Dr. Michael L. McCann MD

Beginning in May, 2002, the Clostridium Difficile Foundation started communicating regularly with Dr. McCann. His expertise and keen interest in our subjects are sure to help us continue our struggles with learning to cope and finding treatments for c. difficile. Here, we will post his articles as they come in.

Meet Dr. McCann

I am a retired pediatrician who has used Probiotics for 30 years with mixed success. Currently I am attempting to write a book about my experience with all kinds of inflammatory bowel disease in order to help patients as you are doing sort out the wheat from the chaff and to get properly diagnosed, and also to try to steer research, badly neglected, in a way I think would be productive.

My approach is to use only clearly defined, proven, non-pathogenic probiotic organisms by the oral route.

I am mainstream with an interest in Probiotic therapy. I have had fellowships in neonatology, metabolism, immunology and allergy and served on the medical faculty of three Universities. My plan on retirement was to open a Probiotic treatment center but Illness has prevented me from that dream. There are alot of misinformation and unproved claims circulating in this field and my basic knowledge might help in sorting some of it out. You might also be a source of some good data collection on such topics as the average no of visits to doctors before a proper diagnosis was made and other such patient surveys we may be able to use in our book.

Respectfully, Michael. L.McCann M.D.

Abnormal Flora, Allergy and C. Difficile...

My major interest is in allergy prevention.

There is a large literature from Europe, the most important of which are by 2 women, who have measured and followed infants from birth, Agnes Wold and Erika Isolauri.

They have shown a significant increase in all types of allergy, most notably allergic asthma, in babies who acquired an abnormal flora at birth, especially C diff.

Their data is impressive and not just a statistical curiosity. The lesser allergy/asthma rate is 4 to 5 fold at age 5 years. The mechanism is theoretically solid and with much supporting evidence. It has to do with the "leaky gut" syndrome.

Two other areas which we will explore in our book are eczema and ADD/ADHD. There is a very important study out of Australia by Rowe and Rowe, now 10 years old, which clearly shows that a subgroup of children who react to the yellow dye # 5, tartrazine, are only the allergic children, not the normal controls. This is not an allergy to the dye per se but to pollens and foods that increase bowel permeability. This in turn allows a normally excluded toxic molecule (such as tartrazine or bacterial toxin) to be absorbed, bypassing the normal bowel barrier mechanisms. Just imagine how much disease could be prevented and drugs avoided if children had normal bowel flora from birth. It is not difficult to do, but it will be years before it is common practice.

The book we plan is to nudge this research along and educate parents so they can ask for these preventive services in the future. Mothers can initiate some of these practices themselves. I have friends in Europe whose baby's first 2 days of feeding include several normal Probiotic bacteria mixed with breast milk.

These are the things I would like to share with your audience, and also protect them from buying expensive products which can be had in foods. Finally there is some misinformation about food allergies and skin testing I would like to share with your audience.

Other Articles & Viability of Probiotics..

The book, we hope, should be done in about a year. In the meantime I would be happy to help answer queries. Meanwhile be sure to refer your readers to article in NEJMed;346;334 (Jan 31, 2002) "Antibiotic-Associated Diarrhea" by Dr John G. Bartlett of Johns Hopkins, the Mecca for this research. It is a very nice summary of the problem of C diff. There is barely a mention of
Probiotics but for a first it is at least mentioned in two lines in the text, p 337, and he refers to Gorbach's Lancet 1987;2;1519 classic article which all patients should know about. Remarkably, a successful probiotic treatment has been known for 15 years and is just now getting the attention of medical establishment.

Another more informative article appeared in just the latest, May 2002, issue of Pediatrics;p956-57 by Jon A. Vanderhoof of U of Nebraska Med Center, Omaha entitled "Probiotics In Pediatrics".. This is a much welcomed publication by a distinguished academician who has made the field his major research interest. So what some practitioners have known empirically for many years is just now being proven in controlled studies. But the field is vast and the organisms so varied that many studies are still required. His summary sentence "Ultimately, we may view probiotics as we now view antibiotics, with many choices of strains useful in different situations." We need to have products labeled with the antibiotic sensitivity pattern of all viable
probiotic organisms, so as to be able to choose the most effective, especially if it is given along with an antibiotic.

We need some sort of Government oversight as to quality and viability because we know that many OTC products are
unreliable. We have cultured some products off the shelf in our lab. Some grow nothing; others have fecal contaminants not listed on the label; one even had an enteric pathogen, a resistant enterococcus; some cannot survive the passage thru the stomach acids. Cost is irrelevant. One of the cheapest was the purest and most viable. So these are the problems patients face. Practicing physicians cannot ethically recommend one product over another or sell it out of their office. That's why we need the help of an independent, non-biased, laboratory where such testing can be done in the absence of any FDA supervision as is the present situation.

Another problem besides quality of product is the proper use. Labeling instructions are inadequate and if followed make most products ineffective. For example, those of us who use probiotics have learned by trial and error that much larger doses are
needed. I routinely incubated our organisms in buttermilk or 1/2 strength skim milk for several hours prior to use in order to get sufficient numbers to inhibit the resident strain. Please fell free to share this email with your readers. Keep up the good work of educating the public about this most important and neglected science of medical therapy.