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 together and you have “for life”. Conversely antibiotic means “against life”.
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. The only caveat to this advice is if you are sensitive to histamine. Fermented foods are unfortunately very high in histamine and may cause you problems if you fall into this category.
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.
Probiotics come in many different concentrations and contain either single or multiple strains. Some contain a prebiotic while others do not.
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 gas potentially produced when taking prebiotics bothers them if taken before bedtime, a time that many prefer to ingest their probiotic. For these reasons you’re better served having a separate probiotic and prebiotic supplement.
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 review 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)
Probiotics have been shown effective against antibiotic-associated diarrhea with the most effective strains identified as being Lactobacillus rhamnosus GG and S. boulardii. (18-23)
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 Disorders in Children
An Italian randomized, double-blind, placebo-controlled study conducted in eight Milan hospitals followed 187 children of both sexes between 2 and 5 years old 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.
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 (Lactobaccillus 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)
Another study followed 237, 234 and 250 adults respectively 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)
Two randomized, placebo-controlled, double-blind studies were conducted over two flu 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)
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.
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 if histamine is not an issue for you.
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