Cold lasers are scientifically referred to as low-level energy lasers, or LLEL. They produce wavelengths from about 625 nm to 904 nm, versus the hot lasers that range from 1064 nm (YAG) to 10,600 nm (Carbon Dioxide), meaning that they do not cause heating of the tissues. Instead, LLEL produces photo-bio-activation of the tissues, which translates to healing rather than destruction.

            There have now been over 200 clinical studies and over 2000 published articles on LLEL over several decades, which have established many of its mechanisms as well as its benefits. This article will review the LLEL and how it can be utilized in clinical practice.

MECHANISMS OF ACTION

            LLELs are described as lasers that penetrate the deepest into tissue without causing tissue damage. In fact, studies have shown that the cold laser does not affect normal tissue. At the same time, tissues that are ischemic and poorly perfused as a result of inflammation, edema and injury have a significantly higher response to laser photon stimulation than normal healthy structures.

            The primary target systems for the LLEL include lymphatics, circulatory and nervous tissue. A major effect of cold laser is to provide energy for repair of damaged tissue in these systems. It does so by its effects on cytochromes, which are proteins that act as energy producers for biological functions. Laser photon stimulation accelerates the functions of several cytochrome enzymes, in turn providing significant increases in ATP and Nitric Oxide, which enhance cellular metabolism, circulatory improvement and nerve function.1

            As a result of these basic mechanisms, additional processes and events have been elucidated in research on LLELs, directly decreasing inflammation and pain as well as enhancing tissue healing and regeneration. These are listed in Charts 1-32.

CHART 1
LLEL PROCESSES FOR REDUCTION OF INFLAMMATION

                        Stabilization of cellular membranes                               Vasodilation stimulated
                        ATP production and synthesis enhanced                       Acceleration of leukocytic activity
                        Reduction in Interleukin 1 (IL-1)                                  Enhanced lymphocyte response
                        Temperature modulation of inflammatory areas              Increased angiogenesis
                        Decreased C-reactive protein and neopterin levels        Enhanced superoxide dismutase (SOD)

CHART 2
LLEL PROCESSES FOR PAIN REDUCTION

                         Increase in beta-endorphins                                          Increased nitric acid production
                         Blocked depolarization of C-fiber afferent nerves          Increased nerve cell potential
                         Axonal sprouting and nerve cell regeneration                 Decreased bradykinin levels
                         Increased acetylcholine release                                     Ion channel normalization

CHART 3
LLEL PROCESSES FOR TISSUE HEALING

                          Enhanced leukocyte infiltration                                      Increased macrophage activity
                          Increased neovascularization                                         Increased fibroblast proliferation
                          Keratinocyte epithelialization                                         Increased growth factor
                          Enhanced cell proliferation and differentiation                 Enhanced healed wound tensile strength  
                          Increased mitochondrial membrane potential
                                                                                                                                  

CONDITIONS BENEFITED BY LLEL

            Based on the above mechanisms of action, there are many medical conditions that can respond beneficially from LLEL treatment. TABLE 1 lists the major conditions that have been researched or have sufficient experiential results. The following are brief summaries of some of the more common indications.

TABLE 1
CONDITIONS BENEFITED BY LLEL

                                               Arthritis of any joint                              Plantar fasciitis
                                               Spine arthritis                                        Trigger points
                                               Frozen shoulder                                    Ganglion Cysts
                                               Degenerative disc disease                     Sciatica
                                               Bulging or herniated discs                      Bone spurs (inflammatory component)
                                               TMJ                                                     Osgood-Schlatters Disease
                                               Dupytren’s contractures                        Headaches (Migraine, tension, sinus)
                                               Wound healing                                      Allergic rhinitis
                                               Mucositis/Stomatitis                              Lymphedema
                                               Tendonitis                                             Bursitis
                                               Acute injuries                                        Trigger fingers
                                               Myofascial pain/Fibromyalgia14 Burns
                                               Compressive neuropathies (carpal, cubital, radial, tarsal tunnel)

Joint Arthritis

            Because the cold laser decreases inflammation and regenerates damaged tissue, joint arthritis responds exceptionally well3. This includes patients who describe “bone on bone” arthritis, as well as those who continue to have symptoms post-joint replacement. In the author’s experience, a significant majority of patients with knee and hip arthritis can delay joint replacement by years and in many cases, altogether. Although knees are the primary joint treated, arthritis of hips, shoulders, ankles and fingers respond equally well. This includes both osteoarthritis and rheumatoid arthritis.

