Probiotic

From Wikipedia, the free encyclopedia

Probiotics are live microorganisms thought to be beneficial to the host organism. According to
the currently adopted definition by FAO/WHO, probiotics are: "Live microorganisms which
when administered in adequate amounts confer a health benefit on the host".[1] Lactic acid
bacteria (LAB) and bifidobacteria are the most common types of microbes used as probiotics;
but certain yeasts and bacilli may also be helpful. Probiotics are commonly consumed as part of
fermented foods with specially added active live cultures; such as in yogurt, soy yogurt, or as
dietary supplements.

Etymologically, the term appears to be a composite of the Latin preposition pro ("for") and the
Greek adjective βιωτικός (biotic), the latter deriving from the noun βίος (bios, "life").[2]

At the start of the 20th century, probiotics were thought to beneficially affect the host by
improving its intestinal microbial balance, thus inhibiting pathogens and toxin producing
bacteria.[3] Today, specific health effects are being investigated and documented including
alleviation of chronic intestinal inflammatory diseases,[4] prevention and treatment of pathogen-
induced diarrhea,[5] urogenital infections,[6] and atopic diseases.[7]

Contents
[hide]

 1 History
 2 Indications
o 2.1 Diarrhea
o 2.2 Lactose intolerance
o 2.3 Colon cancer
o 2.4 Cholesterol
o 2.5 Blood pressure
o 2.6 Immune function and infections
o 2.7 Helicobacter pylori
o 2.8 Inflammation
o 2.9 Mineral absorption
o 2.10 Bacterial growth under stress
o 2.11 Irritable bowel syndrome and colitis
o 2.12 Other
 3 Side effects
 4 Strains
 5 EFSA opinions of probiotics
 6 Multi-probiotic
  7 See also
 8 References
 9 External links

[edit] History
The original observation of the positive role played by certain bacteria was first introduced by
Russian scientist and Nobel laureate Élie Metchnikoff, who in the beginning of the 20th century
suggested that it would be possible to modify the gut flora and to replace harmful microbes with
useful microbes.[3] Metchnikoff, at that time a professor at the Pasteur Institute in Paris, produced
the notion that the aging process results from the activity of putrefactive (proteolytic) microbes
producing toxic substances in the large bowel. Proteolytic bacteria such as clostridia, which are
part of the normal gut flora, produce toxic substances including phenols, indols and ammonia
from the digestion of proteins. According to Metchnikoff these compounds were responsible for
what he called "intestinal auto-intoxication", which caused the physical changes associated with
old age.

It was at that time known that milk fermented with lactic-acid bacteria inhibits the growth of
proteolytic bacteria because of the low pH produced by the fermentation of lactose. Metchnikoff
had also observed that certain rural populations in Europe, for example in Bulgaria and the
Russian steppes who lived largely on milk fermented by lactic-acid bacteria were exceptionally
long lived. Based on these facts, Metchnikoff proposed that consumption of fermented milk
would "seed" the intestine with harmless lactic-acid bacteria and decrease the intestinal pH and
that this would suppress the growth of proteolytic bacteria. Metchnikoff himself introduced in his
diet sour milk fermented with the bacteria he called "Bulgarian Bacillus" and found his health
benefited. Friends in Paris soon followed his example and physicians began prescribing the sour
milk diet for their patients.[8]

Bifidobacteria were first isolated from a breast-fed infant by Henry Tissier who also worked at
the Pasteur Institute. The isolated bacterium named Bacillus bifidus communis[9] was later
renamed to the genus Bifidobacterium. Tissier found that bifidobacteria are dominant in the gut
flora of breast-fed babies and he observed clinical benefits from treating diarrhea in infants with
bifidobacteria. The claimed effect was bifidobacterial displacement of proteolytic bacteria
causing the disease.

During an outbreak of shigellosis in 1917, German professor Alfred Nissle isolated a strain of
Escherichia coli from the feces of a soldier who was not affected by the disease.[10] Methods of
treating infectious diseases were needed at that time when antibiotics were not yet available, and
Nissle used the Escherichia coli Nissle 1917 strain in acute gastrointestinal infectious
salmonellosis and shigellosis.

In 1920, Rettger demonstrated that Metchnikoff's "Bulgarian Bacillus", later called Lactobacillus
delbrueckii subsp. bulgaricus, could not live in the human intestine,[11] and the fermented food
phenomena petered out. Metchnikoff's theory was disputable (at this stage), and people doubted
his theory of longevity.
After Metchnikoff's death in 1916, the centre of activity moved to the United States. It was
reasoned that bacteria originating from the gut were more likely to produce the desired effect in
the gut, and in 1935 certain strains of Lactobacillus acidophilus were found to be very active
when implanted in the human digestive tract.[12] Trials were carried out using this organism, and
encouraging results were obtained especially in the relief of chronic constipation.

The term "probiotics" was first introduced in 1953 by Werner Kollath (see Hamilton-Miller et al.
2003). Contrasting antibiotics, probiotics were defined as microbially derived factors that
stimulate the growth of other microorganisms. In 1989 Roy Fuller suggested a definition of
probiotics which has been widely used: "A live microbial feed supplement which beneficially
affects the host animal by improving its intestinal microbial balance".[13] Fuller's definition
emphasizes the requirement of viability for probiotics and introduces the aspect of a beneficial
effect on the host.

