Probiotic mix effective for IBS?

We are already starting to appreciate just how (a) complex and (b) important our gut microbiota are to health and wellbeing outside of the more traditional duties of food digestion and making the odd nutrient or two. Those trillions of beasties which call us home seem to be cropping up everywhere these days in research terms, based on investigations as diverse as obesity (see here) and autoimmunity (see here) even to the point of speculation about involvement in psychological development (see here) (mice, not humans, mice... so far). That and the fact that stability seems to be a good word to describe their bacterial lives* (assuming that you don't swallow a grenade).

That being said, the involvement of gut bacteria whether alone or as part of the triad of gut involvement - gut bacteria, gut permeability and mucosal / systemtic immunity** - in relation to gastrointestinal (GI) illness and/or dysfunction should not get too lost in the dialogue. Indeed, how modification of gut bacteria, whether through diet, medicine or other means (yes, yuck factor 10) remains a real point of interest when it comes to GI conditions.

With that in mind I turn today to the paper by Yoon and colleagues*** who following quite a rigourous trial (double-blind, placebo-controlled) suggested that a mix of probiotics given over 4 weeks might be able to do some positive things to the symptoms of formally diagnosed irritable bowel syndrome (IBS). The "multi-species" mix included various species and strains: Bifidobacterium longum, Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus, Lactobacillus rhamnosus, and Streptococcus thermophilus. The authors reported that more of those in receipt of the probiotic mix reported greater relief from their IBS symptoms over and above placebo, and when looking at fecal microflora, there were accompanying changes too as a result of the mix. Interestingly even in the placebo group there were some bacterial changes to be had (mind over matter?).

I know that the Yoon paper is not necessarily new news when it comes to probiotics and IBS (see here) but what this paper does add is its suggestion that rather than thinking too narrow about specific bacteria and species affecting specific conditions, we should perhaps be taking a more broad perspective and realising that the whole is greater than the sum of its parts when it comes to the intricate connections between our various passengers residing in the gut.

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* Faith JJ. et al. The long-term stability of the human gut microbiota. Science. 2013 Jul 5;341(6141):1237439. doi: 10.1126/science.1237439.

** Groeger D. et al. Bifidobacterium infantis 35624 modulates host inflammatory processes beyond the gut. Gut Microbes. 2013 Jun 21;4(4).

*** Yoon JS. et al. Effect of multi-species probiotics on irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial. J Gastroenterol Hepatol. 2013 Jul 5. doi: 10.1111/jgh.12322.

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Crohn's disease and the LOFFLEX diet

A short post this one following a very interesting series airing here in the UK called the Food Hospital. 'Let food be your medicine' was the mantra of a certain Greek gentleman called Hippocrates (or perhaps according to Bill and Ted, 'Hippo-crates') and that is exactly what this series is suggesting.

In the programmes so far we have seen conditions ranging from migraine to obesity discussed. Tonight's programme featured a particularly brave young woman called Laura who presented with quite a serious case of Crohn's disease. For those who want more information about Crohn's see here. The long and short of it is inflammation, discomfort and quite a few 'peripheral' symptoms; no recognised cure and a life of medication and possibly surgery. Certainly one of the more serious gastrointestinal (GI) conditions.

Anyhow true to the name, the Food Hospital investigated whether it was possible the manage some of the symptoms of Crohn's disease through dietary changes. The plan in question is highlighted here and included a 3-step dietary intervention beginning with a cessation of food intake and reliance instead on a liquid feed containing all the necessary nutrients, followed a few weeks later by the implementation of the LOFFLEX (LOw Fibre, Fat Limited EXclusion) diet finally followed by dietary challenge/rechallenge in the hope of identifying problem foods related to symptoms.

It was interesting to see that some success was reported whilst on the regime in terms of symptom reduction following a flare-up. This is not proof of anything but certainly an interesting case study (n=1). Looking at the scientific literature for the LOFFLEX diet, things seem to be a little bit sparse at the moment. I found this trial from Addenbrookes Hospital which was the first place to look at the diet (I think). I also noted an interesting name on the authorship list, Prof. John Hunter, who is quite an expert on all things gastroenterology and particularly a role for gut bacteria in various bowel conditions.

I await more research on this very interesting regime and its potential applications to other conditions.