Yoghurt & Probiotics

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Headings and Sub-Headings

INTRODUCTION

There is an enormous amount of evidence which shows that consumption of dietary calcium and dairy foods are crucial for optimum bone growth, bone mass and preventing osteoporosis. [1] Calcium intake is especially important during childhood, adolescence and after menopause in women. Depending upon age and sex, the Recommended Dietary Intakes (RDI) (also known as "recommended dietary allowances") of Calcium range between 1000-1300mg in adults [2], which can be provided by 3 -4 servings of dairy food (preferably low fat) per day. Unfortunately however, most cheeses are relatively high in saturated fat, and milk is generally high in lactose, which may be problematic for those who are "lactose intolerant"; a condition predominantly seen in people of Asian or African descent.[3] Yoghurt however can be found in low fat varieties, and generally contains about 1/3 - 1/2 the lactose of milk. [4] Moreover, another added benefit of yoghurt is that it frequently contains added fruit pieces.

Other than being an excellent low-fat, low-lactose source of calcium, yoghurt contains lactic acid bacteria including members of the Lactobacillus and Bifidobacterium families. These bacteria are added to produce lactic acid which gives yoghurt its characteristic sour taste. Lactic acid bacteria can also be consumed in “probiotic” supplements, which generally contain very large (useveral billion billion organisms) amounts of specific strains of these “friendly” bacteria. Consumption of yoghurt or other fermented dairy foods, as well as probiotic supplements, has been shown to have a wide range of beneficial effects on human health. The major problem however with taking probiotic supplements is that other than being relatively expensive, different studies have used varying concentrations of a plethora of different species and strains of lactic acid bacteria. Consequently, commerically available brands of probiots may not contain the most appropriate strains or doses.

This article discusses some of those effects which include:

•  Reduction in the risk of colon cancer

•  They may result in modest improvements inserum cholesterol levels and blood pressure

•  Improve immune function by increasing the number of IgA-producing plasma cells , increasing or improving phagocytosis as well as increasing the proportion of T lymphocytes and Natural Killer cells

•  Decrease the risk of infections of the upper aero-digestive tract such as respiratory infections and Helicobacter pylori infections

•  Decrease the incidence of and improve the treatment of both infantile diarrhoea and antibiotic associated diarrhoea

•  Modulate inflammatory and hypersensitivity responses by regulating cytokine function, improving milk allergies , decreasing the risk of atopic eczema and preventing reoccurrences of Inflammatory Bowel Disease

•  Improving lactose digestion among those who are lactose intolerant

 

Colon Cancer

* Anti-mutagenic effect

* Animal Studies

* Clinical Trials

* Epidemiology

Anti-Mutagenic Effect

Cooking meat is known to produce certain chemicals called heterocyclic primary amines that are mutagenic (capable of causing mutations in DNA) [5] and have been shown to be extremely carcinogenic in animal studies.[6] Milk cultured with Lactobacilli strains have been shown to have anti-mutagenic effects in laboratory experiments including animal studies, reducing mutagenicity [7] and chromosome damage by approximately 80%. [8]

One proposed mechanism thought to be able to explain the anti-mutagenic action of lactic acid bacteria, is due to their ability to bind with these heterocyclic primary amines produced from cooked meat. [9] Several laboratory studies have demonstrated that various species of lactic acid bacteria are capable of binding these mutagenic chemicals, [10] even in human gastric juice, [11] thus rendering them harmless.

Further experiments suggest that lactic acid bacteria may be capable of protecting against the mutagenic effect of other carcinogens as well. Researchers in Germany exposed rats to the carcinogens MNNG or DMH (chemicals used to induce colon cancer) which subsequently caused damage to the DNA in their intestinal cells. When they fed the rats lactic acid bacteria or yoghurt however, this DNA damage was prevented. [12]

Because cancer initiation occurs due to mutations in DNA, [13] this anti-mutagenic action of lactic acid bacteria lends support to the notion that it may contribute towards preventing cancer of the colon.

