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Prescription 2016: Yakult for Seniors

September 28, 2016 Written by JP    [Font too small?]

Earlier this year there was a major review in the journal Digestive Diseases focusing on the role of gut bacteria in relation to healthy aging. The authors of the paper describe various “pathophysiological” mechanisms such as impaired immune function and systemic inflammation, which appear to be linked to undesirable changes in the microbiota of seniors. However, this observation has not yet been matched with a widely accepted medical solution. In part, the reason has to do with uncertainty about exactly how to re-establish a healthier bacterial environment.

Presently, microbiota and probiotic research is perhaps the hottest area of study in medicine. The amount of interest coming from consumers and medical professionals is indisputably immense. But, along with this profound curiosity, comes many more questions than answers. Chief among the unknowns is: Which probiotic foods or beneficial strains are most effective for those with imbalanced gut bacteria aka dysbiosis?

In 1930, Dr. Minoru Shirota first cultured a probiotic strain by the name of Lactobacillus casei Shirota. Some five years later, Yakult, a fermented dairy product containing this proprietary probiotic, entered the consumer marketplace in Japan. Since then, its popularity and production has spread considerably. Currently, you can find Yakult in grocery and health food stores in over 30 countries. But, more importantly, it has been the subject of dozens of peer-reviewed clinical trials and is featured in over 200 publications in the medical literature.

One of the most promising lines of research has to do with the utility of Yakult in an elderly population. An exciting study appearing in the September 2016 edition of Beneficial Microbes reports that supplementing with Yakult for six months dramatically accelerates the healing of distal radius (wrist) fractures. Another publication from 2016 discovered that drinking this fermented milk for six months successfully altered gut bacteria in patients living in an “aged care facility”. This shift in the microbiota resulted in reduced incidence of fever and constipation. Previous trials support these findings by revealing that Yakult bolsters senior immune function by increasing the activity of dendritic and natural killer cells while lowering inflammation. What’s more, it tends to improve digestive function in general – benefiting those with constipation and diarrhea.

This may sound like a veritable love letter to the makers of Yakult. But, in fairness, I don’t believe this is a perfect product. A quick look at the ingredients reveals why:

Yakult (Original): Water, Sugar, Skim Milk Powder, Glucose, Natural Flavors and Lactobacillus Casei Shirota.

Yakult Light: Water, Skim Milk, Corn Dextrin, Sugar, Glucose, Pectin, Natural Flavors, Stevia Extract and Lactobacillus Casei Shirota.

Of the two products, I recommend the light version which contains only 4 grams of sugar per serving vs. 11 grams in the original. As flawed as most of the ingredients are, the potential benefits for seniors and the product’s widespread availability make this a worthwhile candidate for home care, hospitals, nursing homes and beyond.

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!

Study 1 – Gastrointestinal Microbiota and Their Contribution to Healthy Aging … (link)

Study 2 – The Effect of Probiotic Treatment on Elderly Patients with Distal Radius … (link)

Study 3 – The Effectiveness of Lactobacillus Beverages in Controlling Infections … (link)

Study 4 – Probiotic Modulation of Dendritic Cell Function is Influenced by Ageing (link)

Study 5 – Immunomodulatory Effects of a Probiotic Drink Containing Lactobacillus (link)

Study 6 – Decreased Duration of Acute Upper Respiratory Tract Infections with … (link)

Study 7 – Effect of the Continuous Intake of Probiotic-Fermented Milk Containing (link)

Study 8 – Improving the Bowel Habits of Elderly Residents in a Nursing Home (link)

Yakult May Protect Against Diet-Induced Insulin Resistance

Source: Br J Nutr. 2015 Feb 28;113(4):596-602. (link)

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Posted in Alternative Therapies, Bone and Joint Health, Food and Drink

11 Comments & Updates to “Prescription 2016: Yakult for Seniors”

  1. JP Says:

    Updated 09/28/16:


    Eur J Appl Physiol. 2016 Aug;116(8):1555-63.

    Effects of Lactobacillus casei Shirota ingestion on common cold infection and herpes virus antibodies in endurance athletes: a placebo-controlled, randomized trial.

