

299V

1195

685

CR14

B734

837

17930

HN019

15706

25962

15705

15708

Each strain has an effect on various cytokines within the body

Depending on their effect on enteric cells, different probiotic strains may influence inflammation, allergy and immune response

Research on specific strains does not transfer to other strains within that species

Importance of Strain

it has been clearly demonstrated that probiotic properties are strain-specific and cannot be extrapolated to other strains.(Best Pract Res Clin Gastroenterol. 2003 Oct;17(5))

Same species, different functionSled dog- cold-hardy- good endurance- tough feet

Guard dog- protective- muscular- strong teeth- ferocious bark- courageousHunting dog- soft mouth- good swimmer

All dogs not ideal for all purposesWhen choosing a probiotic rely on the specific research around the specific strain to achieve the desired outcome

What to look for in a clinically relevant probiotic Research ?Stability ?Potency ?

When choosing a formula, look to the research on the primary strain(S. boulardii )(L. acidophilus NCFM)(L. plantarum 299V)Hundreds of human clinical studies in varied patient populations result in exceptional patient outcomes

For improved outcomes, compliment the primary strains with additional well-researched condition-specific strainsImmune support Combine S. boulardii with:B. lactis HN019 L. rhamnosus HN001

Well rounded GI support Combine L. acidophilus NCFM with:B. lactis BI-07

Choose potency at levels supported by published researchS. boulardii / L. rhamnosus HN001 / B. lactis HN019 5.5 billion cfu + 4 billion cfuL. acidophilus NCFM / B. lactis BI-0760 billion cfuL. plantarum 299V18 billion cfucfu = colony forming unitOften commercial probiotic brands offer lower potency to meet price points

Low potency formulas may result in poor clinical results or compliance and cost challenges with your patients15 billion cfu3 billion cfuL. acidophilus NCFM / B. lactis BI-07Typical retail probiotic

Look for stability and expiration guaranteesStable at room temperatureMultiple assays ensure product qualityGuaranteed label claim at time of expiration

B. lactis Bi-07 @ 23C(Lot# 3593J3)

Aws: Conc. = 0.023, IRT = 0.088, Av = 0.060

L. acidophilus NCFM @ 23C(Lot #567D)

Temperature stability ensures potency over time

B. lactis Bi-07 @ 23C(Lot# 3593J3)

Aws: Conc. = 0.023, IRT = 0.088, Av = 0.060

L. acidophilus NCFM @ 23C(Lot #567D)

For many manufacturers, stability at room temperature is a significant challenge

Chart4

25.3

14.4

7.3

3.2

3

1.83

1.52

0.935

1.1

Milled Conc.

Month

Bacteria Count

Temperature Stability of L. rhamnosus (Lr-32) @ 23C (74F) (Lot# 703D)

Sheet1

Month

Lr-32 @ 2303691215182124

1:10 w/IRT2.73E+102.00E+082.00E+081.11E+081.07E+089.10E+077.95E+076.38E+078.20E+07

1:10 w/Avicel2.78E+101.26E+101.01E+104.23E+093.95E+092.63E+091.67E+091.19E+099.45E+08

Milled Conc.25.314.47.33.231.831.520.9351.1

Temperature Stability of L. rhamnosus (Lr-32) @ 23C

(Lot# 703D)

Sheet1

0

0

0

0

0

0

0

0

0

Milled Conc.

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Temperature Stability of L. rhamnosus (Lr-32) @ 23C (Lot# 703D)

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Often manufacturers claim that they have stability, but instead put in high overages to meet label claim

43% loss57% loss

Chart4

3512

27.58

204

Probiotic 1

Probiotic 2

Month

Bacteria Count

Stability of Common Probiotics at Room Temperature

Sheet1

MonthProbiotic 1Probiotic 2

03512

627.58

12204

Sheet1

Probiotic 1

Probiotic 2

Month

Bacteria Count

Stability of Common Probiotics at room temperature

Sheet2

Sheet3

Many other manufacturers just state that the product met label claim at time of manufacture

????