In the following decades intestinal lactic acid bacterial species with alleged health beneficial
properties have been introduced as probiotics, including Lactobacillus rhamnosus, Lactobacillus
casei, and Lactobacillus johnsonii.[14]

[edit] Indications
Experiments into the benefits of probiotic therapies suggest a range of potentially beneficial
medicinal uses for probiotics. For many of the potential benefits, research is limited and only
preliminary results are available. It should be noted that the effects described are not general
effects of probiotics. Recent research on the molecular biology and genomics of Lactobacillus
has focused on the interaction with the immune system, anti-cancer potential, and potential as a
biotherapeutic agent in cases of antibiotic-associated diarrhoea, travellers' diarrhoea, pediatric
diarrhoea, inflammatory bowel disease and irritable bowel syndrome.[15]

All effects can only be attributed to the individual strain(s) tested. Testing of a supplement does
not indicate benefit from any other strain of the same species, and testing does not indicate
benefit from the whole group of LAB (or other probiotics).[16]

[edit] Diarrhea

Infectious

Some probiotics have been shown to be beneficial in preventing and treating various forms of
gastroenteritis.[17] They reduce both the duration of illness and the frequency of stools.[18]
Fermented milk products (such as yogurt) also reduce the duration of symptoms.[19]

Antibiotic associated

Antibiotic-associated diarrhea (AAD) results from an imbalance in the colonic microbiota caused
by antibiotic therapy. Microbiota alteration changes carbohydrate metabolism with decreased
short-chain fatty acid absorption and an osmotic diarrhea as a result. Another consequence of
antibiotic therapy leading to diarrhea is overgrowth of potentially pathogenic organisms such as
Clostridium difficile. The Culturelle product contains the strain Lactobacillur rhamnosus LGG,
which studies indicate may reduce the risk of antibiotic associated diarrhea, improve stool
consistency during antibiotic therapy and enhance the immune response after vaccination[20] .

Probiotic treatment can reduce the incidence and severity of AAD as indicated in several meta-
analyses.[21][22][23][24][25][26] However, further documentation of these findings through randomized,
double blind, placebo-controlled trials are warranted.

Efficacy of probiotic AAD prevention is dependent on the probiotic strain(s) used and on the
dosage.[27][28] Up to a 50% reduction of AAD occurrence has been found.[26] No side-effects have
been reported in any of these studies. Caution should, however, be exercised when administering
probiotic supplements to immunocompromised individuals or patients who have a compromised
intestinal barrier.[citation needed]

[edit] Lactose intolerance

As lactic acid bacteria actively convert lactose into lactic acid, ingestion of certain active strains
may help lactose intolerant individuals tolerate more lactose than they would have otherwise.[29]

[edit] Colon cancer

In laboratory investigations, some strains of LAB (Lactobacillus bulgaricus) have demonstrated

anti-mutagenic effects thought to be due to their ability to bind with heterocyclic amines, which
are carcinogenic substances formed in cooked meat.[30] Animal studies have demonstrated that
some LAB can protect against colon cancer in rodents, though human data is limited and
conflicting.[31] Most human trials have found that the strains tested may exert anti-carcinogenic
effects by decreasing the activity of an enzyme called β-glucuronidase[31] (which can generate
carcinogens in the digestive system). Lower rates of colon cancer among higher consumers of
fermented dairy products have been observed in one population study.[29]

[edit] Cholesterol

Animal studies have demonstrated the efficacy of a range of LAB to be able to lower serum
cholesterol levels, presumably by breaking down bile in the gut, thus inhibiting its reabsorption
(which enters the blood as cholesterol).[29]

A meta-analysis that included five double blind trials examining the short term (2-8weeks)
effects of probiotic yoghurt on serum cholesterol levels found an overall decrease of 8.5 mg/dL
(0.22mmol/L) (~4% decrease) in total cholesterol concentration, and a decrease of 7.7 mg/dL
(0.2mmol/L) (~5% decrease) in serum LDL concentration. [32]

A slightly longer study evaluating the effect of probiotic yoghurt on twenty-nine subjects over
six months found no statistically significant differences in total serum cholesterol or LDL values.
However, the study did note a significant increase in serum HDL from, 50 mg/dL (1.28mmol/L)
to 62 mg/dL (1.6mmol/L) following treatment. This corresponds to an improvement of
LDL/HDL ratio from 3.24 to 2.48, with a 95% confidence interval of ± 0.33. [33]
Studies specifically on hyper-lipidemic subjects are still needed.