Degenerative Disc Disease

            Again, decreasing inflammation (both acute and chronic) and regenerating damaged tissue are the mechanisms responsible for healing both ruptured discs4 and repairing chronic degenerative discs causing neck or back pain5. As with joint arthritis, treatment with the cold laser can often prevent the need for spinal surgeries, epidural injections and other conventional treatments in a large percentage of patients.

Nerve Conditions

            The ML830 laser (see below) was the first laser to be approved by the FDA, after being shown to significantly resolve carpal tunnel syndrome6. Other compressive neuropathies respond equally as well. In addition, various other nerve conditions and injuries may benefit, including facial and 7th nerve (including Bell’s palsy, trigeminal neuralgia), acute herpes zoster and post-herpetic neuralgia, brachial plexus injuries, peripheral nerve injuries7 and neuropathy caused by diabetes or chemotherapy.

Wound Healing

            LLELs are exceptional for accelerating healing of wounds8. It has been used successfully for post surgical wounds and dehiscence, decubitus ulcers, diabetic ulcers, hematomas, and even some cases of dry gangrene. Wounds and fistulas that have not closed over several months to over a year have responded well to LLEL treatment and will close. With LLEL, wounds heal from the bottom up, stimulating granulation tissue and often reducing scarring.

Acute Injuries

            Because LLELs increase blood flow, stimulate lymphatic drainage and reduce inflammation, acute injuries heal much more quickly. This includes skin, soft tissue (tendons, ligaments, cartilage, discs) and even bone. Thus, partial rotator cuff tears, epicondylitis9, Achilles injuries and partial cartilage tears can all respond beneficially.

Mucositis and Lymphedema

            More recent studies  have shown the cold laser to be very effective for mucositis10,11 and stomatitis, common side effects of types of radiation for head and neck cancers and certain chemotherapies for other cancers. In addition, because LLEL stimulates lymphatic flow, it can decrease lymphedema12, even if present for a long duration.

RESPONSE, LENGTH AND DURATION OF TREATMENT

            A significant aspect of LLELs is that they work quickly. Many patients will report benefits even after the first treatment, which also provides positive psychological reinforcement. In general, results should be observed within eight treatments, especially in acute conditions, although more treatments may be necessary for complete resolution.

            For chronic conditions, results should again be observed within eight treatments, but such conditions may require ongoing treatment every few weeks after reaching a plateau level, to resolve or prevent exacerbations. However, long-lasting resolution of symptoms commonly is achieved in many chronic conditions within 8-12 treatments, even if the condition has been present for years.

            In some cases, patients may observe excellent benefits in the first few treatments, then have no change for a few treatments, followed by continued additional benefit. If there is no added benefit after 4-5 treatments, the patient has reached plateau. However, restarting LLEL treatment a month or two later may provide additional benefit and is worth a try if the patient has only obtained partial relief.

            The length of treatment depends on the area involved and condition being treated. Protocols are available that describe the required energy (measured in joules), with most conditions receiving 3-9 joules per area involved. Usually, one area takes only 1-2 minutes to achieve the necessary energy, so length of treatment is determined by the number of areas treated.

            As with any therapy, LLEL is not effective in every patient or for every condition. In general, over 80% of patients will respond fully, with about 10% obtaining partial response. Some conditions, such as tendonitis, may either respond immediately or not respond at all. The most difficult conditions to treat are post-surgical (such as lumbar fusions) due to structural interference. Even so, the LLEL may still be effective and should be tried in these patients: Most often, it will simply take longer to obtain benefits and a longer duration to achieve maximum results.

