E. coli or Escherichia coli is a bacterial organism of the family Enterobacter and was discovered by a German Paediatrician – Theodore Escherich in 1885, hence it’s name.

E. coli is a remarkable organism for many reasons and has the most number of nobel prize winners of any organism to date, particularly from the scientists that have studied it throughout the 19th and 20th centuries.
There are many different strains of E. coli based on structure, function and specifically, the markers O, H and K, as commonly describes any single strain. Each strain has it’s own peculiar traits/characteristics. Strain K12 has been a model micro-organism for scientific study throughout the years.

The most notorious strains are O157:H7 (EHEC) and O104:H4 (Shiga toxin producing) that cause significant diarrhoea and can lead to severe complications. On the positive side O6:K5:H1 (Nissle strain) outcompetes and antagonizes the most dangerous E. coli strains, is the most extensively studied E. coli strain in the world and is now produced as the medical probiotic Mutaflor®.

The biotechnology era in human industrial evolution, was jumpstarted by E. coli, and significant chemicals, substances and foodstuffs are now produced by these mini-factories. Some examples include insulin to treat diabetes and renin in cheese production.

In the human gut, E. coli is a universal commensal species in the lower gut where it performs a variety of functions that help the human body among which are the fermentation of specific difficult to digest carbohydrates and production of short chain fatty acids that facilitate colon cell energy.

There are also bad E. coli that can arise in the gut and these can cause a variety of problems including diarrhoea, fever, stomach cramping, toxins in the blood as well as serious complications including kidney damage and blood infections. But there is also good E. coli that can police the bad E. coli in our guts.

Outbreaks of diarrhoea globally have resulted in bad E. coli becoming prominent in the news. Examples include:

• O104:H4 recent Shiga toxin outbreak in Germany in 2011 linked to Fenugreek seeds and Sprouts
• O157:H7 outbreaks
  • Spinach-related diarrhoea in 2006
  • Jack-in-the-Box hamburger outbreak in 1993
• Enterotoxigenic E. coli (ETEC) outbreaks and occurrences in Asia
  • In South Asia, the term ‘Bali belly’ describes travellers to Indonesia that encounter significant diarrhoea after consuming ‘street food’ or the term ‘Delhi belly’ that describes traveller encounters with significant diarrhoea from ‘street food’ consumption in India

Certain strains of E. coli in your gut can hence be very bad, and the bad E. coli (along with other gut pathogens like viruses) also are often able to transfer their bad genetic material to commensal E. coli that was originally harmless in your gut, and these harmless E. coli then become harmful as a result.

There is nevertheless good E. coli (Nissle 1917 strain) that combats and outcompetes the bad and is resistant to any genetic material from the bad E. coli that you may consume. Nissle 1917 strain that colonizes your lower gut, retains protective and beneficial effects despite exposure to bad E. coli and pathogens.

Bad gut E. coli can generally be sub-classified by the nature of their actions as well as the individual strains that belong to the sub-classes.

These include:

• Enterotoxigenic E. coli (ETEC)
  • Attaches to the intestines via hair-like appendages called fimbriae, and produces toxins. ETEC causes diarrhoea without fever. It is common in infants and is often the cause of traveller’s diarrhoea.
• Enteroinvasive E. coli (EIEC)
  • Invades and destroys cells lining the colon and causes watery dysentery-like diarrhoea. Fever is a common symptom.
• Enteropathogenic E. coli (EPEC)
  • Attaches to cells in the intestines via an attachment protein called intimin and causes watery, sometimes bloody diarrhoea. It is a common cause of infantile diarrhoea in underdeveloped countries.
• Enteroaggregative E. coli (EAEC)
  • Attaches to the cells lining the intestines in a distinctive clumping manner and produce enteroaggregative toxin. EAEC strains often cause prolonged diarrhoea in children.
• Enterohemorrhagic E. coli (EHEC)
  • Attaches to the intestinal cells via intimin protein, but produces a poison called Shiga toxin. EHEC strains cause bloody diarrhoea and can sometimes damage the kidneys and progress to the potentially fatal haemolytic uremic syndrome (HUS). EHEC has caused many large food-borne outbreaks worldwide. O157:H7 is the most notorious strain. This group is also known as Shiga-toxin producing E. coli (STEC).
• Extraintestinal Pathogenic E. coli (ExPEC)
  • Uropathogenic E. coli (UPEC)
  • Septicemic E. coli (SEPEC)
  • Neuropathogenic E. coli (MENEC)

Definitely, the medical probiotic with the most extensive good clinical data for the lower gut is Mutaflor® but there are other probiotic preparations that suit other parts of the human gut and can benefit different conditions, are able to exert complementary beneficial actions to Mutaflor® and occupy a different ecological niche in the gut compared to E. coli Nissle 1917.

