Probiotic Supplements

November 20, 2009 Written by JP       [Font too small?]

One of the hardest “sells” in natural medicine is demonstrating that there can be substantive differences between products that seem similar. Many years ago a skeptical customer was discussing a supplement with an employee at a health food store. At that time, I was a consultant who assisted the owner of that establishment to choose which lines and products to stock. I overheard the conversation and decided to try to help out. The position of the customer was that all echinacea products should be comparably priced. His view was that they all came from the same plant, the same soil, the same planet and therefore should reflect that in their price point. My first approach was to provide details about the specific differences between the brands he was considering – variable concentrations of active ingredients, flower vs. root extracts, the scientific research conducted on certain products, etc. I was unable to sway him with that data. So I tried a different tactic. I asked, “Is it reasonable to pay the same amount for a brand new BMW as you would a used Honda Civic?” “Of course not”, he scoffed. I continued, “Why not? They’re both made with similar materials. They both have four tires and a steering wheel. You can use both cars to get to where you want to go.”

I brought up that experience because I think that many natural health consumers are frustrated with hyperbolic sales pitches. I’m convinced that the gentleman I just mentioned was probably the recipient of more than a few hard sells at other health food stores. I suspect this because I’ve personally had this happen to me on many occasions. A consequence of that type of sales approach is that, eventually, customers will justifiably feel cheated or taken. Perhaps the worst part is that those very same consumers will probably miss out on some really good products and simply opt for the cheapest ones because they just don’t want to get “ripped off” anymore.

Probiotics are a good example of supplements that need to be selected carefully. One strain of healthy bacteria may be suitable for constipation but completely useless for supporting a positive mental outlook. Some varieties work best when combined in foods such as kefir or yogurt and others require a special encapsulation process in order for the good microbes to survive the normal digestive process. The trick here is to verify that you’re taking an appropriate bacterial candidate for the health issue you wish to address.

Example #1 – Probiotics and Immunity in Children and Infants

A study just released in the journal Clinical Nutrition examined the role of a probiotic known as Lactobacillus GG (LGG) in the prevention of upper respiratory tract infections in young children. 281 boys and girls attending day care were administered one of two beverages over the course of 3 months. The treatment group received a fermented milk drink that was supplemented with LGG. The control group was given the same beverage sans the probiotic. The children in the LGG study group were 34% less likely to come down with upper respiratory tract infections. These same kids also demonstrated a 43% reduction in the risk of infections lasting more than 3 days. (1)

The June 2009 issue of the British Journal of Nutrition reports on two specific strains of healthy bacteria that also show promise, this time in infants. Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb-12 or a placebo were added to the formula of infants. During the following year, the incidence of infections prior to 7 months of age and the number of “recurrent (three or more) infection during the first year of life were recorded as the main outcome measures of the study”.

  • 22% of the infants receiving the probiotic formula developed ear infections as compared to 50% of those given the placebo formula.
  • 31% of the probiotic infants required antibiotic treatment (for ear infections), while the placebo group required antibiotics 60% of the time.
  • 28% of the infants given probiotics developed recurrent respiratory infections in comparison to 55% in the placebo group.

The researchers concluded that “probiotics may offer a safe means of reducing the risk of early acute otis (ear infection), antibiotic use and the risk of recurrent respiratory infections during the first year of life”. However, they emphasize that “Further clinical trials are warranted”. Those parting words need to be taken seriously. One example of this can be found in a large Taiwanese study published in February 2009. Over 1,000 preschool aged children were divided into four groups and given various types of probiotics or a placebo. It was determined that one particular probiotic strain (L. casei rhamnosus) was helpful in controlling “bacterial, viral and respiratory infections”, while an unspecified “multi-species probiotic” was effective in reducing gastrointestinal diseases. This reinforces the notion that specific strains of healthy bacteria may benefit their hosts in a selective manner. (2,3)

Example # 2 – Probiotics for the Management of Eczema and Other Skin Disorders

Infants were also the focus of another recent probiotic study. However, in this case, the administration of the probiotics was bit more involved. Researchers from Seoul National University in Korea recruited 112 pregnant women with a “family history of allergic diseases”. The expectant mothers were asked to take either a probiotic supplement or a placebo beginning 4-8 weeks prior to their delivery date and continuing until 6 months post delivery. Three probiotic strains were included in this experiment: Bifidobacterium bifidum BGN4, B. lactis AD011, and Lactobacillus acidophilus AD031. The newborns were fed only breast milk for the first 3 months of life and then received a cow’s milk based formula for the next 3 months. The infants were medically monitored during their first year.