            Finally, the LLEL can be used effectively with other modalities, including physical therapy and medications. In my clinic, we combined the LLEL with acupuncture, resulting in even faster and more efficacious healing.

TYPES OF COLD LASERS

            There are several different types and manufacturers of cold lasers, the differences being in wavelength and power output. The main factor that can affect the actual depth the laser beam penetrates is the wavelength. The output power is of secondary importance because the physical properties of the tissues limit the penetration of particular wavelengths, no matter how much power is behind them.

            The most common wavelengths used and researched are 632.5 nm (Helium-Neon), visible red beam, and 830 nm and 902nm (Gallium-Aluminum-Arsenide), infra-red (invisible) beam. Although all these wavelengths (and others within this range) have been shown to have beneficial effects on tissue, the 830 nm wavelength has been proven to have the greatest consequence to healing14. This beam is well absorbed in sub cellular organelles, increasing their capacity to well beyond their normal state.

            As for power outlay, some single diode lasers (akin to laser pointers and LEDs) have only about 5 mW, which limits their efficacy. Other LLELs have power ranges from 25 mW to 100 mW. The most efficacious outcomes appear to be from 60- 90 mW of power.

Depth of penetration is relatively important to the efficacy of LLEL therapy and the 830 wavelength has the deepest penetration of all LLELs, which correlates with its increased efficacy. Although the depth is only 5cm (see Figure 1), there appears to be a distal effect since tissues may still respond even if the area of concern is deeper than 5cm (such as large patients with lumbar disc disease). Such an effect has not been well researched or defined but has been noted in various studies and in the author’s research.

SAFETY AND SIDE EFFECTS

            The only absolute contraindication of laser use is pointing it directly into the eye. Typical diode laser beam paths are highly divergent, so reflection of the laser beams while applying it to patients does not cause eye damage. There have been no reports of eye damage with use of LLEL. Nevertheless, eye goggles can be used if the provider or patient is concerned.

            A relative contraindication is use on or around cancer cells. It is simply not known whether the cell stimulation effects of LLELs increase tumor growth. However, it is known that LLELs affect primarily injured tissues, which does not include cancer. Several studies on mucositis used the laser in the presence of active tumor and did not show any adverse effects on tumor growth. It has also been used to control metastatic bone pain in palliative patients, again without cancer-stimulating effects.

            The LLEL should not be used in patients taking immune suppression drugs, hemorrhages and should not be directly applied to the thyroid.

            Side effects are minimal and rare. The majority of patients will not feel any reaction from cold laser treatment, although occasionally, patients may feel a “tingling” or warm feeling in the area of treatment or even distally when nerves are being treated, but this reaction is usually described as a pleasant feeling. In over 25 years of use, there have been no serious side effects reported to the FDA.

            The FDA has classified the LLEL as a Class IIIB device under a NHN category (meaning non-heating). Hot lasers are Class IV devices. Laser pointers (with wavelengths of 635 nm) are classified as Class IIIa devices.

            Because the LLEL has been declared a safe device by the FDA, it can be applied by any personnel, including medical assistants, although it is best to use it under the direction of a licensed practitioner.

COSTS AND REIMBURSEMENT

            LLELs range in cost from a few hundred dollars to $12,000, depending on wavelength and power. Obviously, the less expensive lasers do not have as beneficial effects as the more expensive ones, but a mid-expense LLEL can be as effective as the more expensive products. You can obtain an excellent therapeutic LLEL for $4000-$5000.

            Charges for LLEL treatment vary from practitioner to practitioner, depending on the duration of treatment or the number of areas treated. The average fee of most practitioners is $45 for up to 15 minutes of treatment.

            At this time, some insurance companies will reimburse fully or partially for LLEL treatment and some won’t. Medicare will reimburse for some conditions but not others. As more studies on LLELs are accomplished, it is hopeful that all 3rd party payers will reimburse for LLEL treatment since it is very cost-effective and can prevent the need for expensive surgeries.

