Disabled Traveler: Probiotics, Multiple Sclerosis, and Immune System Disorders: Caution

_** This is an update on our previous post**_ "[Are Probiotics Gut Bacteria Good or Bad For Multiple Sclerosis Or Other Autoimmune Diseases?"][1] [1] which sounded a note of caution about the blind use or shotgun approach, of probiotics against autoimmune diseases. Probiotics are helping the beneficial bacteria in your gut. That post was published on Oct 30, 2011. We followed up with an update on the tussle between the FDA and the food industry on the topic of "new ingredients" and probiotics [2]

What prompted this update was the post in NutraIngredients [3] about a warning by Dr Pieter Cohen that the New Dietary Ingredients (NDI) draft does not go far enough in insuring the public that the are safe and true to claim. Although Dr Cohen's article is about supplements in general, probiotics bacteria are seen as a subset of the "supplements" [4]

So the controversy about the benefits or risks of the use of probiotics, particularly in a subset of the population at risk for autoimmmune disease like MS, is still in full bloom.

_**Consider the alarms raised in [1] and [5,6]**_: Essentially, studies have shown that the combination of what is called "commensal bacteria" and some of the immune system's policing bodies (T-Cells, etc) can delivers a one, two punch to the normal balance of the immune system and throws it in to a self destructive attack on the myelin, i.e. Multiple Sclerosis.

_**Note:**_ _Commensal bacteria are bacteria that live in your gut without normally bothering you…._

Clear? Well, no. Because, previous studies attributed a positive, healing role to the probiotic bacteria! See [7-8]. Quoting from [8]'s link :

"…We tested the potential of various strains of lactobacilli for suppression of experimental autoimmune encephalomyelitis (EAE), an animal model of MS..Our findings indicate a therapeutic potential of oral administration of a combination of probiotics." OK, so it is only on a an animal model, but still…

What gives?

The culprit is the probably the confusing shotgun approach, where all probiotics are assumed to work in unison to the same beneficial, nay, therapeutic, goal.

The "bad" commensal bacteria of study [1] is not well identified , quoting the Max Planck Institute : '.._Precisely which bacteria are involved in the emergence of multiple sclerosis remains unclear. Possible candidates are clostridiums_, which can have direct contact with the intestinal wall…" Another study published in the National academy of Science [6] showed that _Segmented Filament Bacteria_, would also be implicated in triggering Experimental Autoimmune Encephalomyelitis (EAE) in mice. EAE is an MS like disease used as a research model.

On the other hand , the "good" bacteria of study [8] is "a mixture of the three lactobacilli strains".

A Dutch study on the effects of probiotics on EAE [8] confirms this approach "…We suggest that conclusions on probiotics are limited to specific strains and models and not generalised…".

Keep also in mind that the industry's record on precise identification of which bacteria are in the probiotic product has been shown to be less than perfect by a study [9] published in the international journal of food microbiology.Quoting [9]

"…Five products were mislabelled with respect to the numbers and three with respect to species of lactobacilli. In four cases, the specified strains were not detected. Four fermented milks sold under three trademarks contained the same strain, which was named differently on each label. As safety and functionality of probiotics are strain dependent, these results demonstrated the need to control lactobacilli present in commercially probiotic human food products, not only at the species but also at the strain level, to ensure their quality and protect the consumer…"

Another study published in Gut Microbes [11] presents a list of substantial risks of using probiotics with scant known properties:

* Infectivity or in situ toxin production.
* Genetic stability of the probiotic over time,
* Deleterious metabolic activities,
* Potential for pathogenicity or toxicogenicity
* _**Immunological effects must be considered, especially in certain vulnerable populations**_
* All of the above "..must be assessed depending on the characteristics of the genus and species of the microbe being used…"

Keep in mind that probiotics recommendation for Multiple Sclerosis food supplementation are already out, and not just in "far out" blogs, but posted on the respectable _University of Maryland Complementary Medicine site_ [12].

Quoting the U. Of Maryland : "…Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health…"

They were probably relying on the Swedish work we mentioned in [8]. The only problem is that if you dig more into [8], you find that they used a cocktail of three specific strains of Lactobacillus: L. paracasei DSM 13434, L. plantarum DSM 15312 and DSM 15313. Even more the study alaso showed that: "…_**each monostrain probiotic failed to be therapeutic**_ in diseased mice, _**while a mixture of the three lactobacilli strains suppressed the progression and reversed the clinical and histological signs of EAE.**_.."

Leaving the MS issue, but staying in the immune system impact of probiotics,_** some studies have targetted the use of probiotics to alleviate allergies**_ [13]. Here to the conclusion is that "…the probiotic performance of strains differs; each probiotic strain is a unique organism itself with specific properties that cannot be extrapolated from other, even closely related, strains…"

So much for broad, simple, advice?

Coming back to the consumption of probiotics and their effect on commensal bacteria,_** the assumption that all commensal bacteria are good for all individuals without regards to the genetic make up and disease susceptibilities of the consumer is probably too simplistic**_. Then again how far does the consumer self knowledge have to go so that he can buy of the shelf shotgun probiotics without anxiety?

_**A start to this answer is that consumer has to back the FDA in their insistence for a pedigree of the species an strain of the probiotics on the open market. **_

_Of course this is an expensive proposition and the food industry vehemently opposes it…..**
**_

_I am not usually a fan of stifling regulation and red tape, but here, a cautionary slowing down of putting probiotic bacteria on the market might be in order._

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What do we know about probiotics live cultures?

1. [MediNewsDigest ][1]; "Are Probiotics Gut Bacteria Good or Bad For Multiple Sclerosis Or Other Autoimmune Diseases?"; Oct 30, 2011
2. [MediNewsDigest][4] ; "Food industry and the FDA are involved in a tussle over the safety of new probiotic bacteria" ; Dec 17, 2011
3. [NutraIngredients][5] ; "Harvard Professor: NDI draft guidance does not go far enough" ; Jan 27, 2012
4. [New England Journal Of Medicine's Perspectives][6] ; "Assessing Supplement Safety — The FDA's Controversial Proposal
5. [ ScienceNews][7] ; "Gut bacteria linked to MS " ; Dec 3rd, 2011
6. [Proceeding of the National Academy of Science USA][8] ; "Proinflammatory T-cell responses to gut microbiota promote experimental autoimmune encephalomyelitis." March 15 2011
7. [MediNewsDigest][9] ; "Multiple Sclerosis: Unusual Probiotics Alternative Therapy" ; April 15, 2011
8. [MediNewsDigest][10] ; "Study Shows Probiotics Show Promise Against Multiple Sclerosis" ; Oct 5, 2010
9. [Vaccine ][11]; "Strain-dependent effects of probiotic lactobacilli on EAE autoimmunity." ; April 16, 2008
10. [International Journal of Food Microbiology ][12]; "Numbers and strains of lactobacilli in some probiotic products." ; Dec 15, 2004
11. [ Gut Microbes][13] ; "Safety assessment of probiotics for human use" ; May-June 2010
12. [Univ. Maryland Medical Center ][14]; Complementary Medicine : Multiple Sclerosis
13. [ Journal of Clinical Gastroenterology][15] ; "Probiotics: use in allergic disorders: a Nutrition, Allergy, Mucosal Immunology, and Intestinal Microbiota (NAMI) Research Group Report. " ; July 2008

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URL: http://www.medinewsdigest.com/?p=3715

Monday, January 30, 2012

Probiotics, Multiple Sclerosis, and Immune System Disorders: Caution

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