Infant/Child Probiotic Risks

Many people have a view of probiotics being a magic bullet that can do no harm and are safe for a 3 month old or a 99 year old. This post attempts to document what we know about the use with infants. The short of it is that there are significant risks.

Probiotics use has been grandfathered in without requiring safety tests in the US.

” The use of probiotics cannot be considered risk-free and should be carefully evaluated for some patient groups. “

Infectious complications following probiotic ingestion: a potentially underestimated problem? A systematic review of reports and case series. [2018]

infections caused by lactobacilli, mainly endocarditis, bacteremia, and pleuropneumonia, occasionally occur. The relevance of Lactobacillus spp. and other members of the LGC as opportunistic pathogens in humans and related risk factors and predisposing conditions are illustrated in this review article with more emphasis on the species L. rhamnosus that has been more often involved in infection cases. 

Members of the Lactobacillus Genus Complex (LGC) as Opportunistic Pathogens: A Review. [2019]
  • ” Three patients were given a diagnosis of B. longum bacteremia: 2 patients in a neonatal unit in which 17 patients were given oral probiotics and 1 patient in a neonatal unit in which 31 patients were given oral probiotics…  Thus, the incidence of Bifidobacterium bacteremia is theoretically underestimated. ” [2016] So risk of developing bactermia is 3/48 or at least 6%
  • Are probiotics safe? Bifidobacterium bacteremia in a child with severe heart failure. [2019]
  • necrotising enterocolitis (NEC) –  NEC was significantly reduced in probiotic group infants fed any breastmilk [20/179 (11.2%) vs. 10/183 (5.5%); P = 0.027]. No benefits were noted in exclusively formula‐fed infants [4/54 (7.4%) vs. 6/44 (13.6%); P = 0.345] (Repa et al., 2015). [2019]
  • Probiotic sepsis: The reports of probiotic sepsis and the death of one preterm infant due to fungal sepsis from a contaminated probiotic product justify the concern about probiotic supplementation in preterm infants (Centers for Disease Control and Prevention, 2014; Bertelli et al., 2015; Esaiassen et al., 2016).
  • ” This is the largest trial to date of a probiotic intervention. It shows no evidence of benefit and does not support routine use of probiotics for preterm infants. “[2016]
  • Prophylactic administration of B.clausii to preterm neonates did not result in a significant difference in the incidence of LOS as compared with placebo. [2015]
  • Our observational data support the use of Lactobacillus acidophilus/Bifidobacterium infantis probiotics to reduce the risk for gastrointestinal morbidity but not sepsis in very low birth weight infants. [2014]

General Studies

Species resulting in infections [2018]

Bottom Line

If there is a risk/indications of necrotising enterocolitis or sepsis for an infant, studies indicate that the risk/benefit for an infant is improved with probiotics [2018, 2017]. ”  Introduction of probiotics was associated with a reduced adjusted odds for ‘NEC or sepsis or death’ in exclusively breastmilk-fed infants (OR 0.43, 95% CI 0.21-0.93, p = 0.03) only. [2016]”

My advice is to not use probiotics for a child or in fact unless there is a serious health risk that the right probiotics have been documented to actually help.

Any probiotic claiming that it is designed for children — demand that they share the clinical studies for their formulation. They are likely pissing urine to make sales (excuse my language). If you get such a study and have a sick child — you really should be asking for studies with similarly sick children.

For the first four years the child microbiome is very different than adults [2012]
The number of bacteria are much fewer than adults. Invading probiotics are less likely to be handled well. [2012]

“The bacteria in your gut may reveal your true age” [2019] We actually see age specific patterns with citizen science.

It is fine for an adult to make a decision to take or not to take; but with a risk of sepsis being established with no certain benefit – IMHO, it’s inappropriate for a parent to make that decision for a child.

Addendum: More Information on Age and the microbiome

Functional microbiome deficits associated with ageing: Chronological age threshold. [2019]

Update on DNA/SNP and ME/CFS

I have done a few prior post on this, listed below. At a high level, this does not mean that ME/CFS is a DNA disease instead of a microbiome dysfunction, rather it paints a richer picture.

