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Lactobacillus reuteri in Infantile Colic: A Randomized, Double-Blind, Placebo-Controlled Trial
Francesco Savino, MD, PhDa, Lisa Cordisco, PhDb, Valentina Tarasco, MDa, Elisabetta Palumeri, MDa, Roberto Calabrese, BSca, Roberto Oggero, MDa, Stefan Roos, PhDc, Diego Matteuzzi, PhDb
a Department of Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy;
b Department of Pharmaceutical Sciences, University of Bologna, Bologna, Italy; and
c Department of Microbiology, Swedish University of Agricultural Sciences, Uppsala, Sweden
Objective To test the efficacy of Lactobacillus reuteri on infantile colic and to evaluate its relationship to the gut microbiota.
Study Design Fifty exclusively breastfed colicky infants, diagnosed according to modified Wessel's criteria, were randomly assigned to receive either L reuteri DSM 17 938 (108 colony-forming units) or placebo daily for 21 days. Parental questionnaires monitored daily crying time and adverse effects. Stool samples were collected for microbiologic analysis.
Results Forty-six infants (L reuteri group: 25; placebo group: 21) completed the trial. Daily crying times in minutes/day (median [interquartile range]) were 370 (120) vs 300 (150) (P = .127) on day 0 and 35.0 (85) vs 90.0 (148) (P = .022) on day 21, in the L reuteri and placebo groups, respectively. Responders (50% reduction in crying time from baseline) were significantly higher in the L reuteri group versus placebo group on days 7 (20 vs 8; P = .006), 14 (24 vs 13; P = .007), and 21 (24 vs 15; P = .036). During the study, there was a significant increase in fecal lactobacilli (P = .002) and a reduction in fecal Escherichia coli and ammonia in the L reuteri group only (P = .001). There were no differences in weight gain, stooling frequency, or incidence of constipation or regurgitation between groups, and no adverse events related to the supplementation were observed.
Conclusion L. reuteri DSM 17 938 at a dose of 108 colony-forming units per day in early breastfed infants improved symptoms of infantile colic and was well tolerated and safe. Gut microbiota changes induced by the probiotic could be involved in the observed clinical improvement.
Each subcommittee of the Commission has developed a services of recommendations that will be the basis for the statewide action plan and your feedback is VERY important to this process!
If you are the parent of a child with autism spectrum disorder or a professional who delivers services to children with autism spectrum disorders, we urge you to complete the survey on the recommendations of the Community Services for Children and Families Subcommittee. Please click on this link - www.surveymonkey.com/
The Public Health Agency of Canada (PHAC) is looking into Vitamin D and H1N1 flu prevention. Also, hot off the press, is a 2009 systematic review of randomized controlled trials that found strong evidence supporting vitamin D as both a treatment and preventive for tuberculosis, influenza, and viral upper respiratory tract illnesses.
We are recommending Vitamin D testing for all patients. If levels are lower than the optimal 60-80 ng/dl, we are recommending supplementation of 5000iu of vitamin D in adults for the duration of the flu season. Keep in mind that it is also important to get 1000-1200mg of Calcium per day (from diet or from a supplement) if taking this higher dose of Vitamin D for a long duration.
Childhood guidelines are similar for patients that have been tested. If a child has not been tested, we are recommending a minimum of 2000iu/ day. For toddlers and infants under two years old, check with your doctor.
At this point, the H1N1 flu is the dominant flu strain for the season and will, most likely, become the seasonal flu for years to come. As this is a novel virus, our collective immune system is "seeing" it for the first time. Although it is faster out of the gate, as of yet it, is no more dangerous than the regular seasonal flu. However, a unique feature of this virus appears to be that it can cause more serious outcomes in young children, pregnant women and those with preexisting chronic disease. It is also more prevalent earlier in the season and keeping folks home from work and school in record numbers.
Our phones have been ringing off the hook with inquiries about the influenza season. Here are resources for some of our most frequent questions:
Should I get the vaccine?
Maybe. You have to be the one to weigh the benefit vs. risk for you and your family. I suggest that you stay informed about your choices. The best vaccine information I have seen is from Dr. Sears and can be found here. At this point in time, the vaccine is not available to everyone, so you still have time to think about it. I do encourage every patient who decides to vaccinate to demand a thimerosal free vaccine.
Is there anything else I can do until the vaccine is available or if we decide not to vaccinate?
Absolutely. Below, I have provided the research on my top three natural interventions: Vitamin D, Elderberry syrup and probiotics. I also still stand by my previous recommendations which are listed at the end in the "Swine Flu To Do List".
Where is the best source of up to date information?
If I think I have the flu, should I go to the doctor?