Please note that taking any other good probiotic relies on good strain/s that are packaged in a good delivery system so that they are targeted to the right parts of the gut with the right quantities of viable organisms. Many probiotic products claim good strains, but don’t deliver appropriate quantities nor accord suitable storage/expiry conditions to ensure viable organisms. Some strains are also highly sub-classified for beneficial clinical effect tested, yet separately classed organisms from the strain are actually made available commercially instead of the clinically tested ones.

For complimentary products, we recognize Mutaflor® and a product like VSL#3 to together deliver the best range of Lactobacillus, Bifidobacter and E. coli species in viable forms and numbers to occupy the best gut ecological niches for physiological benefit.

Please note that if you are looking to treat/prophylact any medical condition with combinations of probiotics, consult a qualified physician.

Mutaflor® capsules are ideally taken in the morning with a glass of water and with food, or in the case of the suspension, dribbled into the mouth in the morning with food.

Mutaflor® nevertheless can also be taken throughout the day, preferably at the same time and before food for daily regimes, or split dosing at equal intervals throughout the day.

No, in fact Mutaflor® is very useful to take when you encounter a course of antibiotics, as it helps to regenerate good gut flora especially in the lower gut, reduce bowel disturbances caused by the antibiotics, reduce inflammatory response that can be brought on by some antibiotics, and can complement antibiotic regimes in modulating immune responses.

Please note that Mutaflor® E. coli Nissle 1917 belongs to a class of bacteria known as Gram –ves. This class of bacteria is sensitive to specific antibiotics including sulphonamides and fluoroquinolones that can kill them, and make a Mutaflor® regime less effective if given together with the antibiotic. The best way to dose Mutaflor® with Gram-ve targeting antibiotics is to separate the doses by 2 – 4 hours with the antibiotic given first then Mutaflor®.

There are other antibiotics including Clindamycin, Erythromycin and Metronidazole, that E. coli Nissle 1917 has a natural resistance to and these can be given together without any damage to Nissle 1917. If you are on any of these antibiotics including treatments for H. pylori infections in the stomach, Mutaflor® complements the therapeutic regime, mediating anti-inflammatory gut activities, moderating bowel movements that can be upset by the antibiotics, and facilitating regrowth of good flora.

Usefully, E. coli Nissle 1917 does not share genetic elements for antibiotic resistance and will not contribute to antibiotic-resistance in the human gut. It is also sensitive to blood components and gets killed very quickly if it gets into the bloodstream from the gut. This unique aspect of Nissle 1917 makes it a safer probiotic option for individuals at risk of being immune-compromised while on antibiotics.

There are many reasons for a stomach ache or upset and a single occasion would not be immediately calmed by taking Mutaflor®, especially if you are taking it for the first time. If this is a sporadic occasion of upset stomach, or due to excessive food/drink consumption, taking Mutaflor® will not offer immediate relief, and you are better advised to seek the qualified use of an anti-spasmodic or engage simple lifestyle measures to manage it. Should your stomach ache/upset be related to gastric, quick relief may be better obtained by taking a preparation that rapidly neutralizes the acid or inflammation. For any prolonged/recurring stomach ache/upset, please consult a qualified physician for a proper diagnosis and treatment.

The primary site of action for Mutaflor® is the lower gut, not the stomach hence there may be other probiotic preparations that are more localized to the stomach and may complement your lifestyle/condition better.

Mutaflor® nevertheless can modulate bowel movements and reduce the inflammatory response throughout the gut once you have taken it appropriately for a sufficient time to enable effective colonization in the lower gut. Mutaflor® also protects your gut from specific pathogenic gut infections that cause localized pain sensations in any part of the gut.

Mutaflor® as a product is at the top-end of probiotic preparations, and has been described as the Rolls Royce of probiotic preparations.

Mutaflor® capsules are specifically designed to provide suitably viable counts of E. coli Nissle 1917 with intact and targeted delivery to the terminal ileum of the human gut.

