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Probiotics Cut Risk for Hepatic Encephalopathy in Half
Probiotics Cut Risk for Hepatic Encephalopathy in Half
Daniel M. Keller, PhD
May 01, 2013
AMSTERDAM, the Netherlands — Probiotics were effective in helping to prevent a first episode of overt hepatic encephalopathy in patients with cirrhosis, compared with patients not receiving probiotics, according to a new study.
"The patients in the control group had 2 times the chance of developing overt hepatic encephalopathy in the follow-up period," lead author Manish Lunia, MD, from the G.B. Pant Hospital in New Delhi, India, told delegates here at the International Liver Congress 2013.
It is estimated that hepatic encephalopathy occurs in 30% to 45% of patients with cirrhosis, and the mortality rate is 20% to 30%. Because bacterial overgrowth in the small intestine leads to endotoxemia, the researchers reasoned that probiotics could prevent the condition.
For their open-label, prospective, randomized trial, they enrolled patients 18 to 80 years of age with cirrhosis and no history of overt hepatic encephalopathy. A battery of psychometric tests, the critical flicker frequency test, and the psychometric hepatic encephalopathy score were used to diagnose encephalopathy. Glucose hydrogen breath tests were used to identify small intestinal bacterial overgrowth and lactulose hydrogen breath tests were used to identify orocecal transit time.
Study participants were randomly assigned to the probiotic group (n = 86) or the control group (n = 74). The researchers used the commercially available VSL#3, which is a mixture of nonurease-producing organisms: Streptococcus thermophilus and various species of Bifidobacterium and Lactobacillus (110 billion colony-forming units, 3 times daily).
There were no significant differences between the probiotic and control groups in terms of baseline age (about 44 to 47 years), sex, cause of cirrhosis, proportion of Child–Turcotte–Pugh classes, and model for end-stage liver disease (MELD) score. The groups also did not differ in various baseline laboratory parameters, such as small intestinal bacterial overgrowth (38.4% vs 35.1%) and the proportion of patients with minimal hepatic encephalopathy, defined as a psychometric hepatic encephalopathy score of 5 or lower (48.8% and 44.6%).
Patients were followed monthly for signs of overt hepatic encephalopathy or death (mean follow-up time, 38 to 40 weeks). Every 3 months, they underwent psychometric, arterial ammonia level, critical flicker frequency, glucose hydrogen, and lactulose hydrogen breath tests. Six probiotic patients and 5 control subjects were lost to follow-up.
More patients in the probiotic group than in the control group developed overt hepatic encephalopathy (8.8% vs 20.3%). Kaplan–Meier analysis revealed a hazard ratio for developing overt hepatic encephalopathy of 2.1 (95% confidence interval, 1.31 - 6.53; P < .05). There were fewer deaths in the probiotic group than in the control group (7.5% vs 11.5%).
A significantly greater proportion of patients with Child class B and C cirrhosis than with class A cirrhosis developed overt hepatic encephalopathy, but patients with Child class A and Child class B did not differ from each other (P = .36).
In the probiotic group, there were significant improvements from baseline to 3 months in arterial ammonia (P = .04), small intestinal bacterial overgrowth (P = .006), orocecal transit time (P = .05), psychometric hepatic encephalopathy score (P = .01), critical flicker frequency test (P = .02), and minimal hepatic encephalopathy (P = .001). In the control group, there were no significant differences from baseline in any of these parameters.
Factors significantly associated with the development of overt hepatic encephalopathy were minimal hepatic encephalopathy (adjust odds ratio [aOR], 3.1), Child–Turcotte–Pugh score (aOR, 1.6), small intestinal bacterial overgrowth (aOR, 2.1), and critical flicker frequency (aOR, 1.44).
Dr. Lunia reported that 5 patients with minimal hepatic encephalopathy or 31 patients without minimal hepatic encephalopathy would need to be treated to prevent 1 case of overt hepatic encephalopathy.
null
This study involved patients with a low level of hepatic encephalopathy at worst, and was therefore for prevention, not treatment, session moderator Isabelle Colle, MD, from Gent University in Belgium, who was not involved with the study, told Medscape Medical News. She explained that the use of probiotics is "certainly not" standard for such patients at this point.
She also questioned whether the use of probiotics in these patients is completely benign. "The gut permeability...is increased, so you can imagine that these bacteria can go through the intestine and cause bacterial translocation.... Do you see infections with this treatment?" she asked. It was a short study, and Dr. Lunia did not present any data on infections, Dr. Colle pointed out.
Dr. Lunia and Dr. Colle have disclosed no relevant financial relationships.
International Liver Congress 2013: 48th Annual Meeting of the European Association for the Study of the Liver (EASL). Abstract 78. Presented April 26, 2013.
http://www.medscape.com/viewarticle/803453
Daniel M. Keller, PhD
May 01, 2013
AMSTERDAM, the Netherlands — Probiotics were effective in helping to prevent a first episode of overt hepatic encephalopathy in patients with cirrhosis, compared with patients not receiving probiotics, according to a new study.