Animal Studies

Lactic acid bacteria has been shown to prevent or reduce the development of colon cancers and polyps in animal experiments. Researchers in 1983 found that that the survival rate among rats exposed with the carcinogen 1,2-dimethylhydrazine (a potent chemical carcinogen used to induce colon cancer in animals, also referred to as “DMH”), was greater in those given milk fermented with Streptococcus thermophilus or Lactobacillus bulgaricus cultures.[14]

Further investigations have demonstrated a decrease in tumorigenesis (tumour initiation) [15] as well as a slowing of the development of colon cancer in rats exposed to DMH. [16] Studies conducted at the University of Ontario [17] and the University of Minnesota [18] found that mice exposed to DMH had a 50% reduction in aberrant crypts if they were fed Bifidobacteria.

Similar results were obtained in a study conducted at Alabama University, where rats fed Bifodobacteria along with their normal feed had significantly fewer colonic aberrant crypt foci after being exposed to azoxymethane (another chemical carcinogen used to induce colon cancer, more commonly referred to as “AOM”) [19] Additional investigations by the American Health Foundation revealed that Bifidobacteria fed to rats exposed to the carcinogen AOM could not only reduce the formation of in aberrant crypt foci but could significantly decrease the activity of faecal beta-glucuronidase; a bacterial enzyme thought to be involved in the process of colon cancer development. [20] A decrease in beta-glucuronidase activity caused by Bifidobacteria ingestion has been demonstrated in further animal studies as well.[21]

Similar results were obtained by researchers in the U.K found that rats fed a type of Bifidobacteria after being exposed to AOM, had a 26% lower incidence of colonic aberrant crypt foci as well as lower beta-glucuronidase activity and ammonia concentration in the caecal contents than control rats. [22] This is significant because both these factors have been associated with colon cancer carcinogenesis in animal experiments.

Another study published in the journal Nutrition and Cancer in 1996, reported that rats given Lactobacillus casei in their feed during exposure to DMH had significantly fewer incidence of subsequent colon tumours. [23]

The results of these experiments give encouraging yet preliminary evidence to support the theory that LAB may assist in the prevention of colon cancer. It should however be noted that these animals were usually given levels of bacteria (approx 1 billion cells) that would be greater than that found in most fermented dairy products such as yoghurt, and probably closer to the numbers found in probiotic supplements.

Clinical Trials

It is thought that the cancer-causing effect of certain toxic and genotoxic chemicals in the gut are affected by particular bacterial enzymes including ß-glucuronidase, which can regenerate toxic or carcinogenic compounds such as polycyclic aromatic hydrocarbons, that would normally be detoxified by the liver. [24] These potentially harmful enzymes are produced more by unfavourable bacteria such as Clostridia, and Enterobacteriaceae, whereas “friendly” bacteria such as Lactobacillus and Bifidobacteria produce less of it. [25] Most importantly, consumption of these lactic acid bacteria has been shown to decrease the activity of ß-glucuronidase.

Faecal ß-glucuronidase activity was significantly reduced in 21 human subjects given Lactobacilli for 4 weeks in a study published in 1984.[26] Bifidobacteria given to 5 volunteers in Japan for 5 weeks also resulted in lower faecal ammonia concentration and beta-glucuronidase activity. [27] Similarly, another trial in Paris found significantly lower faecal beta-glucuronidase activity in 12 volunteers given Bifidobacteria for 12 days. [28]

However another study in France found that giving Lactobacillus acidophilus and Bifidobacterium bifidum to 12 healthy volunteers for 3 weeks had no effect on ß-glucuronidase activity, but it did increase the activity of another enzyme called beta- glucosidase. [29] This is thought to be advantageous because glucosidases can be broken down in the gut and transformed into potentially anti-carcinogenic flavonoids such as quercetin [30] (an antioxidant phytochemical, also found in certain fruits and vegetables)

Epidemiology

Yoghurt and other fermented dairy foods have shown to be protective against colon cancer in a handful of case-control studies. In 1988, researchers from the University of Wisconsin found that fermented dairy products were associated with a significantly decreased risk or colon cancer in a case control study comparing 353 colon cancer patients with 618 cancer free people. [31]

A study published in 1992 compared the diets of 746 colon cancer patients in California with 746 cancer-free people of the same age. A higher calcium intake was associated with a decreased risk, however the only single food which showed to be significantly protective was yoghurt. [32]

Another case control study in France found that yoghurt was the only food found to decrease the risk of colon adenomas (precancerous tumours) in a comparison between 208 cases and 462 controls. Moderate consumption decreased the risk by 40%, whilst higher consumption decreased the risk by 50%. [33]The results from prospective cohort studies have been less consistent.

