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TREATING DIARRHEA: THINK BEYOND ANTIMICROBIALS By Donna Raditic, DVM, DACVN, CVA and Laura Gaylord, DVM, DACVN Diarrhea is a common problem in general practice and can be chronic or recurrent in some patients. Numerous diagnostic tests are often performed along with empirical treatments that include the use of dietary interventions, parasiticides, and antimicrobials. There is increasing concern about the risks of indiscriminate use of antimicrobials as antibiotic resistance has become a global issue facing both human and veterinary medicine. Antibiotic resistance is a growing medical problem due to persistent, selective pressure from the widespread use of antimicrobials in humans, animals, and agriculture.1,2 Indiscriminate use of antimicrobials in the veterinary diarrhea patient may also have detrimental consequences creating antimicrobial resistance as a result of individual, long-term disruptions of normal bacterial populations and worsening of gastrointestinal signs.2,3 Instead of using antimicrobials for patients with diarrhea, veterinarians should use dietary intervention and consider the use of probiotics, prebiotics, and other gastrointestinal support supplements.3-5 Probiotics are defined as live microorganisms, which when consumed in adequate amounts as part of a food, may confer a health benefit on the host (Food and Agriculture Organization of the United Nations/World Health Organization, 2002). Those studied in pet health belong to the genera of Lactobacillus (L. acidophilus, L. casei, L. plantarum, L. paracasei, L. lactis, L. rhamnosus), Bifidobacterium (B. infantis, B. lactis, B. longum and B. bifidum) and Enterococcus (E. faecium). These probiotics have been shown to stimulate growth of resident healthy bacteria, to alter bacterial imbalance directly or indirectly
via interactions with enterocytes and the gut immune system.6 Less familiar organisms found in probiotics include the spore-forming bacterium Bacillus (B. coagulans, B. subtilis) and yeasts (Saccharomyces cerevisiae, Saccharomyces boulardii) and fungi (Aspergillus oryzae).1,7-18 Saccharomyces studies in dogs and other species suggest it may improve fecal characteristics and support a healthy gut immune system.11,19-21
Instead of using antimicrobials for patients with diarrhea, veterinarians should use dietary intervention and consider the use of probiotics, prebiotics, and other gastrointestinal support supplements. 3-5
Prebiotics are defined by the International Scientific Association for Probiotics and Prebiotics (ISAPP) as “a substrate that is selectively utilized by host microorganisms conferring a health benefit” and are used in both veterinary therapeutic diets and supplements intended to support gastrointestinal health.1 Studies of complex carbohydrates or fibers such as fructooligosaccharides (FOS) and mannan-oligosaccharide (MOS), and β glucan have shown some benefit and impact on the gut microbiome composition. Prebiotics can alter gut motility and/or may be fermented to produce short chain fatty acids,
especially butyrate which is a source of fuel for enterocytes.1,3-6,10,22,23 Other nutrients such as essential B vitamins, electrolytes (sodium, potassium, chloride) and L-glutamine can be found in pet supplements that support proper digestion and normal gastrointestinal function. The amino acid, L-glutamine is utilized by enterocytes as an intermediary in energy metabolism, promoting enterocyte proliferation, regulating tight junction proteins, suppressing proinflammatory signaling and protecting against cellular stress during normal and pathological conditions. The gut uses about 30% of body glutamine and although classically considered a non-essential amino acid, L-glutamine is considered “conditionally essential” during certain catabolic states, such as trauma or sepsis.24-29 Various botanicals such as slippery elm (Ulmus rubra), licorice (Glycyrrhiza glabra), aloe (Aloe vera), ginger (Zingiber officinale), and psyllium (Plantago ovata) may also be found as ingredients in gastrointestinal pet supplements. Used historically for gastrointestinal health in the medicine systems of other cultures, studies of the benefits of these botanicals are scant, but they may have prebiotic effect and/or antioxidant properties.30-38 As there are increasing concerns of the overuse of antimicrobials to treat veterinary patients with diarrhea there is a need for more research and consideration of other treatments such as probiotics, prebiotics, gut specific nutrients, and botanicals individually or in specific combinations. For a full list of references, visit: VetriProline.com/CB-gi-references
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Moisture (max) . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1%
Vitamin B5 (Pantothenic Acid) . . . . . . . . . . . .10.5 mg
Total Microorganisms . . . . . . . . 10 Billion CFU/gram Lactobacillus acidophilus Lactobacillus plantarum Lactobacillus casei Lactobacillus brevis Bifidobacterium bifidum Bifidobacterium longum Lactobacillus bulgaricus Lactobacillus reuteri
Dried Aspergillus oryzae fermentation extract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1.89 mg
FOS (Fructooligosaccharides). . . . . . . . . . . . . 200 mg
Vitamin B6 (Pyridoxine HCl) . . . . . . . . . . . . . . 2.5 mg
Vitamin B2 (Riboflavin) . . . . . . . . . . . . . . . . . . 1.0 mg
A Proprietary Blend of (Dried Lactobacillus acidophilus, Enterococcus faecium, Lactobacillus casei, Lactobacillus plantarum fermentation products, Dried Aspergillus niger fermentation extract) . . . . . . . . . . 1.3 x 107 CFU Saccharomyces cerevisiae . . . . . . . . . . . 3.4 x 106 CFU Bacillus subtilis . . . . . . . . . . . . . . . . . . . .3.8 x 105 CFU
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