Culturelle probiotics should be used with caution
Clinically, the use of probiotics has almost reached the point of flooding. It seems to be like a universal cream, which can paste any disease. Perhaps, many doctors, including me, once thought that probiotics are beneficial and harmless. Using probiotics can help regulate the intestines and promote the recovery of diseases without any side effects. However, is this really the case? Can probiotics really be used for any disease? Are there any taboos in the use of probiotics?
First, probiotics have no toxic side effects?
Does probiotics have no toxic side effects? The answer is no, of course. The author only searched for "probiotics" and "septicemia" on pubmed, and a large number of articles appeared. Among them, a review published by the American Nutrition Society in 2006:
Cases of bacterial septicemia related to probiotics were reported from 3 months old to 79 years old.
Probiotics can be understood as "healthy bacteria", which means that probiotics are generally beneficial to health and will not cause disease. But this is by no means the same as probiotics have no toxic and side effects under any circumstances. In fact, in the process of clinical application of probiotics, we will find that probiotics may also cause adverse reactions, such as bacterial and fungal septicemia, promoting harmful metabolic activities, overstimulating immunity, gastrointestinal reactions and gene transfer, especially in some special populations, such as premature infants and immunocompromised people.
What needs to be pointed out in particular is that, needless to say, this article is not to deny the beneficial effects of probiotics on clinic, so as to make a splash. We treat the rational application of probiotics in clinic with a scientific and rational attitude. On the contrary, the author thinks that probiotics play an important auxiliary role in the rehabilitation of many diseases. I just don't approve of using probiotics as dog skin cream everywhere. The view that probiotics may be harmful is not only unknown to ordinary people, but also stubbornly believed by many clinicians that probiotics are beneficial and harmless. This view obviously lacks dialectical thinking and is quite dangerous.
Second, the incidence of infection caused by probiotics
Studies have shown that the incidence of bacteremia in patients who use yeast is about1/5.6 million, while the incidence of lactic acid bacteria is as high as1110,000. On the whole, the incidence of systemic infection caused by probiotics is as high as 0.05%~0.4%. Probiotics may cause bacteremia, mycosis and septicemia, and the risk of infection is not only related to individual factors, but also to the types and doses of probiotics.
Third, the risk factors of infection caused by probiotics
It should be pointed out that most of the infected patients are premature infants or adults with low immune function, which is also the most important risk factor for probiotic-related infections. The risk factors of systemic infection caused by probiotics include immaturity, low immunity or inhibition, serious disease, central venous catheterization, intestinal epithelial barrier damage and so on. Risk factors for probiotic-related infections are as follows:
For pediatricians, all the above risk factors can be encountered clinically. Severe diseases and various hematological tumor diseases often have different degrees of low immunity. In this case, if probiotics are used improperly, the possibility of bacteremia and meningitis infection caused by probiotics will be greatly increased. However, in clinical practice, we often encounter this situation. Children are seriously infected and have obvious gastrointestinal symptoms (such as diarrhea). At this time, we often use probiotics in addition to symptomatic treatment. In fact, many reports show that severe patients are often accompanied by mucosal ulcers or submucosal exposure due to disease stress. At this time, the barrier function of the intestine is seriously challenged, and the use of probiotics may lead to bacterial translocation and secondary bacteremia.
In addition to the above risk factors, the application of probiotics in patients with acute severe pancreatitis can not reduce the infection rate, but may increase the mortality rate, so probiotics are not suitable for patients with acute severe pancreatitis. In addition, intestinal hypoperfusion, mucosal inflammation and increased oxygen demand caused by acute pancreatitis may also be related to probiotics.
Fourth, should broad-spectrum antibiotics be used preventively with probiotics?
In clinical practice, the use of broad-spectrum antibiotics is easy to cause intestinal flora imbalance, because antibiotics not only kill harmful bacteria, but also kill beneficial bacteria. At this time, superior doctors often tell young doctors to add probiotics to prevent antibiotic-related intestinal flora imbalance or diarrhea. So, is this right? What kind of probiotics should be added?
Studies have shown that the application of probiotics to patients receiving antibiotic treatment will lead to infection, because antibiotics can change the intestinal flora and cause probiotics to multiply in the intestine. It should be pointed out that the infections caused by the above probiotics are mainly seen in organ infections such as bacteremia, septicemia and meningitis caused by lactic acid bacteria. At present, there is no systemic infection caused by Bifidobacterium, but there have been reports of secondary sepsis caused by Lactobacillus rhamnosus and Lactobacillus casei.
Verb (abbreviation for verb) Fungemia caused by probiotics
Fungal infection caused by probiotics is considered to be the most serious complication of probiotics, and there is no one. Probiotic-related fungal infections here mainly refer to yeast mycosis.
Enache-Angoulvan et al reported that 40% of patients infected with 9 1 invasive yeast were treated with biological agents containing Saccharomyces boulardii. Seale and other studies have found that the occurrence of yeast mycosis is directly related to the application of probiotics! Especially for critically ill patients receiving enteral nutrition, central venous catheterization and antibiotic treatment. When critically ill patients receive enteral nutrition, the gastrointestinal mucosal barrier is damaged, which is easy to cause bacterial translocation and invasion.