    AIMS: To assess evidence of health and immune benefit by consumption of a Lactobacillus casei Shirota probiotic in highly physically active people.

    METHODS: Single-centre, population-based, randomized, double-blind, placebo-controlled trial. Daily ingestion of probiotic (PRO) or placebo (PLA) for 20 weeks for n = 243 (126 PRO, 117 PLA) university athletes and games players. Subjects completed validated questionnaires on upper respiratory tract infection symptoms (URS) on a daily basis and on physical activity status at weekly intervals during the intervention period. Blood samples were collected before and after 20 weeks of the intervention for determination of Epstein Barr virus (EBV) and cytomegalovirus (CMV) serostatus and antibody levels.

    RESULTS: URS episode incidence was unexpectedly low (mean 0.6 per individual) and was not significantly different on PRO compared with PLA. URS episode duration and severity were also not influenced by PRO. A significant time × group interaction effect was observed for plasma CMV antibody titres in CMV seropositive participants (p < 0.01) with antibody titre falling in the PRO group but remaining unchanged in the PLA group over time. A similar effect was found for plasma EBV antibody titres in EBV seropositive participants (p < 0.01) with antibody titre falling in the PRO group but increasing in the PLA group over time. CONCLUSIONS: In summary, regular ingestion of PRO did not reduce URS episode incidence which might be attributable to the low URS incidence in this study. Regular ingestion of PRO reduced plasma CMV and EBV antibody titres, an effect that can be interpreted as a benefit to overall immune status. Be well! JP

  2. JP Says:

    Updated 09/28/16:


    Appl Environ Microbiol. 2016 May 31;82(12):3649-58.

    Fermented Milk Containing Lactobacillus casei Strain Shirota Preserves the Diversity of the Gut Microbiota and Relieves Abdominal Dysfunction in Healthy Medical Students Exposed to Academic Stress.

    Stress-induced abdominal dysfunction is an attractive target for probiotics. To investigate the effects of the probiotic Lactobacillus casei strain Shirota on abdominal dysfunction, a double-blind, placebo-controlled trial was conducted with healthy medical students undertaking an authorized nationwide examination for academic advancement. For 8 weeks, until the day before the examination, 23 and 24 subjects consumed an L. casei strain Shirota-fermented milk and a placebo milk daily, respectively. In addition to assessments of abdominal symptoms, psychophysical state, and salivary stress markers, gene expression changes in peripheral blood leukocytes and composition of the gut microbiota were analyzed using DNA microarray analysis and 16S rRNA gene amplicon sequence analysis, respectively, before and after the intervention. Stress-induced increases in a visual analog scale measuring feelings of stress, the total score of abdominal dysfunction, and the number of genes with changes in expression of more than 2-fold in leukocytes were significantly suppressed in the L. casei strain Shirota group compared with those in the placebo group. A significant increase in salivary cortisol levels before the examination was observed only in the placebo group. The administration of L. casei strain Shirota, but not placebo, significantly reduced gastrointestinal symptoms. Moreover, 16S rRNA gene amplicon sequencing demonstrated that the L. casei strain Shirota group had significantly higher numbers of species, a marker of the alpha-diversity index, in their gut microbiota and a significantly lower percentage of Bacteroidaceae than the placebo group. Our findings indicate that the daily consumption of probiotics, such as L. casei strain Shirota, preserves the diversity of the gut microbiota and may relieve stress-associated responses of abdominal dysfunction in healthy subjects exposed to stressful situations.

    IMPORTANCE: A novel clinical trial was conducted with healthy medical students under examination stress conditions. It was demonstrated that the daily consumption of lactic acid bacteria provided health benefits to prevent the onset of stress-associated abdominal symptoms and a good change of gut microbiota in healthy medical students.

    Be well!


  3. JP Says:

    Updated 09/28/16:


    Neurogastroenterol Motil. 2016 Jul;28(7):1027-36.

    Probiotic Lactobacillus casei strain Shirota relieves stress-associated symptoms by modulating the gut-brain interaction in human and animal models.

    BACKGROUND: This study aimed to examine the effects of Lactobacillus casei strain Shirota (LcS) on gut-brain interactions under stressful conditions.

