In 1908 Metchnikoff proposed that lactobacillus acidophilus (L A) played an important role in the prolongation of human life through its role in improving the intestinal environment. Metchnikoff's suggestion provoked considerable work on the clinical utility of LA (reviewed by Kopeloff (1926) and by Rettger and his colleagues (1935). Unfortunately, LA products had an acid and cooked taste and were not palatable. After a hiatus in the use of these products during World War II, general interest in LA was not renewed until the 1960s.

Supplementation with LA is an important tool for the maintenance and recovery of health. LA serve directly as antidepressants and mild euphorants since their cell walls contain phenethylalanine (PEA). LA reduce the detoxification burden on the liver because LA inhibit gram negative organisms from proliferating. Fewer gram negative pathogens means a smaller total burden of endotoxin which is found in the cell walls of these pathogens.

LA facilitate the adsorption of food and reduce absorption of allergenic proteins; LA manufactures B vitamins and vitamin K; and LA size and tone the colon by increasing the size and improving the composition of feces. Where the diet is adequately supplied with unrefined carbohydrates and fiber the stool is as much as 85% bacteria, almost all of which are LA. When the ecology of the gut supports a flourishing growth of LA the production of toxins in the colon is almost completely eliminated. Several reviews survey these findings, Sandine et al (1972), Drasar and Hill (1974) and Speck (1978).

Discussion

Intestinal ecology
A favorable intestinal ecology is facilitated by treatment with LA (Beck & Necheles, 1961); infants gain weight after LA feedings (Robinson & Thompson, 1972); E. coli and other pathogens decrease and fecal LA increase after feeding LA (Mutai et al, 1978), and nonfermented LA milk (Gilliland et al, 1971).

Prophylaxis
The major pathway for the lesion of alcoholic sclerosis of the liver may be through an increase in gram negative pathogens. Since endotoxin is found in the cell walls of these pathogens the liver's capacity to detoxify endotoxin may be overcome. Alcohol kills gram positive organisms, including LA, but gram negative pathogens thrive in the alcohol intoxicated gut. LA are antagonistic to S. aureus, Salmonella typhimurium, E. coli and Clostridum perfringens and other pathogens (Gilliland & Speck, 1977); on the other hand, phenethylalanine (PEA), an autogenous antidepressant, is found in the cell walls of gram positive organisms.

LA manufacture B vitamins and vitamin K; LA increase the bulk and improve the composition of feces; LA aid digestion, completely breaking down lactose and galactose; the frequency of eosinophilic leukocytes and immunoglobulin A (IgA) are a function of LA; IgA and LA are often deficient or absent in the gut of schizophrenics (Brown, 1977); and gastrointestinal symptoms associated with many diseases are relieved by aggressive treatment with LA (Rettger op cit).

Antibiotic treatment is followed by an increase in pathogenic bacteria and a decrease in facilitative bacteria such as LA (Dubose et al, 1963). Salmonellosis increased after WWII and LA decreased (Speck, 1978).

Stress is followed by a reduction in LA; meat, alkaline foods, alcohol, sugar and other foods reduce LA (Brown, 1977).

Ordinary Yogurt is Not Adequate
L. bulgaricus, S. thermophilus and S. Lactis rapidly replace LA in yogurt. LA are not stable in yogurt and are replaced by other organisms (Gilliland & Speck, 1977). While yogurt made with L. bulgaricus and other benign organisms may be beneficial to humans, e.g. reducing cholesterol (Hepner et al, 1979), these non-LA yogurts do not increase the ongoing viability of intestinal flora and may even reduce LA (Gilliland & Speck, 1977a, 1977b).

Monitoring Treatment is Easy
Breastfed infants rapidly establish L. bifidis (LB) throughout their originally sterile intestines (Tissier, 1900; Matu & Urutai, 1971); LA and LB can be made to grow in the intestine to the exclusion (95%) of almost all other organisms (Weiss & Rettger, 1934). The establishment of thriving LA is readily observable in the stool (Rettger op cit).

Palatable Acidophilus Milk
A commercial LA product was developed at North Carolina State University in 1975. This product, added to lowfat milk is indistinguishable in taste from ordinary lowfat milk (Speck, 1975); it implants in the human gut; suppresses gram positive organisms (E. coli and others) (Gilliland and Speck, 1977b); and appears to have beneficial effects in human GI illnesses, especially those characterized by diarrhea (Speck, 1975, 1978).

Commercial Strains of LA Adapt to the Human Gut
Rettger (op cit) and other early workers demonstratd that successful implantation of LA in the human gut was followed by symptomatic relief in mucous colitis, irritable colon, idiopathic ulcerative colitis, and various disorders complicated with constipation and biliary symptoms. It was demonstrated that many individuals resist implantation. Recent work verifies Rettger's finding and indicates that LA does not thrive in media which contains l. bulgaricus or other facilitative bacteria (Gilliland and Speck, 1977a). The North Carolina State researchers found that commercial products advertising LA content in conjunction with other lactobacilli in fact do not contain appreciable numbers of LA.