The microbiome and your DNA interact with each other. Your microbiome is actually much richer/more complex than your DNA. There is evidence that the microbiome and DNA cooperate with each other. So, ME/CFS is a “perfect storm” scenario. You need the right DNA mutations to coincide with the right microbiome dysfunction. To the best of my knowledge, no studies have been done combining the two 🙁 .

I focus on the microbiome because it is much more actionable then DNA. You can change the microbiome, i.e. pull your ship caught in the perfect storm into a sheltered harbor…. The ship may still have its defect (DNA) issues, but without the storm beating on it, it won’t sink.

Past Posts

Extracts from Recent Studies

Someone care to extract a summary?

In the past, I have walked thru each article and produced a checklist of SNPs cited with the matching 23andMe item (if they reports it) and even recall creating a template on a 3rd party analysis site. I do not have the time for this at present.

If a reader care to do this and write up a guest post, I would love it!

In time, I would love to add these SNPs to the microbiome site to try to detect which dna-bacteria-symptoms combinations are significant. It will be another step into being uber-specific on why you have certain symptoms and thus have specific treatment based on your DNA, microbiome and symptoms.

I have added maternal haplotypes to the symptoms list now — if you know yours, please associate it with your sample. The types entered are the common one from this page.

Understanding the impact of your medicines

I just pushed out an update to http://microbiomeprescription.azurewebsites.net/ that may help you understand what various prescription, over the counter and some supplements may be doing to your microbiome.

Select any of the links highlighted below

The next page will show some choices at the top:

Compare Impact

This is intended to allow you to better choice between alternatives – for example Aspirin versus  Paracetamol (acetaminophen). I am sure people will find more uses for it.

The process is simple, search for each item, and put a check beside it. Select the Compare Impact radio button and then click the submit button below it.
Hint: Pick Complete List, and then do Ctrl-F to search for each drug.

This will take you to a page listing the impact side by side. In this case we see that their impacts are similar, but different on a few items. At the family level there are a few differences

If a family that is important to you is shifted the wrong way, you may wish to consider the better one

Compensate

This is intended when you are prescribed drugs to treat some conditions and wish to reduce the impact on the microbiome by counteracting the drug or drugs impact on the microbiome.

For this example, we pick lovastatin (a statin), Famotidine (Pepcid AC).

We may wish to first see how much impact they have together (do they reinforce or counteract each other)

Bad news — they reinforce each other in decreasing many families

Just pressing back, and changing radio buttons, and submit produces suggestions.

The suggestions are done by creating a virtual microbiome report based on the above shifts and running that through our AI engine.

The suggestion page is the new format with the long lists hidden until you ask to see them.

The Take or Avoid list is defaulted to 100 items (which is one reason that I toggle visibility). Remember – none of these items are guaranteed to work, nor do you need to take all of them. Each item increases your odds

The avoid list values are a lot higher, and thus you may wish by reducing any of these items that you are taking.

As always, these are suggestions that must be reviewed by a knowledgeable medical professional before doing.

Rickettsia (Lyme/Q-fever) Detection by Microbiome?

Today I had a messenger session with someone who noted that Diplorickettsia was in his results. Rickettsia infection treatment plan is the historic basis of Ceclie Jadin’s protocol that she learnt from the Pasteur Institute for Tropical Medicine which has been successful for some ME/CFS patients.

What is Diplorickettsia genus?

” Doubled rickettsia, for the phenotypic resemblance of the isolated strain with rickettsiae shown by Gimenez staining A novel obligate intracellular gamma-proteobacterium associated with ixodid ticks, Diplorickettsia massiliensis” [Src]

”  The disease (Lyme neuroborreliosis) is caused by multiple genospecies of Borrelia burgdorferi sensu lato bacteria transmitted by ixodid (hard) ticks, ” [2019]

Checking uploads from Thryve, there were two individuals that had this evidence of a tick bite that may have transferred bacteria that has taken up residency. I have put these people in contact with other (with permission).

Legionella and Coxiella, both of which include notable pathogens. For example, Q fever is caused by Coxiella burnetii and Legionella pneumophila causes Legionnaires’ disease[2][3] and Pontiac fever.[4][5][6]

Wikipedia

Looking at other Thryve uploads, I found one more person with Coxiella. For Legionella, I found 6 additional people — including myself!

