Kika,

I understand your concern, butwhile it is true that the manufacturersof artificial milks and pharmaceuticals are actively and inappropriatelypromoting the use of pbx, that does not mean they do not havesignificant value. Personally, I am more concerned about the progressionthat occurs when any natural intervention is usurped by industry, as appears tobe happening now with pbx. First, the intervention is ridiculed of course, butonce it is discovered to have value, the pharmaceutical companies pretend theyinvented it and then they market it as one-size-fits-all. Those who practicebio-individualized medicine know better than this, but our current mainstreamparadigm makes no space for an approach to medicine that would require a newset of clinical assessment tools, a completely new skill set and the dismantling of the entrenched power structure. 

 

So, right now, we are at the point intime where pbx are being recognized as having value by researchers and drugcompanies, even though holistic providers have used them effectively for decades.What that means of course is that those same drug companies will look for waysto take a therapy that has been used holistically and attempt to produce acheap, poorly-manufactured product, claiming the benefits are identical foreveryone and for everything. Of course smart people are not going to jump onboard! But, appropriate distrust of drug company behavior should not taint the value of theintervention when used appropriately. And, due to more than 100 years ofgut-damaging practices in the West (and maybe even since the beginning of theagrarian age), appropriate use may well be very common. 

 

It is not true that the body recoverson its own from abx use. Research demonstrates that infants exposed to abx havecompromised gut flora long after drug therapy is complete. In particular thediversity does not return to normal, even though the numbers in the populationmay do so. "Eight weeks afterantibiotic treatment of infants, the diversity of gastrointestinal floraremained diminished, although the number of individual bacteria was back tonormal, according to a paper in the November 2012 issue of the journal AntimicrobialAgents and Chemotherapy. Additionally, the potentiallydisease-causing Proteobacteria were now the dominantpopulation in the treated infants." (F. Fouhy, C.M. Guinane, S.Hussey, R. Wall, C.A. Ryan, E.M. Dempsey, B. Murphy, R.P. Ross, G.F.Fitzgerald, C. Stanton, and P.D. Cotter, 2012. High-throughput sequencingreveals the incomplete, short-term recovery of infant gut microbiota followingparenteral antibiotic treatment with ampicillin and gentamicin. Antim. AgentsChemother. 56:5811-5820.)

 

In other research, infantsexposed to abx were more likely to become obese, even among those infants ofnormal weight mothers.  http://pediatrics.aappublications.org/content/135/4/617

 

I could post scores of papersdocumenting the damage done by antibiotics, which would not even begin toaddress the damage done to the gut by other stressors. The body does notrecover on its own from these assaults, especially Western bodies, having beenexposed to prolonged and repeated assaults over generations. When we argue thatthe infant's flora can bounce back, we would need to ask "bounce back towhat?" (even if it were possible) because most of these babies are borncompromised. They do not have a healthy baseline to begin with. Maternal gutflora is already less diverse and less abundant in the West than in traditionalcultures or among populations who do not rely on industrial or GMO foods, whodo not have frequent exposure to drugs and environmental toxins, who are lesslikely to have medicalized births or artificially feed their babies, who spendtime in the sun and who are simply less afraid of dirt.

 

In the West, we are dealing withmultiple generations now of damaged guts. Mothers are passing on compromisedmicrobiomes from the time of conception. It does not take much to tip thesecompromised guts into complete dysbiosis. They do not recover on their own andsome researchers believe that one assault with abx is the most thesystem can fully recover from in a lifetime. There is no evidence thatrecovery occurs as you suggest. 



