Probiotic Foods: 2008 Update
Part IX: More Health Claim For Probiotics ~ What’s The Truth?
This is Part IX of a ten-part article. This part addresses health claims for probiotics. Use the article index below to click among the pages. In this section, we take a look at health claims made for probiotic products.
These are not subjects most people care to discuss routinely, but, as was the case last year, more research produced promising results for probiotics in these areas. A study published in 2007 compared results of those drinking a preparation containing L. casei, L. bulgaricus and S. thermophilus, given twice a day during a course of antibiotics and for one week afterward, to those drinking a longlife sterile milkshake (the control group) given during the same term. In this study, 135 hospital patients taking antibiotics, with an average age of 74, were recruited. Of those in the control group, 34% developed AAD, compared to 12% of those drinking the probiotic beverage. Further, 17% of those in the control group developed diarrhea from Clostridium difficile (a spore-forming bacterium that can have results ranging from very unpleasant to life-threatening), compared to no instances of C. difficile-related diarrhea among those who drank the probiotic beverage.
A meta-analysis (effectively, an analysis of many analyses) published in The Lancet Infectious Diseases in June 2006, stated that in 34 masked, randomized, placebo-controlled trials, all but one carried out in developed countries in a health-care setting, probiotics reduced the risk of AAD, traveler’s diarrhea and acute diarrhea from various causes. The risk of acute diarrhea from all causes was lowered more in children than in adults—an important consideration, as children, especially when small, can quickly become dehydrated from diarrhea. The meta-analysis further noted that the species of probiotic did not significantly affect protection from diarrhea, a direct contrast to what some other research has found. This study concluded, “there is a lack of data from community-based trials and from developing countries evaluating the effect on acute diarrhoea unrelated to antibiotic usage.”
Large pharmaceutical companies are taking an interest in probiotics, as well. Sanofi-Aventis, for instance, has conducted at least two studies on the use of a type of Bacillus claudii (given as an oral suspension) as a remedy for diarrhea in infants and children. The first of these studies, conducted in 2004, was an evaluation of clinical safety versus a placebo for more than 400 children, age 6 months to 3 years. But Sanofi-Aventis must have seen promise in the results, as the latter of these two studies had two primary outcome measures, only one related to clinical safety (the other was the reduction of the incidence of AAD in study participants, this time age 6 months to 12 years). Unfortunately, I did not receive an answer to my inquiry about the results of this study.
Conversely, there have been studies attempting to demonstrate the efficacy of probiotics in constipation. In a 2007 pilot study published in Nutrition Journal, and conducted over a four-week period, 20 children with a median age of eight (all with constipation) were given a probiotic mixture once daily, composed of three specific strains of Bifidobacterium and three of Lactobacillus. Increased frequency in bowel movements, decreased incidence of fecal incontinence and decreased abdominal pain resulted, with no side effects reported. The researchers assert, though, that this was simply a pilot study, and that a larger, randomized, placebo-controlled study would be the ideal follow-up.
A slightly larger study reported in a 2007 issue of the journal, Pediatrics International, investigated the use of Lactobacillus casei rhamnosus Lcr35 versus magnesium oxide versus placebo in 45 children with chronic constipation. The researchers found that both Lcr35 and magnesium oxide were helpful in treating this condition; statistically, there was no difference in efficacy between the two. However, patients given the Lcr suffered less abdominal pain than those given magnesium oxide. Again, the researchers emphasized that a larger study is required.
Irritable Bowel Syndrome (IBS) is not a disease. Rather, it is a functional disorder, meaning that the bowel doesn’t function as it should. Among the most common symptoms are bloating, cramping, gas, diarrhea and/or constipation. IBS is far from rare; it’s the most common diagnosis in gastroenterology.
There has been some evidence from clinical trials that probiotics can provide some relief of IBS symptoms. A study published in January 2008 in Alimentary Pharmacology & Therapeutics found that patients given a multispecies probiotic supplement (including two separate strains of L. rhamnosus) fared better with IBS symptoms over the five-month period of the study than did those receiving a placebo, especially in abdominal pain and bloating. Those receiving the probiotic supplement were also observed to have a more stable population of intestinal microflora.