It is the only product with the best investigated therapeutically used E. coli strain in the world, with almost 100 years of use in medicine. E. coli Nissle 1917 is stocked in the German Collection of Microorganisms and Cell Cultures with complete genomic DNA sequenced in 2014.

As a product, Mutaflor® complies with stringent quality and harmlessness criteria. Mutaflor® is produced in Germany to Good Manufacturing Practice (GMP) pharmaceutical standards and has strictly defined microbiological purity, viable strain cell count, apathogenicity and genetic stability.

From the extensive clinical efficacy and safety data available, Mutaflor® is actually registered as a medicinal product, medical probiotic and medical food in different countries. The vast majority of commercial probiotic products cannot fulfil sufficient criteria to be considered a medical probiotic.

Anyone can benefit from Mutaflor®, and there are no known age restrictions, with beneficial effects applicable all the way from full/pre-term babies through to pregnant women and individuals with specific medical conditions.

There are situations when probiotics generally may not be appropriate especially in meteorism or situations where an individual generally has too much bacteria in the gut with inability to expel, or experiences a physical obstruction to proper gut movements.

In considering Mutaflor® or any other probiotic preparation for the treatment or prevention of any medical condition, please consult a qualified physician.

Several strains of Lactobacillus and Bifidobacter, as well as Streptococcus thermophilus and some yeast like Sachromyces Boulardii, all have good clinical data in providing beneficial effects in a variety of situations.

The majority of commercial probiotic products hence look to incorporate as many strains as they can to demonstrate value. This often rarely occurs however simply due to the fact that each product needs a consistent amount of viable cells per strain, maintained in a good product that provides an effective delivery system to ensure the right amounts of beneficial bacteria colonize the right parts of the gut.

Important to note is that most probiotic bacteria that are delivered unprotected are killed by the stomach acids, bile or simply do not adhere to gastric/intestinal cells in any sufficient numbers to colonize and hence get passed out of the human body.

Some product manufacturers look to get around this by bulking up the quantity of probiotic bacteria and strains in the hope that sufficient amounts survive and colonize. These can lead to other problems if too much bacteria (even good ones) are ingested, leading to bloating and other potential discomforts. Ideal quantities to be ingested daily in a probiotic product range from 1 – 40 billion colony forming units (CFUs) per select strain.

Many companies also circumvent the costs required to produce a good quality product with many strains through several different strategies:

• Stating many strains on the product label but neglecting to mention how many viable CFUs of each strain are present – this leads to ‘window dressing’ or bulking up on some good strains at the expense of others. Some products even just state the weight of the product/strains without mention of the CFUs. Others incorporate dead strains instead of live ones.
• Putting many strains together without appropriate consideration or testing for how those strains may even compete with each other in the product itself and lead to inconsistent numbers reaching the targeted sites in the gut.
• Including prebiotics with claims that viable counts of many strains are hence delivered despite the fact that the prebiotics may be selectively used by specific strains at the expense of others.

With Mutaflor®, you can be assured that E. coli Nissle 1917 is a natural colonizer of the lower gut with maximum capability of linking to intestinal cells and to one another in forming biofilms across the gut mucosal layers at the human body temperature of 37 degrees Celsius. When stored and used appropriately, each Mutaflor® capsule delivers 2.5 – 25 billion CFUs of E. coli Nissle 1917 in a coated capsule designed and tested to disintegrate and release the Nissle 1917 cells specifically in the terminal ileum leading on to the colon where it acts most beneficially.

Not least, a good multiple-strain product can be good for you as a general gut well-being probiotic and there are good products with clinical data for specific medical conditions as well. This does not negate/preclude the benefits of taking Mutaflor® daily with it’s unique ecological niche in maintaining lower gut well-being. And if you desire complimentary synergy for such purposes, then a combination of Mutaflor® and a product like VSL#3 can be a good option.

Mutaflor® should ideally be kept cool at all times, or at least kept cool for short periods outside the refrigeration limits of 2-8 degrees Celsius. This better ensures the maximal viable cells that get to be beneficial in your gut.

If you travel in cold climates (-15 to 15 degrees Celsius), up to 7 days outside of refrigeration limits would not affect the product viability. If you travel in warmer climates (>25 – 33 degrees Celsius), 1-2 days outside of refrigeration limits is not expected to affect product viability significantly.

If your circumstances permit, it is useful for you to have ice/cold packs available or a mini-fridge that can help you keep the product cool in transitions.

Mutaflor® should be stored in a cool, dry place and requires storage under refrigerated conditions (2-8 degrees Celsius) to ensure viable cell counts up to expiry.

