In article <1rjifg$bgm@hsdndev.harvard.edu>, rind@enterprise.bih.harvard.edu (David Rind) writes: > In article <1993Apr26.174538.1@vms.ocom.okstate.edu> >  banschbach@vms.ocom.okstate.edu writes: >>oxygen(just like it does in the vagina).  As much stuff as there is in the  >>lay press about L. acidophilus and vaginal yeast infections, I'm really  >>amazed that someone has not done a clinical trial yet to check it out. >  > I've mentioned this study a couple of times now: Ingestion of yogurt > containing Lactobacillus acidophilus as prophylaxis for candidal > vaginitis, Annals of Internal Medicine, 3/1/92 116(5):353-7.  Do you > have a problem with the study because they used yogurt rather than > capsules of lactobacillus (even though it had positive results)? >  > The study was a crossover trial of daily ingestion of 8 ounces of > yogurt.  There was a marked decrease in infections while women were > ingesting the yogurt.  Problems with the study included very small > numbers (33 patients enrolled) and many protocol violations (only > 21 patients were analyzed).  Still, the difference in rates of infection > between the two groups was so large that the study remains fairly > believable. > --  > David Rind  David, this study looks like a good one.  Gordon Rubenfeld did a Medline  search and also sent me the same reference through e-mail.  Since  commercial yogurt does not always have a good Lactobacillus a. or  bulgaricus culture, a negative finding would not have been too informative. This is often the reason why Lactobacillus acidophilus tablets are  recommended rather than yogurt.  I guess the next question is why would this introduction of "good" bacteria  back into the gut decrease the incidence of vaginal candida blooms if the  anus was not serving as a candida reservoir(a fact that Gordon R. vehementy denys)?  I see two possible theories.  One, the L. acidophilus, which is a  facultatively anaerobic bacterium, could make it through the gut and  colonize the rectal area to overgrow the candida.  This would not explain  the reoccurance of candida blooms in the vagina after the yogurt ingestion  was stopped though.  The other is that the additional bacteria in the  intestinal tract remove most of the glucose from the feces and candida  looses it's major food source.  Getting Lactobacillus acidophilus to colonize the vaginal tract(where it is  normally found) would have a much better effect on the recurrance of vaginal  yeast blooms though.  An acetic acid, Lactobacillus acidophilus douche has  been used to get this effect but I've not seen any such treatment reported in  the medical literature.  This would be an example of physicians conducting  their own clinical trials to try to come up with treatments that help their  patients.  When this is done in private practice, the results are rarely, if  ever published.  It was the hallmark of medicine until the modern age  emerged with clinical trials.  It really raises a big question.  Does the  medical profession cast out the adventerous few who try new treatments to  help patients or does it look the other way.  This particular issue is really a very simple one since no real dangerous  therapy is involved(even the anti-fungals are not all that dangerous).  But  there are some areas(like EDTA chelation therapy), where the fire is pretty  hot and somebody could get burned.  It's really tough.  Do I follow only  well established protocols and then give up if they don't work that well or  do it try something that looks like it will work but hasn't been proven to  work yet?  My stand is to consider other treatment possibilities, especially if they  involve little or no risk to the patient.  Getting good bacteria back into  the gut after antibiotic treatment is one treatment possibility.  The other  is getting L. acidophilus into the vaginal tract of a woman who is having a  problem with recurring yeast infections.