[edit] Blood pressure

Several small clinical trials have indicated that consumption of milk fermented with various
strains of LAB may result in modest reductions in blood pressure. It is thought that this is due to
the ACE inhibitor-like peptides produced during fermentation.[29]

[edit] Immune function and infections

LAB are thought to have several presumably beneficial effects on immune function. They may
protect against pathogens by means of competitive inhibition (i.e., by competing for growth) and
there is evidence to suggest that they may improve immune function by increasing the number of
IgA-producing plasma cells, increasing or improving phagocytosis as well as increasing the
proportion of T lymphocytes and Natural Killer cells.[34][35] Clinical trials have demonstrated that
probiotics may decrease the incidence of respiratory tract infections[36] and dental caries in
children.[37] LAB foods and supplements have been shown to aid in the treatment and prevention
of acute diarrhea, and in decreasing the severity and duration of rotavirus infections in children
and travelers' diarrhea in adults.[34][35]

A 2010 study suggested that the anecdotal benefits of probiotic therapies as beneficial for
preventing secondary infections, a common complication of antibiotic therapy, may be because
keeping the immune system primed by eating foods enhanced with "good" bacteria may help
counteract the negative effects of sickness and antibiotics. It was thought that antibiotics may
turn the immune system "off" while probiotics turns it back on "idle", and more able to quickly
react to new infections.[38]

[edit] Helicobacter pylori

LAB are also thought to aid in the treatment of Helicobacter pylori infections (which cause
peptic ulcers) in adults when used in combination with standard medical treatments. However
more studies are required into this area.[39]

[edit] Inflammation

LAB and supplements have been found to modulate inflammatory and hypersensitivity
responses, an observation thought to be at least in part due to the regulation of cytokine function.
[34]
Clinical studies suggest that they can prevent reoccurrences of inflammatory bowel disease in
adults,[34] as well as improve milk allergies.[40] They are not effective for treating eczema, a
persistent skin inflammation.[41] How probiotics counteract immune system overactivity remains
unclear, but a potential mechanism is desensitization of T lymphocytes, an important component
of the immune system, towards pro-inflammatory stimuli .[42]

[edit] Mineral absorption

It is hypothesized that probiotic lactobacilli may help correct malabsorption of trace minerals,
found particularly in those with diets high in phytate content from whole grains, nuts, and
legumes.[43]

[edit] Bacterial growth under stress

In a study done to see the effects of stress on intestinal flora, rats that were fed probiotics had
little occurrence of harmful bacteria latched onto their intestines compared to rats that were fed
sterile water.[44]

[edit] Irritable bowel syndrome and colitis

B. infantis 35624, sold as Align, was found to improve some symptoms of irritable bowel
syndrome in women in a recent study.[45] Another probiotic bacterium, Lactobacillus plantarum
299v, was also found to be effective in reducing IBS symptoms.[46] Additionally, a probiotic
formulation, VSL#3, was found to be safe in treating ulcerative colitis, though efficacy in the
study was uncertain.[47] Bifidobacterium animalis DN-173 010 may help.[48] For maintenance of
remission of ulcerative colitis, Mutaflor (E.coli Nissle 1917) there are 3 controlled, randomized,
double blind clinical studies which have proven equivalence of Mutaflor and mesalazine (5-
ASAs).[49]

[edit] Other

A study in 2004 testing the immune system of students given either milk or Actimel over a 6
week exam period (3 weeks of studying, 3 weeks of exams) tested 19 different biomarkers. Of
these 19 biomarkers only 2 were shown to be different between the two groups, increased
production of lymphocytes and increased production of CD56 cells. The tests were not blind and
show that certain probiotic strains may have no overall effect on the immune system or on its
ability.[50]

A 2007 study at University College Cork in Ireland showed that a diet including milk fermented
with Lactobacillus bacteria prevented Salmonella infection in pigs.[51]

A 2007 clinical study at Imperial College London showed that preventive consumption of a
commercially available probiotic drink containing L casei DN-114001, L bulgaricus, and S
thermophilus can reduce the incidence of antibiotic-associated diarrhea and C difficile-associated
diarrhea.[52]

The efficacy and safety of a daily dose of Lactobacillus acidophilus CL1285 in the prevention of
AAD was demonstrated by Montreal’s Maisonneuve-Rosemont Hospital, in a clinical study of
hospitalized patients.[53]

Current research is focusing on the molecular biology and genomics of Lactobacillus and
bifidobacteria. The application of modern whole genome approaches is providing insights into
bifidobacterial evolution, while also revealing genetic functions that explain their presence in the
particular ecological environment of the gastrointestinal tract.[54][55]
Probiotics are used in industry to improve yields of pork and chicken production.[56]

[edit] Side effects

In some situations, such as where the person consuming probiotics is critically ill, probiotics
could be harmful. In a therapeutic clinical trial conducted by the Dutch Pancreatitis Study Group,
the consumption of a mixture of six probiotic bacteria increased the death rate of patients with
predicted severe acute pancreatitis.[57]

In a clinical trial conducted at the University of Western Australia, aimed at showing the
effectiveness of probiotics in reducing childhood allergies, Dr Susan Prescott and her colleagues
gave 178 children either a probiotic or a placebo for the first six months of their life. Those given
the good bacteria were more likely to develop a sensitivity to allergens.[58]

Some hospitals have reported treating lactobacillus septicaemia, which is a potentially fatal
disease caused by the consumption of probiotics by people with lowered immune systems or who
are already very ill.[58][59]

There is no published evidence that probiotic supplements are able to replace the body's natural
flora when these have been killed off; indeed bacterial levels in feces disappear within days
when supplementation ceases.[60]

Probiotics taken orally can be destroyed by the acidic conditions of the stomach. A number of
micro-encapsulation techniques are being developed to address this problem. [61]

Recent studies indicate that probiotic products such as yogurts could be a cause for obesity
trends.[62] However, this is contested as the link to obesity and other health related issue with
yogurt may link to its dairy attributes.[63][64]

Some experts are skeptical on the efficacy of many strains and believe not all subjects will
benefit from the use of probiotics. A criticism of probiotic supplements is the cost and value of
probiotics products.[65]

[edit] Strains
Live probiotic cultures are available in fermented dairy products and probiotic fortified foods.
However, tablets, capsules, powders and sachets containing the bacteria in freeze dried form are
also available.