REFERENCES

1. Oron U, et.al. Ga-As (808nm) laser irradiation enhances ATP production in human neuronal cells in culture. Photomed Laser Surg. 2007 Jun; 25(3): 180-82

2. Martin, R, Laser-Accelerated Inflammation/Pain Reduction and Healing; Practical Pain Management, Nov/Dec 2003.

3. Hegedus B, et.al. The effect of low-level laser in knee osteoarthritis: a double blind, randomized, placebo-controlled trial. Photmed Laser Surg. 2009 Aug; 27(4): 577-84

4. Unlu Z, et.al. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and MRI. J Manipulative Physiol Ther. 2008 Mar; 31(3); 191-8

5. Chow RT, et.al. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. Lancet. 2009, Dec 5; 374(9705): 1897-908

6. Yagci I, et.al. Comparison of splinting and splinting plus low level laser therapy in idiopathic carpal tunnel syndrome. Clin Rheumatolo. 2009 Sep; 28(9):1059-65.

7. Rochkind S, et.l. Laser phototherapy, a new modality in treatment of long-term incomplete peripheral nerve injury: a randomized double-blind placebo-controlled study. Photomed Laser Surg. 2007 Oct; 25(5):436-42

8. Minatel DG, et.al. Phototherapy promotes healing of chronic diabetic leg ulcers that failed to respond to other therapies. Lasers Surg med. 2009 Aug; 41(6): 433-41

9. Stergioulas A. Effects of low-level laser and plyometric exercises in the treatment of lateral epicondylitis. Photomed Laser Surg. 2007 Jun; 25(3): 205-13

10. Khouri, VY, et. Al. Use of Therapeutic Laser for Prevention and Treatment of Oral Mucositis. Braz Dent J. 2009; 20(3):215-20.

11. Genit-Kalstersky MT, et. Al. The Use of LLEL for the Prevention of Chemotherapy- and/or Radiotherapy-induced oral mucositis in cancer patients: Results from two prospective studies. Support care Cancer. 2008 Dec; 16(12):1381-7

12. Carati CJ, et.al. Treatment of post-mastectomy lymphedema with low-level laser therapy: a double blind, placebo-controlled study. Cancer, 2003 Sep 15; 98(6):1114-22

13. Shirani AM, et.al. Low-level laser therapy and myofascial pain dysfunction syndrome: a randomized controlled clinical trial. Lasers Med Sci. 2009 Sep; 24(5): 715-20

14. Carrinho PM, et.al. Comparative Study using 685 nm and 830nm Lasers in the Tissue Repair of Tonotomized tendons in the mouse. Photomed Laser Surg. 2006; 24:6; 754-758

You Baby Boomers are starting to get the shocks of your lives. Without warning, medical problems seem to appear from nowhere. Whether it’s a bladder problem or memory loss, cancer or a sudden heart attack, osteoporosis or a greater risk of injuries, you are realizing that with increasing age comes a variety of medical problems that you did not have to face previously and that may be totally unexpected. Most boomers aren’t prepared for these new challenges and don’t know how to deal with them most effectively. Fortunately, you have Balanced Healing to help you improve your baby boomer health.

So how can Balanced Healing help? Balanced Healing helps you find the best and most cost-effective treatments, whether from conventional medicine or alternative methods. The problem is that you have many health care choices when faced with illness but may not know which ones are the best for you…which ones really work and which ones you should avoid at all costs. Balanced Healing takes out the guesswork and gives you the answers you need to obtain the best Baby Boomer health.

And just in time. Our health system is undergoing a lot of change and that change will affect baby boomer health significantly. Some of these changes will be beneficial, but many will impact you negatively. The latter may include cuts in Medicare that will lead to restrictions in service, rationing and less access to doctors. This will significantly impact baby boomer health.