Chart8

20

6

Month

Bacteria Count

Stability of Common Probiotics at Room Temperature

Sheet1

MonthProbiotic 2

02012

68

4

Sheet1

0

0

0

Month

Bacteria Count

Stability of Common Probiotics at room temperature

Sheet2

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Shipping temperatures may accelerate die off

Be sure that the strain is genetically verified with periodic DNA testing

Confirm that each lot is tested for resistance to acid and bile to ensure that it is strong enough to survive

Ensure quality with assays at multiple production stepsBulk materialBile resistanceLabel claimFinal analytical

Guidelines for selecting probiotics that offer the greatest benefit

Properties of a Suitable Probiotic for Human Consumption Accurate taxonomic identification genus, species and strainGenetically stableAble to survive intestinal transit, resistant to acid, bile and pancreatin Able to survive in the presence of competing organisms

Guaranteed potency and viabilityGuaranteed full potency until date of expirationAdequate clinical potency (billions of organisms per serving)Transported under refrigeration to minimize die-offPackaged in dark glass, not plastic, which are often permeable to air and even moisture, reducing shelf-life

Choose the proper probiotic strain for the proper condition Genetically verified genus, species and strainSupporting research to achieve the desired clinical outcome (Ensure that all health claims substantiated with references)

For which conditions would you typically recommend strain-specific probiotics in your practice

Cold and flu and post antibiotic therapyIrritable Bowel Syndrome (IBS)Inflammation & IBDOverall GI health

Published studies showing positive effects: Improved lactose digestion Cholesterol Lowering Immune balancing Antimicrobial

A fantastic choice for overall GI healthL. acidophilus NCFM / B. lactis BI-07

Volumes of supporting data make this a fantastic choice to support overall GI healthCytokine ActivityPublished StudiesSurvivability

L. acidophilus NCFM is the only probiotic strain that whose DNA has been fully mappedPNAS March 15, 2005 vol. 102 no. 11 39063912

L. acidophilus NCFM encourages production of lactase enzymes that facilitate milk digestion

Recent research indicates that L. acidophilus NCFM / B. lactis BI-07 may reduce the incidence of respiratory infection in children CONCLUSIONS: Daily consumption of NCFM and Bi-07 and of NCFM alone significantly reduced the incidence and duration of respiratory tract infection symptoms in children.Pediatrics 2008;121;S115, Arthur Ouwehand, Greg Leyer and Didier Carcano

Recommend this well-studied, high quality probioticto patients as daily support for GI healthto support and balance GI microflorato support lactose digestionA great tool to balance and support overall GI health

S. boulardii has been studied in numerous double blind placebo controlled trialsIndicated for C. difficile after antibioticsHN019 and HN001 support NK cell activityS. boulardii / B. lactis HN019 / L. rhamnosus HN001Post antibiotic therapy and immune support

Recommend this advanced strategy for patients:

That have recently taken antibiotics Present with recurrent diarrhea Have plans to travel abroad Have immune support concerns

A great solution for patients before, during and after an immune challenge

Am J Gastroenterol. 1995 Mar;90(3):439-48

Prevention of beta-lactam-associated diarrhea by Saccharomyces boulardii compared with placebo.McFarland LV, Surawicz CM, Greenberg RN, Elmer GW, Moyer KA, Melcher SA, Bowen KE, Cox JL.OBJECTIVES: To determine the safety and efficacy of a new preventive agent for antibiotic-associated diarrhea (AAD) in patients receiving at least one beta-lactam antibiotic. METHODS: A double-blinded, placebo-controlled, parallel group study was performed in a high-risk group of hospitalized patients receiving a new prescription for a beta-lactam antibiotic and having no acute diarrhea on enrollment. Lyophilized Saccharomyces boulardii or placebo (1 g/day) was given within 72 h of the start of the antibiotic(s) and continued until 3 days after the antibiotic was discontinued, after which the patients were followed for 7 wk. RESULTS: Of the 193 eligible patients, significantly fewer, 7/97 (7.2%), patients receiving S. boulardii developed AAD compared with 14/96 (14.6%) on placebo (p = 0.02). The efficacy of S. boulardii for the prevention of AAD was 51%. Using a multivariate model to adjust for two independent risk factors for AAD (age and days of cephalosporin use), the adjusted relative risk was significantly protective for S. boulardii (RR = 0.29, 95% CI = 0.08, 0.98). CONCLUSION: The prophylactic use of S. boulardii given with a beta-lactam antibiotic resulted in a significant reduction of AAD with no serious adverse reactions.CONCLUSION: The prophylactic use of S. boulardii resulted in a significant reduction of AAD (antibiotic-associated diarrhea)Support the your patients GI health by prescribing S. boulardii during and after antibiotic therapy

