The Mudcat Café TM
Thread #171690 Message #4153882
Posted By: Helen
26-Sep-22 - 05:09 PM
Thread Name: BS: robomatic in hospital
Subject: RE: BS: robomatic in hospital
Very interesting article. It's a very short article but I think it is worth reading the whole article and not the bits and pieces one person has chosen to quote from it.
Essentially, the way I read it is that the author surmises that there needs to be further research especially in finding ways to personalise treatments for the most effective results.
This sentence is interesting because it suggests that "trans-poo-sion" (a comical play on words combining "poo" and "transfusion" which I first heard in a medical documentary) appears to have effective results:
"While likely to be considerably less appealing, the group who received autologous faecal microbiota transplantation recovered their microbiota the quickest, with the composition of the microbiota returning to normal within days."
Editorial| Volume 4, ISSUE 2, P81, February 01, 2019
The gut microbiota has been implicated in diseases ranging from obesity to Parkinson's disease and depression. Little wonder then that commercial probiotics have gained widespread popularity and are now estimated to command a US$37 billion market worldwide. But with research into the microbiome still in its infancy, increasing evidence suggests that both commercial and clinical use of probiotics is outpacing the science.
Evidence from clinical trials is mixed and often of low quality, but findings from meta-analyses suggest that probiotics can provide benefits in the treatment of some conditions, such as infectious and antibiotic-associated diarrhoea. As such, taking probiotics after antibiotic treatment is an increasingly common practice. However, two studies recently reported in Cell question whether taking highly concentrated supplements of so-called good bacteria aids the recovery of normal gut flora.
Suez and colleagues investigated the recovery of the gut microbiota after antibiotic treatment and found that probiotics might perturb rather than aid this process. The probiotics rapidly colonised the gut but prevented the normal microbiota from repopulating for up to 5 months. While likely to be considerably less appealing, the group who received autologous faecal microbiota transplantation recovered their microbiota the quickest, with the composition of the microbiota returning to normal within days. Furthermore, Zmora and colleagues showed that colonisation occurred in highly individualised patterns, with some people's gastrointestinal tracts rejecting probiotics and others allowing colonisation by the probiotic strain, meaning that many individuals taking probiotic supplements are simply wasting their money.
Two large-scale clinical trials recently reported in the New England Journal of Medicine suggest that the situation in infectious diarrhoea might also be more complex than previously believed. Freedman and colleagues did a randomised controlled trial of a probiotic containing Lactobacillus rhamnosus and Lactobacillus helveticus in children presenting to the emergency department with gastroenteritis. Contrary to expectations, they found that the probiotic did not prevent development of moderate-to-severe gastroenteritis within 14 days after enrolment. In a separate study, Schnadower and colleagues found similar results with L rhamnosus GG alone. Both trials used probiotics that are available over the counter in North America and showed no significant difference from placebo in the duration of diarrhoea and vomiting, number of unscheduled health-care visits, or length of absence from day care. These results cannot be generalised to other probiotic strains or preparations, but they do show that we have some way to go in elucidating which probiotics might provide benefits in which clinical settings.
Importantly, patients with gastrointestinal conditions are not the only ones taking probiotics. 3·9 million people in the USA alone regularly take probiotic supplements, with promised benefits ranging from improved digestion and immune function to improved mental health and prevention of heart disease. However, evidence for these benefits is lacking, and because probiotics are often sold as supplements, manufacturers in many countries are not required to provide evidence of their safety and efficacy to regulatory bodies. The ubiquity of probiotic products would suggest that, at worst, they are harmless. Nevertheless, some safety concerns have been raised, including the risk of contamination, possibility of fungaemia or bacteraemia (particularly in immune-compromised, elderly, or critically ill individuals), small intestinal bacterial overgrowth, and antibiotic resistance. Adding to concerns, clinical trials of probiotics have not consistently reported safety outcomes.
While the logic behind probiotics might seem sound, it is clear that we have a long way to go before understanding the complexity of the microbiota and the effects—both good and bad—that probiotics might have. All individuals have a unique gut microbiome, and the effects of different bacteria on different people are likely to be highly variable; as such, probiotic use might even need to be personalised for optimal benefits. Commercially available products might not contain the correct strains or quantities of bacteria to provide benefits, and most probiotic supplements contain only single strains, vastly oversimplifying the complexity of the microbiota. While taking a supplement for improved health is certainly an attractive prospect, those looking to aid their gut microbiota might be better served by consuming a healthy, varied diet. In the meantime, rigorous clinical trials are needed to substantiate potential health benefits and to confirm whether probiotics are elixirs or just empty promises.
For the study by Suez and colleagues see Cell 2018; 174: 1406–23 For the study by Zmora and colleagues see Cell 2018; 174: 1388–405 For the study by Freedman and colleagues see N Engl J Med 2018; 379: 2015–26 For the study by Schnadower and colleagues see N Engl J Med 2018; 379: 2002–14