Many businesses and experts are pushing for consumer-oriented health care, which many baby boomers desire anyway. But that requires you to have the knowledge to make the best treatment choices for your baby boomer health. Balanced Healing gives you this knowledge and helps you choose the treatments that will provide the best value and effectiveness.

By Larry Altshuler, M.D.

Published in Radius Magazine, Spring 2011

      Fish oil has quickly become one of the most common supplements purchased by consumers and for good reason. Research studies have shown it to be beneficial for numerous conditions (See Table 1), especially related to the heart (Table 2).

TABLE 1
 SOME CONDITIONS BENEFITED BY FISH OIL

                                                     Age-related eye problems Asthma in children
                                                     Bipolar disorder (depressive type) ADHD
                                                     Cachexia in cancer Depression
                                                     Diabetic kidney disease Painful menstrual periods
                                                     High cholesterol High Blood Pressure
                                                     High triglycerides Obesity (Helps lose weight)
                                                     Osteoporosis Rheumatoid arthritis
                                                     Reduces risk of stroke

Despite its benefits, there are problems with fish oils of which you need to be aware. It is not just a matter of going into a store and buying what’s on the shelf. You may not be getting what you think you are.

Omega fatty acids: It Can Be Confusing

The key ingredients of fish oil are called omega-3 fatty acids (called omega-3’s for short). However, you should realize that there are several types of omega-3’s, and there are also other fatty acids, such as omega-6’s, all of which can have some benefits and are commonly purchased by consumers. What to take can be confusing, so let me clarify.

First, there are two main omega-3’s in fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Another omega-3 is alpha-linoleic acid, which is found primarily in plant oils, such as flaxseed. What you need to know is that omega-3’s from fish oil are much more potent than omega-3’s from plants.

Second, omega-6 fatty acids, found in evening primrose oil and borage oil, are often taken by consumers along with omega-3’s. What you need to know is that omega-6’s and omega-3’s compete with each other for binding sites in the body. Taking fish oil with these herbs, or combination products with both omega-3’s and omega-6’s, can often negate each others’ effects, so you should avoid taking them together.

How Much Is Enough?

A major problem consumers have is to know how much fish oil is needed to obtain the maximum benefits. Many manufacturers recommend taking 1000 mg (1 gram) total of DHA plus EPA daily, but all studies showing the benefits of fish oil utilize 3-4 grams per day. So, if you are only taking one capsule a day of regular fish oil (which usually equates to one gram or less), you will obtain some benefit, but not the maximum.

Side Effects of Fish Oil: What Is Too Much?

Taking too little is one problem, but taking too much is another. If you take the recommended 3-4 grams per day, side effects are uncommon. Even so, you still may have a fishy aftertaste or “fish burp”, halitosis, heartburn, nausea, loose stools or rash. However, you can decrease these side effects by taking the fish oil with meals or freezing them.

More serious, doses greater than 3-4 grams can increase the risk of bleeding, especially if you take blood thinners or aspirin. Some fish oil preparations (like cod liver oil) contain large amounts of vitamin A and vitamin D, which can cause toxicities if taken in large amounts or for a long time. Large doses can also adversely affect immune function and can increase LDL cholesterol (the “bad” cholesterol) in some people. This latter effect can be negated by taking garlic supplements.

The bottom line is that taking 3-4 grams per day will provide you the maximum benefits: Taking more than that will not provide any additional benefit but may cause serious side effects.

Buying Fish Oil: Beware The Pitfalls

Most consumers do not realize that most fish oils deteriorate rapidly, usually within three months. The problem is that fish oil is so unstable, it begins to oxidize as soon as it is extracted from fish and exposed to air, which is usually long before it is placed into a capsule. The more it is oxidized, the less effective it becomes. If the fish oil you buy has been on the shelf for a while, it may have already lost its potency. If you buy large quantities of fish oil capsules, the benefits will quickly diminish and may even disappear before you finish the bottle.