Supports the removal pathogenic microbesS. boulardii is a great tool to help your patients combat harmful microbesPediatr Nephrol. 2006 Jun;21(6):807-10

Influence of oral intake of Saccharomyces boulardii on Escherichia coli in enteric flora

Ipek Akil1, 4 , Ozge Yilmaz1, Semra Kurutepe2, Kenan Degerli2 and Salih Kavukcu3AbstractEnteric flora constitutes 95% of the cells in the human body. It has been shown that the bacterial content of this flora is affected by diet and changes in nutrition. Considering that urinary tract infections (UTI) are mostly due to ascending infections from the gut flora, the importance of the elements of this flora and their characteristics becomes more evident. The aim of this study was to evaluate the influence of oral Saccharomyces boulardii (S. boulardii) intake on the number of Escherichia coli (E. coli) colonies in the colon. This study was carried out with 14 boys and 10 girls (total of 24 children) aged between 36 and 192months (mean: 104.345.1months). A commercial capsule or powder containing 5 billion colony-forming units (cfu) of S. boulardii was administered once a day for 5days. The number of E. coli and yeast colonies was measured in the stool samples of the study group before and after the use of this drug. Before treatment, the mean number of E. coli colonies in g/ml stool was 384,625445,744. This number decreased significantly to 6,28320,283 after treatment (p=0.00). S. boulardii was not detected in stool before treatment and the number of colonies increased to 11,04726,754 in g/ml stool. S. boulardii may be effective in reducing the number of E. coli colonies in stool. The influence of this finding on clinical practice such as prevention of UTI needs to be clarified by further studies. Am J Gastroenterol. 2006 Apr;101(4):812-22

Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease.

