Do You Need to Take Probiotics?
On July 30th, WebMD ran a Second Opinion column entitled "Do You Need to Take Probiotics."1 And as WebMd noted at the bottom of the article:
"The opinions expressed in WebMD Second Opinion are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD Second Opinion are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions."
Nevertheless, by virtue of being on the WebMD site, it carries the WebMD imprimatur, and the disclaimer is at the bottom of the article and has to be expanded to be read. The bottom line is that most people who see the article will take it seriously. And some of the things it asserts, if not outright designed to sow doubt concerning probiotics are, at the very least, misleading.
So what does the article say that is so problematic? Let's go through it paragraph by paragraph and see.
Dissecting WebMD's Probiotic Article.
"It may seem hard to believe, but the human digestive system contains about 100 trillion microorganisms, commonly known as bacteria. While we often think of bacteria as harmful, many gut bacteria are actually beneficial. In fact, researchers have found that some of the bacteria in our digestive system help us digest food, make vitamins, and even help protect against disease -- causing pathogens."
No problem here. These are basic introductory facts that almost everyone can agree on.
"What's less well understood is whether probiotics -- live "helpful" bacteria contained in yogurt, some fermented foods, supplements, and now even in some specialty drinks, can improve our health."
This is highly misleading. While it is true that researches may not yet know exactly "how" all of the different probiotics work to provide health benefits, there are, nevertheless hundreds and hundreds and hundreds of studies that show they indeed do provide benefits. A search on PubMed brings up almost 13,000 studies addressing probiotics--and a huge number find at least some benefit for a wide range of conditions from irritable bowel syndrome to improved immune function.2 We'll take a look at some of the most recent studies a little later in the newsletter. But for now, it's worth noting that peer reviewed studies touting the benefits of probiotics are continually being published.
"The good news is that there's early evidence that some strains of probiotics may help certain conditions including diarrhea, irritable bowel syndrome, inflammatory bowel disease, and even obesity. However, more studies are needed to understand how probiotics work, which strains are most effective, and in what dosage."
I suppose you could call 13,000 studies conducted over several decades "early evidence." But the bigger problem is that the article very subtly, but very decidedly, transitions probiotics into the world of pharmaceutical drugs--even referring to dosage. How many times have you ever heard of anyone say, "I'll have a knockwurst and a dose of sauerkraut?" Or, "I'll have a dose of yogurt for lunch." These are foods, and even when taken in pills or powders, they are still foods--merely in supplement form. No amount or probiotics that you can consume in a food or capsule will ever qualify as a "dose." When compared against the 100 trillion that are supposed to be in your intestinal tract, the numbers of bacteria in a food or a supplement are simply too small to be considered a dose and, in fact, can do little on their own. You take them as seed cultures. Any benefits you receive from taking probiotics results from those bacteria being able to form colonies in the gut and multiply exponentially. It is only after they replicate millions of times over that the probiotics you take have the requisite numbers to do anything. The concept of dosing may be how the medical community thinks of probiotics, but it is anathema to the way they are used in the natural health community.
"So, before you run off to your local drugstore or supermarket in search of probiotic supplements or food, here are a few important factors to keep in mind:
"1 -- Probiotics in supplements are not regulated by the FDA. There are no standardized amounts of bacteria or minimum levels required in foods or supplements, so there's no guarantee that what it says on the box or the label is what you're really getting. And since only specific strains, in large enough quantities, can treat some conditions, what you think is a health-smart purchase could really just be a waste of money."
Let's go back to the opening paragraph in the article where it says, "In fact, researchers have found that some of the bacteria in our digestive system help us digest food, make vitamins, and even help protect against disease-causing pathogens." Where does it say anything about treating conditions? Essentially, the article is now saying that probiotics are potentially a waste of money not because they don't provide health benefits but because they aren't drugs. Let's be clear here, you take probiotics, not specifically to treat "conditions" but to make sure that you maintain the 100 trillion microorganisms in your gut that help you digest food, make vitamins, and even help protect against disease-causing pathogens. Any conditions that may have arisen over time because you didn't maintain proper levels of gut bacteria will then disappear, but that's the result of bringing the body back into balance, not drug intervention. And why do we have to worry about keeping our gut bacteria in balance? What can compromise our 100 trillion microorganisms that might require us to regularly consume probiotics in order to reseed our gut?
As we have discussed in previous newsletters:
- Over time, the colonies of friendly bacteria just naturally age and lose their vitality. (Think of it like a royal family that eventually fizzles out after years of inbreeding.)
