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Probiotic bacteria help conquer 'superbugs'

| Saturday, March 28, 2015, 11:10 p.m.
Julia Saltsman, 31, of Murrysville poses with her husband, Brandon Saltsman, 31 and their dog Tinkerbell at their home in Murraysville, Friday, March 27, 2015. Julia underwent a fecal transplant to help her body bounce back from an infection of Clostridium difficile, a tough-to-treat bacterium.
Andrew Russell | Trib Total Media
Julia Saltsman, 31, of Murrysville poses with her husband, Brandon Saltsman, 31 and their dog Tinkerbell at their home in Murraysville, Friday, March 27, 2015. Julia underwent a fecal transplant to help her body bounce back from an infection of Clostridium difficile, a tough-to-treat bacterium.

Stopping antibiotic-resistant “superbugs” that kill about 700,000 people a year could take vaccines, more powerful drugs and better ways to identify dangerous bacteria, federal authorities warn.

But a growing number of doctors sees hope in something available: the helpful bacteria known as probiotics, long trumpeted in yogurt, unpasteurized sauerkraut and fermented cheese.

Advocates expect the micro-organisms will become one key to preventing and treating drug-resistant infections, which a British study found might cause 10 million annual deaths by 2050 if left unchecked. Gastroenterology specialists in Western Pennsylvania recommend probiotics in select cases, such as persistent infections of clostridium difficile, known as C. diff.

“It may not be the only answer, but it will be part of the answer,” said Dr. Hossam Kandil, chief of gastroenterology at Forbes Hospital in Monroeville.

Kandil often suggests probiotics as a supplemental treatment, including for patients with colon inflammation, diarrhea or infections.

Others take probiotic pills in concert with prescribed antibiotics, which can scrub a patient's gut of bacteria — good and bad — in an effort to wipe out infection. Taken alone, antibiotics might leave the body vulnerable to debilitating bugs, such as C. diff, that can overwhelm immune defenses, doctors said.

The White House last week presented a five-year, $1.2 billion plan to fight the superbugs.

Doctors suspect probiotics prevent harmful bacteria from polluting the bloodstream.

“That's what we theorize, but the real answer of how it works is not clearly defined,” Kandil said.

Researchers generally agree the bacteria promote healthy digestion and strengthen the immune system, helping to keep the destructive microbes from multiplying too much.

Billion-dollar industry

No matter the scientific explanation, Americans in record numbers are latching onto probiotics-rich products. Dietary supplements with the bacteria account for $4 billion to $5 billion of the $32 billion supplements industry in the United States, according to the Washington-based Natural Products Association.

Sales in the probiotics category climbed about 13 percent in the past year, association CEO Daniel Fabricant said. He said the products picked up speed in the late 1990s and keep gaining popularity as more studies suggest tangible health benefits.

“Not everyone likes a tasty yogurt. Not everyone likes milk,” Fabricant said. “If you can get it in a pill, I think that's really what drives a purchase decision.”

Manufacturers intend their probiotic offerings to support health, not to treat specific ailments, he noted.

The federal Food and Drug Administration regulates and lists probiotics as supplements, not as medications that companies can market with proven effects.

The agency declined to say whether anyone has applied to manufacture and market a probiotic product as a medication. Doctors said that using the bacteria in clinical settings has proved mostly safe, although exceptions might apply for immune-compromised patients and for babies and in other limited circumstances.

“There aren't too many scenarios in which they've been shown to be helpful. For many things people take them for, they're not necessarily going to be effective,” said Dr. Marc B. Schwartz, a gastroenterology and nutrition specialist at UPMC Presbyterian in Oakland.

Although promising evidence has led more physicians to suggest probiotics during the past five to 10 years, he rarely recommends them to patients.

Schwartz said self-medicating with dietary supplements carries risks and might encourage people to delay seeking an accurate medical diagnosis.

“Not that it would necessarily cause direct harm, but it might not be the solution to the problem at hand,” he said.

The ‘ultimate probiotic'

When Julia Saltsman, 31, of Murrysville developed a relentless C. diff infection in August, Schwartz suggested probiotics — just not in the conventional sense.

He recommended instead a little-known procedure: a fecal transplant. In short, the approach attempts to rebuild a more complete, healthy bacteria community in the gut by injecting another person's fecal matter through an enema or similar method.

Saltsman's donor was her husband, Brandon, 31. The infection had kept her from work and put her in the bathroom up to 30 times a day.

“I had no good bacteria at all” after rounds of antibiotics that lasted for more than two months, she said, crediting the fecal transplant at UPMC Shadyside with restoring her health.

The transplants have soared in popularity in the past few years, logging an effectiveness rate estimated about 90 percent for C. diff infections, said Catherine Duff, founder of the national Fecal Transplant Foundation. Allegheny Health Network, based in the North Side, also offers the procedure.

“Fecal transplant is the ultimate probiotic,” Duff said.

She cited almost 100 domestic clinical trials exploring the approach and projected that physicians will perform as many as 5,000 of the procedures nationwide in 2015, up from fewer than 20 estimated in 2012.

“No one really wants to keep using human feces,” said Dr. Cliff McDonald, a senior adviser for science and integrity at the federal Centers for Disease Control and Prevention in Atlanta.

McDonald said researchers need to develop targeted, refined probiotic treatments that could be tailored for circumstances. Just taking one probiotic supplement does not ensure a vibrant spectrum of bacteria in the digestive tract, he said.

The CDC has not made recommendations about the products. McDonald acknowledged “growing evidence that there's some benefit” but said reviewers need a better sense of what probiotic blends and doses might work for specific ailments.

“Whatever the final product is, (it) has to have the evidence behind it,” he said.

Adam Smeltz is a Trib Total Media staff writer. Reach him at 412-380-5676 or

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