You're only as healthy as your gut flora

Everything You Wanted To Know About Probiotics But Were Afraid To Ask

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Yogurt: a yummy albeit slow-acting probiotic

 

In the last post I wrote about antibiotics and their effects on our friendly gut flora. I now want to talk about probiotics, what they are and what health benefits, if any, can be attributed to them.

First, a personal testimony to their effectiveness. I honestly don’t believe I could have gotten over my irritable bowel syndrome without them. Now I do realize that anecdotal evidence is the lowest form of evidence. It’s easy to be fooled into believing that taking any pill or undergoing any treatment is effective when what is really going on is the placebo effect. That said, most people know when their “plumbing” is or isn’t working right, and my “plumbing” began righting itself shortly after I added probiotics and prebiotics to my daily regimen.

So what exactly is a probiotic? Well, the word says it all. In Greek biotic means “life” and pro means “for” so put it all together and you have “for life”. Conversely antibiotic means “against life”.

All probiotics have live bacterial strains derived from human strains, although this is not always the case as some manufacturers include strains from soil organisms. Syontix doesn’t because our manufacturer cannot prevent cross contamination when growing human strains in the presence of these soil-based organisms.

Probiotics do not only exist in pill form. Probiotics are found in many fermented foods such as yogurt and kefir. I recommend that you eat them often, especially if you make them yourself which I’ve done many, many times.

However, one of the functions of stomach acid is to kill bacteria that we swallow. This means that if you have a properly functioning stomach, up to 99% of the probiotic organisms you swallow after eating your yogurt or drinking your kefir won’t make it alive to populate your gastrointestinal tract.

That said, I’m still a big fan of fermented foods. Some bacteria does survive the journey plus I love the taste of yogurt, kefir and other lacto-fermented foods. Just keep in mind that if you need to quickly deal with a case of gut dysbiosis, fermented foods are probably not your best option. Consider them a nutritious and long-term companion to viably delivered probiotics.

Most, but not all, probiotics are found in the refrigerated section of your local health-food store as they are highly perishable if not kept cold. Our probiotics do not need refrigeration because we use LiveBac®, a patented process developed by our manufacturer that ensures viability even when stored at room temperature.

My reason for going with this patented process for our probiotics was because I had no guarantee that any retailer or distributor who would carry our line of probiotics in the future would always keep them refrigerated once they left our warehouse. Having a spouse who works in the commercial transportation industry has really opened my eyes to how goods are actually warehoused and shipped via freight or rail. I wanted a process that would survive the unpredictability of wholesale and retail distribution and benefit those who took it.

Another consideration is how well they survive transit through the stomach. The majority of probiotics on the market are encapsulated within an enteric coating. Unfortunately, this does not ensure the survival of all organisms within the capsule. A vast number of them will die, which is why so many probiotic manufacturers put so many colony-forming units in their formulations. The thought behind this is that if enough organisms are put in the pill, some are bound to survive. We don’t rely on enteric coating for probiotic survival. Instead, we use another patented process developed by our manufacturer called Bio-tract® that ensures the overwhelming majority of probiotics survive their journey through the stomach.

Probiotics come in many different concentrations and contain either single or multiple strains. Some contain a prebiotic while others do not. We don’t include a prebiotic with our probiotics for two reasons. There is just so much space in a normal-sized tablet or capsule. If you add a prebiotic, then you need to reduce the amount of probiotic the pill contains unless you’re willing to swallow a capsule fit only for a horse.

Secondly, while I’m a big believer in the symbiotic effect of combining a probiotic with a prebiotic, you may want to take them at different times of the day. Many people, especially those suffering from bowel discomfort, find that the little gas potentially produced when taking prebiotics bothers them if they take it before bedtime, a time that many people prefer to take their probiotic. For these reasons, you’re better served having a separate probiotic and prebiotic supplement.

While I chose my probiotic strains after extensively researching their proven benefits in the scientific literature, the reality is that no one who manufactures or distributes probiotics can tell you with any certainty whether they will do you any good. Not because the strains themselves have no effect, but because we are all unique in the composition of our gut flora and in the health issues that plaque us. What works for your spouse or neighbor may not work for you. That doesn’t mean you shouldn’t take them if you’re trying to overcome IBS or another intestinal disorder, only that you may have to keep looking for a probiotic that works for you.

So with that as introduction, what scientific evidence exists for probiotic supplementation? Following is a reveiw of some promising trials derived from the paper Probiotics and health: An evidence-based review. (1)

Pediatric intestinal disorders

Several studies have found benefits in treating infectious gastroenteritis in child populations. Gastroenteritis is a medical condition that involves inflammation of the stomach and the small intestine that can result in a very unpleasant combination of diarrhea, vomiting, cramping and abdominal pain. Probiotics have been found to reduce the duration of diarrhea as well as reduce its frequency. Administering Lactobacillus GG has been shown to retard the spread of rotavirus. However, the results are less than conclusive on the negative forms of this same virus.