Lynne V. McFarland, Ph.D.1,21CONTEXT:Antibiotic-associated diarrhea (AAD) is a common complication of most antibiotics and Clostridium difficile disease (CDD), which also is incited by antibiotics, is a leading cause of nosocomial outbreaks of diarrhea and colitis. The use of probiotics for these two related diseases remains controversial. OBJECTIVE:To compare the efficacy of probiotics for the prevention of AAD and the treatment of CDD based on the published randomized, controlled clinical trials. DATA SOURCES:PubMed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and Cochrane Central Register of Controlled Trials were searched from 1977 to 2005, unrestricted by language. Secondary searches of reference lists, authors, reviews, commentaries, associated diseases, books, and meeting abstracts. STUDY SELECTION:Trials were included in which specific probiotics given to either prevent or treat the diseases of interest. Trials were required to be randomized, controlled, blinded efficacy trials in humans published in peer-reviewed journals. Trials that were excluded were pre-clinical, safety, Phase 1 studies in volunteers, reviews, duplicate reports, trials of unspecified probiotics, trials of prebiotics, not the disease being studied, or inconsistent outcome measures. Thirty-one of 180 screened studies (totally 3,164 subjects) met the inclusion and exclusion criteria. DATA EXTRACTION:One reviewer identified studies and abstracted data on sample size, population characteristics, treatments, and outcomes.DATA SYNTHESIS:From 25 randomized controlled trials (RCTs), probiotics significantly reduced the relative risk of AAD (RR = 0.43, 95% CI 0.31, 0.58, p < 0.001). From six randomized trials, probiotics had significant efficacy for CDD (RR = 0.59, 95% CI 0.41, 0.85, p= 0.005).CONCLUSION:A variety of different types of probiotics show promise as effective therapies for these two diseases. Using meta-analyses, three types of probiotics (Saccharomyces boulardii Lactobacillus rhamnosus GG, and probiotic mixtures) significantly reduced the development of antibiotic-associated diarrhea. Only S. boulardii was effective for CDD.J Infect Dis. 1993 Nov;168(5):1314-8. Inhibition of Candida albicans translocation from the gastrointestinal tract of mice by oral administration of Saccharomyces boulardii. Berg R, Bernasconi P, Fowler D, Gautreaux M. Dept. of Microbiology and Immunology, Louisiana State University Medical Center, Shreveport 71130. Microbial translocation is defined as the passage of viable microbes from the gastrointestinal (GI) tract to extraintestinal sites, such as the mesenteric lymph node (MLN), spleen, liver, kidneys, and blood. The ability of orally administered viable Saccharomyces boulardii to inhibit Candida albicans translocation from the GI tract was tested in antibiotic-decontaminated, specific pathogen-free (SPF) mice, which were orally challenged with C. albicans to promote intestinal overgrowth and subsequent translocation of this organism. Oral S. boulardii treatment reduced the incidence of MLN cultures positive for C. albicans but did not decrease the numbers of C. albicans per gram of MLN in these immunocompetent mice. Prednisolone immunosuppression increased translocation of C. albicans to the MLN and allowed translocating C. albicans to spread systemically to the spleen, liver, and kidneys. In these immunosuppressed mice, orally administered S. boulardii decreased both the incidence of C. albicans translocation to the MLN, liver, and kidneys and the number of translocating C. albicans per gram of MLN, spleen, and kidneys.E. ColiC. DifficilePakistan Journal of Biological Sciences 9 (4): 632-635, 2006

The Preventive Effect of Sacharomyces boulardii in Pathogenesis of Salmonella typhimurium in Experimentally Infected Rats

M. Mahzounieh, I. Karimi, T. Zahraei Salehi and R. Marjanian The present research studied the capacity of Saccharomyces boulardii (S. boulardii) to antagonize Salmonella typhimurium (S. typhimurium) in the intestinal tract and humoral response of rats after challenging with S. typhimurium. Sixty conventional male rats were divided at random into 4 groups. The S.boulardii suspensions contained 106, 07 and 108 cells mL-1 were administered (orally) to 3 groups (A, B and C) of rats, respectively for 5 continues days. The rats of group D received Saline instead of S.boulardii and used as control. All of rats challenged with 107 CFU of pathogenic S. typhimurium at fifth day. The viable Salmonella were counted at g-1 of faeces of rates at 0, , 3, 5 and 7 days after challenge. Titer of anti- salmonella antibodies were determined. Present experiments showed that S. boulardii could reduce the bacterial colonization in experimental animals. There was a significant reduction at number of S. typhimurium between control and test groups. A daily dose of 106 yeast cells was resulted in the most reduction in bacterial shedding and high titers of anti salmonella antibodies. The mortality rates were 0 and 46.4% in yeast treatment and control animals, respectively. S. typhimurium viable cells were not detected in the organs of yeast-treated rats. We conclude that S. boulardii has a preventive effect in pathogenesis of S. typhimurium.Candida albicansSalmonella

A well accepted approach to manage GI concerns in a variety of patientsAliment Pharmacol Ther. 2007 Feb 1;25(3):257-64