LA and Candida albicans
LA is a normal inhabitant of the healthy human female vaginal vault and is antagonized by vaginomycosis. C. albicans often infests the vagina of depressed women and other psychiatric clients and vaginitis is a routine consequence of pellagra. A common midwife remedy for vaginomycosis is a buttermilk or yogurt douche.

Some Clinical Observations in Psychiatric clients
We observed a series of psychiatric clients (1969 through 1989); most of these clients suffered idiopathic food sensitivities as well as their primary illness and they had fewer LA in stools than normal controls. Psychiatric clients typically had less than 5% LA in stools.

We gave freeze dried LA preparations as supplements to adolescent psychiatric clients (1969-1974); and LA preparations, LA supplemented milk or yogurt cultured from LA milk to adult and adolescent clients (1975 - 1989). When LA increased in stools most clients reported reduction of GI symptoms; and the signs and symptoms associated with food allergy were reduced (frequent bruising, allergic shiners, suborbital edema, myalgia, idiopathic fatigue and endogenous depression).

Almost all milk intolerant clients tolerated freeze dried LA well; and many such clients had no difficulty eating LA yogurt. LA milk was tolerated by some milk intolerant clients. Commercial "Sweet Acidophilus" milk proved an adequate source of LA, especially when cultured into yogurt. Impantation and symptom reduction were adequately produced when "Sweet Acidophilus" milk was used as the source of LA for yogurt cultures. Implantation of LA was more readily obtained by the use of yogurt cultured from "Sweet Acidophilus" milk than by the use of "Sweet Acidophilus" milk without yogurt.

Resistance to LA Implantation
Rettger (op cit) reported that clients require extremely large and persistent supplements of LA. We found this to be true among our clients. We found that dosages as large as 20 standard capsules of LA at meals for 30 days were required to establish LA in the stools of some clients. In several of these resistant clients LA disappeared from stools as soon as supplementation ended.

Most clients maintained a self reproducing colony of LA after they were given three courses of supplementation for a week interspersed with a week rest from supplementation. In the initial period 10 capsules of LA are given with meals for a week.

Subsequently clients are advised to take 10 standard capsules of LA before breakfast, at least once a week, to eat some foods with an acid ash at breakfast, and to observe their stools for the characteristic larger size, lighter color, and tolerable odor associated with LA implantation.

All clients are advised to avoid modern foods, to eat much fiber and to emphasize unprocessed carbohydrates in their diet. A pint of LA yogurt or two quarts of LA milk per day may be adequate substitutes for the freeze dried preparations.

LA and Candida albicans
We have observed a series of 16 women treated for vaginomycosis by douching daily with yogurt cultured from LA while daily consuming 10-20 capsules of freeze dried LA, a pint of LA yogurt, or a quart of LA milk until LA predominates among the microorganisms in the stools.

In 13 of 16 cases the symptoms of vaginitis responded to LA treatment and the clients enjoyed a concurrant lifting of mood. In 3 cases observed in 1981 the clients' skin responded with a positive wheal after intradermal injection of 1:1000 C. albicans vaccine before LA treatment; but after two weeks of LA supplementation an identical injection produced no positive wheal.

Method of Culturing LA Yogurt
In the eastern states LA milk is available in almost all supermarkets under various brand names. This milk is taken and placed directly in one of the containers in a standard yogurt maker (Salton Yogurt Maker, sold by Sears and other stores). The LA milk should not be processed in any way. It is merely poured from the milk box into the yogurt maker glass jar. After 10-20 hours of incubation either a firm yogurt is formed, or a separated white curd with clear whey is found. The white curd or the yogurt is then used as a starter.

Experience indicates that regular, non-LA milk, is best used in the second stage. This milk is brought to a simmer without permitting it to boil. The milk is then allowed to cool to the range indicated on the thermometer supplied with the yogurt incubator. All the jars are then filled and the incubator left on for 10 hours. The resulting palatable yogurt is rich in LA.

Some clients have difficulty following these simple instructions. Our solution to this has been to supply them with yogurt starter, and to hold classes for them at our offices. Since most of our clients are encouraged to rotate foods, to use exotic foods, to prepare foods in ways novel to them and substantially to change their food preparation habits, this added instruction is not a burden to them or to us.

Summary
Observation of a long series of psychiatric clients disclosed a deficiency of lactobacillus acidophilus (LA) in their stools associated with GI symptoms and other evidence of idiosyncratic reactions to food. These clients were also deficient in Immunoglobulin A and had high levels of eosinophilic leukocytes.

Supplementation with high levels of LA in the form of freeze dried LA in capsules, LA cultured milk yogurt, or LA implanted milk ("Sweet Acidophilus") resulted in grossly observable changes in stools, increase in stool LA, and reduction of symptoms associated with food.

Infestations of Candida albicans responded, in 13 of 16 women, to LA douches and LA dietary supplementation. Associated symptoms were relieved as the vaginitis responded to the treatment.

Rettger's early observation that extremely large supplements are required to establish LA was confirmed in these trials. Not less than 10 standard capsules of freeze dried LA per meal for five days appear to be the minimum effective dose for initiating implantation of LA.