Probiotic Research and Producer Information[66]

Potential effect in
Strain Brandname Producer
humans
30
Bacillus coagulans GBI- GanedenBC Ganeden Improves abdominal
30, 6086 Biotech pain and bloating in IBS
patients.[67] Increases

Bifidobacterium LAFTI
LAFTI B94
B94 Bifidobacterium sp
Lactobacillus LAFTI L10
acidophilus LAFTI L10
Lactobacillus acidophilus
immune response to viral
challenge.[68]
Protects against
Salmonella typhimurium
in mice. Uses prebiotics
for improved
colonization. Facilitates
apoptotic response when
used in combination with
resistant starch in a colon
cancer model. Reduces
inflammation and
incidence of diarrhea in
an IBS model. Reduces
allergic responses in an
Institut
allergy model. Reduces
Rosell-
the severity of H.pylori
Lallemand
infection of the stomach
mucosa. Inhibits
pathogenic bacteria,
including H. pylori,
monocytogenes, E. coli,
and salmonella
typhimurium. Survives
in the conditions of the
gastro-intestinal tract.
Adheres to human
intestinal cells.
Synthesizes folate from
yogurts.[citation needed]
Institut Enhances clearance of
Rosell- Candida albicans by
Lallemand induction of an immune
response. Reduces
allergic responses in an
allergy model. Protects
against Listeria
monocytogenes in the
gastro- intestinal tract of
mice. Reduces the
incidence of tumor
formation and the size of
intestinal tumors in rats.
Uses prebiotics for
improved colonization.
Reduces inflammation in
 an IBS model. Inhibits
pathogenic bacteria,
including H. pylori,
monocytogenes, E.
colim, and Salmonella
typhimurium. Superior
survival in the conditions
of the gastro-intestinal
tract compared to other
probiotics. Adheres to
human intestinal cells.
Produces anti-microbial
substances like H202.
[citation needed]

Protects against
Salmonella typhimurium
in mice. Uses prebiotics
for improved
colonization. Reduces
inflammation in an IBS
model. Reduces allergic
responses in an allergy
model. Reduces the
Lactobacillus casei Institut severity of H.pylori
LAFTI L26 Lactobacillus LAFTI L26 Rosell- infection of the stomach
casei Lallemand mucosa. Inhibits
pathogenic bacteria,
including H. pylori,
monocytogenes, E. coli,
and Salmonella
typhimurium. Survives
in the conditions of the
gastro-intestinal tract.
Adheres to human
intestinal cells.[citation needed]
Human studies have
shown that BB-12®
alone or in combinations
Probio-Tec has a beneficial effect
Bifidobacterium animalis
Bifidobacterium Chr. Hansen within gastrointestinal
subsp. lactis BB-12
BB-12 health and immune
health. [69] This claim has
been rejected by EFSA
([70]
Bifidobacterium breve [citation needed]
Bifiene Yakult
Yakult
 Showed significant
improvement for
abdominal
Bifidobacterium infantis Procter &
Align pain/discomfort,
35624 Gamble
bloating/distention, and
bowel movement
difficulty.[71]
Bifidobacterium animalis
[citation needed]
subsp. lactis HN019 Howaru Bifido Danisco
(DR10)
Bifidobacterium longum Morinaga [citation needed]
BB536 Milk Industry
[citation needed]
Escherichia coli M-17 ProBactrix BioBalance
Escherichia coli Nissle [citation needed]
Mutaflor Ardeypharm
1917
Lactobacillus Nebraska [citation needed]
acidophilus DDS-1 Cultures[72]
Human studies have
shown that LA-5® has a
beneficial effect within
Lactobacillus
Chr. Hansen gastrointestinal health.
acidophilus LA-5
The LA-5 strain and its
clinical
documentation[citation needed]
Shown to reduce the side
Lactobacillus
Danisco effects of antibiotic
acidophilus NCFM
therapy.[73]
Lactobacillus casei
DN114-001 [citation needed]
Actimel/DanActive Danone
(Lactobacillus casei
Immunitas(s)/Defensis)
Human studies have
shown that L. casei
431® alone or in
combinations has a
Lactobacillus casei 431 Chr. Hansen
beneficial effect within
gastrointestinal health
Clinical documentation
on L. casei 431[citation needed]
Lactobacillus casei F19 Cultura Arla Foods [citation needed]
Lactobacillus casei [citation needed]
Yakult Yakult
Shirota
Lactobacillus paracasei [citation needed]
Lactobacillus fortis Nestlé
St11 (or NCC2461)[74]
Lactobacillus johnsonii Nestlé Reduces incidences of H
La1 (= Lactobacillus pylori-caused gastritis
LC1, Lactobacillus and reduces
johnsonii NCC533) inflammation [75]
Immune stimulation,
improves digestive
Lactococcus lactis L1A Norrmejerier health, reduces
antibiotic-associated
diarrhoea[76]
GoodBelly /
Lactobacillus plantarum ProViva/ TuZen/ Shown to improve
Probi
299v Bion Transit / symptoms of IBS.[77]
ProbiMage
Diarrhea prevention and
mitigation in children,[78]
[79]
Lactobacillus reuteri eradication of H.
ATTC 55730 BioGaia pylori infection,[80]
(Lactobacillus reuteri Biologics amelioration of
SD2112) gingivitis,[81] general
illness prevention in
children[82] and adults.[83]
Lactobacillus rhamnosus
ATCC 53013 (Also
LGG, Gefilus, Vifit [citation needed]
strain number GG, Valio
and others
discovered by Gorbach
& Goldin)
Immune stimulation,
improves digestive
Lactobacillus rhamnosus
Verum Norrmejerier health, reduces
LB21
antibiotic-associated
diarrhoea[76]
Protects against
antibiotic-associated
diarrhoea and infections
Wren
DiarSafe and of Clostridium difficile
Saccharomyces boulardii Laboratories
others and other clostridial
and others
species; helps treat acute
diarrhoea in adults &
children.[84][85][86]
Oral ingestion results in
tested as mixture:
Bion Flore Intime vaginal colonisation and
Lactobacillus rhamnosus
Jarrow Fem- Chr. Hansen prevention of
GR-1 & Lactobacillus
Dophilus vaginitis.Clinical studies
reuteri RC-14
on RC-14 and GR-1[87]
tested as mixture: Florajen3 American Reduction of C.
Lactobacillus Lifeline, Inc difficile–associated
acidophilus NCFM &
Bifidobacterium bifidum disease (CDAD)[1].
BB-12
Improves digestive
health. Prevents Antiobic
Associated Diarrhea
(AAD) and Clostridium
difficile (C. difficile).[53]