- Disruptions and changes in the acid/alkaline balance of the bowels can play a major role in reducing the growth of beneficial bacteria. In addition, these changes tend to favor the growth of harmful viral and fungal organisms as well as putrefactive, disease-causing bacteria.
- Non-steroidal anti-inflammatory drugs (NSAIDS) like Advil, Motrin, Midol, etc. are destructive to intestinal flora.
- Chlorine in the drinking water not only serves to kill bacteria in the water; it is equally devastating to the colonies of beneficial bacteria living in the intestines. The problem is that nature abhors a vacuum, and harmful bacteria then move in to occupy the abandoned "plots."
- Radiation and chemotherapy are devastating to your inner bacterial environment.
- Virtually all meat, chicken, and dairy that you eat (other than organic) is loaded with antibiotics, which destroy all of the beneficial bacteria in your gastrointestinal tract.
- A diet high in meats and fats, because they take so long to break down in the human body, promotes the growth of the harmful, putrefying bacteria.
- Constipation, of course, allows harmful bacteria to hang around longer, which allows them to proliferate.
- Cigarettes, alcohol, and stress are also major culprits, as are some antibiotic herbs, such as goldenseal (if taken in sufficient quantity and/or used too frequently).
- And if you've ever been subjected to a round of "medicinal" antibiotics, you can kiss your beneficial bacteria goodbye. The problem is that antibiotics indiscriminately destroy both bad and good bacteria, allowing virulent, mutant strains of harmful microorganisms to emerge and run rampant inside the body. Antibiotics (both medicinal and in our food supply) are the number one culprit in the overgrowth of harmful pathogens in the gastrointestinal tract (a condition called dysbiosis).
"2 -- In general, probiotics have few side effects in healthy people. However, the data on safety, particularly long-term safety, are limited, and the risk of serious side effects may be greater in people who have serious health conditions or are immune-compromised."
Amusingly, this a complete reversal of reality. We have a massive amount of data about the long-term safety of maintaining high levels of probiotics in the gut. We literally have thousands of years of data on what it means to your health to maintain probiotic levels in the gut. Consuming probiotic rich foods and having 100 trillion beneficial bacteria in the gut is the natural state of human beings. What we don't have sufficient data on, since it's primarily a condition associated with modern living, is what the health consequences are of NOT maintaining proper levels of gut bacteria--although we're starting to get a sense of what those consequences are, and they're not good.
"3 -- Probiotic supplements and foods can be pricey. According to a recent study by consumerlab.com, some probiotic supplements can cost more than $1 a day. And as noted above, supplements aren't regulated, so you may be getting nothing for your money.
A dollar a day! Imagine that! That's just a shocking amount of money to pay for health insurance. Then again, that's less than half the cost of a can of Red Bull. It's one-third the cost of a tall latte at Starbucks. However, one thing that is true is that any probiotics you get in either your food or as a supplement are not regulated like a drug. But, again, probiotics are not drugs. Let's get serious for a moment. Do you expect the amount of fiber in your apple to be regulated? Or the amount of vitamin C in your orange juice?
The one caveat is that probiotics are living organisms, which means they can die. Heat and exposure to air can kill them off over time. That means that the amount of bacteria you see on the label may not be what you get when consuming your probiotic capsule, depending on which strains are in your supplement, how old the supplement is, and how responsible the manufacturer is. Good manufacturers actually pack their capsules with a notable percentage of live probiotics above what's listed on the label so that even after months of die-off, they're still hitting the listed numbers as long as you consume them before the expiration date. Also, good manufacturers now choose from stable strains that can last for a good 12-18 months when stored at room temperature--or even longer when stored in your refrigerator. And good manufacturers store their probiotics under refrigeration at the warehouse--again, so you have the live strains promised on the label for as long as the label promises. Choose a good manufacturer that you trust and you will have no problems.
"4 -- If you're already healthy, there is no evidence that taking probiotics will make you ‘super' healthy. So before even considering a friendly bacteria food or supplement, ask yourself what you might need it for."
Again, this is just so wrong. Not surprisingly, it is the perspective of a certified nutritionist. Look no further than the phrase, "what you might need it for." Keep in mind that the person who wrote this article is a nutritionist, and these people are trained to think of foods in much the same way doctors think of drugs. They measure the value of foods in terms of proteins, fats, carbohydrates, calories, vitamins, and minerals. Some nutritionists do indeed break out of that mindset, but they are in the minority. Keep in mind, these are the same people who oversee hospital food! Enough said. They actually think it's nutritious. As a rule, they have no understanding of phytonutrients, live enzymes, raw VS cooked food, and, as we now know, probiotics. Forget the nonsense in the WebMd article. The simple reasons you take probiotic supplements are:
- Maintaining a proper probiotic microbiome in your gut is essential for health.
