You can read more about Dr. Tolan’s impressive credentials below.

To summarize, Dr. Tolan is the real deal, and is perhaps the best-qualified person to answer my question:

Will nasal saline rinses result in death from brain-eating amoeba??

The main points from that conversation are these:

• Using a Neti pot or other methods of doing nasal saline rinses won’t cause your death by brain-eating amoeba.
• Just to be safe, for nasal saline rinses, simply use boiled tap water, or simply buy a jug of distilled water.

There you have it. For the rest of what Dr. Tolan had to say, read on …

Image: Brain-eating amoeba, N. fowleri (image credit: CDC). The central B&W image is a "phase-contrast" from under the microscope; the pics on either side are stained brain tissue showing infection with amoeba ("Amoebic Meningoencephalitis")

As a world-renowned expert on infectious diseases of the central nervous system, I called Dr. Tolan to ask his opinion about the recent cases in the media, specifically cases of “brain-eating Amoeba” – Amoebic Meningoencephalitis (AM), linked to use of a Neti pot.

I wanted to get to the bottom of this because I have colleagues, patients and their families (and readers of this blog), asking me whether it’s safe to be doing nasal saline rinses at all. Are we risking Amoebic Meningitis by doing nasal saline rinses??

There are two reports that I am familiar with, and both have received a lot of attention on the web, in social media like Facebook and Twitter.

Here is what Dr. Tolan had to say:

Boogordoctor: Dr. Tolan, thank you so much for taking time to offer your expert opinion about Amoebic Meningoencephalitis, from Neti pot use.

Dr. Tolan: My pleasure, Dr. Faust, glad to help.

Boogordoctor: Are you familiar with the recent cases of AM linked to Neti pot use?

Dr. Tolan: I am not, since they have not yet been confirmed by the CDC (Centers for Disease Control and Prevention). I have not seen them reported in the MMWR (Morbidity and Mortality Weekly Report). Don’t believe everything that you read on the internet. Many things are sensationalized to boost readership.

On the other hand, there are some important points to make using these examples.

Boogordoctor: Such as?

Dr. Tolan:

• The first point for your readers to keep in mind is that AM is incredibly rare. There are usually about 3 cases per year in this country annually.
• Most of those cases occur after swimming in ponds in warm environments – Southern states.
• The next point to keep in mind is that the organism responsible for those cases is usually Naegleria fowleri. It is important to point out that N. fowleri is EVERYWHERE in our environment, including our municipal water supply. It is ubiquitous.
• N. fowleri is difficult to kill, especially in environments where it is happiest – in the South, for example. There is simply no way to chlorinate our water supply in the South to levels that will eliminate all N. fowleri. The farther South you go, the warmer the water, the greater the risk of having N. fowleri in your tap water (and ponds, lakes, etc.).
• My recommendation is, for people using Neti pots or other methods of nasal saline irrigations, USE DISTILLED WATER, or BOILED tap water. Distilled water is not absolutely sterile, but will have much lower risk of containing amoeba species than tap water.

Regarding these cases of AM related to Neti pot use that are reported online, I will be interested to see what the CDC investigators tell us. Regardless, it is important to emphasize how rare these cases are in this country.

Boogordoctor: Dr. Tolan, that is great advice, and supports what I have been telling people: use distilled water for your Neti pot or squeeze-bottle for nasal saline rinses – whether you use a store-bought salt preparation or make your own from a recipe.

Again, thanks so much for lending your expertise.

Dr. Tolan: You are very welcome, call any time.

My take on this: if you are doing nasal saline rinses, you have little to fear from Amoeba, as long as you are using distilled water or boiled tap water. You have a much (much) higher risk of exposure to N. fowleri by swimming in lakes or ponds in Southern states.

Conclusions

• It’s not about the Neti pot, or even about nasal rinses.
• It’s about the water.
• Just be sure your water is safe. How?
• Use distilled or boiled water for your nasal rinses!

The Life-Cycle of N. fowleri

The image below shows how N. fowleri (and some other amoeba species) get into our brains: simply swimming in ponds or lakes with high concentrations of amoeba (think warm, Southern states), can result in amoeba reaching our noses; they crawl through our “olfactory neuroepithelium” – that part of our noses that give us the sense of smell), and enter our brains that way. Bad news!

Image: Life-cycles of amoeba

Please leave a comment / reply and let us know how you are doing nasal saline rinses.

And thanks for visiting!

____________________________

About Dr. Robert Tolan

Dr. Tolan is a world-renowned expert on infections of the central nervous system.