For myself, it was present in nose samples (ubiome) in 2017 (highest count, almost 3%) and 2018 (not in relapse) and then appear in my first Thryve gut sample of 2019-11-10. This echos back to several past post of the nasal cavity and mouth being reserves for various bacteria that may help maintain various medical conditions. For ME/CFS, that has been detected: Chronic fatigue syndrome patients have alterations in their oral microbiome composition and function. [Sep 2018].

Rickettsia

As cited above, this was the experience used by Jadin. I found some 20+ individuals, including myself with the same pattern, in nose prior and in my last gut sample from Thryve.

Borrelia (Lyme)

I found this reported in 3 peoples microbiome from XenoGene, a european provider.

This does not mean that you have a pathogenic version. It indicates that you have a cousin to a pathogenic version (whose disease role may not be known).

I have added both of these to Health reports.. as illustrated below

Whether a low number is significant is an unknown

If you discover any similar ‘interest’ bacteria, please let me know and I will update the risk items. Thanks!

For those wishing more information on 16s Microbiome analysis, see this listing of providers.

  • Thryve reports on two
  • Xenogene reports on the Lyme bacteria

The angst of trying to find a physician for ME/CFS

So, how do we find a doctor who believes in cfs and can check into some of this for us. This site is amazing information. – From Facebook Post

Ken Lassesen There are only handful of MDs in every jurisdiction unfortunately. In the province of British Columbia (5 million people) there was just ONE until she left. They are now back up to two!!!!

” The estimated prevalence of ME/CFS in our study ranges from 519 to 1,038/100,000, ” [CDC] so we have perhaps 5,000 patients for these MDs, all being time consuming. A General practise MD usually have 1500-2000 patients (most of them healthy and just seen once a year). For ME/CFS, the patients numbers drop down greatly.

My first 2 physicians were a GP/Surgeon who diagnosis (because of that chronic CFS cough) was antibiotic resistant walking pneumonia and put me on rotating antibiotics (the right thing!)… and a family practice physician (who I saw 2 weeks before onset). With her, I had to literally lead her thru the treatment plan (Jadin’s rotating antibiotics and Hemex coagulation therapy) and the literature once she accepted the diagnosis. I even arranged conference calls with leading researchers at that time for her.

#3 ended up being a ND that worked with a Lyme MD (very long wait list to see the MD), there was a lot of negotiation on the treatment plan, but it worked. In my jurisdiction NDs may prescribe antibiotics — that is not true everywhere.

The KEY is getting a physician that is willing to learn and read well summarize information.

#4 physician was a loss… sorry not standard of care… changed to a new physician, ex-Armed Forces MD (thus seen PTSD a lot), she is very interested in the microbiome model. The remission was not due to her, but instead of “physician heal thyself” became it became Artificial Intelligence heal me!.

With that said, many “CFS physicians” can be locked into a certain view of ME/CFS (which can be 20 years stale). A few people with that speciality still believe it’s a psychological condition.

https://www.mefm.bc.ca/for-health-care-providers

My facebook response

The purpose of this blog containing over 1200 documented posts citing existing medical literature was to try to give an alternative path when there is no specialist physician available.

The path premise is to use the data here (or suggestions from the microbiome prescription site – after getting a 16s analysis). 16s analysis DOES NOT REQUIRE A MD’S REQUISITION!!!! They are direct to retail (and expect some MDs to raise their eyebrows!). The cost is often the same as a few bottles of probiotics.

Use this information and present the changes that you are planning to do to your physician and ask if they have any concerns with doing those. Most MD’s will look at it and shrug. If there have any questions on an item— tell them you will bring in the study next time (I link to all of the studies!).

So, technically you are under a MD’s supervision but have 0% dependency on him generating a treatment plan.

For those of you with brain fog, you may wish to get a significant other or friend to sort thru things.

I suggest these links as a starting point:

Remember that the greatest cause of back-sliding is forgetting how you were when symptoms improve and you stop taking items because they appear to no longer help. The second cause is absent mindedness.