There are numerous fish oils on the market and it is difficult to know which one to buy. As a general rule, you get what you pay for: the cheaper fish oils usually deteriorate quicker and are not as high quality. However, some over-the-counter fish oils can be just as beneficial as more expensive fish oils sold by pharmaceutical companies. You may also pay more if the fish oil is combined with other vitamins and minerals (See Table 3).

One fish oil that may be advantageous is Krill oil. This oil is more expensive than other regular fish oils but has the advantage of being shelf stable for two years. It also contains the natural antioxidants vitamins E and A, astaxanthin and canthaxanthin. In addition, 500 mg of Krill oil is equivalent to 2 grams of regular fish oil in its effects, so you can take one or two capsule rather than three or four.

Should You Take Fish Oil?

So, who should take fish oil? You should definitely take it if you have heart disease or even a high risk for heart disease. You should take it if you have one of the medical conditions in Tables 1 or 2. Overall, however, it has benefits for most people, even if healthy, and can even be taken by children.

Published in Radius Magazine, Winter 2010

Back in 1907, a scientist named Elie Metchnikoff observed that peasants living in the Balkans appeared to have longer and healthier lives than other societies and postulated that it was because they consumed fermented milk products (i.e., yogurt). He theorized that the putrefactive processes in the intestines produced toxins that caused degeneration of the body and by ingesting certain “good” bacteria found in yogurt, these toxins could be negated.

Today, research is showing that Metchnikoff was correct in many ways. In fact, it is well recognized that our intestines contain an enormous amount of bacteria that are beneficial to not only the intestines, but to our general health as well. These “good” bacteria (also referred to as normal intestinal “flora”) are now known to have numerous health functions, as seen in Table 1.

One particularly important benefit is maintaining immune function. Approximately 80% of our immune protection takes place in the gut, which is important in sustaining a barrier against harmful substances that we ingest from our environment. In fact, infants do not have a fully developed immune system and it is thought that breast feeding prevents many allergies and infections because the mother’s milk contains these good bacteria.

TABLE 1
KNOWN FUNCTIONS OF “GOOD” INTESTINAL BACTERIA

Improve digestion Improve absorption of nutrients
Improve immune function Help move and remove waste
Production of B vitamins Repair/turnover of intestinal wall cells
Influences secretion of hormones Prevents yeast overgrowth
Prevents overgrowth of “bad” bacteria (including antibiotic-resistant),
parasites, fungi.

Enter Probiotics
Unfortunately, our lifestyles have changed dramatically over the past century regarding hygienic measures, diet, living standards, usage of medical drugs, use of preservatives, sterilized foods and chlorine in our drinking water, all of which can affect our normal flora adversely. Refrigerators and freezers have replaced the natural processes of food fermentation that produced good bacteria. Antibiotics in healthcare, agriculture, and in household products (such as toothpaste and deodorants) are detrimental to and can destroy these beneficial microorganisms. Additional factors that can harm our normal flora include infection, chemotherapy, radiation, and surgery.

It is now being recognized that such a decrease in intestinal flora can cause not only gastrointestinal medical problems, but also negatively affect our general health. It would thus make sense that by replacing the good bacteria that has been harmed or reduced, our guts can begin to function normally again and these medical conditions can be resolved or prevented. That is the purpose of probiotics, which are supplements or food sources that contain these good bacteria. Probiotic literally means “for life” and initial research now supports the possible benefits of taking them in various medical conditions (see Table 2).

TABLE 2
MEDICAL CONDITIONS THAT MAY BE RESPONSIVE TO PROBIOTICS

Infectious diarrhea Irritable bowel syndrome (IBS)
H pylori infection (ulcers) Tooth decay, periodontal disease
Vaginal Infections Daycare-acquired stomach/lung infections
Skin infections Lactose intolerance
Viral gastroenteritis Atopic dermatitis (eczema) in children
Endstage liver disease Boost immune system (colds/flu)
Colon cancer preventative HIV enteropathy
Prevent urinary infections Infection with C difficile
Pouchitis Reduce recurrence of bladder cancer
Inflammatory bowel disease (IBD) (e.g., Crohn’s disease, ulcerative colitis)

What Exactly Is In A Probiotic?
There are numerous types of good bacteria living in our guts. In general, there are two groups: bacterial (lactobacillus, bifidobacterium, streptococcus) and yeast (saccharomyces). Within each of these groups are numerous species and within each species are multiple strains, each of which may have separate functions. Different probiotic products contain either a single strain or various combinations (see Table 3).