He is currently Chief, Division of Allergy, Immunology and Infectious Diseases, The Children’s Hospital at Saint Peter’s University Hospital, New Brunswick, New Jersey and Clinical Associate Professor of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania.

He earned a Master’s Degree in Microbiology before earning his Medical Degree at Washington University School of Medicine. Following his training in Pediatrics, he pursued advanced training and research in Infectious Diseases at Washington University/St. Louis Children’s Hospital. He is board certified in Pediatrics by the American Board of Pediatrics, and also the Sub-Board of Infectious Diseases. He teaches at Drexel University, where he is Associate Clinical Professor.

Dr. Tolan’s research is funded by the NIH; he studies various infections in children and infants, and his list of publications is longer than I am tall.

_______________________________________

Resources:

http://new.dhh.louisiana.gov/index.cfm/newsroom/detail/2332

http://www.medicalnewstoday.com/articles/239422.php – be sure to read the comments: this isn’t about Neti pots! It’s about the WATER.

http://health.yahoo.net/articles/flu/neti-pot-deaths-linked-brain-eating-amoeba-tap-water

http://phoenix.about.com/od/health/qt/Ameba.htm

http://www.wwltv.com/news/health/Doctors-explain-cause-of-brain-eating-amoeba-128043523.html

Image Credit:  All images from the CDC (Centers for Disease Control and Prevention) Image Library, in the Public Domain.

_______________________________________

Hi, I’m Russell Faust, author of this medical education blog.

Let me know what topics are important to you and your child’s respiratory health.

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Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

Cool name. Sounds a little futuristic. In my mind, any name with X’s or Z’s sounds like something from a 1950’s scifi movie. Maybe an alien name.

First, to see the full image, click on the image that accompanies this blog post – it is the cover from a 1938 publication of Amazing Stories. Not only is that appropriate for the story of Xylitol, but it’s just a cool image.

Sounds alien. But it’s not. It’s natural, grown right here on Earth.

Xylitol is a naturally-occurring sugar substitute. It is found in nature in various fruits and vegetables, but is usually prepared for human consumption by extracting it from corn or other vegetable sources.

Xylitol was discovered late in the 19^th century.

Since then, it has been shown to have many benefits:

1. Xylitol has about 1/3 fewer calories than table sugar (sucrose)
2. Xylitol has about the same sweetness for taste as table sugar
3. Xylitol has a low glycemic index – this makes it safer for diabetics
4. Xylitol consumption reduces growth of yeast (Candida)
5. Xylitol in the diet reduces dental caries
6. Xylitol inhibits the growth of various species of bacteria
7. Xylitol inhibits the attachment of various bacteria to the mucosal lining of our respiratory tract
8. Xylitol increases neutrophil activity in experimental models (rats)
9. Xylitol reduces sinusitis in experimental models (rabbits)

Most of these benefits have been demonstrated from human studies. The features #5-7 above are probably responsible for the reduction in ear infections in clinical trials!

Only those last couple – #8 & 9 – are from experimental animal studies. Those have not yet been studied in humans, but the findings are encouraging.

Bottom line: most bacteria and yeast (fungus) cannot easily metabolize Xylitol. They prefer a 6-carbon sugar like glucose (Xylitol is a 5-carbon sugar). Incorporation of Xylitol into the surface polysaccharides of our mucosal cells – lining our aero-digestive tract – prevents bacteria from adhering to the surface. If the bacteria cannot stick to the lining of your nose, or your throat, they cannot have their evil way with you. You win.

What HAS Been Studied in Humans?

Xylitol and Otitis Media

Xylitol has been found to reduce the incidence of acute otitis media – ear infections – in children.

Now we’re getting to the interesting stuff, no?

In the 1970’s there were studies from Finland that showed significant reduced ear infections in children who chewed gum that was sweetened with Xylitol instead of sucrose or fructose. These results have been reproduced in multiple clinical trials in children.

So now you’re thinking, “Well, that doesn’t do me much good, my 1-year-old with the ear infections can’t chew gum.”

That thought occurred to Dr. Lon Jones, too.

Image: Dr. Lon Jones, and Jerry

He was treating otitis media in children, looking for ways to prevent it, to treat it, without surgery.

So he asked whether there were other ways to get Xylitol into children. His goal was to get Xylitol into children without changing their diets, but to get the Xylitol to the area it is needed to achieve the benefits listed above – namely, to reduce adherence of bacteria, to inhibit growth of bacteria and yeast – in the upper respiratory tract of children.

Dr. Jones settled on a simple solution: he added Xylitol to salt water and used it as a nasal spray in children. His clinical trials found a similar reduction in ear infections to those already seen for Xylitol-chewing gum.