In vitro inhibition of
tested as mixture:
Listeria monocytogenes
Lactobacillus
Bio-K+ and L. innocua,
acidophilus CL1285 & Bio-K+ CL1285
International Escherichia coli,
Lactobacillus casei
Staphylococcus aureus,
LBC80R
Enterococcus faecalis
and Enterococcus
faecium.[88]
Reduction of symptoms
of lactose intolerance
and immune stimulation.
[89]

Lactobacillus plantarum Reduces the risk of

Bravo Friscus/
HEAL 9 & Lactobacillus Probi acquiring common cold
ProbiFrisk
paracasei 8700:2 infections.[90]
Lactobacillus helveticus
A'Biotica and
R0052 & Lactobacillus Institut Rosell [citation needed]
others
rhamnosus R0011
Lactobacillus casei var.
rhamnosus MG001 &
Lactobacillus
Symprove Symprove [citation needed]
acidophilus MG002 &
Probiotic Ltd.
Lactobacillus plantarum
MG003 & Enterococcus
faecium MG004

Some additional forms of yogurt bacteria include:

 Lactobacillus bulgaricus
 Streptococcus thermophilus
 Lactobacillus bifidus - became new genus Bifidobacterium

Some fermented products containing similar lactic acid bacteria include:

 Pickled vegetables[91][92][93]
 Fermented bean paste such as tempeh,[94] miso and doenjang
  Kefir[citation needed]
 Buttermilk or Karnemelk
 Kimchi [92][95]
 Pao cai[citation needed]
 Sauerkraut[96]
 Soy sauce[97]
 Zha cai[citation needed]

[edit] EFSA opinions of probiotics

The European Food Safety Authority has so far rejected most claims on probiotics in Europe due
to insufficient research and thus no conclusive proof. This includes:

 Lactobacillus paracasei LMG P 22043 does not decrease potentially pathogenic gastro-
intestinal microorganisms or reduce gastro-intestinal discomfort.
 Lactobacillus johnsonii BFE 6128 . Immunity and skin claims all too general for
consideration under the NHCR.
 Lactobacillus fermentum ME-3 not shown to decrease potentially pathogenic gastro-
intestinal microorganisms.
 Lactobacillus plantarum BFE 1685. Immunity claim deemed too general for NHCR.
 Bifidobacterium longum BB536 does not improve bowel regularity; does not resist cedar
pollen allergens; does not decrease pathogens.
 Bifidobacterium animalis ssp. lactis Bb-12 does not help maintain normal LDL-blood
cholesterol; does not decrease pathogens or boost immunity.
 Lactobacillus plantarum 299v does not reduce flatulence and bloating or protect DNA,
proteins and lipids from oxidative damage.
 Lactobacillus rhamnosus LB21 NCIMB 40564 does not help maintain individual
intestinal microbiota in subjects receiving antibiotic treatment.
[98]

[edit] Multi-probiotic
Research is emerging on the potential health benefits of multiple probiotic strains as a health
supplement as opposed to a single strain.[99][100] The human gut is home to some 400-500 types of
microbes. It is thought that this diverse environment may benefit from multiple probiotic strains;
different strains populate different areas of the digestive tract, and studies are beginning to link
different probiotic strains to specific health benefits.