  • The infants whose mothers received the probiotic mix showed a statistically lower rate of eczema (18.2% vs. 40%).
  • The “cumulative incidence of eczema during the first 12 months” was also significantly reduced in the probiotic infants (36.4% vs. 62.9%). (4)

The mechanism by which healthy bacteria counter skin disorders isn’t entirely clear yet. A recent French study indicates that certain probiotics, such as L. casei (DN-114 001), appear to combat “allergic and inflammatory skin disorders” by beneficially modulating immune response – at least in a mouse model of skin inflammation. However scientists from New Zealand have determined that not all varieties of probiotics are capable of this same activity. Their research indicates that Lactobacillus rhamnosus HN001 can effectively reduce the likelihood of eczema (by almost 50%) in infants. But these same scientists also tested another strain (Bifidobacterium animalis HN019) and discovered that it didn’t produce any relevant decline in eczema incidence. (5,6)

Example #3 – Probiotics for Improved Dental Health

One of the more novel applications for probiotics is in the arena of dental care. The very thought of using any bacteria to improve the condition of one’s mouth may seem counterintuitive at best and, frankly, downright odd. But if you think about it in terms of balance, it tends to make much more sense. There is a constant population flux between beneficial bacteria (probiotics) and pathogenic microbes in the body. Many factors, including poor hygiene, a sub-par diet or a weakened immune system can easily tip the scale in favor of the harmful bacteria. But eating and supplementing with probiotics and remedying the underlying issues that originally brought about the imbalance can help to improve many aspects of health.

A mouthwash containing a probiotic known as Bacillus subtilis was recently compared to a conventional mouthwash which contained a conventional/synthetic antiseptic (benzethonium chloride). The intent of the researchers was to test the relative efficacy of each mouth rinse on periodontitis symptoms. The participants using the probiotic mouthwash showed a greater reduction in pathogenic bacteria and also exhibited small improvements in “probing pocket depth and bleeding on probing”, indicators of improved gingival health. A different probiotic mouthwash (ProBiora3) that contains three strains of healthy bacteria was recently shown to substantially reduce the levels of harmful bacteria when administered twice-daily for 4 weeks. Periodontal pathogens not only declined in the participants’ saliva but also in the plaque underneath their gumline. (7,8)

The prior examples involved swishing the mouth with a probiotic mouthwash. Several other current studies suggest that consuming probiotics via food or supplementation may also improve oral health. The latest trial was conducted at the Department of Conservative Dentistry and Periodontology at the University of Leipzig, Germany. 50 students were split into 2 groups. One half received a probiotic beverage and the remainder was not supplemented at all. Over the course of 8 weeks, half the students drank the probiotic once a day. Dental examinations were provided prior to and post study. The researchers concluded that the “probiotic milk drink” reduced markers of gum inflammation. A Japanese study from June 2009 established that a probiotic strain known as Lactobacillus salivarius WB21 could successfully reduce the levels of 5 “periodontopathic bacteria” that are associated with poor gingival status. Finally, a 2006 trial from Sweden provides convincing evidence that Lactobacillus reuteri can reduce the incidence of gum bleeding in those with gingivitis after as little as 2 weeks of supplementation. The authors of that trial also noted a decrease in plaque build up in the L. reuteri group. (9,10,11)

The next time you go shopping for probiotics at your local health food store, talk to the resident expert. Inquire about which probiotic product they think is best suited for you. Ask for any relevant product literature. If there is none available, at least write down the name of the product itself. But don’t buy it. Instead, go home and do a little online research. See if there’s reasonable evidence to support the information you received at the health food store. In most instances, it’s unreasonable to expect to find dozens of studies which will back such claims. Most natural products simply aren’t financed in such a way that allows for voluminous scientific testing. However, there should be at least a hint of solid evidence. Perhaps you’ll find a few studies that can provide you with the necessary confidence you’re after. Maybe you’ll even come across an endorsement or two from reputable health authorities that back the use of the supplement in question. Collect all of the information you can and then decide what makes sense. If the advice you were given is sound, reward that store with your business. If, on the other hand, you find that you were likely the recipient of a holistic fairy tale, consider finding a new place to spend your hard earned money. But before you do that, let the store owner know why they’re losing your business.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

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Posted in Children's Health, Dental Health, Nutritional Supplements

27 Comments & Updates to “Probiotic Supplements”

  1. anne h Says:

    Very good and very interesting!

  2. JP Says:

    Thanks, Anne! :)

    Be well!

    JP

  3. Dr. Bill Rawls Says:

    Many people think that supplements are harmless because they are “all natural” (well, sometimes). What many people don’t know is that supplements that contain fillers or improper ratio of ingredients can actually do more harm than good. The good news is, there ARE excellent products available that have been backed by countless clinical studies. Thanks JP for providing this clinical research in easy-to-read essays that can help bridge this gap in understanding of quality nutritional supplements.

  4. JP Says:

    Thank you, Bill! I appreciate your kind words and your contribution to this site. :)

    The two basic guidelines in my book of supplements state that: a) supplements are only meant to supplement an otherwise healthy lifestyle – in other words, they shouldn’t be used as a replacement for a nutritious diet and proper mind/body practices and b) they need to be used judiciously. Dietary supplements are not to be taken lightly. In fact, they’re often more complicated than synthetic medications.