    METHODS: Three double-blind, placebo-controlled trials were conducted to examine the effects of LcS on psychological and physiological stress responses in healthy medical students under academic examination stress. Subjects received LcS-fermented milk or placebo daily for 8 weeks prior to taking a national standardized examination. Subjective anxiety scores, salivary cortisol levels, and the presence of physical symptoms during the intervention were pooled and analyzed. In the animal study, rats were given feed with or without LcS for 2 weeks, then submitted to water avoidance stress (WAS). Plasma corticosterone concentration and the expression of cFos and corticotropin releasing factor (CRF) in the paraventricular nucleus (PVN) were measured immediately after WAS. In an electrophysiological study, gastric vagal afferent nerve activity was monitored after intragastric administration of LcS to urethane-anesthetized rats.

    KEY RESULTS: Academic stress-induced increases in salivary cortisol levels and the incidence rate of physical symptoms were significantly suppressed in the LcS group compared with the placebo group. In rats pretreated with LcS, WAS-induced increases in plasma corticosterone were significantly suppressed, and the number of CRF-expressing cells in the PVN was reduced. Intragastric administration of LcS stimulated gastric vagal afferent activity in a dose-dependent manner.

    CONCLUSIONS & INFERENCES: These findings suggest that LcS may prevent hypersecretion of cortisol and physical symptoms under stressful conditions, possibly through vagal afferent signaling to the brain and reduced stress reactivity in the PVN.

    Be well!


  4. Nigel Chua Says:

    Hmm – I find most cultured milk drinks including Yakult, Vitagen and the other companies that are trying to jump on the gut health bandwagon tends to have too much sugar and too little health benefits, but sometimes it becomes a “better than nothing” approach and plus they’re pretty easy to buy in most supermarkets.

    However, I do not buy these for my family, preferring to buy direct gut health supplements such as probiotics in capsule form as well, live probiotics minus all the sugars. A bit more pricey than the usual Yakult but healthier in my opinion.

  5. JP Says:

    Thank you, Nigel.

    A few comments:

    1) I wish that Yakult used better/healthier base ingredients as well. No disagreement there.

    2) Yakult isn’t jumping on any bandwagon. It’s one of the longest commercially available probiotic foods available today – since 1935.

    3) I like the idea of sugar-free probiotic supplements too. But, which ones are effective in a real-world setting? Most haven’t been subjected to many clinical trials – unlike Yakult.

    Be well!


  6. JP Says:

    Updated 11/06/16:


    Benef Microbes. 2016 Dec 1:1-8.

    Habitual intake of fermented milk products containing Lactobacillus casei strain Shirota and a reduced risk of hypertension in older people.

    This study investigated relationships between the frequent intake of fermented milk products containing Lactobacillus casei strain Shirota (LcS) and the onset of hypertension (resting systemic pressure ≥140 mmHg [systolic]/≥90 mmHg [diastolic], a doctor’s diagnosis and/or antihypertensive medicine use) during a 5-year period in 352 communityliving Japanese aged 65 to 93 years (125 men and 227 women). Initially normotensive subjects were divided into two groups (n=254 and n=98) on the basis of their intake of fermented milk products (<3 or ≥3 times/week, respectively), as estimated during an interview by a certified nutritionist. The incidence of hypertension over the 5-year interval was significantly lower in those who took fermented milk products ≥3 rather than <3 times/week (6.1 vs 14.2%, P=0.037). A multivariate-adjusted proportional hazards model predicted that blood pressures were significantly more likely to remain normal over 5 years in subjects who took ≥3 fermented milk products rather than <3 times/ week (relative risk 0.398 [95% confidence interval 0.167-0.948], P=0.037). These results suggest that after adjustment for potential confounders, the risk of developing hypertension is substantially lower in elderly people who take fermented milk products containing LcS at least 3 times a week.

    Be well!


  7. JP Says:

    Updated 04/30/17:


    Benef Microbes. 2017 Apr 26;8(2):153-162.

    Beneficial effects of Lactobacillus casei strain Shirota on academic stress-induced sleep disturbance in healthy adults: a double-blind, randomised, placebo-controlled trial.