- As we've already discussed, many factors compromise the integrity of that biome--from chlorinated water to antibiotics in your food to simply growing older.
- At one time, virtually all diets contained large amounts of foods naturally high in probiotics cultures. Think: yogurt, kefir, buttermilk, sauerkraut, kimchi, olives in brine--and of course, fruits and vegetables pulled right from the garden that are high in soil based organisms.
Forget what the WebMd article says, you don't supplement with probiotics to cure a condition like you take a drug. You supplement with probiotics to maintain the beneficial cultures that should be naturally in your gut and that perform multiple functions that prevent you from getting sick in the first place.
"The Bottom Line:
"The early research on probiotics is promising; however don't look to these friendly bacteria as a cure-all.
"And if you're healthy, you probably don't need them at all. If you think you might benefit from probiotics, be sure to check with your doctor first. While they may help some conditions for some people, there could be more effective medical alternatives, and in some instances, probiotics might be a waste of money."
Really? Really? Really? Again, with turning probiotics into drugs. You don't take probiotics to cure disease. You don't take probiotics as "medical alternatives." You take them because good health requires that they be present. You take them because so many things in modern life work to diminish their numbers. You take them, not to cure disease, but to prevent it. Yes, studies have shown that a number of conditions that might have been caused or exacerbated by a deficiency of probiotics in the gut can clear up with probiotic supplementation. To better understand what I'm talking about, think vitamin C. You don't take vitamin C to cure scurvy; you take it to prevent scurvy. But if your vitamin C levels have dropped so low that you come down with scurvy, supplementing with vitamin C will indeed cure it. But unlike a drug, you keep supplementing with the vitamin C after the scurvy clears up to make sure it doesn't reappear. That's why and how you supplement with probiotics. And finally, I'm pretty sure that preventing the onset of a number of major diseases--and keep in mind that a well maintained intestinal biome actually comprises upwards of 80% of your immune function3--is not a "waste of money".
The other thing of note about the WebMD article is that it is based on information that is so "last year." As I mentioned earlier, new studies proving the benefits of supplementing with probiotics are constantly being published. Here are just a few recent studies. And keep in mind that although most of these studies actually are tied to specific medical conditions, the improvement seen from probiotics is the result of reestablishing healthy levels of particular strains and their supernatant in the gut--not using the probiotics to "cure" the conditions.
Probiotics, Autism, and ADHD
A study published just last June in Pediatric Research concluded that probiotic supplementation early in life may reduce the risk of neuropsychiatric disorder development--specifically ADHD and autism--later in childhood.4 The study included 75 infants who were randomly given lactobacillus rhamnosus or a placebo. Upon revisiting those same children thirteen years later, 17.1 percent of the placebo group had developed a neuropsychiatric disorder such as ADHD or autism. None of the probiotic group were diagnosed with any neuropsychiatric disorder.
The study is not saying that probiotics cure neuropsychiatric disorders, but again, that's not why we take them. We take them because the microbiome requires them and their presence may prevent disease--in this case, possibly, neuropsychiatric disease. Yes, this was a small study, but the results were dramatic and stark: 17.1 percent VS ZERO. Incidentally, I have included L. rhamnosus in every probiotic formulation I have designed over the last quarter century.
Probiotics and Peanut Allergies
And speaking of L. rhamnosus, a study published in March in the Journal of Allergy and Clinical Immunology found that a combination of L rhamnosus and peanut oil therapy was effective in inducing sustained protection against peanut allergies.5 This was a randomized placebo controlled study conducted with 62 children between the ages of 1 and 10. Some were given the probiotic/peanut oil combination; others were given a placebo. The placebo group demonstrated a 4 percent positive response. Eighty-two percent of the rhamnosus children "achieved sustained unresponsiveness."
Again, do you supplement with probiotics to cure anaphylactic shock experienced as the result of a peanut allergy? No, you supplement with them as a possible means to prevent the anaphylaxis from ever happening in the first place.