    I’m often frustrated by the composition of many supplements I see. But, such is life. In the current environment, it’s important that both patients and physicians inform themselves well in order to find the best of what’s out there.

    Be well!

    JP

  5. Dez Says:

    this is incredibly informative. i love your vocabulary & your ability to convey your message & research in an articulate yet professional manner. the whole time i was reading, i was getting the information i needed as well as thinking – wow, i need to learn to form sentences like this..haha! lovely JP, just lovely. God Bless :)

  6. JP Says:

    Dez,

    Thank you very much for your kind words. I’m happy that you got something of value out of this blog and that it was easy on your eyes! :)

    Be well!

    JP

  7. Betty Schabo Says:

    My 3 mos old premature twin grandchildren suffer from GRE. I am interested in learning about any probiotic that can ease their discomfort and calm their colic outbursts. They have a difficult time staying asleep and wake up shreiking. Can you suggest something or recommend additional informational articles?

    Anxiously awaiting your reply,
    Betty Schabo

  8. JP Says:

    Betty,

    I would run this information by their pediatrician:

    http://pediatrics.aappublications.org/cgi/content/full/119/1/e124

    Be well!

    JP

  9. JP Says:

    Update: Fascinating study finds that probiotics increase breast milk mineral concentrations …

    http://www.sciencedirect.com/science/article/pii/S0946672X15000097

    J Trace Elem Med Biol. 2015 Apr;30:25-9.

    A pilot study of synbiotic supplementation on breast milk mineral concentrations and growth of exclusively breast fed infants.

    Despite the crucial role of breast milk mineral contents for health and growth of the infants, they decrease with the duration of lactation. So, this pilot study aimed to determine the effects of synbiotic supplementation on breast milk mineral composition and infants’ growth. In this pilot, randomized, double-blind, placebo-controlled trial, 57 lactating mothers were randomly divided into two groups to receive a daily supplement of synbiotic (n=30) or a placebo (n=27) for 30 days. Breast milk zinc, copper, Iron, magnesium and, calcium concentrations were determined by flame atomic absorption spectrometry. Weight for age Z-score (WAZ) and height for age Z-score (HAZ) were assessed for infants. Dietary intake was collected from lactating women using the 24-h recall method. Data analyses were carried out using nutritionist IV, Epi Info and SPSS soft wares. Synbiotic supplementation led to an insignificant increase of the mean breast milk levels of zinc (from 2.44±0.65 to 2.55±0.55mgL(-1)), copper (from 0.35±0.24 to 0.40±0.26mgL(-1)), iron (from 0.28±0.42 to 0.31±0.38mgL(-1)), magnesium (from 17.14±1.35 to 17.17±1.09mgL(-1)), and calcium (from 189±25.3 to 189.9±21.7mgL(-1)); whilst in the placebo group, these variables decreased significantly (P=0.001). The observed changes between two groups were statistically significant (P<0.05). Although WAZ and HAZ of infants increased slightly in the supplemented group (from 1.19±0.79 to 1.20±0.69 and 0.36±0.86 to 0.37±0.85 respectively), these two parameters decreased in the placebo group which was significant only for WAZ (P=0.01). Moreover, no significant association was found between mineral intake and breast milk mineral contents. It seems, synbiotic supplementation may have positive effects on breast milk mineral contents.

    Be well!

    JP

  10. Cynthia D'Auria Says:

    Hello JP,

    I have been scanning the topics in your blog. I had been looking at food and drink, however I did not come across what I was looking for. People on the East Coast are really into “Organic Cider Vinegar” for many reasons so I am told.

    Since I did not find it on your blog, I am wondering how this is effective without upsetting the GI system. Seems as though it has many benefits and I know you would have the facts on it.

    Thinking of trying it but I am uncertain of its “HYPE”. I would appreciate your opinion on it.

    Regards,

  11. JP Says:

    Hi, Cynthia.

    I indirectly covered cider vinegar in this column:

    http://www.healthyfellow.com/432/vinegar-and-blood-sugar-control/

    If you check it out, please be sure to look over the comments/updates at the bottom of the column.

    Most of the claims relating to cider vinegar are anecdotal. This is not to say that they’re not valid. However, in most instances, the noted benefits aren’t supported by scientific studies.