Probiotic strains found to be most effective in childhood gastroenteritis are Lactobacillus casei, subspecies of Rhamnosus GG, Lactobacillus delbrueckii, subspecies of Bulgaricus, Lactobacillus acidophilus, Streptococcus themophilus and Bifidobacterium bifidum. (2-17)

Antibiotic-associated diarrhea

Probiotics have been shown effective against antibiotic-associated diarrhea with the most effective strains identified being Lactobacillus rhamnosus GG and S. boulardii. (18-23)

Necrotizing enterocolitis

Necrotizing enterocolitis is a condition in which portions of the colon undergo tissue death and is a major cause of mortality in sick and premature infants. It is also of concern in some elderly populations. A review of 11 recent studies has shown that the risk of necrotizing enterocolitis and death is lower in populations treated with probiotics. The review concluded that because of the positive results seen in these trials, further randomized, placebo-controlled studies were unnecessary. (24)

Allergic diseases in children

An Italian randomized, double-blind, placebo study conducted in eight Milan hospitals followed 187 children of both sexes aged between 2 and 5 years who presented with allergic symptoms. Those children who consumed fermented milk containing Lactobacillus casei for twelve months showed a 33% reduction in their allergic symptoms. A genetic analysis in a subgroup of patients showed more probiotic flora in the intestines of the children who improved as against those children who did not receive the fermented milk. These results persisted even after the study was concluded. (25)

However, before you get too excited about these results, there have been two recent studies that have found no benefit in using probiotics to prevent allergies. (26 – 29) It’s difficult to know if the strains used or the amount or the duration was the problem in these studies. Let it serve as a caution that strains that may work for one person may not work for another.

Respiratory infections

A randomized, double-blind, placebo-controlled trial showed that infants younger than two months who were fed milk containing Lactobacillus rhamnosus GG and Bifidobacterium lactis until the age of one reduced their risk of middle ear and respiratory infections. (30) Another study following 326 children ages 3 to 5 found that probiotic supplementation reduced the number of school days missed due to illness by 25% and saw a 65% decrease in visits to the doctor for antibiotic treatment. (31)

Another randomized, double-blind, placebo-controlled trial followed 479 adults for two winter seasons to determine whether supplementation for 3 months with 3 different strains of probiotics (Lactobaccilus gasser, Bifidobacterium longum and Bifidobacterium bifidum) would positively affect rates and severity of the common cold. Those receiving probiotics saw a reduction of at least two days in the duration of their cold as well as a lessening in severity. (32)

Still another randomized, double-blind, placebo-controlled study followed 237, 234 and 250 adults over three consecutive winter seasons to assess how well probiotics would restore intestinal balance and prevent respiratory-tract infections. Each winter season represented a phase of the trial. In the first phase, the treatment group received a combination of Lactobacillus plantarum, Lactobacillus rhamnosus and Bifidobacterium lactis along with the prebiotic FOS. During the second trial phase, the treatment group received the same formula but with the addition of the antimicrobial lactoferrin. Finally, the treatment group in the third phase received a symbiotic formula that contained both probiotics and prebiotics in one pill. The average duration of flu-like and upper-respiratory-tract infections improved in phases one and two of the trial. Incidences of cold and cough decreased in phase three.

Finally, in a review of the literature, reductions in the severity of respiratory-tract infections were seen in five out of six studies. (33)

The Elderly

Two randomized, controlled, double-blind studies were conducted over two flu vaccine seasons on first 86 and then 222 elderly volunteers. The treatment group received either fermented milk containing Lactobacillus casei or fermented yogurt. The placebo group received un-fermented dairy products. They drank or ate their dairy products twice a day for 7 weeks in the first trial and 13 weeks in the second. They were all given flu vaccinations four weeks later. Those receiving the probiotic-containing dairy showed improved immune response to the vaccine. (34)

In another study, 1,072 elderly people were randomized to receive either Lactobacillus casei or a placebo. Those receiving the probiotic saw a reduction in the duration of upper-respiratory-tract infections and the common cold. (35)

Digestive system

Five placebo-controlled studies that covered 377 people found favorable effects on constipation and stool consistency in adults that were taking the following three strains of probiotics: Lactobacillus casei, Bifidobacterium lactis and E. coli Nissl 1917 strain. (36)

A 2008 placebo-controlled trial using Lactobacillus reuteri in children treated for eight weeks showed a significant improvement in stool frequency after two weeks of daily probiotic use. Constipation in children is a big concern as it signals gut dysbiosis. Constipation in kids has been implicated as the number-one cause of bed wetting as detailed in this article.