The usual dose of Mutaflor® for adults and teenagers is 1 capsule a day. If starting on Mutaflor® and you experience some bloating, the dose can be reduced to 1 capsule every alternate day for 1 – 2 weeks as you get used to it, then increased up to 1 – 2 capsules per day.

Conditions like chronic constipation can benefit from up to 4 capsules of Mutaflor® per day. Certain conditions benefit from long-term regular use of low-dose Mutaflor®. Others may benefit simply from short-term use or replenishment periods of E. coli Nissle 1917 to the lower gut.

If you look to treat or prevent any medical condition, please consult a qualified physician in determining suitability, the optimal dose and frequency.

Yes, for individuals who have never taken Mutaflor® before, experiencing some bloating on initial dosing is quite normal. This subsides as your body gets used to the regular pattern of consumption. If you prefer a more gradual adjustment, take Mutaflor® 1 capsule every alternate day for the first 2 weeks then gradually increase the dosing frequency.

Yes, usually people that start on Mutaflor® experience a first few days of increased gas production in the gut that can manifest in bloating, burping or flatulence as the gas looks to be released from the body. This is normal and is from the E. coli Nissle 1917 starting to perform it’s functions in the lower gut where it ferments food particles and starts to colonize and regulate bowel movements into a healthy rhythm. Your stool consistency and frequency will experience changes as well over the course of the first few days of taking Mutaflor®. All this is normal.

All this is part of Mutaflor® improving bowel rhythms and getting your body to move food/material through the gut better and more consistently.

As your body gets used to Mutaflor®, stable bowel functioning emerges within a week and is maintained by regular dosing of Mutaflor® to protect against food-based lower gut pathogens and maintain Nissle 1917 levels in the lower gut that may get diminished with daily/lifestyle stressors.

Very rarely, if you are just starting on Mutaflor®, stomach discomfort may be experienced with Mutaflor® adding to other physiological functions that may be causing you pain/discomfort/cramping/sounds to the stomach area or perhaps nausea or vomiting.

If you are unsure about any effect that persists or that you experience as may not be listed here, please check with a doctor.

The strains are significantly different despite being from the same species of E. coli. Nissle 1917, as the best studied good E. coli strain, has good traits that are different from the bad E. coli strains and provides the human gut with many beneficial effects including competing with and antagonizing the bad strains. Nissle 1917 also does not produce any toxins that lead to diarrhoea and is genetically stable so it is not influenced by bad E. coli to become harmful.

The short expiry for Mutaflor® is related to it’s manufacture and maintaining sufficient viable cells for each capsule and suspension to be effective when consumed. We aim to ensure that you receive Mutaflor® with at least 4 – 6 months to the listed expiry date.

The average shelf-life upon manufacture completion for any Mutaflor® product is 12 months when stored under refrigerated conditions (2 – 8 degrees Celsius). Upon completion of manufacturing tests and eventual shipment from Germany to Singapore, the remaining shelf-life is about 10 months. We look to ensure this product then reaches you in expedited fashion upon an order.

Please note that upon expiry of the product, toxic substances are NEVER generated. A Mutaflor® capsule remains viable even 1 – 2 months past the listed expiry date when stored appropriately. We just cannot guarantee the viable cell count based on refrigerated storage after expiry.

The vast majority if not all good probiotics have to be kept at low temperature to ensure sufficient numbers of viable cells upon consumption into the human gut and exposure of the probiotic organisms, wherein the temperature rapidly reaches 37 degrees Celsius or slightly more.

Just as you can expect a fresh market item like fish to go bad faster when kept at room temperature as opposed to frozen or refrigerated, a similar process occurs with all forms of living probiotic organisms whereby for every 10 degrees Celsius rise in temperature, there is roughly a doubling in the rate of degeneration of the product content, reducing shelf-life and viable cells concurrently.

For Mutaflor®, the ‘live’ E. coli Nissle 1917 cells are freeze dried such that they are in suspended animation without water and function at very low metabolism that limits them from growing and consequently dying. If the temperature rises and hydration occurs to the cells when they haven’t yet been consumed into the human body, they can quickly become animated and begin to die without the ecosystem nutrition and support of the human gut.

