Saturday, April 7, 2018

This Probiotic HATS is a Crown

H.A.T.S. Probiotics:  This one is the Kings Crown
R. H. Bennett Ph.D.
© Applied Life Sciences LLC

It is amusing and enlightening to browse dietary supplement stores.  There is something for everybody and always a product fad of the day.   Many products are me tooʻs attempting to capitalize on the latest from Dr. Oz. Some products are soundly backed by scientific data.  Some extoll the verbiage of the newest science jargon, but it is nothing more the technical propaganda (TP) (acronym intended).
One afternoon at the Admiral Nutrition Center (ANC) a clerk and an inquisitive customer had a curious conversation about probiotics.
 The clerk walked up. “I see you’re interested in a probiotic. Can I help you?”
  The fifty-something customer grinned sheepishly.   “There are more probiotics on the market than I can shake a stick at these days.  How can I tell which ones are good and will help restore my aging bacteria?” he mused. 
  The lanky clerk paused recognizing the question was odd.  “What do you mean, aging bacteria, the clerk asked?”
  “Well, I have been reading a fascinating blog about HATS Probiotics and…”.
  The clerk interrupted, “we don't have that brand here at ANC."
 “Hang on," the gentlemen responded, realizing this clerk is confused. “HATS is not a brand; it is a distinction for probiotics.  It means Human-Adapted, Targeted, Symbiotics.  It simply means they work together to do good things and they live and thrive naturally in the human gut”.   
“HATS hmmm that does make sense, but I have never heard that term," the clerk confessed. But all of our probiotics are HATS”.  
“Really, how do you know? You just said you’ve never heard of it."
“Well," followed by a long sigh, “most of these strains have been around a long time, and if they did not do good things for people, ANC would not keep around. I’m pretty sure”. 
“You see, HATS is not based on what sells well, HATS is based on research.”
"Yeah sure," the clerk interrupted again.  You can read it on the label, so there must be research.  I think the FDA makes them do it”.
Now frustrated with the know-it-all kid, the gentleman asserts, "those statements can be backed by research, but if they don't cite the research report, they are just marketing hype.  And sorry no, the FDA does not require it.  Look at the label.  It says the FDA has not evaluated these statements.  Probiotics from good companies must provide substantiation for any health claim; that is required.  I know it is confusing when marketing statements are intertwined with health claims.  After all the goal is sell, sell sell”.
Ok, I need to take charge the man thought to himself.  “You see he remarked, I am 62, and from the research, I read says, as we age the beneficial strains of bacteria we had as kids gradually die off. Many of us seniors can have entire species that go extinct”. 
Humbled now, the clerk says in a soft tone, "wow I had no idea."
That is so true the man thought silently.  “The bacteria I am talking about are called Bifidobacteria, and there are many members of the group that has special talents."
Ecstatic that he finally had something to say that might please the customer, Oh, we got those!”
“I am sure you do, but I am looking for two in particular.  One is Bifidobacterium longum subspecies infantis and Bifidobacterium longum subspecies longum. And there has to be a strain identifier like BB356 after the name”.
Gee sir, I am not sure, those are complicated names.  You seem to know a lot about probiotics.  Ah, I mean HATS Probiotics.”
“Thanks, I will keep looking.  I have a friend that says a new one is coming out soon. I will ask her, and I want to rejuvenate my bacteria.  I don't like the feeling that part of me is dying.”
"Thank you, sir.  I can see I need to do my homework", the clerk humbly offered.