The Netherlands Cohort Study analysed the diets of 120,852 Dutch men and women, aged between 55-69. After 3.3 years, 215 of these people had been diagnosed with colon cancer. Those who consumed the most fermented dairy products had a 30% reduced relative risk compared with those who consumed the least. [34]

A smaller cohort study whose findings did not support this theory, involved 47,935 American men aged 40-75. After 6 years there were 203 new cases of colon cancer, however consumption of fermented milk products had no significant association. [35]

At present there is inadequate epidemiological evidence to give strong support to the notion that yoghurt consumption may prevent colon cancer, however these preliminary findings are encouraging, especially given the results from animal experiments and clinical trials measuring biochemical markers. It should however be noted that the majority of clinical and laboratory experiments used levels of lactic acid bacteria which may be greater than that consumed by people in these population-based studies, as presumably their intake would be from fermented fairy foods such as yoghurt, whereas supplemental doses of probiotics may have afforded the more significant effect seen in short term trials. Controlled clinical trials assessing cancer incidence would be needed to determine whether or not probiotic supplements alone may decrease the risk of colon cancer.

Cardiovascular Disease (CVD)

* Cholesterol

* Blood Pressure

Cholesterol

It is thought that the mechanisms by which lactic acid bacteria exert their effect on cholesterol is through bile acids. The liver uses cholesterol to produce bile acids, which are secreted into the small intestine, and then absorbed again and sent back to the liver. Whilst these bile acids are in the intestine however they can be broken down by certain kinds of bacteria that inhabit the gut. [36] This has been evidenced in animal studies which found that greater gut bacteria resulted in greater elimination of bile acids. [37,38]

If the intestinal bacteria are breaking down and thus inhibiting the reabsorption of bile salts, then they would not be able to be recycled. Therefore, livers cholesterol storage would begin to be reduced because it would be needed to synthesise new bile acids due to the lack of recycling. [39] Therefore it has been suggested that this effect could be increased if the gut were to be colonised with more of the bacterial types capable of breaking down the most bile, [40] such Lactobacillus acidophilus . [41] Because most of the cholesterol found in blood serum comes from the liver, this effect would inevitably help to lower serum cholesterol levels, thus decreasing the risk of heart disease.

Studies in animals have demonstrated the ability of food fermented or inoculated with lactic acid bacteria to significantly lower serum levels of total cholesterol and or LDL “bad” cholesterol, using Streptococcus thermophilus [42] Lactobacillus bulgaricus [43] and Lactobacillus cremoris [44] in rats, L. acidophilus in pigs [45] and mice [46] as well as Lactobacillus casei and Bifidobacteria bifidum in chickens. [47]

In 1979, the first trial to evaluate the effects of lactic acid bacteria on serum cholesterol levels in humans was conducted. Fifty four volunteers participated in a randomised cross over trial; the results of which revealed reductions of between 5-10% in serum cholesterol levels after several weeks of moderate consumption of yoghurt fermented with Lactobacillus bulgaricus and S. thermophilus .[48]

In 1995, the results of a 6-week long double blind, placebo-controlled crossover trial in Denmark involving 58 middle-aged healthy men, revealed that consumption of milk fermented with Enterococcus faecium and two strains of S. thermophilus cultures resulted in a 10% decrease in LDL “bad” cholesterol.[49] A similar Danish study using the same fermented milk product this time lasting 6 months, revealed that after as little as 1 month, the lactic acid bacteria containing product lowered LDL cholesterol levels in both men and women by 10 and 8% respectively.