Probiotics and Colon Cancer
Lactobacillus salivarius is another probiotic that I have used in my formulas for almost 25 years. A 2014 study published in the Journal of Applied Microbiology found that supplementation with salivarius can improve the balance of colonic microflora--promoting the growth of other beneficial bacteria as well as decreasing the growth of unfriendly bacteria.6 One benefit is that the metabolism of everything moving through the colon is optimized for improved health--and more importantly, early colorectal carcinogenesis is prevented. As the study concluded, colonic microflora are an important factor in colorectal carcinogenesis. Modulating the structural shifts of microflora may provide a novel option for preventing colorectal carcinogenesis. In conclusion, this study suggests a potential probiotic-based approach using L. salivarius to modulate the intestinal microflora in the prevention of colorectal carcinogenesis. That certainly is not a "waste of money."
The Immunomodulatory Activity of Probiotics
And then there is the July 2015 study published in Anaerobe that found that L. salivarius and L. plantarum (also used in all my probiotic formulas) have beneficial effects on the regulation of immune responses.7 L. plantarum was the more active strain in enhancing the phagocytic activity of macrophages, while, L. salivarius was the more effective strain at maintaining the Th1/Th2 balance. On the other hand, both strains were found to improve the spleen lymphocyte transformation rate and enhance sIgA production. SIgA (secretory immunoglobulin A) is the main antibody found in mucous secretions from the tear glands, salivary glands, mammary glands, the respiratory system, the genito-urinary tract, and the gastrointestinal tract and plays a key role in protecting vulnerable areas such as the oral cavity, lungs, and gut from invading pathogens.
Probiotics and Diarrhea in Geriatric Patients
Diarrhea caused by pathogenic E. coli infection is not uncommon in geriatric wards. A recent study published in Geriatrics & Gerontology International found infection rates running at 41 percent.8 In fact, pathogenic E. coli is one of the primary agents responsible for epidemic diarrheal sickness in geriatric patients--with the pathogens likely introduced by contamination from staff or new inpatients. However, the study found that the infection of pathogenic E. coli was "significantly lower" in patients taking L. bifidus. Bifidus is one of the major genera of bacteria that make up the colon flora in mammals and can exert a wide range of beneficial health effects, including the regulation of intestinal microbial homeostasis and the inhibition of pathogens and harmful bacteria that colonize and/or infect the gut mucosa. It is also, along with acidophilus, one of the most common strains used in probiotic supplements.
Probiotics and the Health of Colon Cells
Butyrate, a key short-chain fatty acid produced by probiotic action on dietary fiber, serves as a primary fuel for colonocytes (the epithelial cells of the colon wall). The absorption of butyrate into the colonocytes is essential for ameliorating mucosal inflammation and stimulating salt absorption. Monocarboxylate transporter 1 (MCT1) plays a major role in the absorption of butyrate. Low levels of MCT1, for example, are usually found in conditions of intestinal inflammation. A study published just last month in the American Journal of Physiology, Gastrointestinal and Liver Physiology, found that even a short, 3-hour treatment with acidophilus can significantly increase the MCT1-mediated butyrate uptake by colonocytes.9 Although the study, not surprisingly, found that heat-killed acidophilus was ineffective, it did find that the presence of the acidophilus culture supernatant by itself, with no actual living bacteria present was equally effective in stimulating MCT1 function. The supernatant is the liquid that surrounds the probiotic cells in any given culture. Notably, as this study confirms, the supernatant contains beneficial secreted soluble factor(s). Many probiotic supplements filter it out. As this study shows, that's a big mistake. It's the primary reason I've always included the supernatant for all of the bacterial strains I've used in my probiotic formulas.
Probiotics Protect Against Liver Damage
And when it comes to supernatant, it's not just acidophilus supernatant that's beneficial. Rhamnosus supernatant has proven equally beneficial--in different ways. Endotoxemia is a contributing cofactor to alcoholic liver disease (ALD), and alcohol-induced increased intestinal permeability is one of the mechanisms of endotoxin absorption. Probiotic bacteria have been shown to promote intestinal epithelial integrity and protect barrier function in both inflammatory bowel disease and in ALD. What is new, however, is that a study published in the American Journal of Physiology, Gastrointestinal and Liver Physiology found that rhamnosus supernatant--without any actual probiotic bacteria present-- reverses the compromising of intestinal integrity induced by alcohol consumption and its consequent liver injury.10 Specifically, pretreatment with the supernatant reversed the alcohol-induced reduction in several signaling proteins and peptides found in the final section of the small intestine, all of which play important roles in intestinal barrier integrity.