Bifidobacteria versus Lactobacillus
When asked to name a probiotic most people will say Lactobacillus or Lactobacillus acidophilus.  That is because it's been in yogurt and the like for decades.  The name is familiar to most people.  Why then is Bifidobacteria so obscure? First of all, it will not make good yogurt.  It is hard to grow; it does not like the oxygen in the air. 
 Just the same over the years researchers document its unique attributes while noting it is more commonly found in the stools of infants and children and much less in adults.  Thus some may conclude it is important for kids but not adults.  That conclusion is just wrong.
What are Bifidobacteria and why are they Important?
A French Pediatrician discovered the "Bifidus" as they were called in 1899. Dr. Tissier isolated the bacteria from the stool of breastfed infants.  Thier Y shape inspired the Bi-fid name. They are common natural flora of the colon, the mouth and the birth canal (1).  There are over 50 species of "Bifidus," but only ten live in the human microbiome.  These ten are HATS for sure. 
Big Role in Metabolism
Like other select probiotics, Bifidobacteria help maintain insulin sensitivity. Insulin resistance is common in metabolic syndrome and diabetes.  Moreover, “Bifidus” increase the hormone adiponectin. This hormone helps to regulate glucose and fatty acid oxidation (3).  “Bifidos” functions synergistically with Leptin. This hormone helps regulate appetite. The Bifidobacteria also down-regulate inflammatory cytokines from fat cells. The fatter the fat cells, the higher the inflammation throughout the body. (3). Bifidobacteria also helps to manage fat metabolism reduce fat accumulation in the liver. Fatty livers are common in obesity metabolic syndrome (4).
More Than Just Immune Support
 Any enhancement of immune function that reduces the duration and severity of upper respiratory infections is significant. In a random and blinded trial, B. longum combined with another probiotic mitigated the consequences of the common cold.  It appears to be enhancing the functions of both the innate and adaptive immune responses.  Both are critical for effective immunity (5).  The importance of strain differences is born out in observations of differential immune modulation from differing strains of B. longum. Bifidobacterium longum BB536/ATTC 15707 uniquely induced a cytokine profile of increased IL10 and decrease TNF alpha.  These immune messengers have an immune modulatory function (6). This Bifido strain improved immune function parameters in very ill hospitalized geriatric patients (7).  In short, Bifidobacteria have a role in the optimal immune function that is much more than supportive, it is essential. 
A Healthy Gut is a Happy Gut
Control of pathobionts (resident opportunistic microbes that can cause infection) in the microbiome is an essential function of the Bifidobacteria.  This biological control keeps the gut sound and feeling good.
 In a lab culture system, B. longum inhibited the growth of a number of microbes with distinct pathogenic (infection) potential (8).  Similar functions are documented with animal and human studies. Unique polysaccharides on the surface of B. longum have an anti-inflammatory role in the gut.   The effect dampens host inflammatory responses and reducing the activation of proinflammatory T Helper cells (TH-17 cells) (11).  B. longum isolated from centenarians (people 100+ years old) and transferred to mice confers a benefit to the gut health of the rodent (12). Evidence of microbe species interaction or symbiosis occurs with B. longum interacting with Lactobacillus to better compete with resident pathogens (13). Given its documented functions, it is curious that the probiotic companies don't do a better job of signing its praises, scientifically speaking that is.
Clearly, the "Bifidus" is a HATS probiotic and uniquely adapted to serve its human host in the gut ecosystem. The service to the host is the homeostasis of wellness.  In the Western World this very beneficial genus of microbes declines in number and function in the microbiome of most adults and the elderly.
In infants, Bifidobacteria are detected in the stool within the first days of life and increase through three years of age. Infants that are breastfed have more “Bifidus” and more species diversity (2,12). This genus of bacteria is uniquely able to metabolize milk oligosaccharides (complex carbohydrates) to support their growth and function.  By three years of age several species are present and the numbers plateau in the billions per gram of stool.  This diversity and numbers will persist for decades in most people.  
However, in some people living in the modern urban environment, the numbers and diversity of the Bifidobacteria begin an insidious decline. The decrease in “Bifidus” with advancing age is documented by many studies (8), and this observation is coincidental to an overall reduction in species diversity (8).  No doubt the Law of Diversity applies here as well (13).  For the gut microbe ecosystem, this means that high diversity creates an elasticity of healthy functions of the microbiome. As diversity declines with age, the features of the microbiome become unstable and may proceed to the point of failure.  Given the critical role Bifidobacteria play for the functions of our physiology, a decline in the species will likely have profound consequences for health, wellness, and longevity.
(Arboleya 2016)