Drug companies are only interested in profits. Long before the drug companiesbecame interested in pbx, holistic practitioners knew to recommend thenwhenever patients had abx or other causes of dysbiosis. Just as they knew torecommend vitamin D and to only rely on 25(OH)D testing when mainstream medicine did not. They did not recommendvitamin D to everyone and they recognized the need for co-factors such asmagnesium and a homeostatic balance among the fat soluble vitamins. When vitamin D became the darling of mainstream medicine,it was prescribed for all babies completely unnecessarily, creating a ripemarket for drug companies. The exploitation of breastfeeding dyads by drugcompanies, however does not mean that many women and therefore babies are *not*actually vitamin D deficient. It simply meant that a cheap, poor qualityvitamin would now be given to babies who did not need it because of the tendencyto paint everyone with the same broad stroke. For those who needed vitamin D,it meant they would probably see little if any benefit from the inferiorproducts. Most importantly, instead of using vit D in abio-individualized way that addresses balance in all the fat solublevitamins, magnesium as a co-factor and assessment of transport proteins,everyone gets the same thing. When we do that with any supplement, we do itincorrectly. A few people will accidentally benefit, buy many more may beharmed. 



The same is true for pbx. They need to be used intelligently by folks who knowwhat they are doing. Functional medicine doctors, naturopaths and nutritionistshave 30-40 years of clinical experience behind them. This is not new medicine.It is only new to the predominant model. But, the same is even more true forabx, yet for all the call for reducing their use, it is typically the very samefolks complaining about everyone else's use of abx who are overusing them. Iwould argue that the majority of their use is unnecessary.



Any use of abx is a scourge to the gut. When the average child has 20 coursesby the age of 18, we are doing something very seriously wrong. IMO the averagechild should have no more than one course. Among my three adult/teen children,one has ever had an abx. They are rarely necessary. And, IMO, it should be thepriority of anyone in health care to protect the microbiome. That is nothappening at all. Including among IBCLCs. 

 

A study from 2014 addressed thedrastic overuse of abx in Spain as compared with Nordic countries: Conclusion "The use ofantibiotics in the Spanish region is very high, and there are markeddifferences in the choice of drug between this region and Denmark.Interventions are needed that promote the rational use of these drugs to reducepotential bacterial resistance, and to avoid unnecessary risks topatients." The link ishere: http://www.elsevier.es/es-revista-enfermedades-infecciosas-microbiologia-clinica-28-articulo-differences-in-outpatient-antibiotic-use-90340084

 

Given this excess use not only ofabx, but of the most powerful abx available, I think it would be fair to saythat many is Spain are probably in need of pbx therapy. Obesity rates are veryhigh in Spain as well, as is highly interventive birth, while breastfeedingrates are low. None of this bodes well for the condition of the infant'smicrobiome. I agree that many factors modulate our flora, but those factors thatsupport healthy and diverse flora are not prevalent, while those that damageflora are very prevalent among this population. 

 

You write,"On the other I have seen babies who grow fussy or colichy orgreen-stooled when givenprobiotics. And we know so little about human milk flora and what modulates itthat we can´t play god and pretend to know exactly what particular bacteriawill be the perfect one for this mother or that baby. One size does not fitall, and even less in something as complex as this."

 

I would tend to agree, butoddly I wonder that the urgency in this comment does not apply to the"one-size fits-all" approach to drugging mothers and babies atevery turn. I have not had a single client require abx for mastitis in adecade. Homeopathy, home remedies and herbs are more than sufficient. IMO,we should not be arguing against pbx, which are just a way of mitigatingdamage; we should be arguing against inflicting damage in the first place. Youmay not see improvements when mothers are using pbx, because they are beingused in an allopathic way or the gut is still damaged or the wrong strains aregiven. When you give an abx and someone does not get better, do you decide allabx are useless or do you simply use a different strain? Why not the same forpbx?

 

I don't recommend personally pbxoutside of the context of a comprehensive approach to gut healing. Pbx are atool, just as vitamin D supplements are a tool. Holistically-speaking one would not generally give eitherin a vacuum. When you do, you typically will not see great success. 