Claiming, as does the WebMD article, that 13,000 studies supporting the benefit of probiotics in improving health is not enough to give us some sense of surety, seems, to say the least, a bit contrarian. And claiming that we don't have the data to understand the long term implications of supplementing with probiotics also seems a bit contrarian when, in fact, the opposite is true. We have virtually all of human history to draw on. As stated earlier, what we don't have is any data to understand the long term implications of NOT supplementing since this is a relatively recent occurrence in human history. On the other hand, we do have suggestive data, including the dramatic increase in visits to doctors for intestinal tract issues over the last hundred years, to get an inkling of what the dramatic reduction in the consumption of probiotic rich foods and the dramatic increase in microbiome stressors such as the unconstrained use of antibiotics and chlorine in our water have meant to our health.
In any case, silliness aside, a good probiotic formula is absolutely essential for long-term intestinal health and long-term parasite control. When choosing a probiotic, look for the following characteristics:
- Not all strains of beneficial bacteria are created equal. For each type of bacteria, there are recognized super strains. Choose a formula that uses only recognized super strains of beneficial bacteria -- clearly identified as such on the label or in the company literature.
- Make sure the probiotic formula you choose includes the all-important supernatant -- the medium the culture was grown in. The supernatant, contains a multitude of beneficial byproducts of the growth process, including: vitamins, enzymes, antioxidants, and immune boosters.
- Then there's the question of how many live microorganisms are left in your formula when you actually use it. Pick up any probiotic formula, look at the label, and you'll see something like: "Contains 13 billion live organisms per capsule at time of manufacture." And that's the problem: "at time of manufacture." The die-off rate for probiotics can be astounding. Most formulas will experience a die-off approaching log 3 within just 60 days of manufacture. That means that the 13 billion you see on the label may be down to 13 million, or less, by the time you use it. Heat and moisture accelerate the process, which is why most manufacturers recommend keeping your probiotic supply refrigerated. Look for a probiotic that guarantees that the number of probiotics present at the time of consumption--even if that consumption is present 12-18 months out. And if possible look for a probiotic that can make that guarantee even if it is stored at room temperature.
There are many beneficial bacteria that can be contained in a good probiotic, but two are preeminent. To maximize the probiotic benefits, look for a formula based on these two:
- L. acidophilus resides primarily in the small intestine and produces a number of powerful antimicrobial compounds in the gut (including: acidolin, acidolphilin, lactocidin, and bacteriocin). These compounds can inhibit the growth and toxin producing capabilities of some 23 known disease-causing pathogens (including: campylobacter, listeria, and staphylococci), as well as reduce tumor growth and effectively neutralize or inhibit carcinogenic substances. It's also important to note that L. acidophilus is the primary beneficial bacteria in the vaginal tract. When the presence of the acidophilus is compromised, this allows the bad guys such as Gardnerella vaginalis or E. coli or Chlamydia to take over.
- Many researchers believe that declining levels of bifidobacteria in the large intestine actually mark the eventual onset of chronic degenerative disease. Bifidobacteria benefit the body in a number of ways. They consume old fecal matter, have the ability to remove cancer-forming elements (or the enzymes which lead to their formation), and protect against the formation of liver, colon, and mammary gland tumors.
More is not always better. Too many beneficial bacteria in one formula may find the bacteria competing with each other before they can establish themselves in separate areas of the intestinal tract. On the other hand, there are several other bacteria that are extremely beneficial in any probiotic formula.
- L salivarius helps digest foods for a healthy intestinal tract and makes vital nutrients more assimilable. It also works to eat away encrusted fecal matter throughout the entire colon; it helps repair the intestinal tract by providing needed enzymes and essential nutrients; and it adheres to the intestinal wall, thereby forming a living matrix that helps protect the mucosal lining.
- L. rhamnosus is powerful for immune system support. It can increase the natural killing activity of spleen cells, which may help to prevent tumor formation. It boosts the ability of the body to destroy foreign invaders and other harmful matter by three times normal activity; and has been shown to increase circulating antibody levels by six to eight times.
- L. plantarum has the ability to eliminate thousands of species of pathogenic bacteria. It also has extremely high adherence potential for epithelial tissue and seems to favor colonizing the same areas of the intestinal tract that E. coli prefers -- in effect, serving to crowd E. coli out of the body. At one time, plantarum was a major part of our diets (found in sourdough bread, sauerkraut, etc.), but is now virtually nowhere to be found.
Note: a good probiotic formulation will usually contain fructooligosaccharides (FOS) which help promote the growth of beneficial bacteria. For some friendly bacteria, such as the Bifidus, FOS can increase their effectiveness by a factor of 1,000 times or more!!