So: Xylitol can reduce ear infections. Big up-side benefit.

What is the downside?

None known.

Xylitol in saline nose spray is a safe means of reducing ear infections, and reducing upper respiratory infections in general.

If this is so effective, must cost a lot, no?

No. Xylitol is cheap, cheap. The Xlear patented brand of Xylitol nasal spray can be found online for less than $10. This brand has the optimal concentration of Xylitol to help prevent ear infections and sinus infections, based on medical studies. (Most other sprays that list Xylitol on their ingredients contain only the minimal concentration to be able to meet legal requirements to list it as an ingredient. Scammy.)

If this is so effective, why haven’t I heard about it before?

Perhaps it’s because there are no big pharmaceutical companies behind the product. No advertising.

I’m not a conspiracy-theorist. It is just a simple fact that a generic, inexpensive product like Xylitol cannot make a company a lot of money. As a result, there are no big advertising campaigns behind Xylitol.

So, what are you waiting for?

Image: Xlear Saline Nasal Spray with Xylitol

If YOUR child has recurrent or chronic ear infections, frequent URI’s, rhinitis, or sinusitis, why not give Xylitol a try?

Transparency:

1. I have no financial arrangements with any sources of healthcare products that contain Xylitol.
2. After reviewing the medical literature and all available data, I DO use Xlear Xylitol products for myself and my family, and recommend them for my clinic patients.
3. After using Xlear products, and reading Dr. Jones’ books, I made an effort to meet him (and his wonderful wife, Jerry). For complete transparency, I consider them friends.
4. This site is an Amazon affiliate, and will make some pennies from any purchase through the Amazon Store link. Yes, pennies :))

_______________

Hi, I’m Russell Faust, author of this blog, and I appreciate your comments and questions.  Keep ‘em coming.  Please, “be excellent to one another.”

I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday.

Click here to receive free weekly updates: (http://eepurl.com/FGnP)

Type in your best email address (the one you actually use).

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When the confirmation email from boogor doctor arrives, click on the link to give your okay to receive free weekly updates, occasional book reviews or product reviews, occasional discount-coupons for products that I use (not affiliates), all without needing to visit the website.

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Stay Informed.

Stay Healthy.

Best of health and success to you and your families.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

Randomized clinical trials – the gold standard of medical evidence – have demonstrated significant benefits of Probiotics in a variety of patient populations.

I just reviewed some of these here on this blog: http://wp.me/pR4iB-Gj

Challenges

Unfortunately, most Probiotics are delicate, and are sensitive to various conditions.

These things can KILL your expensive Probiotics:

• Heat: the best probiotics are prepared using a low heat process to avoid damaging the organisms
• Moisture: probiotics must be kept dry until they enter your system; a rainy or humid day can be all that is needed to kill a probiotic preparation
• Oxygen: all probiotics naturally live in an anaerobic environment – without oxygen; oxygen will kill probiotics
• Stomach acid: our stomach acid is designed specifically to kill bacteria that we ingest; stomach acid will rapidly kill most probiotic strains

Variations

There is a huge variation in the quality of Probiotic preparations, in the number and type of bacteria in the preparations, and in the “survivability” of the preparations.

Due to these factors, most probiotic preparations are not guaranteed beyond a certain shelf life or expiration date. Furthermore, there is no way to guarantee how much of the probiotic preparation will make it into your lower GI tract alive.

Most manufacturers simply tell you how much of the preparation is alive at the end of the manufacturing process. This is usually declared on the package as a number of colony-forming-units (CFU’s), named for the number of “colonies” the preparation formed when cultured in the laboratory.

Survival

For any Probiotic organism to be effective it must do these things:

• Survive stomach acid
• Make it through the stomach to the lower GI tract
• “Stick” or adhere to the cells of the intestinal wall – the enterocytes
• Incite the proper immune response – cytokines, bacteriocidins, etc.

That’s a lot of variables.

Maybe that’s why some Randomized Clinical Trials find a strong effect of Probiotics, and some don’t find any effect.

How to Use This Information?

• If you simply swallow some bacteria, the majority of them will be killed by exposure to the air, and by your stomach acid.
  Result? You just wasted a bunch of money on Probiotic bacteria that weren’t alive when they got where you need them. How to avoid that?
• In general, look for a Probiotic preparation with a higher CFU number. That is, the higher the CFU number, the more useful bugs there are in the preparation.
• In general, look for a Probiotic preparation with 3 or 4 different species of bacteria in them. Most of the Randomized Clinical Trials that have found a benefit from Probiotics were based on multi-bacteria preparations.
• Enteric-coated is better than not enteri-coated; powders probably survive least-well – they are exposed to the air (oxygen) and stomach acid. If powder is the best that you can get into your infant, it is probably better than nothing. Look below for comments under Looks Promising for the best of the best for getting active Probiotics to your lower GI tract.