Call your doctor first! Chances are that most of your care can be handled over the phone. In most cases, flu symptoms can be managed safely at home. At this point, we are not testing every patient for the swine flu, but assuming that if you have flu like symptoms, it is H1N1. Again, stay home unless you have any of the following warning signs:
- Unable to keep fluids down/ stay hydrated
- Difficulty breathing
- Flu-like symptoms improve but then return with fever and worse cough
- Fever with a rash
- Preexisting conditions or diseases that put you more at risk for developing complications of the flu
Funding Your Family's Healthcare
We can compare our nation's financial situation to an illness. There are two possibilities. It could be a slow, chronic process or we may spike a very rapid fever. Although painful, I hope that America's economic illness is swift and make us stronger in the end.
As our nation weathers the fever of this financial crisis, we are forced to rethink the way we provide, receive and fund health care. Here are some ideas to consider which may make your health care more affordable.
1. Prevention of Disease
Never was there a more important time to talk about prevention. The most cost effective way to deal with a disease is to prevent it from happening. We all know that diet and exercise is the best medicine. However, talk to your doctor about the things you can do to prevent illnesses for which you may be at a higher risk. Is there diabetes or cancer in your family? Are you on medication that puts you at higher risk for developing a secondary disease? Are there things you can do now to prevent it?
2. Reevaluate Your Current Health Insurance
If you have a health benefit through your employer, explore the options that are available and reassess if the product you have is truly serving your needs.
If you are self insured and relatively healthy, consider moving into a high deductible (low monthly premium) health plan (HDHP) attached to a Health Savings Account (HSA). If you make the switch, be sure to commit a generous monthly contribution to the HSA for at least the first year. That way, if you need to cover your deductible in full, the money is there. If not, the money stays in the savings account and accrues interest. This money is available to you to spend as needed on vision, dental, acupuncture, massage and any other health care service that may not typically be covered in a basic plan. Contributions to your HSA are 100% tax deductible. For 2009, these amounts are $3,000 for single HDHP coverage and $5,950 for family HDHP coverage. These amounts will be increased for inflation in future years.
3. Shop Around!
Do you need medication, lab work or imaging? Just like any other customer service, pricing for medication and procedures is negotiable and you need to shop for deals!
Pharmacies frequently provide incentives to move your prescription. Check the newspaper and web for coupons and gift cards offered to make the switch. All you need to do is take an empty Rx bottle to the new pharmacy and they will do the rest. Click here for a $50.00 coupon to transfer your Rx to Rite Aid Pharmacy.
Pharmaceutical companies frequently post coupons online to cover co-pays or percentages for brand name medicines. Look up your medication online and go to the manufacturer's website for coupons. For example, if you are on Advair for your asthma and you google "advair coupon," you will link to the following savings.
Lastly, generic medications are always cheaper than brand names, so make sure you have made the switch. Fred Meyer will fill many generic meds for 4 dollars a month. Click here for the list of $4 prescriptions.
Lab work is another way that you can save by shopping around. Particularly if you pay out of pocket, have a very high deductible or are only needing basic routine labs. Every lab will have its own fee scale. You are not required to use your doctor or hospital's lab. Have your doctor write a prescription for your lab work and take it to the lab where you will get the best deal. Call around and ask the prices for the blood work that you need.
At our clinic, patients are able to get the following cash deals:
Vitamin D $40.00
Cholesterol Panel $20.00
Complete Blood Count $15.00
Thyroid Panel $25.00
Those are great prices! Call around to compare!
There are many imaging centers in town that provide MRI, X-Ray and Mammogram services. Call around to make sure you are getting the best deal. For example, I spent 10 minutes calling around about a cash price for an MRI of the knee. My results are as follows:
Providence hospital $968.00
EPIC Imaging $840.80
Mt. Scott MRI/ CT center $690.00 with a great financing plan!
4. Participate in Research
Do you have a particular condition that may qualify you for participation in research? Frequently, being enrolled in a research trial will provide free labwork, evaluation and treatment for your condition.
The National Institute of Health keeps record of clinical trials that are both privately and federally funded at www.clinicaltrials.gov.
OHSU posts their own open trials at this link.
The Helfgott Research Institute is a local facility advancing the science of natural medicine. Clinical research projects with a natural focus are posted at the above link. Contact the institute to see if any projects are recruiting.
5. Seek Out Assistance Through Grants and Non-Profits
Many conditions have support organizations that provide grants for treatment. Follow this link for updated list of funding resources for children with Autism. Keep in mind, I have several patients now who have been successful at acquiring grants and scholarships through these organizations. Persistence pays off!
Click on the link below to see the Swine Flu Check List
Autism in 2009
One in every 150 children in the US has autism, which means 1 million children are living with this disorder. In boys, the statistics are even more alarming: 1 in 94. A new case of autism is diagnosed nearly every 20 minutes
AUTISM RESEARCH FUNDING:
There is a disparity of research funding for autism, even though its prevalence is staggering.
- $29.5 billion dollars is the total pool of NIH funding in FY 2008
- Less than $100 million of the $5 billion dollars that is allocated to relevant NIH departments goes to autism research.