Note: Using enteric encapsulation to protect the probiotics from stomach acid is not essential. Most cultures are easily hearty enough to survive stomach acid. If they weren't, people would never have received any benefit from eating probiotic rich foods since they don't come with enteric coating, and we wouldn't even be talking about probiotics now. In the end, though, I began using acid stable encapsulation on my own probiotic formulas--not because it helped, but because so much misinformation had been promulgated on the net about the need for it that a number of customers had come to believe it was important. In this case, accommodating misinformation about enteric encapsulation and probiotics was possible because, although it doesn't help, it also doesn't hurt. I mention this because the same cannot be said for the websites that claim digestive enzymes also need to be enteric encapsulated. Preventing the breakdown of digestive enzyme capsules in the stomach is actually counterproductive. You lose all the benefit of both enzymatic pre-digestion, HCL regulation, and pancreatic signaling. That's three-quarters of the benefit of digestive enzymes. Sometimes misinformation is harmful.
The bottom line is that there can be no true health or recovery from disease unless you have colonies of over 100 trillion beneficial microorganisms flourishing in your intestinal tract, from your mouth to your anus, aiding in digestion, absorption, the production of significant amounts of vitamins and enzymes, and working to crowd out all harmful bacteria -- allowing them no place to gain a foothold. Despite what the article on WebMD says, supplementation with a good probiotic is mandatory to raise your baseline of health and strengthen your immune system.
- 1. Katherine Brooking. "Do You Need to Take Probiotics?" WebMD July 30, 2015. (Accessed 3 Sep 2015.) http://blogs.webmd.com/food-and-nutrition/2015/07/do-you-need-to-take-probiotics.html
- 2. http://www.ncbi.nlm.nih.gov/pubmed/?term=probiotics
- 3. Andrew L. Kau, Philip P. Ahern,et al. "Human nutrition, the gut microbiome, and immune system: envisioning the future." Nature. 2011 Jun 15; 474(7351): 327--336. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298082/
- 4. Pärtty A, Kalliomäki M, Wacklin P, Salminen S, Isolauri E. "A possible link between early probiotic intervention and the risk of neuropsychiatric disorders later in childhood: a randomized trial." Pediatr Res. 2015 Jun;77(6):823-8. doi: 10.1038/pr.2015.51. Epub 2015 Mar 11. http://www.ncbi.nlm.nih.gov/pubmed/25760553
- 5. Tang ML, Ponsonby AL, Orsini F, Tey D, et al. "Administration of a probiotic with peanut oral immunotherapy: A randomized trial."J Allergy Clin Immunol. 2015 Mar;135(3):737-44.e8. http://www.ncbi.nlm.nih.gov/pubmed/25592987
- 6. Zhu J, Zhu C, Ge S, Zhang M, et al. "Lactobacillus salivarius Ren prevent the early colorectal carcinogenesis in 1, 2-dimethylhydrazine-induced rat model." J Appl Microbiol. 2014 Jul;117(1):208-16. http://www.ncbi.nlm.nih.gov/pubmed/24754742
- 7. Ren D, Li C, Qin Y, et al. "Evaluation of immunomodulatory activity of two potential probiotic Lactobacillus strains by in vivo tests." Anaerobe. 2015 Jul 2;35(Pt B):22-27. http://www.ncbi.nlm.nih.gov/pubmed/26143437
- 8. Kosaka Y, Ohrui T, Ohtawara A, et al. "Lactobacillus bifidus and pathogenic Escherichia coli in geriatric patients." Geriatr Gerontol Int. 2015 Mar;15(3):387-8. http://www.ncbi.nlm.nih.gov/pubmed/25752668
- 9. Kumar A, Alrefai WA, Borthakur A, Dudeja PK. "Lactobacillus acidophilus counteracts enteropathogenic E. coli-induced inhibition of butyrate uptake in intestinal epithelial cells." Am J Physiol Gastrointest Liver Physiol. 2015 Aug 13:ajpgi.00186.2015. http://www.ncbi.nlm.nih.gov/pubmed/26272259
- 10. Wang Y, Liu Y, Sidhu A, Ma Z, McClain C, Feng W. "Lactobacillus rhamnosus GG culture supernatant ameliorates acute alcohol-induced intestinal permeability and liver injury." Am J Physiol Gastrointest Liver Physiol. 2012 Jul;303(1):G32-41. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404581