"The patients in the control group had 2 times the chance of developing overt hepatic encephalopathy in the follow-up period," lead author Manish Lunia, MD, from the G.B. Pant Hospital in New Delhi, India, told delegates here at the International Liver Congress 2013.
It is estimated that hepatic encephalopathy occurs in 30% to 45% of patients with cirrhosis, and the mortality rate is 20% to 30%. Because bacterial overgrowth in the small intestine leads to endotoxemia, the researchers reasoned that probiotics could prevent the condition.
For their open-label, prospective, randomized trial, they enrolled patients 18 to 80 years of age with cirrhosis and no history of overt hepatic encephalopathy. A battery of psychometric tests, the critical flicker frequency test, and the psychometric hepatic encephalopathy score were used to diagnose encephalopathy. Glucose hydrogen breath tests were used to identify small intestinal bacterial overgrowth and lactulose hydrogen breath tests were used to identify orocecal transit time.
Study participants were randomly assigned to the probiotic group (n = 86) or the control group (n = 74). The researchers used the commercially available VSL#3, which is a mixture of nonurease-producing organisms: Streptococcus thermophilus and various species of Bifidobacterium and Lactobacillus (110 billion colony-forming units, 3 times daily).
There were no significant differences between the probiotic and control groups in terms of baseline age (about 44 to 47 years), sex, cause of cirrhosis, proportion of Child–Turcotte–Pugh classes, and model for end-stage liver disease (MELD) score. The groups also did not differ in various baseline laboratory parameters, such as small intestinal bacterial overgrowth (38.4% vs 35.1%) and the proportion of patients with minimal hepatic encephalopathy, defined as a psychometric hepatic encephalopathy score of 5 or lower (48.8% and 44.6%).
Patients were followed monthly for signs of overt hepatic encephalopathy or death (mean follow-up time, 38 to 40 weeks). Every 3 months, they underwent psychometric, arterial ammonia level, critical flicker frequency, glucose hydrogen, and lactulose hydrogen breath tests. Six probiotic patients and 5 control subjects were lost to follow-up.
More patients in the probiotic group than in the control group developed overt hepatic encephalopathy (8.8% vs 20.3%). Kaplan–Meier analysis revealed a hazard ratio for developing overt hepatic encephalopathy of 2.1 (95% confidence interval, 1.31 - 6.53; P < .05). There were fewer deaths in the probiotic group than in the control group (7.5% vs 11.5%).
A significantly greater proportion of patients with Child class B and C cirrhosis than with class A cirrhosis developed overt hepatic encephalopathy, but patients with Child class A and Child class B did not differ from each other (P = .36).
In the probiotic group, there were significant improvements from baseline to 3 months in arterial ammonia (P = .04), small intestinal bacterial overgrowth (P = .006), orocecal transit time (P = .05), psychometric hepatic encephalopathy score (P = .01), critical flicker frequency test (P = .02), and minimal hepatic encephalopathy (P = .001). In the control group, there were no significant differences from baseline in any of these parameters.
Factors significantly associated with the development of overt hepatic encephalopathy were minimal hepatic encephalopathy (adjust odds ratio [aOR], 3.1), Child–Turcotte–Pugh score (aOR, 1.6), small intestinal bacterial overgrowth (aOR, 2.1), and critical flicker frequency (aOR, 1.44).
Dr. Lunia reported that 5 patients with minimal hepatic encephalopathy or 31 patients without minimal hepatic encephalopathy would need to be treated to prevent 1 case of overt hepatic encephalopathy.
null
This study involved patients with a low level of hepatic encephalopathy at worst, and was therefore for prevention, not treatment, session moderator Isabelle Colle, MD, from Gent University in Belgium, who was not involved with the study, told Medscape Medical News. She explained that the use of probiotics is "certainly not" standard for such patients at this point.
She also questioned whether the use of probiotics in these patients is completely benign. "The gut permeability...is increased, so you can imagine that these bacteria can go through the intestine and cause bacterial translocation.... Do you see infections with this treatment?" she asked. It was a short study, and Dr. Lunia did not present any data on infections, Dr. Colle pointed out.
Dr. Lunia and Dr. Colle have disclosed no relevant financial relationships.
International Liver Congress 2013: 48th Annual Meeting of the European Association for the Study of the Liver (EASL). Abstract 78. Presented April 26, 2013.
http://www.medscape.com/viewarticle/803453
Oy I remembered! Eureka! Who's got brain fog? ha ha
It was Let's get well by Adelle Davis from 1965
It was so informative, it is relevant for today.
Great book on deficiencies, symptoms and what we can do about it. :)
It was Let's get well by Adelle Davis from 1965
It was so informative, it is relevant for today.
Great book on deficiencies, symptoms and what we can do about it. :)
Hey there! Glad it could help, yes this is my 4th edition, I may need a new one myself :)
My Mom used one by a Ms Davis, can't remember what it was called exactly though she also wrote a book "feed our kids right" in addition to the one I can not think of :)
Gosh, now I will go search
My Mom used one by a Ms Davis, can't remember what it was called exactly though she also wrote a book "feed our kids right" in addition to the one I can not think of :)
Gosh, now I will go search
I've had 2 of those books. It was my bible back in the late 80s. After reading your post ill find my book. Mine is about 16 years old. Maybe I'll buy a new one. Lol!