In addition, there are foods that contain probiotics, referred to as functional foods. Some naturally contain beneficial bacteria and others have them added. Although most yogurts contain natural flora, many yogurt products may not contain the important species or the bacteria is destroyed in the manufacturing process. Activia, DanActive and Align are specific probiotic-added yogurts that are advertised widely and are found in most grocery stores. Other foods that contain good bacteria include sauerkraut, fermented and unfermented milk, foods that are “pickled”, miso, tempeh and some juices and soy beverages.

TABLE 3
SOME COMMON PROBIOTIC FORMULATIONS

Probiotic GI (Lactobacilli acidophilus and casei; Bifidobacteria bifidum and lactis; Strep.
Thermophilus)
Allipro (Lactobacilli acidophilus, rhamnosus, salivarius and plantarum, Bifidobacteria bifidum)
Culturelle (Lactobacillus GG)
VSL #3 (Lactobacilli casei, plantarum, acidophilus, and bulgaricus; Bifidobacterium longum,
breve and infantis; Strep. thermophilus)*
Probiotica (Lactobacillus reintera)
Flora-Q (Lactobacillus acidophilus)
Floraster (Saccharomyces boulardii)
Activia (Bifidus regularis)
DanActive (Lactobacillus casei)
Align (Bifidobacteria infantis)

*Must be refrigerated

Which probiotic is most effective?
Obviously, there are many different probiotic combinations (also referred to as bacterial “cultures”) as well as single strains, so how do you know which one to take? Although specific benefits have been demonstrated for some strains, many of the actions and benefits of our intestinal flora have yet to be fully determined.

Additional factors can also dictate the benefits you receive. For one, cultures must remain stable during storage; many have to be refrigerated to survive and die off quickly if not. Furthermore, probiotics must be delivered primarily to the small or large intestines, where most of their beneficial functions occur. Some formulations will not survive the passage through the stomach and bile acids.

There are also many forms of probiotics, such as the liquid yogurt products. To improve stability, many cultures are freeze-dried into powder, capsule or tablet form, which improves the chances for the bacteria to survive the passage to the small/large intestines. Many of the pharmaceutical products are in gelatin capsules, but they contain 10-15% water which decreases stability and viability of the cultures. Products that have regulated disintegration (primarily tablets and capsules) are usually the best, since this continuously exposes the intestinal system to viable bacteria.

There is also a matter of the quantity of bacteria in the probiotic product. This can vary from 1 billion to 450 billion per capsule or dose. This varies so much because each species has different characteristics, some are stronger than others, some are destroyed more easily either before being ingested or while traveling through the intestine, some medical conditions require larger amounts of bacteria, and differing amounts are needed depending on where the bacteria end up (e.g., the large intestine requires higher counts than the small intestine).

What this means is that the initial amount of bacteria in the product may not correlate with its eventual benefits. What is most important is how many bacteria are available at the time you take the product. Be aware that many probiotic products do not deliver enough good bacteria to have a beneficial effect. In 2006, ConsumerLab.com evaluated 13 popular products and found that 9 out of the 13 had low levels of viable bacteria (less than 1 billion) at the time of purchase.

Thus, the effect of the supplement is influenced by the choice of bacteria, the amount of bacteria, the quality, viability and stability of the bacteria and how the bacteria is distributed from the mouth to the intestine. Unfortunately, there is no easy way to know which formulation will work for you and often, you just have to try different brands to see which works the best. In general, I recommend non-refrigerated tablets or capsules that contain several different strains of bacteria (see reference below).