Meta-analysis: Saccharomyces boulardii for treating acute diarrhoea in children.Szajewska H, Skrka A, Dylag M.The Second Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland. BACKGROUND: Saccharomyces boulardii is a non-pathogenic probiotic yeast considered useful against enteropathogens. AIM: To assess the effectiveness of S. boulardii in treating acute infectious diarrhoea in children. METHODS: The following electronic databases were searched through August 2006 for studies relevant to acute infectious diarrhoea and S. boulardii: MEDLINE, EMBASE, CINAHL and The Cochrane Library; additional references were obtained from reviewed articles. Only randomized-controlled trials were included. RESULTS: Five randomized-controlled trials (619 participants) met the inclusion criteria. Combined data from four randomized-controlled trials showed that S. boulardii significantly reduced the duration of diarrhoea compared with control. The pooled weighted mean difference was -1.1 days (95% CI: -1.3 to -0.8) with a fixed model and remained significant in a random effect model. Saccharomyces boulardii significantly reduced the risk of diarrhoea on days 3, 6 and 7. Also the risk of diarrhoea lasting >7 days was significantly reduced in the S. boulardii group vs. control group (1 RCT, n = 88, RR 0.25, 95% CI: 0.08-0.83; NNT 5, 95% CI: 3-20). CONCLUSIONS: There exists a moderate clinical benefit of S. boulardii therapy in otherwise healthy infants and children with acute gastroenteritis, mainly a shorter duration of diarrhoea. However, these results should be interpreted with caution due to methodological limitations of the included studies.Intensive Care Medicine Volume 23, Number 5 / May, 1997

Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients, A multicenter, randomized, double-blind placebo-controlled trial G. Bleichner1, H. Blhaut2, H. Mentec1, D. Moyse3 Objective: To assess the preventive effect of Saccharomyces boulardii on diarrhea in critically ill tube-fed patients and to evaluate risk factors for diarrhea. Design: Prospective, multicenter, randomized, double-blind placebo-controlled study. Setting: Eleven intensive care units in teaching and general hospitals. Patients: Critically ill patients whose need for enteral nutrition was expected to exceed 6 days. Intervention: S. boulardii 500 mg four times a day versus placebo. Measurements and results: Diarrhea was defined by a semiquantitative score based on the volume and consistency of stools. A total of 128 patients were studied, 64 in each group. Treatment with S. boulardii reduced the mean percentage of days with diarrhea per feeding days from 18.9 to 14.2 % [odds ratio (OR) = 0.67, 95 % confidence interval (CI) = 0.50-0.90, P = 0.0069]. In the control group, nine risk factors were significantly associated with diarrhea: nonsterile administration of nutrients in open containers, previous suspension of oral feeding, malnutrition, hypoalbuminemia, sepsis syndrome, multiple organ failure, presence of an infection site, fever or hypothermia, and use of antibiotics. Five independent factors were associated with diarrhea in a multivariate analysis: fever or hypothermia, malnutrition, hypoalbuminemia, previous suspension of oral feeding, and presence of an infection site. After adjustment for these factors, the preventive effect of S. boulardii on diarrhea was even more significant (OR = 0.61, 95 % CI = 0.44-0.84, P < 0.0023). Conclusion: S. boulardii prevents diarrhea in critically ill tube-fed patients, especially in patients with risk factors for diarrhea.Numerous randomized double-blind placebo controlled trials in varied patient populations make S. boulardii a great therapeutic choice for practitioners

Two additional probiotic strains to support your patients immune systems J Clin Immunol. 2001 Jul;21(4):264-71.

Dietary probiotic supplementation enhances natural killer cell activity in the elderly: an investigation of age-related immunological changes.

Gill HS, Rutherfurd KJ, Cross ML.Many elderly subjects are at increased risk of infectious and noninfectious diseases due to an age-related decline in lymphoid cell activity (immunosenescence). Noninvasive means of enhancing cellular immunity are therefore desirable in the elderly. Previous reports have suggested that dietary supplementation could represent an effective means of enhancing the activity of circulating natural killer (NK) cells in the elderly. In the present study, we have conducted a pre-post intervention trial to determine the impact of dietary supplementation with probiotic lactic acid bacteria (LAB) on peripheral blood NK cell activity in healthy elderly subjects. Twenty-seven volunteers consumed low-fat/low-lactose milk supplemented with known immunostimulatory LAB strains (Lactobacillus rhamnosus HN001 or Bifidobacterium lactis HN019) for a period of 3 weeks. A dietary run-in of milk alone was shown to have no significant effect on NK cells. In contrast, the proportion of CD56-positive lymphocytes in peripheral circulation was higher following consumption of either LAB strain, and ex vivo PBMC tumoricidal activity against K562 cells was also increased. Supplementation with HN001 or HN019 increased tumoricidal activity by an average of 101 and 62%, respectively; these increases were significantly correlated with age, with subjects older than 70 years experiencing significantly greater improvements than those under 70 years. These results demonstrate that dietary consumption of probiotic LAB in a milk-based diet may offer benefit to elderly consumers to combat some of the deleterious effects of immunosenescence on cellular immunity.Supplementation with (L. rhamnosus) HN001 or (B. lactis ) HN019 increased tumoricidal activity by an average of 101 and 62%, respectively