***

What should be clear from the studies just cited is that probiotics can be highly effective in treating a number of health-related conditions both within and outside the gut. However, don’t take that to mean that all strains are created equal. What might help with IBS may do nothing to avoid a respiratory-tract infection. For that reason, I formulated Syontix Probiotics Ultra with 10 different strains.

What should also be clear from these studies is that supplementing your probiotic regimen with probiotic-rich foods is a smart long-term strategy. So by all means find that probiotic that works for you but don’t forget to add probiotic-rich foods to your diet.

References:

  1. Aureli P., Capruso L., Castellazzi A. M., Clerici M.,  Giovannini M., Morelli L., Poli A., Pregliasco F., Salvini F., Zuccotti G. V. Probiotics and health: An evidence-based review. Phamacological Research 2011;63:366-376.
  2. DavidsonGP,ButlerRN. Probiotics in pediatric gastrointestinal disorders. Current Opinion in Pediatrics 2000;12:477–81.
  3. Szajewska H, Setty M, Mrukowicz J, Guandalini S. Probiotics in gastrointestinal diseases in children: hard and not-so-hard evidence of efficacy. Journal of Pediatric and Gastroenterology & Nutrition 2006;42:454–75.
  4. Michail S, Sylvester F, Fuchs G, Issenman R. Clinical efficacy of probiotics: review of the evidence with focus on children. Journal of Pediatric and Gastroenterology & Nutrition 2006;43:550–7.
  5. Guandalini S. Probiotics for children: use in diarrhea. Journal of Clinical Gastroenterology 2006;40:244–8.
  6. Van Niel CW, Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics 2002;109:678–84.
  7. Szajewska H, Kotowska M, Mrukowicz JZ, Armanska M, Mikolajczyk W. Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants. Journal of Pediatrics 2001;138:361–5.
  8. Guandalini S, Pensabene L, Zikri MA, Dias JA, Casali LG, Hoekstra H, et al. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. Journal of Pediatric and Gastroenterology & Nutrition 2000;30:54–60.
  9. Kaila M, Isolauri E, Soppi E, Virtanen E, Laine S, Arvilommi H. Enhancement of the circulating antibody secreting cell response in human diarrhea by a human Lactobacillus strain. Pediatric Research 1992;32:141–4.
  10. Szymanski H, Pejcz J, Jawien M, Chmielarczyk A, Strus M, Heczko PB. Treatment of acute infectious diarrhoea in infants and children with a mixture of three Lactobacillus rhamnosus strains – a randomized, double-blind, placebo-controlled trial. Alimentary Pharmacology & Therapeutics 2006;23:247–53.
  11. Oberhelman RA, Gilman RH, Sheen P, Taylor DN, Black RE, Cabrera L, et al. A placebo-controlled trial of Lactobacillus GG to prevent diarrhea in undernourished Peruvian children. Journal of Pediatrics 1999;134:15–20.
  12. Mastretta E, Longo P, Laccisaglia A, Balbo L, Russo R, Mazzaccara A, et al. Effect of Lactobacillus GG and breast-feeding in the prevention of rotavirus nosocomial infection. ournal of Pediatric and Gastroenterology & Nutrition 2002;35:527–31.
  13. Costa-Ribeiro H, Ribeiro TC, Mattos AP, Valois SS, Neri DA, Almeida P, et al. Limitations of probiotic therapy in acute, severe dehydrating diarrhea. Journal of Pediatric and Gastroenterology & Nutrition 2003;36:112–5.
  14. Salazar-Lindo E, Miranda-Langschwager P, Campos-Sanchez M, Chea-Woo E, Sack RB. Lactobacillus casei strain GG in the treatment of infants with acute watery diarrhea: a randomized, double-blind, placebo controlled clinical trial [ISRCTN67363048]. BMC Pediatrics 2004;4:18.
  15. Mack DR, Michail S, Wei S, McDougall L, Hollingsworth MA. Probiotics inhibit enteropathogenic E. coli adherence in vitro by inducing intestinal mucin gene expression. American Journal of Physiology 1999;276:G941–50.
  16. Sarker SA, Sultana S, Fuchs GJ, Alam NH, Azim T, Brussow H, et al. Lactobacillus paracasei strain ST11 has no effect on rotavirus but ameliorates the outcome of nonrotavirus diarrhea in children from Bangladesh. Pediatrics 2005;116:e221–8.
  17. Guarino A, Lo VA, Canani RB. Probiotics as prevention and treatment for diarrhea. Current Opinion in Gastroenterology 2009;25:18–23.