All other ‘live’ probiotic products experience the same phenomenon despite manufacturers sometimes claiming specific technology that allows the products to remain viable with full shelf-life yet without refrigeration. Some manufacturers hence only guarantee the viable cell count at the time of manufacture. Others add prebiotics or bulk up with higher bacterial cell quantities than labelled into the product so that sufficient ‘live’ quantities survive despite room temperature storage.

There are however certain probiotic preparations that either use hardy strains like soil bacteria which are more naturally resistant to temperature/humidity variations despite nutritional starvation or use strains that have longer life cycles or ones that thrive at higher temperatures/humidity, and these may hence confer a suitable shelf-life without refrigeration.

For preparations like Lacteol Forte that are stored at room temperature, the product is essentially ‘dead’, and has no prolonged positive impact other than symptom management in certain conditions.

From our best experience to date, the ‘live’ probiotics with the best clinical data that include specific strains of Lactobacillus, Bifidobacter and Mutaflor® with E. coli Nissle 1917, all have to be refrigerated to ensure the most viable numbers of live cells throughout the intended shelf-life.

VSL#3 is regarded as a medical food with clinical studies and data that provide useful benefits in certain conditions similar to Mutaflor®. VSL#3 is also an 8-strain product that contains a good range of beneficial Lactobacillus and Bifidobacter strains as well as Streptococcus thermophilus. These strains may provide beneficial effect in different ecological niches to E. coli Nissle 1917 in the human gut.

It is not entirely clear though how many of each strain of VSL#3 is available per dose nor whether an appropriate amount of each strain makes it to colonization in the human gut apart from the acute effects per dose.

VSL#3 also does not provide targeted nor protected delivery of the organisms and much of any dose gets killed by the stomach acids and bile while the remaining Lactobacillus also often does not adhere well in the lower gut and gets passed out rather that colonize.

Flushing the human body with excessively large numbers of bacteria like that found in VSL#3 also can lend to potential bacterial overload problems like bloating while too much Lactobacillus in immune-compromised individuals or those with leaky gut syndrome, can increase the likelihood of Lactobacillus getting into the blood stream from the gut and causing serious problems.

VSL#3 product strains importantly cannot antagonize or compete with bad/pathogenic E. coli strains in the gut to the same degree as Mutaflor® has been shown to in it’s specific gut ecological niche.

VSL#3 nevertheless supplies strains of accepted good bacteria different from Mutaflor®, and with clinical study support for beneficial use in general gut health and certain specific conditions. Some people can benefit from switching and alternating between Mutaflor® and VSL#3 for general gut health and well-being as well as supporting different conditions. Others choose maximal benefit by taking both Mutaflor® and VSL#3 together.

For individuals with specific medical conditions, your physician can best help you with the most appropriate product/s and regime/s.

The combination of effectiveness of E. coli Nissle 1917 strain, it’s safety data and long-term safe use in medicine (almost 100 years to date) along with quality to the overall product design and manufacture all lend to a very uniquely good medical probiotic.

Please visit our homepage for specifics to why E. coli Nissle 1917 and Mutaflor® as a product brings your gut value beyond any other probiotic product.

If you need any additional information, please contact our customer service.

Mutaflor® was not specifically developed for pets hence the release profile of the product for targeted delivery into the guts of different pet animals would be different and somewhat unpredictable especially in relation to adult pet animals like dogs or cats.

E. coli Nissle 1917 strain nevertheless has been well used in farm animals, especially in young or newly born animals for colonization prophylaxis and diarrhoea treatment/prevention in farm animals like cows and pigs. Today, E. coli Nissle 1917 is being used in the animal industry to protect livestock from pathogenic E. coli, enable faster immune system development and maturity, as well as treat and protect against diarrhoea.

If you would like to use Mutaflor® for your pet, please consult with your vet.

Mutaflor® in Singapore can be purchased by retail at Amber Compounding Pharmacy and select reputed healthcare retailers with qualified physicians, pharmacists, nutritionists or dieticians.

Under the Amber Shield range, Amber Laboratories offers Mutaflor® online here with free delivery to any address in Singapore (minimum order of SGD150 applies).

Please click the ‘Buy’ icon on our site for directions to make your purchase online.
If you have any questions, our customer service representative can be reached by live chat or our contact us email form.

Mutaflor® in Singapore can be purchased by retail at Amber Compounding Pharmacy located in Chinatown (further location and operating hours are available on our ‘Contact’ page) as well as select reputed healthcare retailers with qualified physicians, pharmacists, nutritionists or dieticians. You can find a selection of these in our ‘Resources’ page.