For patients with central venous catheterization, probiotics are usually administered in the form of capsules, and then injected into patients through nasal feeding tubes. In this case, probiotics can be detected within 1 cm of the open position due to air transmission when the capsule is opened. We know that under normal circumstances, yeast can survive indoors for 2 hours. Even if medical staff strictly carry out hand hygiene, they may be contaminated by yeast because their hands are exposed indoors. At this time, central venous catheterization is easy to be polluted, leading to mycosis. This is why central venous catheter is a risk factor for probiotics.
Know what it is, and know why it is. It is not enough that we only know that probiotics may cause serious infection, because we only know the phenomenon and ignore the essence, and you will still make mistakes next time. Besides causing infection, what are the common side effects of probiotics? How to avoid the adverse reactions of probiotics and help treat diseases to the greatest extent? Therefore, in order to answer the above questions and systematically grasp the clinical application of probiotics, we first need to know: what is the essence of probiotics? What is the classification of probiotics? Physiological function and mechanism of probiotics?
refer to
Liu Fei, Hao Xuanyu, Li Dongyang. Research progress on toxic and side effects of probiotics in clinical application [J]. Shandong Medicine, 2016,56 (20):106-108. Doe: 10. 56866 . 68868868667
[2] Jiang Xueliang. Understanding and Practice of Clinical Application of Probiotics [J]. Chinese Journal of Digestive Diseases and Imaging (Electronic Edition), 2016,6 (4):145-149. DOI: 10.3877/。
Ian Nitti, Palmiri. Therapeutic application of probiotics in clinical practice [J]. Clinical Nutrition, 20 10/0,29 (6): 701-725. DOI: 10. 10 16/j . clnu . 20 10.05 . 004。
[4] Boyle, Robbins Brown RM, Tang ML. Application of Probiotics in Clinical Practice: What are the risks? [J]。 American Journal of Clinical Nutrition, 2006,83 (6):1256-1264; Quiz 1446- 1447.
Common misunderstandings of probiotics
The more probiotics, the better. The "richness" of probiotics can be understood from two aspects: first, the "richness" in quantity. The quantity of probiotics has always been the focus of business promotion, and different brands of probiotic drinks often compare their respective probiotic quantities. Usually, the greater the quantity, the greater the efforts of merchants to promote the efficacy of beverages. But in fact, probiotics will be inactivated soon after entering the gastrointestinal tract. Often, when they reach the real site of action (colon), the number of probiotics will only be less than half of the original, which will not play an idealized role as advertised by merchants. The second is the "multi" type of flora. Some probiotic drinks will boast that they contain a variety of probiotics, which is more conducive to intestinal health. At present, there are only about 5 kinds of probiotics recognized in the industry as beneficial to human intestinal health, and the efficacy of other kinds of probiotics has not been generally recognized. Therefore, even if the beverage contains a variety of probiotics, it will not be more beneficial to the human body.
Probiotics are not suitable for people.
Now many parents have begun to pay attention to the role of probiotics. However, among many probiotic products, which are reliable in quality and can play a very good role, mothers are afraid that they have no bottom. Many consumers may not know that the most important thing to buy probiotic baby food is "activity".
Probiotic preparation is generally considered to have no side effects, but it is composed of bacterial strains after all, and should be used with caution if there are congenital immunodeficiency diseases such as AIDS. Patients with the following diseases should be used under the guidance of a doctor:
① Fatty liver; ② Hypertension; ③ Diabetes; ④ Diarrhea or constipation; ⑤ Lactose intolerance; ⑥ Cirrhosis and its complications; ⑦ Patients receiving chemotherapy or radiotherapy; (8) Functional dyspepsia and protein's overeating; Pet-name ruby inflammatory bowel disease, including chronic ulcerative colitis and Crohn's disease; Indications for patients who take antibiotics and adrenocortical hormone for a long time, it is best to supplement probiotics (but not at the same time).
The more probiotics, the better. The "richness" of probiotics can be understood from two aspects: first, the "richness" in quantity. The quantity of probiotics has always been the focus of business promotion, and different brands of probiotic drinks often compare their respective probiotic quantities. Usually, the greater the quantity, the greater the efforts of merchants to promote the efficacy of beverages. But in fact, probiotics will be inactivated soon after entering the gastrointestinal tract. Often, when they reach the real site of action (colon), the number of probiotics will only be less than half of the original, which will not play an idealized role as advertised by merchants. The second is the "multi" type of flora. Some probiotic drinks will boast that they contain a variety of probiotics, which is more conducive to intestinal health. At present, there are only about 5 kinds of probiotics recognized in the industry as beneficial to human intestinal health, and the efficacy of other kinds of probiotics has not been generally recognized. Therefore, even if the beverage contains a variety of probiotics, it will not be more beneficial to the human body.
Use with caution for those with spleen and stomach deficiency and cold.
Probiotic drinks can only keep the activity of their flora at low temperature, and this special storage condition adds an additional attribute-"cold and cool". Chinese medicine believes that people with deficiency of spleen and stomach should not eat cold things, such as cold drinks and ice cream, which will aggravate abdominal pain, indigestion and diarrhea.
From the point of view of western medicine, patients with chronic gastritis, pancreatitis or after surgery are not suitable for eating cold probiotic drinks. So probiotic drinks are not suitable for men, women and children.
Although probiotics can relieve constipation, there is no research to prove that large doses of probiotics can treat or prevent colds.