Powerful B. lactis HN019 for demonstrated support for immune functionAm J Clin Nutr 2001;74:8339. American Society for Clinical Nutrition

Consumption of B. lactis HN019 led to average increases in cellular immune function of between 14.5% and 61.8%, with the greatest effect on NK cell activity

B. lactis HN019 may therefore offer the most promise as a dietary supplement for optimizing or restoring effective immunity

Of the immune responses that were enhanced by dietary consumption of HN001, phagocytic activity by PMN (polymorphonuclear) cells constitutes an important anti-microbial defense mechanism while NK cell killing activity is thought to be important in the control of viral-infected cells.

It is therefore possible that enhanced performance by these cells, following consumption of HN001, could lead to an increased ability of consumers to fight infectious diseasesJ Am Coll Nutr. 2001 Apr;20(2 Suppl):149-56. Revolutionary L. rhamnosus HN001 for additional immune support

Additional considerations during cold and flu seasonCombine: Bioavailable Vitamin C Immune-enhancing mushrooms Immune supporting ZincVitamin C complexA buffered combination of ascorbates and vitamin C metabolites for superior bioavailability

*Vojdani A, Namatalla G. Enhancement of human natural killer cytotoxic activity by vitamin C in pure and augmented formulations. J Nutr Env Med 1997;7:187-95.

18% to 25% increased uptake in white blood cellsNK activity in Vitamin C complex patients increased between 200-400%*NK activity in ascorbic acid patients initially decreased where Vitamin C complex patients did not*

Bioavailable Vitamin C complex superior for boosting the bodys natural defenses

Published Research Demonstrates Superiority of Vitamin C complex*J Nutr Env Med 1997;7:187-95

Enhancement of human natural killer cytotoxic activity by vitamin C in pure and augmented formulations

A Vojdani, G Namatalla The antitumor activity of ascorbic acid has been reported by different investigators. In this study, we determined the in vivo effects of ascorbic acid and its modified formulation (Ultra Potent-C) on human natural killer (NK) cell activity. Twenty-two healthy subjects were given either ascorbic acid or Ultra Potent-C orally at a concentration of 60 mg kg[-1]. Vitamin C uptake was measured in the plasma and by peripheral blood lymphocytes (PBLs). The uptake of vitamin C by PBLs was maximized at 2-4 h and was maintained at a high level up to 24 h. At the maximal point the uptake of Ultra Potent-C was higher by 18-25% than plain ascorbic acid. In addition, PBL-NK activity was measured by a 4-h [51]Cr release assay using K562 as targets. The results demonstrated that ascorbic acid has a biphasic pattern of NK function; an early transient depression in NK activity (29%) at 1-4 h that is subsequently followed by a significant enhancement (200-400%) between 8 and 24 hours. However, the pattern of NK activity in the Ultra Potent-C group was different from the ascorbic acid group and the early transient depression in NK activity was not observed. We conclude that ascorbic acid or its modified form is a potent immunomodulator **Immunopharmacol Immunotoxicol. 1997 Aug;19(3):291-312

Enhancement of natural killer cell activity and T and B cell function by buffered vitamin C in patients exposed to toxic chemicals:

