Kefir Beats Yogurt in H. pylori Treatment

Kefir improves efficacy and tolerability of triple antibiotic therapy

By Jacob Schor, ND, FABNO

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Reference

Bekar O, Yilmaz Y, Gulten M. Kefir improves the efficacy and tolerability of triple therapy in eradicating helicobacter pylori. J Med Food. 2011;14(4):344-347.

Design

Randomized, double-blind study

Participants

82 consecutive patients with symptoms of dyspepsia and Heliobacter pylori infection confirmed by the urea breath test

Study Medication and Dosage

All patients received a standard triple antibiotic therapy for H. pylori infection consisting of a 2-week course of lansoprazole, amoxicillin, and clarithromycin. In addition, twice each day, 46 of the patients drank a cup of kefir and the remaining 36 drank a cup of milk.

Outcome Measures

A urea breath test was performed on all patients 45 days after beginning treatment. A questionnaire was completed 15 days after the start of treatment in order to assess side effects.

Key Findings

Kefir significantly improved triple antibiotic therapy eradication of H. pylori. Infection was eradicated in more than three-quarters of those patients drinking kefir (36 of 46 [78.2%]), compared with only half of those who received antibiotics plus placebo (18 of 36 [50.0%]). Reported side effects occurred significantly less often and were less severe in those who received kefir.

Practice Implications

One cup of kefir twice per day should be added to standard antibiotic protocol used in the treatment of H. pylori. Kefir increased effectiveness of standard treatment by about 30%. The standard pharmaceutical protocols that employ proton pump inhibitors plus 3 separate antibiotics to treat these infections are not 100% successful; cure rates have fallen below 80%.1

Yogurt does not appear to have the same benefit. A paper published in January 2011 reported that using a yogurt that contained multiple strains of probiotic bacteria, along with triple antibiotic therapy, to treat H. pylori infection “neither improved H. pylori eradication rates nor reduced the adverse events of treatment.”2

Side effects occurred significantly less often and were less severe in those who received kefir.

Kefir differs significantly from yogurt. Yogurt is milk that has been fermented by any of several strains of lactic acid–producing bacteria, typically Lactobacillus acidophilus. Kefir in contrast "is produced by microbial activity of "kefir grains," which have a relatively stable and specific balance of lactic acid bacteria and yeast.” Yogurt cultures do not contain yeast. Yogurt fermentation requires incubation at warm temperatures, while kefir is fermented at room temperature.

Kefir has become quite popular in recent years because of the many claimed health benefits, including “reduction of lactose intolerance symptoms, stimulation of the immune system, lowering cholesterol, and antimutagenic and anticarcinogenic properties.”3

In the literature, kefir is often lumped with other probiotic preparations, and search engines do not distinguish studies on kefir from those on yogurt. For example, a 2009 meta-analysis on fermented milk products and whether they improve H. pylori eradication did not distinguish between them. In this review, the combined data did show a small benefit: “Fermented milk-based probiotic preparations improve H. pylori eradication rates by approximately 5–15%.”4

A 2007 meta-analysis that combined data from earlier studies also examined the effect of probiotic preparations on H. pylori eradication by triple antibiotic therapy. This earlier paper also reported slightly improved eradication rates—about 10% over placebo. All of the studies in this earlier review investigated yogurt made from Lactobacilli acidophilus and not kefir.5

If kefir increases the efficacy of antibiotics against H. pylori, does it improve antibiotic effect against other types of intestinal infections? Possibly. A 2009 paper reports an open trial in which kefir appeared useful in treating Clostridium difficile infections in combination with antibiotics.6

About the Author

Jacob Schor ND, FABNO, is a graduate of National College of Naturopathic Medicine, Portland, Oregon, and recently retired from his practice in Denver, Colorado. He served as president to the Colorado Association of Naturopathic Physicians and is on the board of directors of the Oncology Association of Naturopathic Physicians. He is recognized as a fellow by the American Board of Naturopathic Oncology. He serves on the editorial board for the International Journal of Naturopathic Medicine, Naturopathic Doctor News and Review (NDNR), and Integrative Medicine: A Clinician's Journal. In 2008, he was awarded the Vis Award by the American Association of Naturopathic Physicians. His writing appears regularly in NDNR, the Townsend Letter, and Natural Medicine Journal, where he is the Abstracts & Commentary editor.

References

1. Graham DY. Efficient identification and evaluation of effective Helicobacter pylori therapies. Clin Gastroenterol Hepatol. 2009;7(2):145-148.

2. Yoon H, Kim N, Kim JY, et al. Effects of multistrain probiotic-containing yogurt on second-line triple therapy for Helicobacter pylori infection. J Gastroenterol Hepatol. 2011;26(1):44-48. doi: 10.1111/j.1440-1746.2010.06477.x.

3. Guzel-Seydim ZB, Kok-Tas T, Greene AK, Seydim AC. Review: functional properties of kefir. Crit Rev Food Sci Nutr. 2011;51(3):261-268.

4. Sachdeva A, Nagpal J. Effect of fermented milk-based probiotic preparations on Helicobacter pylori eradication: a systematic review and meta-analysis of randomized-controlled trials. Eur J Gastroenterol Hepatol. 2009;21(1):45-53.

5. Tong JL, Ran ZH, Shen J, Zhang CX, Xiao SD. Meta-analysis: the effect of supplementation with probiotics on eradication rates and adverse events during Helicobacter pylori eradication therapy. Aliment Pharmacol Ther. 2007;25(2):155-168.

6. Bakken JS. Resolution of recurrent Clostridium difficile-associated diarrhea using staggered antibiotic withdrawal and kefir. Minn Med. 2009;92(7):38-40.