An earlier study (published in 2005) in the same journal found that, of 103 patients in a six-month study, those receiving a probiotic capsule once daily (consisting of four strains of probiotics) felt some mitigation of their symptoms compared to those receiving a once-daily placebo capsule. Considering individual symptoms, “growling” of the stomach (borborygmi, caused by gas moving through the intestines) was milder in the probiotic group. A Chinese study of 85 patients determined that a live probiotic mixture in capsule form, combining Lactobacillus, Bifidobacterium and Enterococcus strains, eased IBS symptoms over the four-week study and that there was a gradual improvement in this effect.
As is typical with studies, though, not all reach the conclusion that probiotics can be helpful. A 2005 study in The Journal of Pediatrics noted that administration of Lactobacillus GG to children with IBS did not significantly affect symptoms (versus those given a placebo), with the exception that those given the probiotic experienced less perceived abdominal bloating.
According to the Centers for Disease Control and Prevention, Heliobacter pylori is the bacterium responsible for more than 90% of duodenal ulcers and up to 80% of gastric ulcers. While some 2/3 of the world’s population is infected with this bacterium, most people never suffer any symptoms related to the infection. However, infection with H. pylori can cause chronic active, chronic persistent and atrophic gastritis in adults and children.
Since H. pylori was discovered, the usual treatment (at least in the U.S.) involves a course of antibiotics. More recently, studies have sought to ascertain if probiotics can help with an H. pylori infection or reduce side effects from the antibiotics used to treat it.
A 2006 article in Alimentary Pharmacology & Therapeutics noted that attempts to eradicate H. pylori in children fail 25% to 30% of the time, due mostly to side effects and resistance to antibiotics. This research selected 40 H. pylori-positive children treated consecutively with a ten-day course of antibiotics and blindly randomized to receive either a placebo or L. reuteri ATCC 55730. Overall, children receiving the L. reuteri reported fewer gastrointestinal symptoms than those receiving the placebo. A 2005 research project in the same journal was conducted on 47 subjects, randomized to receive either a placebo or a mixture of four probiotic strains during the course of eradication treatment and for three weeks afterward. Results showed that probiotic supplementation did not significantly diminish the frequency of new or exacerbated symptoms during eradication. However, with regard to total symptom severity, subjects given the probiotic supplement showed an improved tolerance to the eradication treatment. And, despite intensive antibiotic therapy, probiotic bacteria were able to survive in the gut.
A more recent pilot study (April 2008) investigated the direct effects of probiotics on H. pylori. In a double-blind, placebo-controlled trial, 40 H. pylori-positive subjects were given L. reuteri or a placebo once daily for 4 weeks. Those subjects on the probiotic experienced significantly fewer gastrointestinal symptoms than they had before the study started (compared to the placebo group, in which there was no change), and had a reduced H. pylori load, as determined by both breath and stool tests. When all subjects were treated with antibiotic therapy after the study concluded, there was no difference in rate of eradication.
Environmental Health published a study in 2005 on reducing short-term illness in the workplace. In this randomized, double-blind, placebo-controlled study, 181 subjects received either a placebo beverage or a beverage with L. reuteri protectis (ATCC 55730) for 80 days, in order to document any effect on short-term respiratory and gastrointestinal illnesses. The frequency of sick days was greater in the placebo group than in the group receiving the probiotic beverage, both among day workers and shift workers. Most notably, among 53 shift workers, 33% in the placebo group reported sick during the study period for the defined causes, as opposed to none in the L. reuteri group.
A somewhat older study involved 201 healthy infants (4 to 10 months old) in Israel. Between December 1, 2000 and September 30, 2002, subjects were randomly assigned to a 12-week course of formula supplemented with Bifidobacterium lactis (BB-12), L. reuteri ATCC 55730 or no probiotics. All subjects were fed only the assigned formula (no breast milk); no prebiotic or probiotic supplements or foods were permitted. Rate and duration of respiratory illnesses did not differ significantly between groups. However, the infants fed both the B. lactis and L. reuteri formulas had significantly fewer episodes of fever. In addition, the two groups fed probiotic-containing formula had significantly fewer episodes of diarrhea, and those episodes were of shorter duration. The infants fed formula containing L. reuteri had a significant drop in the number of days with fever, clinic visits, childcare absences and antibiotic prescriptions compared to those fed the control formula or the formula with B. lactis.
It would occupy too many more pages to inform you of the research that has been done concerning probiotics and other health issues. However, the list includes allergies, asthma, bacterial vaginosis, cholesterol, the common cold, dermatitis and prevention of tumors.
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