    Having said that, here’s a recent study I uncovered:

    http://bragg.com/blog/wp-content/uploads/2013/04/ASU-Bragg-ACV-Drink-Study-PDF-2.pdf

    THEREPUTIC EFFECT OF DAILY VINEGAR INGESTION FOR INDIVIDUALS AT RISK FOR TYPE 2 DIABETES

    Vinegar ingestion reduces postprandial glycemia and lowers hemoglobin A1c in individuals with type 2 diabetes (T2D); however, the long-term effect of vinegar in non-T2D is not known. This 12-week, randomized, parallel-arm trial examined the impact of vinegar ingestion on fasting and postprandial glucose in high-risk individuals (fasting glucose, 98.3±3.7 mg/dl; fasting insulin, 19.0±2.9 uU/ml). Of the 14 participants (13/1 F/M; 46.0±3.9 y; 28.5±1.4 kg/m2), 8 were diagnosed prediabetic but not prescribed hypoglycemic medications. Two daily treatments were followed: VIN [2 tablespoons vinegar or 1.5 g acetic acid] or CON [2 vinegar pills or 0.08 g acetic acid]. Treatments were taken as a divided dose immediately prior to the lunch and dinner meals daily. Fasting glucose and 2-h postprandial glucose concentrations were recorded daily using a glucometer. Reductions in fasting glucose were immediate and sustained for VIN vs. CON (average 12 week reduction: -16.3±4.9 and -4.5±3.2 mg/dl respectively, p=0.05). Controlling for prediabetes diagnosis did not impact these results. Average 12 week reductions in 2- h postprandial glucose did not vary significantly between groups (-7.7±6.9 vs. 3.3±5.4 mg/dl for VIN and CON respectively, p=0.259). These results support a therapeutic effect for vinegar in individuals at risk for T2D, including those diagnosed with prediabetes.

    Be well!

    JP

  12. JP Says:

    Update 05/28/15:

    http://www.nmcd-journal.com/article/S0939-4753%2815%2900119-2/abstract

    Nutrition, Metabolism and Cardiovascular Diseases – May 13, 2015

    The triglyceride-lowering effect of supplementation with dual probiotic strains, Lactobacillus curvatus HY7601 and Lactobacillus plantarum KY1032: reduction of fasting plasma lysophosphatidylcholines in nondiabetic and hypertriglyceridemic subjects

    Background and Aims: This study evaluated the triglyceride (TG)-lowering effects of consuming dual probiotic strains of Lactobacillus curvatus (L. curvatus) HY7601 and Lactobacillus plantarum (L. plantarum) KY1032 on the fasting plasma metabolome.

    Methods and Results: A randomized, double-blind, placebo-controlled study was conducted on 92 participants with hypertriglyceridemia but without diabetes. Over a 12-week testing period, the probiotic group consumed 2 g of powder containing 5 x 109 colony-forming units (cfu) of L. curvatus HY7601 and 5 x 109 cfu of L. plantarum KY1032 each day, whereas the placebo group consumed the same product without probiotics. Fasting plasma metabolomes were profiled using UPLC-LTQ-Orbitrap MS. After 12 weeks of treatment, the probiotic group displayed a 20% reduction (p = 0.001) in serum TGs and 25% increases (p = 0.001) in apolipoprotein A-V (apoA-V). At the 12-week follow-up assessment, the following 11 plasma metabolites were significantly reduced in the probiotic group than the placebo group: palmitoleamide, palmitic amide, oleamide, and lysophosphatidyl choline (lysoPC) containing C14:0, C16:1, C16:0, C17:0, C18:3, C18:2, C18:1, and C20:3. In the probiotic group, changes (△) in TG were negatively correlated with △ apoA-V, which were positively correlated with △ FFA. In addition, △ FFA was strongly and positively correlated with △ lysoPCs in the probiotic group but not the placebo group.

    Conclusions: The triglyceride-lowering effects of probiotic supplementation, partly through elevated apoA-V, in borderline to moderate hypertriglyceridemic subjects showed reductions in plasma metabolites; fatty acid primary amides and lysoPCs (NCT02215694; http://www.clinicaltrials.gov).

    Be well!

    JP

  13. JP Says:

    Updated 09/22/15:

    http://medicalxpress.com/news/2015-09-probiotic-formula-reverses-cow-allergies.html

    “To examine whether probiotic administration modulates gut bacterial composition to enhance acquisition of tolerance to cow’s milk, Nagler and colleagues performed sequence analysis to identify bacteria in stool samples collected from healthy infant subjects, infants with cow’s milk allergy who had been fed the LGG enriched probiotic formula, and those who had been fed the formula without added probiotics.

    Overall, the gut microbiome of infants with a cow’s milk allergy was significantly different than healthy controls, suggesting that differences in the structure of the bacterial community indeed influence the development of allergies. Infants treated with the LGG probiotic formula who developed tolerance to cow’s milk also had higher levels of bacteria that produce butyrate than those who were fed the probiotic formula but did not develop tolerance. This further suggests that tolerance is linked to the acquisition of specific strains of bacteria, including Blautia and Coprococcus, which produce butyrate.”

    Be well!