A Vojdani, G HeuserAfter exposure to many toxic chemicals, NK function can be decreased significantly. Weeks or months later, natural killer (NK) function can rebound to normal levels in some and can be suppressed for prolonged periods of time in other patients. In view of this, we decided to study the effect of buffered vitamin C on NK, T and B cell function in patients who had been exposed to toxic chemicals. After the first blood draw, 55 patients immediately ingested granulated buffered vitamin C in water at a dosage of 60 mg/Kg body weight. Exactly 24 hours later, blood was again drawn for a follow-up study of NK, T and B cell function. Vitamin C in high oral dose was capable of enhancing NK activity up to ten-fold in 78% of patients. Lymphocyte blastogenic responses to T and B cell mitogens were restored to the normal level after vitamin C usage. Signal transduction enzyme protein kinase C (PKC) appeared to be involved in the mechanism of induction of NK activity by vitamin C.

We conclude that immune functional abnormalities can be restored after toxic chemical exposure by oral usage of vitamin C.

This study looked at chemically exposed patients with decreased NK activity and T & B cell functionPatients received approximately 3 grams of Vitamin C complex78% of patients experienced a 10-fold increase in NK activity**T and B cell activities were restored to normal levels**

Immune-enhancing mushroom extract

The responsible bioactive compounds in these mushrooms belong to several chemical groups, very often water soluble polysaccharides or triterpenes. One species can possess a high variety of compounds resulting in multidimensional effects.

Lindequist U et al eCAM 2005; 2(3)285-299water extracts of shiitaki, reishi, maitaki, fu-ling, cordyceps, turkey tail and oyster mushrooms, traditionally and scientifically shown to support immune function.

For patient with Irritable Bowel SyndromeMay modulate intestinal painMay Reduce duration of diarrheaSupports the GI barrier60 billion cfu dailyL. acidophilus NCFM / B. lactis BI-07

Recommend this high-potency combination for patients presenting with symptoms of IBS:

Frequent urges with constipation or diarrhea Abdominal discomfort Bloating and cramping

A great tool to address the pain and discomfort of IBS The similar efficacy, in treating pain, of orally administered L. acidophilus NCFM and a standard dosage of morphine suggests that specific modulation of intestinal flora may be a promising, safe and relatively inexpensive new treatment for abdominal pain, a prominent symptom of irritable bowel syndromeNat Med. 2007 Jan;13(1):35-7. Epub 2006 Dec 10

Results of Clinical Work Subjects and Methods26 IBS patients (23 females; 3 males)L. Acidophilus NCFM + Bifidobacteria complex 30 billion live cells two times daily OutcomeIBS-QOL 63.3 at baseline; after treatment 84.5 indicating significant improved quality of life (p

For inflammation and IBDNumerous human clinical studies in multiple patient populations Research in inflammatory conditions such as Ulcerative ColitisMay have an effect on systemic inflammatory markers and cytokines

L. Plantarum 299V

Recommend L. plantarum 299V for patients: with inflammation or elevated inflammatory markers presenting with other inflammatory conditions with Crohns & ulcerative colitis as part of a well rounded anti-inflammatory protocolA fantastic probiotic to address inflammation in your patients

Great probiotic tool for GI inflammation Conclusion: In our opinion Lactobacillus plantarum can improve the results of classical pharmacological therapy of ulcerative colitis.