    The present study examined whether Lactobacillus casei strain Shirota (LcS) improves sleep quality under psychological stress. A double-blind, placebo-controlled trial was conducted in healthy 4th year medical students exposed to academic examination stress. The trial was repeated over two consecutive years in different groups of students, and the data were pooled. For 8 weeks prior to and 3 weeks after a national standardised examination, a total of 48 and 46 subjects received a daily dose of 100 ml of LcS-fermented milk or non-fermented placebo milk, respectively. Study measures included subjective anxiety, overnight single-channel electroencephalography (EEG) recordings, and the Oguri-Shirakawa-Azumi (OSA) sleep inventory scores of subjective sleep quality. Total OSA scores were significantly lower than baseline on the day before the exam and recovered after the exam, indicating a stress-induced decline in sleep quality. There was a significant positive effect of LcS treatment on OSA factors for sleepiness on rising and sleep length. Sleep latency measured by EEG lengthened as the exam approached in the placebo group but was significantly suppressed in the LcS group. The percentage of stage 3 non-REM (N3) sleep decreased in the placebo group as the exam approached, whereas it was maintained in the LcS group throughout the trial. Delta power during the first sleep cycle, measured as an index of sleep intensity, increased as the exam approached in the LcS group and was significantly higher than in the placebo group. These findings suggest that daily consumption of LcS may help to maintain sleep quality during a period of increasing stress. The observed retention of N3 sleep and increased delta power in the LcS group may have contributed to higher perceived sleep satisfaction.

    Be well!


  8. JP Says:

    Updated 05/31/17:

    Note: This yogurt isn’t Yakult. But, this study still illustrates the potential of cultured, probiotic dairy re: immunity.


    Nutrients 2017, 9(6), 558

    Consumption of Dairy Yogurt Containing Lactobacillus paracasei ssp. paracasei, Bifidobacterium animalis ssp. lactis and Heat-Treated Lactobacillus plantarum Improves Immune Function Including Natural Killer Cell Activity

    The aim of this study was to investigate the impact of consuming dairy yogurt containing Lactobacillus paracasei ssp. paracasei (L. paracasei), Bifidobacterium animalis ssp. lactis (B. lactis) and heat-treated Lactobacillus plantarum (L. plantarum) on immune function. A randomized, open-label, placebo-controlled study was conducted on 200 nondiabetic subjects. Over a twelve-week period, the test group consumed dairy yogurt containing probiotics each day, whereas the placebo group consumed milk. Natural killer (NK) cell activity, interleukin (IL)-12 and immunoglobulin (Ig) G1 levels were significantly increased in the test group at twelve weeks compared to baseline. Additionally, the test group had significantly greater increases in serum NK cell activity and interferon (IFN)-γ and IgG1 than placebo group. Daily consumption of dairy yogurt containing L. paracasei, B. lactis and heat-treated L. plantarum could be an effective option to improve immune function by enhancing NK cell function and IFN-γ concentration.

    Be well!


  9. JP Says:

    Updated 06/19/17:


    Benef Microbes. 2017 Jun 16:1-10.

    The effects of the Lactobacillus casei strain on obesity in children: a pilot study.

    There are few data regarding the role of probiotics as a dietary intervention in the management of obesity in children. An open prospective examination was conducted to clarify the effects of Lactobacillus casei strain Shirota (LcS)-containing beverages in obese children. We compared the intestinal microbiota and organic acid levels between 12 obese (average age, 10.8 years; body mass index (BMI) Z score, 2.7±1.7) and 22 control children(average age, 8.5 years; BMI Z score, 0.1±0.7), and pre- and post-intervention in the obese children. The obese group underwent diet and exercise therapy for 6 months and then were given an LcS beverage daily for another 6 months and the body weight and serological markers were monitored. Significant reductions in the faecal concentrations of Bifidobacterium (obese group, 7.9±1.5 vs non-obese group, 9.8±0.5 Log10cells/g; P<0.01) along with a significant decline in the Bacteroides fragilis group, Atopobium cluster and Lactobacillus gasseri subgroup, and acetic acid (obese group, 45.1±16.9 vs non-obese group, 57.9±17.6 μmol/g; P<0.05) were observed in the obese group at baseline. A significant decline in body weight (-2.9±4.6%; P<0.05) and an elevation in the high density lipoprotein cholesterol level (+11.1±17.6%; P<0.05) were observed 6 months after ingestion of the LcS beverage compared to baseline. Furthermore, a significant increase in the faecal concentration of Bifidobacterium (7.0±1.2 before ingestion vs 9.1±1.2 Log10cells/g after ingestion; P<0.01) and an apparent increase in the acetic acid concentration (7.0±1.2 before ingestion vs 9.1±1.2 Log10cells/g after ingestion; P<0.01) were observed 6 months after ingestion. LcS contributed to weight loss while also improving the lipid metabolism in obese children via a significant increase in the faecal Bifidobacterium numbers and the acetic acid concentration.