    JP

  14. JP Says:

    Updated 10/27/16:

    http://www.mdpi.com/2072-6643/8/10/660/htm

    Nutrients 2016, 8(10), 660

    Effect of Bifidobacterium breve on the Intestinal Microbiota of Coeliac Children on a Gluten Free Diet: A Pilot Study

    Abstract: Coeliac disease (CD) is associated with alterations of the intestinal microbiota. Although several Bifidobacterium strains showed anti-inflammatory activity and prevention of toxic gliadin peptides generation in vitro, few data are available on their efficacy when administered to CD subjects. This study evaluated the effect of administration for three months of a food supplement based on two Bifidobacterium breve strains (B632 and BR03) to restore the gut microbial balance in coeliac children on a gluten free diet (GFD). Microbial DNA was extracted from faeces of 40 coeliac children before and after probiotic or placebo administration and 16 healthy children (Control group). Sequencing of the amplified V3-V4 hypervariable region of 16S rRNA gene as well as qPCR of Bidobacterium spp., Lactobacillus spp., Bacteroides fragilis group Clostridium sensu stricto and enterobacteria were performed. The comparison between CD subjects and Control group revealed an alteration in the intestinal microbial composition of coeliacs mainly characterized by a reduction of the Firmicutes/Bacteroidetes ratio, of Actinobacteria and Euryarchaeota. Regarding the effects of the probiotic, an increase of Actinobacteria was found as well as a re-establishment of the physiological Firmicutes/Bacteroidetes ratio. Therefore, a three-month administration of B. breve strains helps in restoring the healthy percentage of main microbial components.

    Be well!

    JP

  15. JP Says:

    Updated 11/04/16:

    http://journals.lww.com/jcge/pages/articleviewer.aspx?year=2016&issue=11001&article=00017&type=abstract

    J Clin Gastroenterol. 2016 Nov/Dec;50 Suppl 2, Proceedings from the 8th Probiotics, Prebiotics & New Foods for Microbiota and Human Health meeting held in Rome, Italy on September 13-15, 2015:S164-S167.

    The Association of Bifidobacterium breve BR03 and B632 is Effective to Prevent Colics in Bottle-fed Infants: A Pilot, Controlled, Randomized, and Double-Blind Study.

    GOALS: To assess the effectiveness of Bifidobacterium breve B632 and BR03 association in the reduction of infants crying over time. The second endpoint was to observe the effect of the same strains on daily evacuations and on the number of regurgitations and vomits.

    BACKGROUND: Infant colics represent a clinical condition in childhood, characterized by an uncontrollable crying that occurs without any apparent organic cause. An altered intestinal microbiota composition in the very first months may induce intestinal colics in infants. Thus far, no treatment is really effective for this problem, but recent literature shows an increasing attention toward probiotics.

    STUDY: A total of 83 subjects were enrolled, 60 breastfed infants and 23 bottle-fed infants. Sixty of them carried out the study: 29 infants were given probiotics, whereas 31 placebo. During the 90 days of the study, parents were asked to give 5 drops of active product (10 viable cells/strain) or placebo and to daily take note of: minutes of crying, number, color, and consistency of evacuations, and number of regurgitations or vomits.

    RESULTS: No significant differences were detected in the infants treated with probiotics, compared with placebo group (P=0.75). The analysis of the 3 months of treatment demonstrated that during the third month, the probiotic group cried 12.14 minutes on average and the placebo cried 46.65 minutes. This difference is statistically significant (P=0.016).

    CONCLUSIONS: The evidence of the usefulness of some probiotic strains in the treatment and prevention of infant colics is growing, and therefore their use in clinical practice is spreading.

    Be well!

    JP

  16. JP Says:

    Updated 03/16/17:

    http://www.mdpi.com/2072-6643/9/3/284/htm

    Nutrients. 2017 Mar 15;9(3).

    Effects of a Diet-Based Weight-Reducing Program with Probiotic Supplementation on Satiety Efficiency, Eating Behaviour Traits, and Psychosocial Behaviours in Obese Individuals.

    This study evaluated the impact of probiotic supplementation (Lactobacillus rhamnosus CGMCC1.3724 (LPR)) on appetite sensations and eating behaviors in the context of a weight-reducing program. Obese men (n = 45) and women (n = 60) participated in a double-blind, randomized, placebo-controlled trial that included a 12-week weight loss period (Phase 1) based on moderate energy restriction, followed by 12 weeks of weight maintenance (Phase 2). During the two phases of the program, each subject consumed two capsules per day of either a placebo or a LPR formulation (10 mg of LPR equivalent to 1.6 108 CFU/capsule, 210 mg of oligofructose, and 90 mg of inulin). The LPR supplementation increased weight loss in women that was associated with a greater increase in the fasting desire to eat (p = 0.03). On the other hand, satiety efficiency (satiety quotient for desire to eat) at lunch increased (p = 0.02), whereas disinhibition (p = 0.05) and hunger (p = 0.02) scores decreased more in the LPR-treated women, when compared with the female control group. Additionally, the LPR female group displayed a more pronounced decrease in food craving (p = 0.05), and a decrease in the Beck Depression Inventory score (p = 0.05) that was significantly different from the change noted in the placebo group (p = 0.02), as well as a higher score in the Body Esteem Scale questionnaire (p = 0.06). In men, significant benefits of LPR on fasting fullness and cognitive restraint were also observed. Taken together, these observations lend support to the hypothesis that the gut-brain axis may impact appetite control and related behaviors in obesity management.

