Tag Archive for: Cochrane Review

“Give Up Meat or Else!”

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“Animal Foods Conclusively Cause Heart Disease!” was the title in my news feed that attracted my attention. I had to check it out, because I’m not a fan of absolute statements in the health field; too often, some facts have to be ignored to make definitive statements such as that true. Was this any different?

A cardiologist from Michigan was interviewed in response to a recently published paper in the Cochrane Review. The review updated the information related to saturated fat intake and the rate of cardiovascular disease and mortality. After reading the paper, that’s the response the doctor gave to an interviewer from the Plant Based News. He suggested that the review conclusively shows that reducing saturated fat intake will result in a 21% decrease in CVD events. The implication is that most saturated fat comes from animal products: if we really buckle down and reduce our saturated fat consumption more, we can reduce events even further.

He makes the connection between animal products and saturated fat. But is that correct? It would mean that vegans, who consume no animal products, are protected from cardiovascular disease. Is that true? I’ll let you know on Thursday

What are you prepared to do today?

        Dr. Chet

More Reasons to Use Probiotics

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One of the most frequently asked questions I get is this: “Should I take probiotics when I take antibiotics? I don’t want to negate the benefits of the antibiotics.” Based on the summary of the Cochrane Review, I think there’s enough evidence to say that you should take probiotics any time you have to be on antibiotics. The research evidence is not perfect and the authors called for more and better research to confirm the results, but there appears to be no harm when taking probiotics during antibiotic use. If it doesn’t harm, then it’s a good idea to do it, even if the rate of C. diff is relatively low to begin with. But it’s a good idea to clear it with your doctor because reasons for taking antibiotics can be different.

There are a couple of things that we don’t know. What is the best type of probiotics to take? And how much should we take? In spite of those unknowns, when examining the data summary of all the studies, there was an overall benefit when probiotics were used. That means whether it was just one strain or several, in differing quantities, they all seemed to work. Whatever probiotic you typically use, take it during antibiotic use until we know more.

Another Review Paper

I’m currently going through a review paper on the brain-microbiome connection (3), and it’s one of the best reviews I’ve read in a long time. I’m still checking the background research; it’s complicated physiology and biochemistry. I can’t get it into the typical three Memos per week so it will be a new Bottom Line in the near future.

What I’ve taken away so far is that we should all be taking probiotics every day, unless there’s a reason you can’t. If you buy a quality product, they’re not inexpensive, but it’s still a good decision based on the potential benefits. In addition, it would be a good idea to add fermented foods to your diet every day: yogurt, especially Greek yogurt, kefir, sauerkraut, kim chi, and more. They all contain a variety of probiotics that can add to your microbiome.

You should also take a fiber supplement every day. Fiber supplements contain prebiotics that feed the probiotics—you’re feeding the good bacteria. In addition, eat foods with more fiber, and that means vegetables and fruits. Again, they can provide positive bacteria to help the microbiome if you eat them raw as well as the food the bacteria needs to thrive.

The Bottom Line

There is a long way to go until we have enough research that identifies the best strains and amounts of probiotics to take as well as the best sources. There’s always the possibility we’ll find a better way, such as eating specific varieties of fruit grown in a specific region of the world that has the right strains of bacteria. We just don’t know. But what we do know is that there are benefits to taking probiotics every day right now. I think that’s the path forward at this point for almost everyone.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.
3. Cell Mol Gastroenterol Hepatol 2018;6:133–148.

 

Probiotics Can Cut C. Diff Rates

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The authors reported that there were 39 studies included in the Cochrane review; 33 on adults and six on children. They included studies that were in-patient, out-patient, and using varying strains and quantities of probiotics. Here’s what they found.

There was moderate evidence that the use of probiotics together with the administration of antibiotics did reduce the occurrence of C. diff. The risk of getting the C. diff infection was reduced by 60% when compared to control subjects or those who were not treated; typically about 4% of the subjects got C. diff when treated by antibiotics, and it was reduced to 1.5% when probiotics were given concurrently. The phrase “moderate evidence” is one I haven’t used before. It’s generally specific to Cochrane Reviews and is assessed using various factors, ending with a number that reflects the quality of studies included in the analysis.

There was also a reduction in abdominal cramping and diarrhea in those subjects who were given probiotics with their antibiotics compared to those who didn’t get probiotics. In this case, the quality of the research was considered of poor quality. Does that mean that the probiotics were ineffective? No. More than likely it was due to the subjective assessments of pain by individuals. You can test stool to see if C. diff is present, as would have been done in the other part of the research, but relying on people’s self-assessment of pain is less objective. (That’s why my website offers the pain scale developed by the Missoula Project; it has physical activity descriptors that make it easier to determine where you are on the scale. Look for it on the Health Info page.)

Where does that leave us? I’ll finish on Saturday with some recommendations for the use of probiotics.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.

 

Can Probiotics Prevent C. Diff?

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Probiotic research is hot right now. Researchers are trying to figure out what these beneficial microbes can do for our health for a number of reasons. What types of infectious diseases can be prevented, whether food-borne or not? What are the best microbes to treat specific conditions? After all, there are estimated to be around 5,400 different bacteria, yeasts, and fungi. Which ones are best for an E. coli infection? Or salmonella? How about inflammatory bowel disease? Can probiotics benefit other organs in the body by not allowing negative bacteria to enter the blood stream? The questions are almost endless at this point.

We may be starting to get some answers. This week I’m going to focus on the role probiotics may play in preventing clostridium difficile, commonly known as C. diff, infections in people who’ve had to take antibiotics for different diseases. Antibiotics are beneficial when we need them but they do not discriminate; they kill microbes whether they’re beneficial or not. As a result, our gut bacteria—our microbiome—can be decimated. As a result, people who are on heavy doses of antibiotics are prone to C. diff infections. While treatable in most cases, it can have devastating effects on some people including severe pain, cramping, and uncontrolled diarrhea. Not fun!

The authors of a recent paper examined whether probiotics, administered with courses of antibiotics, helped to reduce the rate of C. diff in patients. A Cochrane Review paper examines all available studies from around the world, ranks the quality of the research, and analyzes all the data. Some of the authors of that paper published a summary of that review in JAMA. We’ll take a look at the results on Thursday.

DrChet.com

Tomorrow is the anniversary of the launching of the new DrChet.com website. This past weekend I was speaking in Texas, and several people who are Insider members said that the free monthly Insider Conference Calls were very informative and helped their personal health and the health of their family and clients. Think about becoming an Insider as we begin our second year of memberships.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.