A Dutch trial involving 30 healthy men also found that consuming yoghurt fermented with L. acidophilus cultures for several weeks decreased both total and LDL cholesterol levels by 4.4 and 5.4% respectively compared with controls. [51]

Similar results were not obtained however, in a controlled trial lasting 6 weeks involving 78 healthy subjects, which found that consumption of yoghurt fermented with L. acidophilus had no significant effect on serum cholesterol levels at all. [52]

Another study failed to find any significant changes in cholesterol levels after consumption of milk inoculated with L. acidophilus or yoghurt fermented with L. bulgaricus and S. thermophilus , however the subjects in this study had particularly low cholesterol levels to begin with. [53]

Several of these trials however failed to mention what concentration of bacteria was present in each product; thus it is not possible to know what dosage would be required to obtain these cholesterol-lowering results. Moreover, the subject in these studies had cholesterol levels that were either normal or relatively low, so it can not be know how effective such treatments may be in subjects with high cholesterol. It may be reasonable to speculate that the cholesterol lowering effect may be more pronounced in hypercholesterolemic patients, however at present there is no data to support this theory.

Blood Pressure

Because milk proteins can be fermented to form peptides which have an action similar to that of a type of medication used to treat high blood pressure known as “ACE Inhibitors”, [54] it has been suggested that consumption of fermented milk may be beneficial to hypertensive patients, after feeding either fermented products [55] or peptides isolated from fermented milk [56,57] could lower blood pressure in hypertensive rats.

In a placebo-controlled trial involving hypertensive patients, 8 weeks of consuming sour milk fermented by Lactobacillus helveticus and Saccharomyces cerevisiae resulted in significant reductions in both systolic and diastolic blood pressure. [58]

Several years later, the results of another 8–week pilot study demonstrated blood pressure lowering effects of milk fermented with Lactobacillus helveticus . [59] More recently, the same authors published the results of a double blind, placebo -controlled trial involving 39 hypertensive subjects which once again revealed that consumption of milk fermented with L. helveticus could exert a modest lowering effect on blood pressure. [60]

Although the reductions in blood pressure seen in hypertensive patients consuming fermented milk products may not be significant enough to be used as a sole treatment for high blood pressure, these studies provide preliminary evidence to suggest that consumption of lactic acid bacteria fermented dairy foods along with a host of other functional foods known to have beneficial effects on blood pressure, could at least be incorporated into dietary strategies used to complement medical treatments for hypertensive patients. For the rest of us, it may simply aid in maintaining healthy blood pressure levels; thus acting as a preventative measure.

Immune Function

There is a significant body of evidence from clinical and laboratory investigations to suggest that consumption of lactic acid bacteria may have favourable effects on immune function.

IgA

Antibodies such as Immunoglobulin A (IgA) are produced by plasma cells of the immune system and are involved in protecting the body from potentially harmful microbes. Secretory immunoglobulin A, (sIgA) is specifically found at the surface of the intestinal mucosa (the outer membrane layer coated in mucous that is exposed to the guts contents) and works by preventing pathogens from binding with and penetrating the gut wall. Lactobacillus casei , Lactobacillus acidophilus and yogurt have been shown to enhance the number of IgA-producing plasma cells in a dose-dependent manner [61] as well as increasing sIgA levels in mice and humans. [62]

Phagocytosis.

Another beneficial mechanism that lactic acid bacteria may have on immune function is the ability to enhance a process known as phagocytosis, which is where certain types of white blood cells known as macrophages literally engulf and ingest “invaders” such as harmful bacteria and other disease causing microbes (pathogens) ; a process thought to be one of the bodies first lines of defence against harmful bacterial infections.

Recent investigation have shown that macrophage numbers increased in mice fed cultures of L. acidophilus or L. casei . [63] Furthermore , Lactobacillus acidophilus and Bifidobacterium longum have been found to enhance phagocytic function of human macrophages in vitro [64] whilst animal studies have demonstrated that L. acidophilus [65] L. casei [66] and Streptococcus thermophilus [67] either enhanced or increased phagocytosis in the macrophages of rodents.