    Be well!

    JP

  17. JP Says:

    Updated 05/02/17:

    https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/probiotics-to-prevent-necrotising-enterocolitis-and-nosocomial-infection-in-very-low-birth-weight-preterm-infants/0E9FC401C3ECD29E49360C287B1306F3

    Br J Nutr. 2017 Apr 26:1-7.

    Probiotics to prevent necrotising enterocolitis and nosocomial infection in very low birth weight preterm infants.

    The aim of the study was to determine whether routine probiotic supplementation (RPS) with Lactobacillus rhamnosus GG (LGG) or Lactobacillus acidophilus +Lactobacillus bifidum is associated with reduced risk of necrotising enterocolitis (NEC)≥Stage II in preterm neonates born at ≤32 weeks’ gestation. We conducted a retrospective cohort study on the effect of probiotic supplementation in very low birth weight infants in our neonatal unit by comparing two periods: before and after supplementation. The incidence of NEC≥Stage II, late-onset sepsis and all-cause mortality was compared for an equal period ‘before’ (Period I) and ‘after’ (Period II) RPS with LGG or L. acidophillus+L. bifidum. Multivariate logistic regression analysis was conducted to adjust for relevant confounders. The study population was composed of 261 neonates (Period I v. II: 134 v. 127) with comparable gestation duration and birth weights. In <32 weeks, we observed a significant reduction in NEC≥Stage II (11·3 v. 4·8 %), late-onset sepsis (16 v. 10·5 %) and mortality (19·4 v. 2·3 %). The benefits in neonates aged ≤27 weeks did not reach statistical significance. RPS with LGG or L. acidophillus+L. bifidum is associated with a reduced risk of NEC≥Stage II, late-onset sepsis and mortality in preterm neonates born at ≤32 weeks’ gestation.

    Be well!

    JP

  18. Liz Says:

    Interesting info
    How would someone find out HOW and WHERE to buy the specific probiotics etc used in these studies ?
    The studies are thought provoking and seem helpful … but I am not able to find commercial outlets that have these SPECIFIC strains available for sale

    Thx for any help you could provide !

  19. JP Says:

    Hi Liz,

    I think the easiest way to track down specific strains is to copy and paste their names into search boxes online. For instance, you might be interested in Lactobacillus GG (LGG) and find that it’s sold under the brand name Culturelle. You can use a general search engine such Google or try searching on sites like Amazon.com, IHerb.com or Vitacost.com.

    If you have trouble finding a specific strain or product, feel free to let me know. I might be able to access additional resources to point you in the right direction.

    Be well!

    JP

  20. Liz Says:

    Thx for reinforcing that doing a google/internet search is a good way to look for a specific strain of probiotics.

    Here is the study I was really interested in / my interest was piqued after reading an article / short blurb on Science News Daily site.

    The specific strains are not coming up as commercially available ( that I can find)

    Title is

    Supplementation of Lactobacillus curvatus HY7601 and Lactobacillus plantarum KY1032 in Diet-Induced Obese Mice Is Associated with Gut Microbial Changes and Reduction in Obesity

    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0059470

  21. JP Says:

    Hi Liz,

    A quick search didn’t turn up a commercially-available supplement containing the strains in the linked study. However, another strain may be worth considering: Lactobacillus gasseri

    https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/effect-of-lactobacillus-gasseri-sbt2055-in-fermented-milk-on-abdominal-adiposity-in-adults-in-a-randomised-controlled-trial/304E3E2EE11E0D3D4F5D85E7046118A1/core-reader

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3611107/

    https://www.nature.com/ejcn/journal/v64/n6/full/ejcn201019a.html

    There are other probiotic and symbiotic candidates as well. But, this strain has a pretty good track record – in this relatively new field of research. And, it’s featured in several supplements currently sold in the US market. In fact, I just suggested a blend that contains it, Kyo-Dophilus, for a client struggling with seasonal allergies.

    Be well!

    JP

  22. Liz Says:

    Thank you for your interesting reply.
    I look forward to reading your site – and will post if I find other followup information

    Appreciate your time!
    Liz

  23. JP Says:

    Updated 06/20/17:

    https://www.ncbi.nlm.nih.gov/pubmed/28628374

    J Am Coll Nutr. 2017 Jun 19:1-10.

    Effects of a Multispecies Probiotic Supplement on Bone Health in Osteopenic Postmenopausal Women: A Randomized, Double-blind, Controlled Trial.