We Don’t Know

Things that we don’t know include how well the probiotic preparations attach to the lining of the GI tract. The biological benefits of probiotic bacteria are due in part to their ability to attach to those lining cells – the enterocytes.

Binding of probiotic bacteria to the GI lining enterocytes results in:

• That binding of beneficial bacteria inhibits the binding of the bad bacteria – the pathogens.
• That binding of probiotic species to the enterocyte also results in the production of “cytokines” – biochemical signals that can enhance the immune system.
• Probiotic bacteria affect the balance of bacteria in the GI tract by their production of lactic acid, and bacteriocidins. These substances inhibit the growth of pathogens, and also change the balance of species in the local environment – the gut ecological balance – the “microbiome”.
• Some probiotic species help neutralize the effects of carcinogenic metabolites such as nitrosamines.

As always, the challenge with Probiotics is to get a preparation that can deliver the proper combination of bacteria past the stomach, to the lower GI tract, alive.

Looks Promising

For Probiotic preparations that look promising, see website for Integrative Therapeutics – an outstanding resource for information on Probiotics. The Probiotic Pearls from Integrative Therapeutics – with the triple enteric coating – allows their Probiotics to make it to the lower GI tract alive!

This is worth repeating:

Probiotic Pearls from Integrative Therapeutics has the FDA regulated guarantee that their Probiotic preparation will make it to the lower GI tract alive!!   I am looking forward to reviewing the randomized clinical trials data for their Probiotic preparations as data become available.

Their data looks good to me. Check out their Probiotic Pearls for yourself.

This is the Probiotic preparation that I am using personally, for our children, and recommend to my patients.

Transparency:  I have NO financial or other arrangements with Integrative Therapeutics.

To summarize, at this time, there are not many evidence-based recommendations in the medical literature. However, we can expect more to come in the near future, as clinical trials demonstrate significant benefits in a variety of patient populations, including newborns, infants, toddlers, and children.

_____________________

Click here to download my free guide to Probiotics: http://bit.ly/dFi1q7

___________________

One caution:  A few studies have shown that patients with extremely compromised immune systems have actually been made sick when given probiotics. If a person has an immune system problem, he or she should consult a doctor before taking probiotics.

Let me put in a plug here for Dr. Greene’s site. He is a pediatrician at Stanford / Packard Children’s Hospital, and his site is a GREAT resource.

Dr. Greene reviews some studies of probiotics, and recommends which ones to get for your little boogorheads:

http://www.drgreene.com/blog/2010/09/07/probiotics-powerful-prevention

___________________

Please leave a message and tell us:

Have you used probiotics for your child(ren)?

If so, what was your goal – what were you treating, if anything?

How did it go?

Which probiotics did you use?

We will all benefit by everyone sharing their experiences.

____________________

Image Credit: MRSA, Just another extraordinary electron-microscopy image by Janice Haney Carr, CDC, Published in the Public Health Image Library.

I want to acknowledge and thank Cathy Leet, BSN, Medical Development Consultant at Integrative Therapeutics, Inc., for kindly pointing out the factors that we should take into account when selecting our probiotic preparations, and for kindly providing data on their probiotic preparations.

____________________

Thanks for visiting.

I appreciate your comments and questions.  Keep ‘em coming.  Please, “be excellent to one another.”

I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday.

Click here to receive free weekly updates: (http://eepurl.com/FGnP)

Type in your best email address (the one you actually use).

Your email is safe - will never be shared or sold. Ever.

Click here to read our Privacy Policy: http://wp.me/PR4iB-r

When the confirmation email from boogor doctor arrives, click on the link to give your okay to receive free weekly updates, occasional book reviews or product reviews, occasional discount-coupons for products that I use (not affiliates), all without needing to visit the website.

It’s free, it’s convenient. No ads. No spam. You can un-subscribe at any time. How cool is that?

Stay Informed.

Stay Healthy.

Best of health and success to you and your families.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

What we really want to know is this:

• Do probiotics help reduce symptoms of any diseases?
• Do probiotics help reduce respiratory symptoms of allergies, rhinitis, sinusitis, asthma, or viral URI syndrome?
• Do probiotics help reduce symptoms of diarrhea or other GI imbalances?
• Do they help reduce any other diseases – infectious or otherwise?

The short answer is: in some cases, yes; in some cases, no.

You will hear grandiose claims by those who are trying to SELL you probiotics.