Incomplete list of supplement products that contain more than one probiotic strain.

Strain
Company Product Probiotic Strains
Qty
EMD Multibionta Lactobacillus gasseri PA16/8, Bifidobacterium bifidum 3
Canada Inc. MF20/5, Bifidobacterium longum SP07/3
Bifidobacterium longum Rosell-175, Lactococcus lactis
OptiBac For daily Rosell-1058, Bifidobacterium breve Rosell-70, Lactobacillus
6
Probiotics wellbeing rhamnosus Rosell-11, Lactobacillus acidophilus Rosell-52,
Bifidobacterium bifidum rosell-71
Lactobacillus casei var. rhamnosus MG001, Lactobacillus
Symprove Symprove
acidophilus MG002, Lactobacillus plantarum MG003, 4
Ltd. UK Probiotic
Enterococcus faecium MG004

[edit] See also

What are probiotics?

Probiotics are bacteria that help maintain the natural balance of organisms (microflora) in the
intestines . The normal human digestive tract contains about 400 types of probiotic bacteria
that reduce the growth of harmful bacteria and promote a healthy digestive system. The largest
group of probiotic bacteria in the intestine is lactic acid bacteria, of which Lactobacillus
acidophilus, found in yogurt, is the best known. Yeast is also a probiotic substance. Probiotics
are also available as dietary supplements.

It has been suggested that probiotics be used to treat problems in the stomach and intestines. But
only certain types of bacteria or yeast (called strains) have been shown to work in the digestive
tract. It still needs to be proved which probiotics (alone or in combination) work to treat diseases.
At this point, even the strains of probiotics that have been proved to work for a specific disease
are not widely available.

What are probiotics used for?

In most circumstances, people use probiotics to prevent diarrhea caused by antibiotics.

Antibiotics kill "good" (beneficial) bacteria along with the bacteria that cause illness. A decrease
in beneficial bacteria may lead to diarrhea. Taking probiotic supplements (as capsules, powder,
or liquid extract) may help replace the lost beneficial bacteria and thus help prevent diarrhea.

A decrease in beneficial bacteria may also lead to other infections, such as vaginal yeast and
urinary tract infections, and symptoms such as diarrhea from intestinal illnesses.

Research has shown that certain probiotics may restore normal bowel function and may help
reduce:1

 Diarrhea that is a side effect of antibiotics.

 Certain types of infectious diarrhea.
 Inflammation of the ileal pouch (pouchitis) that may occur in people who have had surgery to
remove the colon.

These results suggest that eventually probiotics may also be used to:
  Help with other causes of diarrhea.
 Help prevent infections in the digestive tract.
 Help control immune response (inflammation), as in inflammatory bowel disease (IBD).

Researchers are studying the use of probiotics for inflammatory bowel disease, colon cancer, and
irritable bowel syndrome (IBS).

The results of some early studies suggest that probiotics found in yogurt may help prevent
diarrhea caused by antibiotics.1 But more studies are needed to confirm that yogurt is effective.
To offer benefit, the yogurt must contain active cultures. Most yogurt containers indicate
whether active cultures are present.

Are probiotics safe?

Probiotic bacteria are already part of the normal digestive system and are considered safe.

The U.S. Food and Drug Administration (FDA) does not regulate dietary supplements in the
same way it regulates medicines. A dietary supplement can be sold with limited or no research
on how well it works or on its safety.

Always tell your doctor if you are using a dietary supplement or if you are thinking about
combining a dietary supplement with your conventional medical treatment. It may not be safe to
forgo your conventional medical treatment and rely only on a dietary supplement. This is
especially important for women who are pregnant or breast-feeding.

When using dietary supplements, keep in mind the following:

 Like conventional medicines, dietary supplements may cause side effects, trigger allergic
reactions, or interact with prescription and nonprescription medicines or other supplements you
are taking. A side effect or interaction with another medicine or supplement may make other
health conditions worse.
 Dietary supplements may not be standardized in their manufacturing. This means that how well
they work or any side effects they cause may differ among brands or even within different lots
of the same brand. The form you buy in health food or grocery stores may not be the same as
the form used in research.
 The long-term effects of most dietary supplements, other than vitamins and minerals, are not
known. Many dietary supplements are not used long-term.

What are Probiotics?

Probiotics are live microbial organisms that are naturally present in the digestive tract and
vagina.

Probiotics are considered beneficial and are sometimes referred to as "friendly" bacteria. Some
of the ways they are thought to promote health include suppressing the growth of potentially
harmful bacteria, improving immune function, enhancing the protective barrier of the digestive
tract, and helping to produce vitamin K.

There are over 400 species of microorganisms in the human digestive tract, including
Lactobacillus and Bifidobacterium.

A number of medical, diet, and lifestyle factors are believed to disturb the balance in the colon.
This imbalance is called dysbiosis. Factors include:

 Inadequate dietary fiber

 Oral antibiotic therapy
 Infant formula feeding
 Ingestion of environmental toxins

No longer kept in check, less healthy bacteria and yeast may flourish, which is thought to
increase the likelihood of conditions such as infectious diarrhea and vaginal yeast infections.