The most common interaction is of Mutaflor® with Gram –ve targeting antibiotics. This range of antibiotics can reduce the effectiveness of Mutaflor® as the E. coli Nissle 1917 strain is a Gram –ve bacteria. It does not develop antibiotic resistance and is susceptible to being killed by this range of antibiotics. Examples of these antibiotics include fluoroquinolones like ciprofloxacin or levofloxacin, sulphonamides like Bactrim® or specific cephalosporins like ceftriaxone etc. If you are in doubt whether you are on a Gram –ve targeting antibiotic, please check with your treating doctor or pharmacist.

Mutaflor® can nevertheless still be given with any antibiotics, because Mutaflor® does not affect the antibiotic’s effectiveness. In maximising Mutaflor®’s effectiveness when given with Gram –ve antibiotics, take the 2 separately at an interval of 2 – 4 hours.

Gram +ve targeting antibiotics do not affect E. coli Nissle 1917 nor vice versa. And Mutaflor® is not expected to have any significant interactions with any other medications.

Mutaflor® for general gut health and well-being can be taken 1 – 2 capsules a day regularly for long-term use.
For it’s supportive actions in specific medical conditions like inflammatory bowel diseases that include the remission phase of ulcerative colitis, Mutaflor® is ideally taken 1 capsule daily, regularly and for at least a year.

In conditions like chronic adult constipation and acute diarrhoea, Mutaflor® is beneficial in normalising bowel movements when taken regularly or in acute instances for short periods over the condition’s course.

For short instances of antibiotic use or travel-related gut protection, Mutaflor® can be taken 1 -2 capsules a day before, during and just after the period of indication for good flora regrowth and protection against pathogenic E. coli.

With long-term use of antibiotics, taking Mutaflor® 1 – 2 capsules a day can be a useful option to maintain good colonic E. coli flora without the development of antibiotic resistance and reducing associated inflammatory gut activity.
For infants and toddlers experiencing diarrhoea, Mutalfor® suspension is ideally dribbled into the mouth 1ml – 3ml per day usually for the week of the diarrhoea for it’s supportive benefits in shortening the duration and recovery.

With newborns and the very young, in supporting development and protecting against gut pathogens, Mutaflor® suspension is ideally dribbled into the mouth 1ml per day for the first week then 1ml per alternate day over the next 2 weeks.
Please check with your treating physician if you look to use Mutaflor® for the treatment or prevention of any medical condition to determine the suitability and optimal length of use.

Mutaflor® is a medical probiotic with extensive research and development into understanding Nissle 1917, accumulating almost 100 years of good data and experience in medicine.

Mutaflor® as a product, contains E. coli Nissle 1917 as the only good E. coli-based medical probiotic with uniquely beneficial ecological niche in the lower gut of humans. The delivery system is targeted very specifically with capsules that protect the E. coli Nissle 1917 from stomach acids and bile, only subsequently disintegrating when it reaches the terminal ileum, reaching the colon. Each product is designed, developed, manufactured, stored and delivered with aspects of quality that assure you of the 2.5 – 25 billion ‘live’ E. coli Nissle 1917 cells that will reach your lower gut and start to provide beneficial activity with each capsule.

The safety testing for Mutaflor® is nothing short of standards ascribed to pharmaceutical product development, and every Mutaflor® product that reaches you conforms to very strict standards of number of ‘live’ Nissle 1917 cells, purity of the Nissle 1917 strain without any contamination, the non-harmful nature of the product and the genetic stability of Nissle 1917 such that it never changes to cause harm nor acquite/contribute to antibiotic resistance.

The quality of the product is ensured throughout all stages of manufacturing, production, storage, distribution and delivery. Every batch and product of Mutaflor® is produced to Good Manufacturing Practice (GMP) standards, distributed and stored with cold chain standards to ensure 2 – 8 degrees Cesius, and delivered in Singapore under Good Distribution Practice (GDP).

Mutaflor® is acknowledged as a medical probiotic for several reasons as it fulfils stringent criteria and requirements for:

• Clinical data, comparable to pharmaceutical products for effectiveness in specific medical conditions
• Safety tested and confirmed for in many aspects including viable count, microbiological purity, apathogenicity and genetic stability
• Quality of the product and manufacturing standards to German and Eropean Union pharmaceutical Good Manufacturing Practice (GMP)

Mutaflor® has been used for almost 100 years now in medicine with good tolerance and clinical benefits that go beyond the dietary and functional food aspects.