Thanks for bar code! Kitty
Thanks for bar code! Kitty
Me again...:)
I have a book called Nutritional Healing. I can look up the problem and it will tell me which nutrients I need. They are graded from essential to helpful
For cirrhosis it says essential
Liquid Kyolic with B1 and B12 - an excellent liver detoxifier
Phosphatidyl choline - for fatty liver
Primrose oil or Total EFA - to prevent imbalance of fatty acids
Vitamin B - necessary for proper digestion/absorbtion
Bifido Factor from Natren - repairs liver cells and aids healing
Kyo-Dophilus - human cultured flore from small intestine to improve assimilation
Garlis - detoxifies the liver and bloodstream
enzymes that act to inhibit inflammation
Larginine to detox ammonia a by-product of protein digestion
I hope this helps someone
I have a book called Nutritional Healing. I can look up the problem and it will tell me which nutrients I need. They are graded from essential to helpful
For cirrhosis it says essential
Liquid Kyolic with B1 and B12 - an excellent liver detoxifier
Phosphatidyl choline - for fatty liver
Primrose oil or Total EFA - to prevent imbalance of fatty acids
Vitamin B - necessary for proper digestion/absorbtion
Bifido Factor from Natren - repairs liver cells and aids healing
Kyo-Dophilus - human cultured flore from small intestine to improve assimilation
Garlis - detoxifies the liver and bloodstream
enzymes that act to inhibit inflammation
Larginine to detox ammonia a by-product of protein digestion
I hope this helps someone
Hi I went to Amazon and could not find the yellow bottle but found this
http://www.amazon.com/Renew-Life-Ultimate-Critical-Billion/dp/B000CMKC5Y/ref=sr_1_cc_1?s=aps&ie=UTF8&qid=1372082202&sr=1-1-catcorr&keywords=ultimate+flora
Maybe I bought the yellow bottle from Walmart.or they are out of it on amazon...can I still use brain fog?:)
One thing to watch out for is the herkmier response. As the good bacteria replaces the bad, some people will feel as if they are getting the flu, the best thing to do in this case it to back off...drink more water.. etc. The best way to take acidolphilus or probiotics is to start out slow. i.e. I have taken just the acidolphilus for many many years due to yeast/thrush problems. I just started the probiotics when I read this article so started out with Walmart version of Align. Align is recommended by many doctors.
It seemed to work ok. Then Rivil said something about live so I found these Ultimate Flora which start out with 15 billion as of manufacturing date.
I can tell these are superior to what I was taking.
So sorry for all the posts. I "talk" too much :)
Dee
http://www.amazon.com/Renew-Life-Ultimate-Critical-Billion/dp/B000CMKC5Y/ref=sr_1_cc_1?s=aps&ie=UTF8&qid=1372082202&sr=1-1-catcorr&keywords=ultimate+flora
Maybe I bought the yellow bottle from Walmart.or they are out of it on amazon...can I still use brain fog?:)
One thing to watch out for is the herkmier response. As the good bacteria replaces the bad, some people will feel as if they are getting the flu, the best thing to do in this case it to back off...drink more water.. etc. The best way to take acidolphilus or probiotics is to start out slow. i.e. I have taken just the acidolphilus for many many years due to yeast/thrush problems. I just started the probiotics when I read this article so started out with Walmart version of Align. Align is recommended by many doctors.
It seemed to work ok. Then Rivil said something about live so I found these Ultimate Flora which start out with 15 billion as of manufacturing date.
I can tell these are superior to what I was taking.
So sorry for all the posts. I "talk" too much :)
Dee
Hi I don't have the box but the yellow bottle of Ultimate Flora 15 Billion live cultures per capsule made by Renew Life has a bar code 31257 15864 on it.
I looked up the the other one and it is just too expensive.
Money is very tight for me so I have thought that once I finish the Ultimate Flora I may try to maintain with another less expensive item.
This UF was $18 for 30. Not a lot but per pill much more expensive than the Walmart brand of Align I was taking.
A nutritionist on Amazon felt that Align had too many fillers...sugar so she recommended Natren which is supposed to be delivered cold and then refrigerated.
It is expensive as well....the search continues.
Gosh Mike, did you think your article would create such a buzz? :)
Thanks again
I looked up the the other one and it is just too expensive.
Money is very tight for me so I have thought that once I finish the Ultimate Flora I may try to maintain with another less expensive item.
This UF was $18 for 30. Not a lot but per pill much more expensive than the Walmart brand of Align I was taking.
A nutritionist on Amazon felt that Align had too many fillers...sugar so she recommended Natren which is supposed to be delivered cold and then refrigerated.
It is expensive as well....the search continues.
Gosh Mike, did you think your article would create such a buzz? :)
Thanks again
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