    Be well!


  10. JP Says:

    Updated 09/03/17:


    Gerodontology. 2017 Aug 23.

    Effects of yogurt fermented with Lactobacillus delbrueckii ssp. bulgaricus OLL1073R-1 on the IgA flow rate of saliva in elderly persons residing in a nursing home: A before-after non-randomised intervention study.

    OBJECTIVE: The aim of this study was to investigate the alterations in the salivary IgA levels of elderly persons administered yogurt fermented with Lactobacillus delbrueckii ssp. bulgaricus (L. bulgaricus) OLL1073R-1, which has been reported to reduce the risk of colds.

    BACKGROUND: Salivary immunoglobulin (Ig)A plays an important role in the defence of the oral cavity mucous membrane against foreign antigens and pathogens. Accordingly, low levels of salivary IgA are associated with an increased risk of upper respiratory tract infection. Furthermore, salivary IgA secretion has been reported to decrease with age. Recently, several studies have reported that certain strains of Lactobacillus and their products can modulate the immune response, but there are currently few studies on the effects of on the IgA level in human saliva.

    MATERIALS AND METHODS: This was a before-after non-randomised intervention study. Thirty-seven elderly persons (mean age, 82.7 years) residing in a single nursing home ingested 112 g of the yogurt every morning for 12 weeks. The participants’ saliva was collected before and after 4, 8 and 12 weeks of yogurt intake.

    RESULTS: Our results showed that yogurt intake affected the concentration of IgA in the saliva (P < .0001). Additionally, yogurt intake and the body weight of the participants affected the IgA flow rate of saliva (P = .0003 and .03, respectively). CONCLUSION: Continuous intake of yogurt fermented with L. bulgaricus OLL1073R-1 may help improve the mucosal immune function in elderly people with weakened immune systems. Be well! JP

  11. JP Says:

    Updated 03/09/19:


    Front Microbiol. 2019 Feb 21;10:324.

    Lactobacillus casei Strain Shirota Alleviates Constipation in Adults by Increasing the Pipecolinic Acid Level in the Gut.

    The benefits of probiotics for constipation are widely accepted, but the mechanisms involving gut metabolites are unclear. In this study, we investigated the effects of Lactobacillus casei strain Shirota (LcS) on constipated patients and revealed that a metabolite mediator is involved in the LcS-induced constipation alleviation. Sixteen constipated patients and 22 non-constipated participants were recruited. The subjects consumed 100 mL of an LcS beverage (108 CFU/mL) per day for 28 days. The fecal non-volatile metabolites were determined by GC/MS, and the targeted metabolites were further verified in a constipated mouse model. In constipated patients, LcS intervention significantly improved defecation frequency (from 4.81 to 7.81 times per week, p < 0.05), stool consistency (from 2.52 to 3.68, p < 0.05) and constipation-related symptoms. A total of 14 non-volatile fecal metabolites were obtained as potential constipation-related metabolites that were regulated by LcS. Among these metabolites, pipecolinic acid (PIPA) had a significant positive correlation with defecation frequency in constipated patients. PIPA significantly promoted the small intestinal propulsive rate (from 25.45 to 39.68%) and increased the number of fecal pellets (from 30.38 to 57.38 pellets) in constipated mice (p < 0.05). The 5-hydroxytryptamine (5-HT) and acetylcholine (ACh) in colonic tissue may be partly involved in PIPA-mediated constipation alleviation. In conclusion, PIPA was a metabolic mediator in the gut that participated in LcS-induced constipation alleviation. Be well! JP

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