E. coli Nissle 1917 is cultured, developed and manufactured into Mutaflor® as a product in German facilities under pharmaceutical standards of Good Manufacturing Practice (GMP). Quality controls and standards are built into every stage of research and development, production and manufacturing.

Every batch produced is fully tested to conform to stringent quality standards reflected in a Certificate of Analysis (CoA) prior to export.

Throughout the delivery process of Mutaflor® products from Germany to us here in Singapore, the finished product is consistently managed under refrigerated conditions of 2 – 8 degrees Celsius.

Upon arrival at Amber Compounding Pharmacy in Singapore, Mutaflor® remains stored under refrigerated conditions in compliance with Good Distribution Practices (GDP) for medicinal products as certified by the Health Sciences Authority in Singapore.

Healthcare professionals and related healthcare-related retail establishments receive the Mutaflor® from the pharmacy also under cold-chain delivery conditions prior to their own refrigerated storage and subsequent availing of the product to individuals.

If you purchase online from us here with a delivery address in Singapore, your order will be shipped to you similarly under cold chain conditions so that you receive your fresh, optimal quality Mutaflor®!

Lacteol Fort® is quite different from Mutaflor® in that:

• It is a ‘dead’ component of the Lactobacillus species, purported to cover/cloak intestinal cells in protecting them from pathogenic attachments and toxin contact. Consumption of Lacteol Fort® is actually likely to result in most of the dose not adhering to the lower gut mucosal cells and getting passed out. Orally administered ‘live’ Lactobacillus itself usually will not adhere to lower gut mucosal cells to any good degree for colonization let alone ‘dead’ components. E.coli Nissle 1917 has active ‘live’ components tailored for attachment to the lower gut mucosal cells and the formation of biofilms optimally at 37 degrees Celsius in outcompeting related pathogens.
• Lacteol Fort® may only act towards symptom management in aspects like acute diarrhoea without any substantive effect in improving the gut ecosystem. ‘Live’ good bacteria like E. coli Nissle 1917 naturally improve lower gut and colonic flora while exerting good effects that are much more lasting upon colonization.
• Lacteol Fort® does not have anti-inflammatory action in the lower gut nor is it able to outcompete or antagonise pathogens and pathogenic E. coli growth/colonization.
• Lacteol Fort® has no effect on improving tight junctions between lower gut cells, which may exacerbate the impact of diarrhoea on toxins and other pathogens that can leak through the gut wall towards the blood. E. coli Nissle 1917 however works to restore the barrier function in leaky gut syndrome and can actively complement diarrhoea reducing strategies with additional barrier development and protection.
• Lacteol Fort® may have a role in short-term symptom management of certain conditions related to diarrhoea, but does not come close to the same spectrum of activity nor level of clinical efficacy for the conditions that Mutaflor® is used for supportive management. Lacteol Fort® also has only around 30 years history of clinical use compared with almost 100 years of good clinical experience with Mutaflor®.

In normalising bowel movements related to the lower gut abnormalities and protecting against specific infectious pathogens including diarrhoea-inducing pathogenic E. coli, the ‘live’ E. coli Nissle from Mutaflor® not only resolve bowel symptoms quickly, but also provide a longer-term protective effect along with lower gut ecosystem development.

Certain soil-based bacteria are among some of the newer promoted strains of bacteria with purported benefits as probiotics for human consumption. Bacillus subtilis was even used quite significantly as a probiotic in the 1950’s and 1960’s.

The science behind the benefits is that these bacteria may do for plants what our gut microbiome does for us. These strains can produce specific nutrients, with some exerting anti-fungal properties. Some of these strains are also preferred by various probiotic manufacturers because they do not require refrigeration or special protection and are more resistant to being destroyed by stomach acid and bile salts. They are hence also perhaps hardier in the gut without being so easily killed off by commensal gut microbes.

Many of these soil-based bacteria have little to no studies and their full spectrum of actions are often unknown. To some extent, it can be useful to expose your human gut ecosystem to novel bacteria in the form of soil-based ones, potentially helping your gut immune system to recognize a wider variety of external material. Nevertheless while soil-based bacterial strains may be good for plants, most if not all can have pathogenic potential in humans.