- Leukemia Funding: $300 million (1 in 25,000 children are diagnosed with leukemia per year)
- Muscular Dystrophy Funding: $160 million (1 in 20,000 children are diagnosed with MD per year)
- Juvenile Diabetes Funding: $140 million (1 in 500 children are diagnosed with Juvenile Diabetes per year)
According to the Harvard School of Public Health each individual with autism accrues about $3.2 million in costs to society over his or her lifetime, with lost productivity and adult care being the most expensive components. Direct medical costs, such as physician and outpatient services, prescription medication, and behavioral therapies are estimated at more than $29,000 per person per year. Direct non-medical costs, such as special education, camps, and child care can cost anywhere from $38,000 to $43,000 per year.
Many states are passing legislation that requires insurance providers to cover behavioral and speech therapy for children with autism. In Oregon, most children are covered by the Mental Health Parity Law SB 1 or HB 2918. For more extensive and detailed information about healthcare coverage for kids with Autism in Oregon click here. Keep in mind that these laws only cover therapy! All medical and biological treatments are still limited to treating physical conditions (diarrhea, eczema, asthma, immune dysfunction, strep, seizures) that occur more frequently in kids with autism. The good news is that treating these associated conditions will improve cognitive and behavioral function in autistic children.
Despite the disparity in funding, autism research is happening with more momentum than ever before. The research that is coming out right now continues to reshape the way I practice and validate the treatments that I see working in children. Highlights of some of my most recent favorites are listed.
Environmental toxicology continues to represent a large percentage of published research into some of the origins of autism. In the last few years, it has been well established that defective genetics and environmental insult create an intricate interface that predispose a developing nervous and immune system to developmental delay. Current evidence now suggests that autism prevalence is increased in areas of environmental industrial toxic release.
The winter holiday season has drawn to a close and I have finally heard the little voice in my head say, "phew, i'm glad that's over!" Don't get me wrong, I love celebrating. What an amazing time to be surrounded by friends, family and tradition! However, celebration seems to involve too much sugar, too much wine, indulgent food, busy schedules, travel, going to bed late, and did I even mention the cheese platters?
I challenge you to join me in kicking off 2009 with Detox Diet! Anyone can do it. Trust me, I live to eat. Truly, I do. But my new year tradition is to take a few weeks to give my body a break.
For a detailed plan, check out my 14 day Detox Program. This cleanse provides a comprehensive plan that is designed to address all aspects of clinical detoxification. With a two week commitment, you will find yourself energized, motivated and ready to make healthy lifestyle choices that permanently change the way you eat. You may even notice that you lose a few of those holiday pounds!
Let Food Be Thy Medicine,
And Let Thy Medicine Be Food- Hippocrates
Every physician in practice today swears the "Hippocratic Oath" written by the founder of modern medicine. I can think of no better way to honor Hippocrates than to practice good medicine and provide patients a path to whole health.
In this concept of whole health, we have planted an experiment in "food as medicine" by farming the land behind our clinic.
With an organic farm in our back lot, we are expanding the model of health care to recognize food as medicine, sustainability as medicine, community as medicine and exercise as medicine (farm work is hard work!)
What a wonderful feeling to have patients explore the garden after an appointment and take tomatoes fresh off the vine! We invite all of you to stop by and take a look at our garden. Hopefully our farm will be an inspiration to bring gardens to your yard and fresh food to your table. It is easier than you think!
For more photos of the garden, click here!
Here are some Autism Statistics to be aware of :
Autism is diagnosed in 1 in 150 children and 1 in 94 boys(1)
1 to 1.5 million Americans have Autism(2)
Autism is America's fastest-growing developmental disability with 10 - 17 % annual growth
Growth comparison during the 1990s(3):
U.S. population increase: 13%
Disabilities increase: 16%
Autism increase: 172%
Autism has a price tag of about $90 billion annually with 90% of all costs in adult services(4)
Cost of lifelong care can be reduced by 2/3 with early diagnosis and intervention(4)
If you are wondering what you can do to get involved and stay informed, then participate in one of the events listed in the link below. Each of these events donates money to organizations that support families by providing resources and funding research.
1. Based on prevalence statistics from the Centers for Disease Control and Prevention (2007).
2. Based on the autism prevalence rate of 2 to 6 per 1,000 (Centers for Disease Control and Prevention, 2001) and 2000 U.S. Census figure of 280 million Americans.
3. U.S. Department of Education's "Twenty-First Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act" (1999). 4. Jarbrink K, Knapp M, 2001, London School of Economics study: "The economic impact on autism in Britain," 5 (1): 7-22.
Indoor lead dust is a major cause of lead poisoning in children. In a recent Multnomah county study, a screening procedure was used to measure the amount of lead dust in 125 houses in North, Northeast, and Southeast Portland that were built before 1930. Seventy-one percent of the houses had composite lead dust levels that exceeded federal standards. These levels are hazardous to the neurological development and physical health of children and adults! Read more to find out what you can do to protect your family.
Who will benefit: Any parent struggling with feeding a child who suffers from a sensory integration disorder, pervasive developmental disorder, Autism, Asperger Syndrome or ADHD. What parents will learn from this seminar...