Reduce GI inflammation and support healingAdministration of Lactobacillus plantarum 299v reduces side-effects of external radiation on colon anastomotic healing in an experimental model.Liu Q, Nobaek S, Adawi D, Mao Y, Wang M, Molin G, Ekelund M, Jeppsson B. OBJECTIVE: Preoperative radiotherapy of patients with rectal carcinoma is frequently used to reduce the incidence of local recurrence. However, the radiation therapy is associated with several complications, including diarrhea, retarded anastomotic healing and mucosal atrophy. Exogenous administration of lactobacilli has been demonstrated to be effective in stimulating intestinal mucosal growth and reduce mucosal inflammation. The objective of this study was to examine the effects of Lactobacillus plantarum 299v administration on external radiation injury in colon anastomotic healing at different time points. MATERIAL AND METHODS: Sprague-Dawley rats were treated with Lb. plantarum 299v or saline as control and received external radiation of the lower abdomen (10 Gy/day) on day 3 and 7 of the experiment. After 4 days, a colonic resection with anastomosis was performed. Animals were sacrificed on 4th, 7th and 11th day postoperatively. Body weight, white blood cell (WBC) count, mucosal myeloperoxidase (MPO) activity, hydroxyproline, nucleotide, DNA and RNA content, colonic bacterial microflora, bacterial translocation and histology were evaluated. RESULTS: On the 4th postoperative day body weight, WBC and MPO decreased significantly after radiation. On the 7th postoperative day MPO decreased after radiation. In the two irradiated groups it decreased significantly in the Lb. plantarum group compared to the radiated group without treatment. Collagen concentration on the 7th postoperative day was significantly higher in Lb. plantarum group without radiation compared to the group with radiation without Lb. plantarum. On the 11th postoperative day MPO was significantly higher in irradiated rats without treatment compared to Lb. plantarum treatment. The collagen concentration increased significantly in the irradiated Lb. plantarum group compared to the other two groups. CONCLUSION: The collagen content decreased and MPO activity increased significantly of the colonic anastomosis in irradiated rats without treatment compared to those treated with Lb. plantarum. It therefore seems that administration of Lactobacillus plantarum 299v reduces the intestinal injury and inflammation following external radiation and improves the colonic anastomotic healing.Colorectal Dis. 2001 Jul;3(4):245-52 It therefore seems that administration of Lactobacillus plantarum 299v reduces the intestinal injury and inflammation following external radiation and improves the colonic healing.

The association between arthritis and intestinal inflammation is well established. . .Rooney, PJ et al. A short review of the relationship between intestinal permeability and inflammatory joint disease. Clinical and Experimental Rheumatology 1990;8:75-83A probiotic tool to address the connection between GI and systemic inflammation

Dramatic effects on systemic inflammatory markers such as IL-6 and fibrinogenfibrinogen concentrations fell by 21%....the result of the anti-inflammatory properties of L. plantarum, as evidenced by thereduction in plasma IL-6

Dosing guidelines for probiotics in your practice

Overall GI health & lactose digestionL. acidophilus NCFM / B. lactis BI-0715 billion cfu daily**cfu = colony forming unit

Post antibiotic therapy and cold and fluS. boulardii / B. lactis HN019 / L. rhamnosus HN001Before, during and after and immune challenge 9.5 billion cfu dailyFor patients that: have recently taken antibiotics present with recurrent diarrhea have plans to travel abroad have immune support concernsDuring cold and flu season consider adding Vitamin C complex, Immune Enhancing Mushrooms and Zinc

Irritable bowel syndromeL. acidophilus NCFM / B. lactis BI-07 60 billion cfu dailyFor patients that: Have frequent urges with constipation or diarrheaAbdominal discomfortBloating and cramping

For inflammation and IBDL. Plantarum 299V18 billion cfu dailyFor patients with inflammation or elevated inflammatory markers with Crohns & ulcerative colitis presenting with other inflammatory conditions as part of a well rounded anti-inflammatory protocol

Other considerationsFor sensitive patients, introduce probiotics slowly to avoid excess gas

Great tools to help you teach your patients

Use the probiotic info sheet to describe the benefits of probiotics

Prescription PadScreening SurveyScreening tools to and prescription forms to identify patients and recommend probiotics

Research summaries and supporting studies

Probiotic brochures to help engage and educate your patients

Choose great patient outcomes with probiotics that: Extensive clinical researchClinically demonstrated potencyGenetically identified genus, species and strainStability at room temperaturePotency guaranteeRecommend probiotics to all of your patients today!

Thank You

Immediate GI distressInflammation and IBDIrritable Bowel SyndromeOverall GI healthS. BoulardiiB. lactis HN019L. rhamnosus HN001L. Plantarum 299V

L. Acidophilus NCFMB. Lactis BI-07L. Acidophilus NCFMB. Lactis BI-07

9.5 billion cfu18 billion cfu60 billion cfu15 billion cfuChoose the specific strains to meet the unique needs of your patients

***MET 863MET 863