It, therefore, should not be too surprising to find that in specific populations of decidedly older adults, the numbers and diversity of the microbiome persists to some extent. In one study, European centenarians had Bifidobacteria numbers similar to that of adults (14).  However, higher numbers of the bacteria live in centenarians, than in the elderly in China (15). Healthy aging is a very complex system and the microbiome is only one part.  However, how diet and lifestyle influence the sustainability of the microbiome in extreme age cannot be ignored.  Dietary changes and supplementation with HAT probiotics, especially the Bifidobacteria is inexpensive health assurance and just may have life-extending benefits.
Please Don't Step on the Bifidus
Throughout our lives, events occur that step on and crush the Bifidobacteria.  One of the heaviest feet is antibiotic use especially in the elderly.  Hospitalized seniors almost always receive antibiotics, if for no other reason than to protect them from hospital-acquired infections.  In a European study, the estimate for hospital-acquired infections is 2.5 million cases per year (16)!   Thus antibiotics are doled out in an attempt to reduce the risk.  Unfortunately, that practice has dire consequences for the vitality of the microbiome. One study found a seven-fold reduction of Bifidobacteria in elderly treated with antibiotics (18).
Hospitals are known to recommend and serve non-HATS probiotic yogurts to the patients on antibiotics.  Most yogurts contain Lactobacillus and high doses of sugars. Sugar and Lactobacillus will not benefit the Bifidos at all.  Clinicians need to learn about HATS and Bifidos. When headed for a stay in the hospital, pack your "Bifidos." 
One big foot that smashes the Bifidobacteria is an abundance of calories from simple sugars and carbohydrates.   People consuming the Western Diet have a microbiome dramatically shifted toward the sugar fermenters.  The Lactobacilli and relatives are a member of the group Firmicutes.  This phylum predominates in the microbiome of Westerners.  In other words, people consuming an indigenous low sugar diet have low numbers of Firmicutes in their microbiome.  The low soluble fiber diet of the West fails to support large, diverse populations of the Bifidobacteria (17).
As the gentlemen returned home, a friend called.  "How was the search for a good Bifidobacteria?"
In a voice of frustration, he answered, "not so good; I had to teach the store clerk what little I know."
“Oh, don't fret, the new one just hit the market, has three Bifidos and some prebiotics that support them.   After reading the latest blog on the Bifidobacteria,  I am convinced, this HATS is a crown". 
2. Nagpal, Ravinder, et al. "Evolution of gut Bifidobacterium population in healthy Japanese infants over the first three years of life: a quantitative assessment." Scientific Reports 7.1 (2017): 10097.
3. Le, Thi Kim Chung, et al. "Oral administration of Bifidobacterium spp. improves insulin resistance, induces adiponectin, and prevents inflammatory adipokine expressions." Biomedical Research 35.5 (2014): 303-310.
4. Xu, Ren-ying, et al. "Supplementation with probiotics modifies gut flora and attenuates liver fat accumulation in rat nonalcoholic fatty liver disease model." Journal of clinical biochemistry and nutrition 50.1 (2011): 72-77.
5. de Vrese, Michael, et al. "Effect of Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, B. bifidum MF 20/5 on common cold episodes: a double blind, randomized, controlled trial." Clinical nutrition 24.4 (2005): 481-491.
6. Medina, M., et al. "Differential immunomodulatory properties of Bifidobacterium logum strains: relevance to probiotic selection and clinical applications." Clinical & Experimental Immunology150.3 (2007): 531-538.
7. Akatsu, Hiroyasu, et al. "Clinical effects of probiotic Bifidobacterium longum BB536 on immune function and intestinal microbiota in elderly patients receiving enteral tube feeding." Journal of Parenteral and Enteral Nutrition 37.5 (2013): 631-640.
8. Arboleya, Silvia, et al. "Gut bifidobacteria populations in human health and aging." Frontiers in Microbiology 7 (2016): 1204.
9. Ouwehand, Arthur C., et al. "Bifidobacterium microbiota and parameters of immune function in elderly subjects." FEMS Immunology & Medical Microbiology 53.1 (2008): 18-25.
10. Konieczna, Patrycja, et al. "Portrait of an immunoregulatory Bifidobacterium." Gut Microbes 3.3 (2012): 261-266.
11. Ewaschuk, Julia B., et al. "Secreted bioactive factors from Bifidobacterium infantis enhance epithelial cell barrier function." American Journal of Physiology-Gastrointestinal and Liver Physiology 295.5 (2008): G1025-G1034.
12. Lievin, V., et al. "Bifidobacterium strains from resident infant human gastrointestinal microflora exert antimicrobial activity." Gut 47.5 (2000): 646-652.
13. Thibaut LM, Connolly SR, He F. Understanding diversity–stability relationships: towards a unified model of portfolio effects. Ecology Letters. 2013;16(2):140-150. doi:10.1111/ele.12019.
14. Biagi, Elena, et al. "Ageing of the human metaorganism: the microbial counterpart." Age 34.1 (2012): 247-267.
15. Drago, Lorenzo, et al. "Cultivable and pyrosequenced fecal microflora in centenarians and young subjects." Journal of clinical gastroenterology 46 (2012): S81-S84.
16. Cassini, Alessandro, et al. "Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modeling study." PLoS medicine 13.10 (2016): e1002150.
17. Hidaka, Hidemasa, Yasuhito Tashiro, and Toshiaki Eida. "Proliferation of bifidobacteria by oligosaccharides and their useful effect on human health." Bifidobacteria and Microflora10.1 (1991): 65-79.
18. O'sullivan, Orla, et al. "Alterations in intestinal microbiota of elderly Irish subjects post-antibiotic therapy." Journal of Antimicrobial Chemotherapy 68.1 (2012): 214-221.