Sources of Probiotics

Probiotics can be found in capsule, liquid, powder, or tablet form. Acidophilus drinks can be
found in health food stores and some grocery stores and Asian grocers.

Probiotics can also be found in cultured dairy products such as yogurt or kefir, however, the
number of live organisms varies greatly from product to product due to differences in processing
methods. Fermented foods such as sauerkraut also contain probiotics.

Once ingested, probiotics colonize the intestines and other parts of the body and can sustain
themselves unless they are destroyed by antibiotics or other factors.

Although they are thought to be essential for health, because they can sustain themselves in the
body under normal circumstances, there is no recommended daily intake of probiotics.

Prebiotics
"Prebiotics" are also thought to improve the balance of probiotics in the intestines. They are non-
digestible carbohydrates that stimulate the growth of beneficial bacteria in the intestines. Sources
of prebiotics include fructo-oligosaccharides (FOS) and inulin, found in onions, asparagus,
chicory, and banana. FOS is also available as a supplement and is sometimes combined with
probiotic dietary supplements.

Why Do People Use Probiotics

 Diarrhea Due to Antibiotic Use

 Traveler's Diarrhea
 Side Effects of Radiation Therapy
 Irritable Bowel Syndrome
 Vaginal Yeast Infections
  Ulcerative Colitis
 Crohn's Disease
 Immune Support
 Lactose Intolerance
 Prevention of Colds
 Allergic Rhinitis / Hayfever
 Constipation
 Colon Cancer Prevention
 Pouchitis
 Small Intestine Bacterial Overgrowth
 Canker Sores

What is the Evidence for Probiotics

 Diarrhea
A literature review found 185 studies published in what they deemed to be credible
journals between 1980 and 2004. The most commonly studied condition was diarrhea (41
or 22% of the 185 studies).

Seven studies looked at probiotic use in adults, focusing on the strains Lactobacillus
reuteri, Lactobacillus GG, L casei, L acidophilus, and S boulardi. Although they varied in
dose and probiotic strain, in six of the studies, probiotics shortened the course of diarrhea
or decreased its severity.

Many studies have looked at probiotic use in children. Once again, there is a wide range
of doses and probiotic strains. The most commonly used strains were Lactobacillus
acidophilus, L casei, L GG, and Bifidobacteria. In 20 of the studies published between
1980 and 2004, all of the studies found an improvement.

Seven out of 12 controlled trials reported a definite prevention of antibiotic-associated

diarrhea. In addition, a meta-analysis looked at 9 randomized, double-blind, placebo
controlled trials with a total of 1214 patients. Six of the nine trials showed a significant
benefit of probiotics.

 More evidence is needed on the effectiveness of probiotics in such conditions as lactose

intolerance, constipation, heart disease risk factors, and Crohn's disease.

Safety Concerns of Probiotics

Side effects of probiotics may include mild, temporary digestive complaints, such as gas and
bloating.

People who are immunosuppressed should seek medical advice before using probiotics. It is
possible that the probiotic itself may cause a serious infection. One death was reportedly linked
to probiotic use in a person taking immunosuppressant medication.
Potential Drug Interactions

Probiotics may interact with immunosuppresant medication (see above).

Probiotics are recommended by some health practioners during and/or after antibiotic use. What
are Probiotics?

Probiotics are "live microorganisms which when administered in adequate amount confer a
health benefit on the host (FAO 2001)."

This definition came from a consensus group of experts convened by the FAO in 2002 (PDF,
page 5). Through the years, many other definitions have been suggested, but this definition from
the FAO group seems the most encompassing.

Check out the latest articles and reports on probiotics In The News, in our featured Clinical
Study Highlight and on our Resources page.

Why Probiotics?

Scientists are learning more each day about the role of microbes in keeping people healthy and
the multitude of health benefits associated with consuming the right type and levels of probiotic
microbes.

Research has suggested that probiotic bacteria can:

 Help reduce the risk of certain diarrheal illnessesref

 Assist lactose intolerantref people with lactose digestion
 Enhance the immune functionref

Some preliminary studies also report that certain probiotics can play a role in reducing the
development of allergy in children, decreasing Helicobacter pylori colonization of the stomach,
helping patients cope with side effects of antibiotic therapy, managing relapse of some
inflammatory bowel conditions, decreasing the risk of certain cancers, decreasing dental-caries-
causing microbes in the mouth, and keeping healthy people healthy.

See Probiotics Basics for this and more.

The gut microflora or microbiota comprises about 10E 14 (100 trillion) microorganisms,
corresponding to more than 10 times the number of the body’s own cells. It is a very complex
microbial ecosystem composed of more than 1,000 species.

The intestinal tract is the body's most important immune function—related organ: approximately
70 percent of the body’s immune cells are located in the intestinal mucosa/lining of the
gastrointestinal (GI) tract. Activities such as regulating immune function, enhancing the
intestinal barrier to prevent unwanted microbes from entering the blood stream, and digestion are
important functions of microbiota. Current research on probiotics and microbiota aims at
understanding host-microbe interactions within the gut lumen, microbe-microbe interactions
within the microbiota and the combined health effects of these interactions.