    OBJECTIVE: The development of alternative approaches to prevent and/or treat osteoporosis, as a chronic progressive bone disease, is being considered currently. Among dietary supplements, probiotics may have favorable effects on bone metabolism. Therefore, the aim of this study was to evaluate the effects of a multispecies probiotic supplementation on bone biomarkers and bone density in osteopenic postmenopausal women.

    METHODS: This randomized double-blind placebo-controlled clinical trial was performed on 50 patients with osteopenia aged 50-72 years. Participants were randomly assigned to take either a multispecies probiotic supplement (GeriLact; n = 25) or placebo (n = 25) for 6 months. GeriLact contains 7 probiotic bacteria species. Participants received 500 mg Ca plus 200 IU vitamin D daily. Bone mineral density (BMD) of lumbar spine and total hip and blood biomarkers including bone-specific alkaline phosphatase (BALP), osteocalcin (OC), collagen type 1 cross-linked C-telopeptide (CTX), deoxypyridinoline (DPD), parathyroid hormone (PTH), 25-OH vitamin D, and serum pro-inflammatory cytokines (tumor necrosis factor [TNF]-α and interleukin [IL]-1β) were assessed at baseline and at the end of the study.

    RESULTS: The multispecies probiotic significantly decreased BALP (p = 0.03) and CTX (p = 0.04) levels in comparison with the control group but had no effect on BMD of the spine and total hip. Moreover, there was a statistically significant decrease in serum PTH (p = 0.01) and TNF-α (p = 0.02) in the intervention group compared to the placebo group.

    CONCLUSIONS: These results may suggest the favorable effects of the multispecies probiotic supplementation for 6 months on bone health in postmenopausal women due to slowing down the rate of bone turnover.

    Be well!

    JP

  24. JP Says:

    Updated 07/02/17:

    https://www.ncbi.nlm.nih.gov/pubmed/28665038

    Neurogastroenterol Motil. 2017 Jun 30.

    Efficacy of a standardized extract of Matricariae chamomilla L., Melissa officinalis L. and tyndallized Lactobacillus acidophilus (HA122) in infantile colic: An open randomized controlled trial.

    BACKGROUND: Infant colic (IC) is a prevalent physiological event of infants, which can disrupt the child’s home environment. We aimed to investigate the effectiveness of a mixture of Matricariae chamomilla L., Melissa officinalis L. and tyndallized Lactobacillus acidophilus (HA122) compared with Lactobacillus reuteri DSM 17938 and with simethicone for the treatment of IC.

    METHODS: A multicenter randomized comparative study was conducted in infants with colic, according to Rome III criteria, who were randomly assigned to receive M. chamomilla L., M. officinalis L. and tyndallized L. acidophilus (HA122) (Colimil® Plus® ; Milte Italia Spa, Milan, Italy) (Group A), L. reuteri DSM 17938 (Group B) and simethicone (Group C). Treatment was given to subjects for 28 days.

    KEY RESULTS: One-hundred and seventy-six patients completed the study. Mean daily crying time at day 28 was significantly lower in group A (-44, 95% CI: -58 to -30, P<.001) and group B (-35, 95% CI: -49 to -20, P<.001) when compared to group C. No significant difference was observed between Group A and Group B (mean difference: -9 minutes, 95% CI -23 to +5, P=.205). At day 28, 39 of 57 (68.4%) of infants in Group C responded to the treatment compared with 57 out of 60 patients (95%) of Group A and 51 out of 59 (86.4%) of Group B (P<.001).

    CONCLUSIONS: This study suggests that administration of M. chamomilla L., M. officinalis L. and tyndallized L. acidophilus (HA122) and L. reuteri DSM 17938 are significantly more effective than simethicone in IC.

    Be well!

    JP

  25. JP Says:

    Updated 09/30/17:

    https://www.ncbi.nlm.nih.gov/pubmed/28961980

    J Antimicrob Chemother. 2017 Aug 23.

    A randomized controlled trial of probiotics for Clostridium difficile infection in adults (PICO).

    Background: Clostridium difficile is the most common cause of hospital-acquired infections, responsible for >450 000 infections annually in the USA. Probiotics provide a promising, well-tolerated adjunct therapy to standard C. difficile infection (CDI) treatment regimens, but there is a paucity of data regarding their effectiveness for the treatment of an initial CDI.

    Objectives: We conducted a pilot randomized controlled trial of 33 participants from February 2013 to February 2015 to determine the feasibility and health outcomes of adjunct probiotic use in patients with an initial mild to moderate CDI.

    Methods: The intervention was a 28 day, once-daily course of a four-strain oral probiotic capsule containing Lactobacillus acidophilus NCFM, Lactobacillus paracasei Lpc-37, Bifidobacterium lactis Bi-07 and B. lactis Bl-04. The control placebo was identical in taste and appearance. Registered at clinicaltrials.gov: trial registration number = NCT01680874.