An inherent reality is that most soil-based bacteria are not natural to the human body; they may only be transient visitors without any evolutionary long-term benefit hence never naturally colonizing the human gut.
Importantly soil-based bacteria reproduce by spores that are very resistant to even the immune system and are hence contraindicated in pregnancy and the immune-compromised. Anyone with or with potential for leaky gut syndrome should be cautious with soil-based probiotics as the spores. Should they penetrate the gut barriers and reach into the bloodstream, they can distribute to other parts of the body pathogenically and cause blood infections that are very dangerous.

Compared to soil-based bacteria, E. coli Nissle 1917 has a completely sequenced genome with extensive study into it’s safety and efficacy. Mutaflor® hence has a much wider spectrum of activity than any known soil-based bacteria and a much longer history of positive clinical use and experience over almost 100 years.
In the event that Nissle 1917 ever gets into the blood stream from the gut, it is not serum resistant – it is readily killed in the blood by a natural blood-based defence mechanism called the complement cascade that recognizes a specific part of Nissle 1917’s cell wall (LPS).

In contrast as well, Mutaflor® is actually beneficial in pregnancy as it not only benefits the mother but also can result in natural transmission of the E. coli Nissle 1917 strain as an early commensal E. coli strain into the newborn during birth.

Taking yogurt regularly can be a good thing as it often contains or is fortified with good strains of probiotic bacteria, including probably the most commonly known Lactobacillus acidophilus. It can be a good lifestyle choice to consistently be introducing good ‘live’ bacteria to your gut whether it’s through yogurt or other fermented milk products like kefir.

Of note however, relying on yogurt completely has some significant limitations and disadvantages:
• Yogurt is often commercially made to contain high amounts of sugar/calories that can disturb good nutrition and contain dairy types of proteins that can contribute to upset stomachs and disturbed bowel movements in certain people. Home-made yogurt or that produced with healthy parameters may be more beneficial.
• Yogurt is an inconsistent source of good probiotic bacteria. The quantity of probiotic that you consume is often too low to be beneficial even if good strains are consumed, especially considering that most of the bacterial content is unprotected and easily destroyed by your stomach acids and bile while the lactobacillus species is often not strongly adherent to lower gut cells so that much of the remaining bacteria that survives human early gut breakdown, also gets passed out of the body. Taking small quantities of good bacteria regularly over the long-term is also not the same as giving your body the right boosts of good bacteria to result in colonization and associated protective benefits.
• Many yogurt and associated drink manufacturers look to incorporate Lactobacillus acidophilus and other Lactobacillus strains for beneficial properties in the gut. Please note that Lactobacillus including Lactobacillus acidophilus is strongly associated with the development and progression of dental caries, especially in children. Even in adults, deep dental caries, gum and plaque swabs reveal significant Lactobacillus growth that is exacerbated by the consumption of probiotic yogurt or preparations that are high in lactobacillus. Theses allow the Lactobacillus to be significantly exposed to teeth and gums. Coupled with sugars that the Lactobacilli can ferment, they produce significant quantities of acids like lactic acid that reduce the pH and damage the teeth and gums.

Generally speaking, Mutaflor® has a wider spectrum of activity than any yogurt or fermented milk preparation, is a concentrated medical probiotic with targeted delivery to the lower gut, and with regular consumption provides sufficient Nissle 1917 to colonize the lower gut and extend beneficial effects.

This is not usually necessary, as the E. coli Nissle 1917 is a natural colonizer of the lower gut and easily finds and manages nutrition in the lower gut, especially fermenting different types of carbohydrates and obtaining available iron in the lower gut environment preferentially compared with other microbes.

There are no good new commercial E. coli strains available that can take the place of Nissle 1917 in it’s ecological niche in the lower gut. Importantly when looking at newer strain products whether of E. coli or other bacterial species, newer strains are often based on new discoveries or recombinant DNA technology whereby an ‘old’ strain known and researched for a long time can be altered to provide a specific benefit to a human host.

Much research is ongoing into recombinant versions of Nissle 1917 itself, some to even secrete anti-viral compounds in offering protection against specific viral infections in areas beyond the gut, extending to the reproductive tracts.

A key aspect to consider is that while recombinant technology and newer strains can offer different benefits or improved ones from older strains. A specific strain like the Nissle 1917 in Mutaflor® offers almost a century’s worth of clinical experience, safety and a significantly enlarged spectrum of benefits that no new strain can immediately offer without time to accumulate the appropriate experience in situational use and confidence in safety.

No, Mutaflor® as a product is not made from any dairy products and is produced to minimise any potential for allergies or unexpected reactions.