One of the founding principles underlying the concept of administering probiotics is the notion
that disturbances in gut microecology, also referred to as dysbiosis, is associated with intestinal
conditions such as constipation and diarrhea, to more serious complications such as irritable
bowel syndrome (IBS) and inflammatory bowel disease (IBD). The probiotic concept asserts that
adding the appropriate strains to this complex ecosystem can result in health benefits through
interactions within the GI tract and the microbiota.

Defining Probiotics

A broadly accepted definition of probiotics has been put forward by the World Health
Organization (WHO), stating probiotics are “live microorganisms which, when administrated in
adequate amounts, confer a health benefit on the host" (FAO/WHO 2001).

The minimum criteria to be met for probiotic products are the probiotic must be:

 Specified by species and strain—research on specific probiotic strains cannot be applied to any
product marketed as a probiotic.
 Alive.
 Delivered in adequate dose through the end of shelf life (with minimal variability from one batch
to another).
 Shown to be efficacious in controlled human studies.

The probiotic potential of different bacterial strains, even within the same species, differs.
Different species and also different strains of the same species have their own unique
characteristics and consequently exert their own specific effects on microbiota and the GI tract.

The scientific basis of Lactobacillus plantarum 299v (Lp 299v)

The strain L. plantarum 299v is an example of what is termed clinically documented strain
(CDS). Lp 299v was first isolated from human intestine, and satisfies many of the selection
criteria requirements of a CDS. It is backed by many scientific and clinical studies during a span
of more than 15 years.

Here is a summary of its key characteristics:

 It has been shown to have good resistance to gastric acid and bile salts.
 It has exceptional adherence and colonization characteristics. This adherence ability prevents
the adhesion and translocation (penetration and entrance through the gut’s protecting layers) of
pathogens.
 It stimulates the secretion of mucin, which hinders the growth of disease-promoting bacteria.
 In one study, 299v helped with antibiotic-associated diarrhea.
  It reduces mucosal inflammation. When 299v adheres to the mucosal membrane of the gut, the
numbers of gram-negative bacteria (which always contain endotoxins and even a small number
cause an extreme inflammatory reaction) reduces substantially.
 It produces various short chain fatty acids(SCFAs) that lower gut pH, creating an unfavorable
environment for the growth of pathogens, including molds, yeasts and bacteria. 
 Multiple studies have shown Lp299v reduces the colonization of enteropathogenic E.coli  (EPEC),
which is often associated with occasional diarrhea and bowel discomfort.
 It has antimicrobial activity against various other pathogens.
 It helps increase the Lactobacilli population.

Lp 299v and IBS: Human Clinical Studies

IBS is a common disease that currently affects 10 percent to 20 percent of the adult population in
developed countries. The cause remains obscure, but the main triggers are thought to be overuse
of antibiotics, intestinal infections and stress. The composition of microflora significantly
contributes to GI health, and an increasing number of studies have reported an association
between alternation of microbiota and IBS development. Dysbiosis of the microbiota is thought
to alter GI function (immunological/inflammatory mechanisms). Symptoms often include
abdominal pain, flatulence, bloating, diarrhea and constipation. 

Niedzelin K et al. have assessed the efficacy of Lp299v versus placebo treatment in a
randomized, controlled, double blind study. Forty IBS patients received either Lp299v (20
billion cfu/d) or placebo treatment for four weeks, and improvements in their symptoms were
evaluated at the end of the study.  All patients in the treatment group reported complete
disappearance of abdominal pain after the study period while 80 percent of the placebo group
reported persisting pain. Occurrence of irregularity was also resolved in 60 percent of the
Lp299v treatment group versus 18 percent of the placebo group.   

Nobaeck et al. also conducted a controlled, double blind study using Lp299v. Fifty-two IBS
patients were treated with either Lp299v (20 billion cfu/d) or placebo for four weeks. Subjects
were monitored for up to 12 months after the initial treatment. In the Lp299v group, rapid and
significant improvements in IBS symptoms were observed. For example, 44 percent of treated
patients reported a reduction in flatulence by more than 50 percent, whereas only 18 percent of
the control patients reported an improvement. Similarly, abdominal pain disappeared in more
than 33 percent of the Lp299v patients after the first two weeks of treatment, while the effect was
much less in the control group. 

In a third study, Maladkar et al., 214 patients were enrolled in a four-week, randomized placebo-
controlled trial. The patients received either Lp299v 10 billion cfu/d or placebo. The variables
(abdominal pain, feeling of incomplete emptying, abdominal bloating and frequency of stools)
were significantly reduced in the Lp299v group compared to the placebo group. A total of 78
percent of the subjects in the Lp299v judged the global efficacy of the product was excellent or
good, while only 8 percent in the placebo group reported this.

In summary, the results of these clinical trials have shown L. plantarum 299v contributes to
various improvements in IBS patients. These improvements include, but are not limited to, the
following:
  Reduction of flatulence and bloating
 Reduction of abdominal pain
 Normalization of frequency and volume of stools
 Improvement of general GI health

Silvano Arnoldo has more than 25 years of experience in the natural products industry. He’s
worked for two major probiotics suppliers during a 12-year span and as a probiotics industry
consultant for the last eight years. His career in the probiotics industry has involved a broad
range of activities from scientific and technical issues to educational and marketing services. He
holds a Bachelor of Science in biology.