 

The fact is that we are carelessand we continue to be careless, using drugs that we don’t need in situations inwhich they can do great harm and often little or no good at all. We havealready done the damage. We can’t undo generations of gut-brain inflammationand dysfunction by ignoring that it happened and that it is still happening. Solong as we have placed human health and survival in such a precarious position,we will need help if there is any hope to recover. Pbx are just one tool thatoffers that hope, but providers need to become adept in their use, in the useof pre and probiotic foods and in understanding the best ways to assess andsupport gut healing. No pbx manufactured as the “junk food” of their speciesand marketed for any and all things should ever be embraced, but until we arewilling to do the hard work of eliminating all the damaging factors Imentioned, we will need to learn to make good use of them. 

  

Date:    Mon, 11 Jan 2016 00:11:40 +0100 From:    Carmela Baeza <[log in to unmask] <mailto:[log in to unmask]>>Subject: Probiotics, a word of caution  Aword of caution about probiotics…    Herein Spain both Nestle and Danon are supporting probiotic research. Currentmarketing of probiotics for breastfeeding mothers is so agressive right now...you would not believe how many of the mothers I see are taking them. Theinitial recommendation was  to takeprobiotics for “subacute mastitis” and during antibiotic treatment for acutemastits. But the campaign has been so aggresive, specially among midwives, thatmothers are being told to buy probiotics for breast pain, nipple pain, low milksupply, and now even for prevention of breastfeeding problems. The latest isthat pregnant mothers are taking them to prevent breastfeeding problems aftertheir babies are born!!! It is completely, ridiculously out of hand. I hopethis craze does not get to where you all are helping moms and babies.    I do not agree with what you say, Jennifer,that probiotics need to be given when anyone takes antibiotics. Unless it is abrutal, prolonged dose of antibiotics, normal flora usually returns in more orless time. Human flora is so diverse, so different for each individual, and sowell designed, that we have to give it some credit. We cannot standardizeprobiotics -  how can we know thatprecisely that one bacteria is good for that one individual, if we are all sodifferent and there are so many factors that modulate our flora?    Seeing the current avalanch, I´ve startedgathering data on mothers who come to my practice with breast and or nipplepain and are taking probiotics at the time of the visit. Some have been onprobiotics for ore than a month when I see them. Obviuosly, the probiotics havenot made these mothers better, or they would not come. And what I´m starting tosee (and jot down) are many mothers who, WHILE ON PROBIOTICS, have one or moreepisodes of acute mastitis. Others have abscesses, also while on probiotics.Others report that their babies´ stools have turned green or that baby isfussy, and this stops after they stop the probiotics. Of course, this is merelyobservational and I can´t deduce causality. But I´m starting to be veryworried. And, at the very least, the probiotics certainly did not preventmastitis or abscesses.    Dawn writes:I've been recommending probiotics supplements for babies, ever since.  It's one of the few things in the world thatcan't hurt and is highly likely to have a positive effect.    Well, I would not agree to that. On the onehand, probiotics can be contaminated and have caused at least, that we know of,the death of one baby.    http://www.medscape.com/viewarticle/835514<http://www.medscape.com/viewarticle/835514>    On the other I have seen babies who growfussy or colichy or green-stooled when given probiotics. And we know so littleabout human milk flora and what modulates it that we can´t play god and pretendto know exactly what particular bacteria will be the perfect one for thismother or that baby. One size does not fit all, and even less in something ascomplex as this.    Remember, almost allprobiotic research is done or funded by industry. They make A LOT of money. Abottle with 28 probiotic pills costs 30 euros here (32 USD). And they are beingsold like candy, recommended by midwives, Obs, peds and other HCP thanks tobrilliant marketing.    I am just sayingbe cautious, I would not recommend probiotics lightly or to everyone.    Worried in Madrid  Kika --  Dra. Carmela Baeza  [log in to unmask]<mailto:[log in to unmask]>    

 



  

      Jennifer Tow, IBCLC, USA & France

   Intuitive Parenting Network, LLC

      

   

 

      

       

     

 



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