In a double blind, placebo-controlled trial designed to determine the effects of lactic acid bacteria on immune function, 25 elderly volunteers were given either low fat milk or the same milk with added cultures of a strain of Bifidobacteria lactis called HN019 . The results demonstrated that after 6 weeks, those who received the probiotic milk had significantly improved markers of natural immunity such as e nhanced levels of interferon-alpha and increases in the phagocytic capacity of certain immune cells. [68]

T-Cells and NK Cells

A similar trial in New Zealand demonstrated that elderly volunteers given the same strain of B. lactis showed significant improvements in the immune function including an increase in the proportion of immune cells known as T lymphocytes, especially helper and activated T-cells, as well as natural killer cells; a type of white cell known to attack tumours. [69] The same researchers found both an increase the number of natural killer cells as well a 101 and 62% enhancement of their immune cells ability to attack tumours when elderly people were given either B. lactis HN019 or Lactobacillus rhamnosus HN001 respectively, for as little as 3 weeks. [70]

These probiotic strains have also demonstrated significant immune enhancing ability in animal studies. For example, 27 out of 30 mice given L. rhamnosus HN001 survived after being infected with a deadly type of Salmonella , compared with only 2 out of 29 who did not receive the probiotic. [71]

Infections

In a randomised, double blind, placebo controlled study in Finland, 857 healthy children aged 1-6 years in 18 day-care centres throughout Helsinki were studied for 7 months to see whether consumption of a probiotic milk could reduce the incidence of respiratory infections. The children that were given milk with L. rhamnosus GG had 16% fewer days absent due to illness. Furthermore, there were 17% fewer cases of respiratory tract infections, and a 19% reduction in the need for antibiotic treatment for respiratory infections among the children that received the probiotic compared to those that did not. [72] Additionally, the children who received the probiotic had 44% fewer dental carries than those who received the placebo (normal milk), presumably because Lactobacillus GG acts as an antagonist to the bacteria that cause dental problems. [73]

In an open, prospective trial involving 209 volunteers, daily consumption of a probiotic drink resulted in a 19% reduction in the occurrence of potentially disease causing bacteria found in the nasal tract [74] – a part of the body that can harbour pathogenic microbes such as those that cause pneumonia, haemolytic anaemia as well as Staphylococcus aureus “golden staph”.

Helicobacter Pylori

Ingestion of lactic acid bacteria has also been found to be beneficial in people infected with the bacterium Helicobacter pylori which is responsible for gastritis and peptic ulcers. [75] Various strains of lactic acid bacteria probiotics such as those isolated from yoghurt [76] have been proven to reduce the growth of H.pylori in vitro, [77] in animal studies [78-80] and human clinical trials, presumable by producing selectively anti-bacterial substances known as bacteriocins , [81,82] and by inhibiting binding ability.[83] Lactobacillus johnsonii is probably the most successful species of probiotic shown to reduce H.pylori infection. For example, L. johnsonii was shown to reduce H.pylori infection in children in Santiago, Chillie. [84]

A double blind trial in Switzerland randomly assigned 50 patients with H. pylori infections to receive either a L. johnsonii probiotic or a placebo for 16 weeks. Those given the probiotic experienced a modest improvement such as decreases in the severity and activity of antral gastritis, decrease of H.pylori density and increased mucous thickness. [85] The authors concluded that

“Regular ingestion of fermented milk containing L. johnsonii may reduce the risk of developing disorders associated with high degrees of gastric inflammation and mucus depletion."