    Results: Probiotic adjunct therapy was associated with a significant improvement in diarrhoea outcomes. The primary duration of diarrhoea outcome (0.0 versus 1.0 days; P  =   0.039) and two exploratory outcomes, total diarrhoea days (3.5 versus 12.0 days; P  =   0.005) and rate of diarrhoea (0.1 versus 0.3 days of diarrhoea/stool diary days submitted; P  =   0.009), all decreased in participants with probiotic use compared with placebo. There was no significant difference in the rate of CDI recurrence or functional improvement over time between treatment groups.

    Conclusions: Probiotics are a promising adjunct therapy for treatment of an initial CDI and should be further explored in a larger randomized controlled trial.

    Be well!

    JP

  26. JP Says:

    Updated 11/25/17:

    http://www.turkishjournalpediatrics.org/uploads/pdf_TJP_1672.pdf

    Turk J Pediatr. 2017;59(1):13-19.

    The effect of early administration of combined multi-strain and multi-species probiotics on gastrointestinal morbidities and mortality in preterm infants: A randomized controlled trial in a tertiary care unit.

    The effect of early administration of combined multi-strain and multi-species probiotics on gastrointestinal morbidities and mortality in preterm infants: A randomized controlled trial in a tertiary care unit. Turk J Pediatr 2017; 59: 13-19. Necrotizing enterocolitis (NEC) is a gastrointestinal emergency of the neonatal period. The aim of this study was to demonstrate the use of multistrain and multispecies probiotic on gastrointestinal morbidities and mortality. The study was organized as a randomized controlled, prospective study in premature infants (≤32 week and ≤1500 gram). The ready commercial preparations which contain multi-combined probiotics of Lactobacillus rhamnosus (4.1×10⁸ cfu) + Lactobacillus casei (8.2×10⁸ cfu) + Lactobacillus plantorum (4.1×10⁸ cfu) + Bifidobacterium animalis (4.1×10⁸ cfu) together with 383 mg of fructooligosaccharides and 100 mg of galactooligosaccharides as the prebiotic content, was administered enterally to the probiotic group (n=70); control group constituted of 40 preterms. Primary outcomes of the present study were ≥ Stage 2 NEC and the mortality. Secondary outcomes were culture-proven sepsis and days to reach full enteral feeding. All cases of NEC were seen in group 2 as 3.6% (n=4) of all infants. The mortality was found to be 1.4% (n=1) in Group 1 and 22.5% (n=9) in Group 2. The incidence of NEC and the mortality rate were found to be significantly lower in Group 1 (p=0.016, p=0.001, respectively). In Group 1, the NEC-related mortality rate and sepsis-related mortality rate were significantly lower than that of the control group (p=0.046, p=0.023). In this study, we showed that using probiotic strains in combined multistrain and multispecies forms at higher doses and for prolonged duration had positive effects on gastrointestinal complications, sepsis and mortality in premature infants.

    Be well!

    JP

  27. JP Says:

    Updated 12/30/17:

    https://www.ncbi.nlm.nih.gov/pubmed/29279326

    Pediatrics. 2017 Dec 26. pii: e20171811.

    Lactobacillus reuteri to Treat Infant Colic: A Meta-analysis.

    CONTEXT: Lactobacillus reuteri DSM17938 has shown promise in managing colic, but conflicting study results have prevented a consensus on whether it is truly effective.

    OBJECTIVE: Through an individual participant data meta-analysis, we sought to definitively determine if L reuteri DSM17938 effectively reduces crying and/or fussing time in infants with colic and whether effects vary by feeding type.

    DATA SOURCES: We searched online databases (PubMed, Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, the Database of Abstracts of Reviews of Effects, and Cochrane), e-abstracts, and clinical trial registries.

    STUDY SELECTION: These were double-blind randomized controlled trials (published by June 2017) of L reuteri DSM17398 versus a placebo, delivered orally to infants with colic, with outcomes of infant crying and/or fussing duration and treatment success at 21 days.

    DATA EXTRACTION: We collected individual participant raw data from included studies modeled simultaneously in multilevel generalized linear mixed-effects regression models.

    RESULTS: Four double-blind trials involving 345 infants with colic (174 probiotic and 171 placebo) were included. The probiotic group averaged less crying and/or fussing time than the placebo group at all time points (day 21 adjusted mean difference in change from baseline [minutes] -25.4 [95% confidence interval (CI): -47.3 to -3.5]). The probiotic group was almost twice as likely as the placebo group to experience treatment success at all time points (day 21 adjusted incidence ratio 1.7 [95% CI: 1.4 to 2.2]). Intervention effects were dramatic in breastfed infants (number needed to treat for day 21 success 2.6 [95% CI: 2.0 to 3.6]) but were insignificant in formula-fed infants.

    LIMITATIONS: There were insufficient data to make conclusions for formula-fed infants with colic.

    CONCLUSIONS: L reuteri DSM17938 is effective and can be recommended for breastfed infants with colic. Its role in formula-fed infants with colic needs further research.

    Be well!

    JP

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