  18. Szajewska H, Ruszczynski M, Radzikowski A. Probiotics in the prevention of antibiotic-associated diarrhea in children: a meta-analysis of randomized controlled trials. Journal of Pediatrics 2006;149:367–72.
  19. Cremonini F, Di Caro S, Nista EC, Bartolozzi F, Capelli G, Gasbarrini G, et al. Meta-analysis: the effect of probiotic administration on antibiotic-associated diarrhoea. Alimentary Pharmacology & Therapeutics 2002;16:1461–7.
  20. D’Souza AL, Rajkumar C, Cooke J, Bulpitt CJ. Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis. BMJ 2002;324:1361.
  21. Arvola T, Laiho K, Torkkeli S, Mykkanen H, Salminen S, Maunula L, et al. Prophylactic Lactobacillus GG reduces antibiotic-associated diarrhea in children with respiratory infections: a randomized study. Pediatrics 1999;104:e64.
  22. Castagliuolo I, Riegler MF, Valenick L, LaMont JT, Pothoulakis C. Saccharomyces boulardii protease inhibits the effects of Clostridium difficile toxins A and B in human colonic mucosa. Infection and Immunity 1999;67:302–7.
  23. McFarland LV. Evidence-based review of probiotics for antibiotic-associated diarrhea and Clostridium difficile infections. Anaerobe 2009;15:274–80.
  24. Claud EC, Walker WA. Hypothesis: inappropriate colonization of the premature intestine can cause neonatal necrotizing enterocolitis. FASEB Journal 
2001;15:1398–403.
  25. Giovannini M, Agostoni C, Riva E, Salvini F, Ruscitto A, Zuccotti GV, et al. A randomized prospective double blind controlled trial on effects of long-term consumption of fermented milk containing Lactobacillus casei in pre-school children with allergic asthma and/or rhinitis. Pediatric Research 2007;62:215–20.
  26. Valsecchi C, Marseglia A, Ricci A, Montagna L, Leone M, Marseglia GL, et al. Probiotics and children: is an integration useful in allergic diseases? Pediatr Med Chir 2008;30:197–203.
  27. Johannsen H, Prescott SL. Practical prebiotics, probiotics and synbiotics for allergists: how useful are they? Clinical & Experimental Allergy 2009;39:1801–14.
  28. Boyle RJ, Bath-Hextall FJ, Leonardi-Bee J, Murrell DF, Tang ML. Probiotics for the treatment of eczema: a systematic review. Clinical & Experimental Allergy 2009;39:1117–27.
  29. van der Aa LB, Heymans HS, van Aalderen WM, Sprikkelman AB. Probiotics and prebiotics in atopic dermatitis: review of the theoretical background and clinical evidence. Pediatric Allergy and Immunology 2010;21:e355–67.
  30. Rautava S, Salminen S, Isolauri E. Specific probiotics in reducing the risk of acute infections in infancy – a randomised, double-blind, placebo-controlled study. British Journal of Nutrition 2009;101:1722–6.
  31. Leyer GJ, Li S, Mubasher ME, Reifer C, Ouwehand AC. Probiotic effects on cold and influenza-like symptom incidence and duration in children. Pediatrics 2009;124:e172–9.
  32. de Vrese M, Winkler P, Rautenberg P, Harder T, Noah C, Laue C, et al. Effect of Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, B. bifidum MF 20/5 on common cold episodes: a double blind, randomized, controlled trial. Clinical Nutrition 2005;24:481–91.
  33. Vouloumanou EK, Makris GC, Karageorgopoulos DE, Falagas ME. Probiotics for the prevention of respiratory tract infections: a systematic review. International  Journal of Antimicrobial Agents 2009;34:197–210.
  34. Boge T, Remigy M, Vaudaine S, Tanguy J, Bourdet-Sicard R, van der WS. A probiotic fermented dairy drink improves antibody response to influenza vaccination in the elderly in two randomised controlled trials. Vaccine 2009;27:5677–84.
  35. Guillemard E, Tondu F, Lacoin F, Schrezenmeir J. Consumption of a fermented dairy product containing the probiotic Lactobacillus casei DN-114001 reduces the duration of respiratory infections in the elderly in a randomised controlled trial. British Journal of Nutrition 2010;103:58–68.
  36. Chmielewska A, Szajewska H. Systematic review of randomised controlled trials: probiotics for functional constipation. World Journal of Gastroenterology 2010;16:69–75.

 

 

 

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A special thanks to the University of California, Irvine, Grunigen Medical Library for allowing me access to their extensive collection.

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