Further investigations in Switzerland have found that L. johnsonii probiotics are capable of producing a favourable affect on H.pylori gastritis in human subjects [86] including a trial which found that 2 weeks of L. johnsonii consumption suppressed H.pylori infection regardless of whether it was combined with a standard medication used to treat H. pylori called omeprazole, or with a placebo. [87]

Similar investigation demonstrated a modest suppressive effect on H.pylori growth in patients given L. Casei Shirota strain for 3 weeks in the Netherlands [88] whilst Japanese researchers found that consuming yoghurt containing Lactobacillus gasseri OLL2716 also resulted a suppression of H. pylori as well as a reduction in gastric mucosal inflammation in 31 patients for 8 weeks. [89]

Similarly, the results of a more recent clinical trial in China revealed that compared to those given a placebo, H.pylori growth was significantly inhibited in after 6 weeks in 59 patients who consumed yoghurt containing L. acidophilus La5 and Bifidobacterium lactis Bb12. [90]

Other investigations have found that the addition of probiotics to standard drug treatments can enhance their effectiveness [91] or reduce the severity of the drug-related side effects [92] including a trial involving 120-infected patients in Italy which found that patients given the conventional medical treatments (rabeprazole, clarithromycin and amoxicillin) had a 72% successful eradication of the infection after 1 week, whereas those given the same treatment plus L. acidophilus probiotics had an 88% rate of success. [91]

A similar trial by the same authors found no difference in the rate of successful eradication between those given standard drug treatment alone or in conjunction with probiotics; however the probiotics did ease the side effects of the drugs such as diarrhoea and taste disturbance. [92]

Consumption of Lactobacillus and Bifidobacterium -containing yoghurt was shown to improve drug treatment in a Taiwanese study where the rate of successful eradication after 1 week of treatment in those given only drugs was 78% compared to 91% in those also given the yoghurt. [93]

Diarrhoea

Diarrhoea is one of the most common causes of sickness in young children, often caused by rotavirus infections. It results in approximately 3 million doctors visits per year [94] and contributes roughly 13% of hospitalizations among children under 5. [95]

The results of randomized, double blind placebo-controlled trials have found that administration of probiotics containing Lactobacillus GG, [96-99] Lactobacillus reuteri [100,101], L. acidophilus [102] or L. acidophilus combined with L. bulgaris [103,104] have proven effective in the treatment of diarrhoea in children between 1 month and 2.5 years old, by reducing the duration and severity of symptoms.

Consumption of lactic acid bacteria has also been shown to reduce the risk of developing a type of diarrhoea which commonly occurs as a result of antibiotic treatments. The results of various randomized double-blind placebo-controlled trials have demonstrated that probiotics containing Lactobacillus GG may prevent antibiotic associated diarrhoea in both adults [105,106] and children [107,108]. A meta-analysis of these trials reported a 60% average reduction in the incidence of antibiotic-associated diarrhoea in people given probiotics concurrently. [109]

Several studies have also found that consumption of yoghurt during antibiotic treatment can also halve the likelihood of getting diarrhoea, half the duration of diarrhoea symptoms [110] as well as decrease some of the other side effects associated with antibiotics s uch as abdominal distress, stomach pain and flatulence. [111]

Similar randomized trials have demonstrated that consumption of lactic acid bacteria can protect against diarrhoea in healthy people as well. One such recent study involved 541 young soldiers,275 of whom were given yoghurt containing Lactobacillus casei , the other 266 received ordinary non-probiotic yoghurt. Throughout the duration of the study, there were approximately 25% fewer cases of diarrhoea among those given the probiotic yoghurt. [112]

Inflammation and Allergies 

* Cytokines

* Allergies

* Inflamatory Bowel Disease (IBD)

Cytokines

Several studies have shown that probiotics can alter the production of behavioural and communication molecules called cytokines that are released from certain cells of the immune system and are involved in immune regulation as well as inflammatory responses.

Different strains of Streptococcus thermophilus increased the cytokine production of human white blood cells in vitro [113] whilst mice given Bifidobacterium bifidum also displayed an increase in cytokine production. [114] Furthermore, it has been suggested that probiotics may boost the immune systems of the elderly by helping to reverse the age-related decline in the production of cytokines [115] based on a study where administration various probiotic species in aging rodents resulted in restored production in the levels of certain cytokines [116]

Some of the many beneficial effects that probiotics have on mediating immune regulation include balancing the control of pro-inflammatory and anti-inflammatory cytokines. Studies indicate that probiotics can be used as innovative tools to alleviate intestinal inflammation, normalize dysfunctional of the mucosa, and down-regulate hypersensitivity reactions such as allergies. [117]

