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Role of Probiotics in Health and Disease

About a month ago, I wrote that there is some evidence to advise patients to take probiotics when they are on antibiotics. This is to prevent antibiotic-associated colitis. The probiotic suggested was Bio-K. I understand patients are having trouble finding Bio-K. My pharmacist tells me that they can order one if the patient can wait for a day or so. So talk to your pharmacist and I am sure they can get one for you.

Bacterial content of Bio-K are Lactobacillus acidophilus CL 1285 and Lactobacillus casei LBC80R. Research has shown that these bacteria reduce the incidence of antibiotic-associated diarrhoea.

There is increasing trend towards the use of probiotics by patients suffering from certain kinds of illnesses and by the public in general. In fact, Ipsos Reid poll conducted this year revealed that 72 per cent of Canadians believe that probiotics improve their health.

Probiotics are bacteria that help maintain the natural balance of bacteria in the intestine. The normal human digestive tract contains about 400 types of probiotic bacteria that reduce the growth of harmful bacteria and promote a healthy digestive system.

The word probiotics is a compound of a Latin and a Greek word. It means “favourable to life.” Probiotics, as defined by the Food and Agricultural Organization of the United Nations (FAO), are live microorganisms administered in adequate amounts which confer a beneficial health effect on the host.

The largest group of probiotic bacteria in the intestine is lactic acid bacteria, of which Lactobacillus acidophilus, found in yogurt, is the best known. Probiotic yogurt was first launched in Canada in 2004. Yeast is also a probiotic substance. Probiotics are also available as dietary supplements.

There are a number of products available in the market. It is difficult to know which one to use. An article in the Medical Post (April 19, 2011) provides some guidelines and I will try and summarize that here.

For diarrhoea, try Danone’s Activia and DanActive. Bio-k has been mentioned earlier. DanActive has also been shown to reduce the duration of respiratory infection. Bio-K and DanActive should be routinely used in the hospitals where the incidence of diarrhoea and respiratory infection is high.

It would be nice to find a probiotic which will help two fairly common conditions affecting our gut – inflammatory bowel disease and irritable bowel syndrome. But there are no solid recommendations in the Medical Post article. That means more research is required. Probiotics in the form of chewing gum and lozenges are being investigated for oral hygiene.

So, don’t spend your money on probiotics just because your friend or neighbour says it is a good idea. Probiotics do not fix all your problems. Do your own research. Go on the internet. Check Health Canada website. Eat yogurt regularly – it has many other benefits – before you spend your precious dollar.

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A Holiday for an Epic Wedding on the High Seas

Click on photos to enlarge. Download as a PDF for easy printing.

The Ship
The Ship

Traditional henna application.
Traditional henna application.

The end result of pithi ceremony for the groom, Navroz. The bride goes through the same process.
The end result of “pithi” ceremony for the groom, Navroz. The bride goes through the same process.

Backdrop to the wedding ceremony - Bay of Naples, Sorrento, Italy
Backdrop to the wedding ceremony – Bay of Naples, Sorrento, Italy

Zahra and Navroz getting married.
Zahra and Navroz getting married.

The cake ceremony.
The cake ceremony.

At the reception - Zahra and Navroz Khimji
At the reception – Zahra and Navroz Khimji

Every now and then go away,
Have little relaxation,
For when you come back to your work
Your judgement will be surer;
Since to remain constantly at work
Will cause you to lose power of judgement…
Leonardo da Vinci (1452-1519)

Once again, I am using my favourite 500-years-old quote from Leonardo da Vinci to justify my holiday. This holiday was no ordinary holiday. It required many months of planning. But now it is over, my jet lag taken care of, I can keep my eyes open and look with happiness and pride hundreds of pictures taken on the trip.

My nephew in Calgary, Navroz, and his beautiful bride, Zahra decided to get married in Sorrento, Italy. A typical old-fashioned Indian marriage involves almost a week of rituals and celebrations, culminating in the wedding and the reception.

Sorrento is a small town in Campania, southern Italy, with some 16,500 inhabitants. It is a popular tourist destination which can be reached easily from Naples, about hour and a half by coach, winding through narrow beautiful roads up the mountain overlooking the Bay of Naples. A breathtaking view.

The couple planned to have the week-long rituals on the high seas – by way of taking a Mediterranean cruise. They invited all their friends and families, from several countries, to join them in this epic wedding. The couple made special arrangements with Norwegian Cruise Line (NCL) to provide facilities to perform the pre-wedding rituals on the ship without disturbing the other guests. One hundred and twenty family members and friends booked their passage on this cruise ship, appropriately named, Norwegian Epic.

Norwegian Epic is NCL’s newest, largest and most modern ship with a capacity to carry 4,100 guests (double occupancy) and 1,730 crew members. I have taken many cruises before but this was the best cruise ship – like a five star hotel. The only thing which has not changed is the noisy whoosh sound-effect when you flush the toilet – a good way to make you jump if you are asleep and somebody decides to use the washroom.

I landed in Barcelona, Spain (where the cruise began) with my family five days before boarding the ship. The idea was to get over the jet lag and see the wonderful city. The cruise lasted seven days with stops in Livorno to visit Florence and Leaning Tower of Pisa, Civitavecchia to see Rome and the Vatican City, Naples where the wedding took place in Sorrento, Palma De Mallorca to visit the island and then back to Barcelona. It was indeed an epic wedding and a wonderful holiday.

There isn’t enough room in this column to provide all the finer details of the wedding or each city we visited. You can visit this article on my website (nbharwani.com) to see few pictures of the wedding I have posted.

I am sure many of you have travelled far and wide and seen most if not all the places mentioned here. Many of you have attended weddings as well. But some weddings and holidays are exceptional. For me this was one of them.