What About Prebiotics?
Prebiotics are complex carbohydrates that are sometimes taken with probiotics to boost their effectiveness. Prebiotics are not broken down by enzymes in the stomach or small intestines, so they can reach the large intestine in viable form. They then stimulate the growth and activity of added probiotic bacteria as well as the normal flora already in the colon. Although some products contain both prebiotics and probitoics, prebiotics can be taken separately by taking additional supplements (such as fructooligosaccharide [FOS], inulin or allicin) or adding bran, psyllium, or germinated barley foodstuffs (GBF) to your diet. In fact, these prebiotic-containing foods are often recommended if you have IBS or IBD. Many other foods contain natural prebiotic carbohydrates as well, including most fruits, barley, garlic, onions, whole grains, leeks and honey.

Safety
There are little to no side effects or concern about taking probiotics. The most common side effect is flatulence, which can improve on its own or by changing to a probiotic that contains different bacteria. However, it is not known whether probiotics can harm people who are immune-compromised, so they are not recommended in such conditions.

The Future
The first proven beneficial probiotic was developed in 1983 (called Lactobacillus GG), yet the researchers could not get either pharmaceutical companies or academic medical centers in the U.S. to become interested in further studies. It is only now that alternative medicine has demonstrated the wide ranging benefits that conventional medicine has decided to investigate these supplements.

Even so, most people are not waiting for the research. In our country, spending on probiotics nearly tripled from 1994 to 2003. In Japan, the world’s leader in probiotic usage, probiotics are available in vending machines to a much greater extent than soft drinks. In Spain, DanActive outsells Coca Cola. In Europe, many physicians now routinely give probiotics to patients who take antibiotics.

Until more research is done, however, it will be difficult to know exactly which strains and which formulations will help which conditions the best. At this time, definitive claims cannot be made that probiotics are effective against specific diseases, but we can say they have a beneficial effect on our health as a whole.

When you search for health information on the Internet, what do you find? On one hand, there are many sites that provide excellent information on conventional medicine and on the other hand, there are many sites that provide information on alternative medical approaches.

However, perhaps asking what you don’t find is a better question. The fact is that these websites usually focus on only one type of approach: most conventional sites have very little information on alternative methods and alternative sites rarely have information on conventional treatments.

And that’s a problem if you are trying to find out how to most successfully treat your medical condition(s). After all, both medical approaches have benefits. By using the ‘best of both worlds’, you are more likely to obtain the outcomes you desire.

Combining conventional and alternative approaches together has been referred to by different names. Integrative medicine implies using alternative methods as if they are conventional treatments. Complementary health implies using alternative methods as an adjunct (add-on) to conventional treatments to make them work better. Whether you use the term complementary health or the term integrative medicine, the end result is that you can obtain more options for your health.

There is a catch, however. Both medical approaches have benefits, but they also have pitfalls and you need to know what they are, especially with alternative methods that are less well researched. That is why it is important to use evidence-based complementary and alternative medicine.

There are numerous complementary health and integrative medicine websites that will laud the benefits of any number of methods, many of which have no research support. Even conventional medical websites that discuss complementary health or integrative medicine may list methods that are not well studied. That is what makes this website so unique… the information and education we provide is solely based on evidence-based complementary and alternative medicine. We tell you what works and what doesn’t, from both medical approaches.

Rather than using the terms complementary health and integrative medicine, we prefer to use the term Balanced Healing. The reason for this is that integrative medicine and complementary health both imply always using alternative methods with conventional treatments. Instead, Balanced Healing implies ‘balancing’ the two approaches, i.e., sometimes using alternative methods only, sometimes using conventional methods only, and of course sometimes using them together…whatever works best for your particular condition(s).

Certainly, complementary health or integrative medicine or Balanced Healing… whichever term or approach you prefer…can benefit you greatly. And whatever website you obtain information from regarding these approaches, make sure it uses only evidence-based complementary and alternative medicine.