Human studies have found that administration of Lactobacillus rhamnosus GG can enhance the cellular immune response to intestinal micro-organisms whilst causing a decrease in the production of pro-inflammatory cytokines but an increase in anti-inflammatory cytokines. [118]

Allergies

In another interesting study, milk with added Lactobacillus GG prevented the usual hypersensitivity reaction in people with milk allergy, whilst it induced an immune response (but not a hypersensitive one) in those without milk allergy; that is, it stimulated the immune system of healthy volunteers whilst it had an antiinflammatory effect in those prone to over-immune stimulation. No suggestions have been given to explain this selective influence on immune function. [119]

It has been hypothesized that an increase in the occurrence of childhood allergies may be due to a increase in hygiene, and thus a reduction in the exposure to microbes early in life. Therefore it was suggested that exposure to “friendly” bacteria early in life might reduce the subsequent risk of allergies. In a randomised double-blind, placebo-controlled study in Finland , 132 pregnant women with a family history of atopic (allergic) eczema were given either L. rhamnosus GG or a placebo for several weeks prior to giving birth, as well as to their infants after birth. After both 6 months [120] and a follow up 4 years later, [121] there was a 50% reduction in frequency of atopic eczema in the group given the probiotic compared to the placebo group. This is significant because early childhood atopic eczema is an indicator of other allergies later in life.

Other studies conducted by researchers in Finland also demonstrated a significantly greater reduction in the symptoms from atopic eczema and cows milk allergy [122] as well as a decrease in markers of inflammation [123] in infants given Lactobacillus GG compared to those given a placebo.

Inflammatory Bowel Disease (IBD)

Another potentially beneficial use for probiotics has been found to be in the treatment of Inflammatory Bowel Diseases (IBD), which include Chrohn's Disease (an inflammation of the small intestine), Ulcerative Colitis (an inflammation of the Colon resulting in ulceration) and pouchitis (an inflammation of the pouch created as treatment of a patient with ulcerative colitis).

Researchers are unsure what causes the effects seen in Inflammatory Bowel Disease. Although some investigations have revealed that lactic acid bacteria such as Bifidobacteria sp . are particularly low in Chrohn's Disease patients, [124] it has been suggested that rather than just a disruption to the normal microbes of the gut, this normal gut “flora” may actually cause an aggressive immunological response in IBD patients. Therefore it has been proposed that perhaps colonizing the gut with bacteria capable of favourably modulating this immunological response may be an effective strategy for preventing relapses in IBD patients. [125]

A double blind, placebo-controlled trial in which 40 patients suffering from refractory pouchitis were randomly assigned to receive either a treatment of various strains of probiotics or a placebo for 6 months found that the probiotics effectively resulted in 17 out of 20 patients going into remission, whereas all of the patients given the placebo still had symptoms. [126] The same researchers found that the same probiotic formula resulted in 12 out of 15 patients with Ulcerative Colitis going into remission after 1 year of treatment. [127]

Similar results were obtained in a randomised clinical trial in Japan where after 12 months, only 3 out of 11 Ulcerative Colitis patients given bifidobacteria-fermented milk still had symptoms compared to 9 out of 10 patients given the placebo. [128]

More recently, a controlled clinical trial in Italy involved 40 patients which had undergone a procedure called ileal pouch-anal anastomosis for ulcerative colitis. They were randomised to receive either a highly concentrated probiotic supplement or a placebo and monitored for a year. By the end of the trial, only 10% of patients given the probiotic had reported an episode of acute pouchitis compared with 40% of those given the placebo. [129]

These studies provide encouraging results however further investigation are needed to identify which probiotic strains are the most effective, determine whether or not consumption of lactic acid bacteria may prevent an initial onset of IBD, and help to understand the mechanisms to explain how these probiotics actually exhibit their beneficial effects in inflammatory conditions.

Recipes

For those who wish to add more yoghurt to their diet, Alice Henneman MS, RD has published a series of "9 delicious recipes" using yoghurt, which can be found on the University of Nebraskas "Cook It Quick" website.

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