Read-on to get the facts.

What Does Science Say About Probiotics?

What is the Medical Evidence?

Probiotics for Sinusitis, Rhinitis, and Asthma

In general, there have been no randomized clinical trials (the “gold standard” for medical evidence) that clearly show a benefit for probiotics in treating or preventing sinusitis. On the other hand, many preliminary studies suggest that there may be some benefit, and all studies that have been carried out to date conclude that better studies need to be done. This review was published in the Journal of Antimicrobial Chemotherapy, in 2002.

Similarly, a recent review of randomized clinical trials that looked at using probiotics to reduce allergic rhinitis or asthma concluded that we need more, better-quality studies before a definite decision can be reached. This review was published in the Annals of Allergy, Asthma & Immunology, in 2008.

So – are there areas where probiotics have some PROVEN benefit?

For gastro-intestinal imbalances, the answer has generally been “yes”.

Probiotics and Gastrointestinal Microbiome Health

Probiotics supplements have been shown to be beneficial for treating antibiotic-associated diarrhea, necrotizing enterocolitis (NEC), H. pylori overgrowth, and preliminary evidence suggests that probiotics may perhaps benefit inflammatory bowel disease.

This might make sense – taking a handful of beneficial bacteria by mouth will enter the gastro-intestinal tract. If those beneficial or benign bacteria can survive the stomach acid, they may restore a more beneficial balance in our GI microbiome.

As noted above, there are several well-studied examples where this is indeed the case.

The surprising benefit of probiotics has been demonstrated – not in the GI tract, we expected that – but in the respiratory tract.

Probiotics and Respiratory Health

In a study of children aged 3-5 years, daily consumption of probiotics were found to significantly reduce the incidence and duration of respiratory tract infection symptoms. These results were published in the journal, Pediatrics in 2008.

A study on the affect of probiotics on more than 300 children concluded that probiotic supplements was a safe and effective way to reduce fever, rhinorrhea (runny nose), and cough – both incidence and duration – as well as reduce the need for antibiotics and the number of missed school days due to illness; this study was published in the journal, Pediatrics in 2009.

Got that?  randomized clinical trials discovered that probiotics reduced the frequency, reduced the severity, reduced the need for antibiotics, and reduced the length of symptoms from respiratory illness in children.

What more can you ask from a remedy?

How?

We can only speculate on just HOW probiotics might benefit respiratory infection symptoms, but some studies suggest that our microbiome helps us maintain a healthy immune system:

Probiotics and Human Immune Response

Preliminary results suggest that probiotics can strongly affect our immune system response. For example, results of a study of 7 different probiotic strains suggested that probiotics may act to boost our immune response following oral vaccines.

How our microbiome affects our health, how our diet affects our microbiome, and how probiotics, pre-biotics, and syn-biotics, may affect our microbiome, all provide intriguing potential to optimize our health and wellness.

Stay tuned for updates as I find them.

One caution:  A few studies have shown that patients with extremely compromised immune systems have actually been made sick when given probiotics. If a person has an immune system problem, he or she should consult a doctor before taking probiotics.

You can download my review on Probiotics for Children, including where you can get them, here: http://bit.ly/dFi1q7

Let me put in a plug here for Dr. Greene’s site. He is a pediatrician at Stanford / Packard Children’s Hospital, and his site is a GREAT resource.

Dr. Greene reviews some studies of probiotics, and recommends which ones to get for your little boogorheads:

http://www.drgreene.com/blog/2010/09/07/probiotics-powerful-prevention

___________________

In the meantime, please leave a message and tell us:

Have you used probiotics?

If so, what was your goal – what were you treating, if anything?

How did it go?

Which probiotics did you take?

We will all benefit by everyone sharing their experiences.

____________________

Image Credit: MRSA, by Janice Haney Carr, CDC, Published in the Public Health Image Library

____________________

Thanks for visiting.

I appreciate your comments and questions.  Keep ‘em coming.  Please, “be excellent to one another.”

I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday.

Click here to receive free weekly updates: (http://eepurl.com/FGnP)

Type in your best email address (the one you actually use).

Your email is safe - will never be shared or sold. Ever.

Click here to read our Privacy Policy: http://wp.me/PR4iB-r

When the confirmation email from boogor doctor arrives, click on the link to give your okay to receive free weekly updates, occasional book reviews or product reviews, occasional discount-coupons for products that I use (not affiliates), all without needing to visit the website.

It’s free, it’s convenient. No ads. No spam. You can un-subscribe at any time. How cool is that?

Stay Informed.

Stay Healthy.

Best of health and success to you and your families.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)