Holidays and weddings, large or small, are a source of happiness,. And there is a lot to say about occasions which provide bonding, love and joy. Navroz and Zahra did an amazing job organizing such an event. Now, it is the time to make love, have lots of children and live happily after.

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C. difficle colitis – fighting bacteria with bacteria

When was the last time I wrote about the outbreaks of Clostridium difficile (C. difficile) colitis in hospitals and nursing homes in Canada, U.S.A. and the U.K.? It was 20 months ago (see www.nbharwani.com January 26, 2010).

C. difficile colitis is not out of the news. It is also called antibiotic-associated colitis.

Recently, Southern Ontario and other parts of Canada have had outbreaks of C. difficile colitis. So, what is C. difficile colitis, and how can we prevent it?

C. difficile is a bacterium common in the environment. It is transmitted from person to person by fecal-oral route. That means we ingest food which is contaminated by somebody who handled that food. It comes down to poor hygiene.

The bacterium, in the form of a spore, settles down in the colon (large bowel) and waits there to create trouble. The normal colonic bacteria are resistant to these spors.  However, if the normal colonic bacterial flora is altered, for example, by taking antibiotics, resistance to colonization is lost. Then there is trouble and there is overgrowth of C. difficile.

What happens then? You may have no symptoms but become a carrier and spread it around if you do not maintain good hygiene. Or you may have symptoms like watery diarrhoea to life- threatening colitis.

How can we prevent it?

In a recent article in the Globe and Mail, Dr. Khursheed Jeejeebhoy, an emeritus professor of medicine and gastroenterology at the University of Toronto and Pierre-Jean Maziade, a microbiologist and infectious diseases specialist at Centre hospitalier Pierre-Le Gardeur said the following:

“While health authorities are mobilizing to enact stricter hygiene protocols, namely hand washing and hospital cleaning procedures, it’s clear that hygiene alone is not enough to prevent C. difficile colonization, particularly given that 20 per cent to 40 per cent of hospital patients are C. difficile carriers.”

According to Jeejeebhoy and his colleague, the logical solution is to fight bacteria with bacteria. That means use of high-dose probiotic formula to prevent C. difficile infection by repopulating the intestine with “friendly” bacteria.

There are many probiotics in the market. A recent randomized clinical trial published in the American Journal of Gastroenterology demonstrated that C. difficile infection can be reduced by 95 per cent in at-risk patients receiving antibiotics, with the use of a probiotic. (The study used a Canadian formula, Bio-K+.)

Jeejeebhoy and his colleague say that many hospitals have started using probiotics as a prophylactic measure to prevent C. difficile colitis. To date, 35,000 patients have received the probiotic formula, with no side effects. C. difficile infections were reduced by 73 per cent, and C. difficile-related death declined by 91 per cent. Probiotics are now considered standard protocol at Pierre-Le Gardeur Hospital, and it has among the lowest incidence of C. difficile in a hospital environment in Canada.

Finally, in a comment, Jeejeebhoy says, “I have myself used Bio-K prophylactically when I had to take a prolonged course of antibiotics.” Next time you are on antibiotics, make sure you take a probiotic like Bio-K.

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Overactive thyroid can affect your eyes.

According to Thyroid Foundation of Canada website, it is estimated that 200 million people in the world have some form of thyroid disease. One in every three Canadians (about 10 million people) has a thyroid disorder. Of those, as many as 50 per cent are undiagnosed.

The normal function of the thyroid gland is to secrete hormones. These hormones have multitude of functions and are vital to metabolism in adults and for normal growth and development of children.

Underactive thyroid (hypothyroidism) causes many symptoms like weight gain, lethargy, cold intolerance, menstrual irregularities, depression, constipation and dry skin. Deficiency of thyroid hormone in children leads to dwarfism and mental retardation.

Overactive thyroid (hyperthyroidism) results in palpitations, nervousness, tremor, heat intolerance, weight loss, muscular weakness and usually there is a presence of goitre.

Hyperthyroidism can be caused by a number of conditions, including Graves’ disease, toxic adenoma, Plummer’s disease (toxic multinodular goitre) and thyroiditis.

Graves’ disease accounts for at least 90 per cent of all patients with hyperthyroidism. It is a condition where eyes are affected. A condition called exophthalmos – protrusion of the eyeballs. Graves’ disease is an autoimmune disorder in which antibodies produced by your immune system stimulate your thyroid to produce too much thyroid hormone.

These antibodies mistakenly attack your thyroid and occasionally the tissue behind your eyes (Graves’ opthalmopathy) and the skin, often in your lower legs over the shins (Graves’ dermopathy). Scientists aren’t sure exactly what causes Graves’ disease, although several factors, including a genetic predisposition, are likely involved.

The disease has a genetic component, although not every member of the afflicted families will suffer this condition. It is more common in females than in males.

In Graves’ eye disease, the eyes are painful, red and watery – particularly in sunshine or wind. The eye lids and tissues around the eyes are swollen with fluid. The eyeballs bulge out of their sockets (exophthalmos). Because of eye muscle swelling, the eyes are unable to move normally and there may be blurred or double vision. Some patients have decreased colour vision as well.

Fortunately, the eye changes tend to “burn out” within a period of about 24 months and, in most cases, there is a satisfactory end result even without any treatment. The double vision and the bulginess usually do not disappear completely.

Unfortunately, there is no satisfactory treatment to prevent Graves’ eye disease. Because hyperthyroidism seems to influence the eye disease, it is very important to treat the hyperthyroidism quickly and effectively. In most patients, the eyes tend to get somewhat better when the thyroid abnormality has been treated.

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