Probiotics Article Nmr News Nov Dec 2009

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Probiotics: Good Bacteria, Good for Gut, and Good Evidence

Probiotics: Good Bacteria, Good for Gut, and Good Evidence

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  • 1. Volume 2, Issue 8, Nov/Dec 2009 Probiotics: Good Bacteria, Good for Gut, and Good Evidence By: Charles Spielholz, Ph.D. P robiotics are live microorganisms that are fed to a host in order to bring about a health benefit. In our case, the host is a person. Probiotics usually consist of yeast and/or bacteria. The bacteria Lactobacillus (lactic acid bacteria) and Bacillus (Bifidobacteria) are the most common genera of probiotics used in functional foods designed for human consumption. Each of these genera comprises many different strains and not all strains are effective in all situations. Therefore manufacturers of probiotic products must use strains that are known to provide the benefits which are claimed. Probiotics are generally active in the digestive system and are administered orally as a constituent of a functional food, such as fermented milk or yogurt, or in capsule or powder forms. Some companies are working on adding probiotics to fruits such as apples (which would offer users a non- dairy functional food source) as well as to fun-to-eat foods like pizza and pasta. In cases where probiotics are used to help alleviate skin conditions, the probiotics are administered topically. © Copyright 2009. Nutraceutical Medical Research, LLC – All Rights Reserved. 1
  • 2. Volume 2, Issue 8, Nov/Dec 2009 Regardless of how probiotics are delivered to the host’s digestive tract, it is critical that the probiotic species be stable and remains alive while it is in storage in the functional food, capsule or powder or whatever method is used as a delivery vehicle. It is equally critical that the probiotic species be able to survive long enough in the host’s digestive tract to have the intended beneficial effect. It is equally critical that the specific strain used have the beneficial effect desired and to not cause infections or any kind of pathogenicity. At this point, it is useful to define the term prebiotic. Prebiotics are best described as roughage or fiber. Fiber is food material that is not digestible by the host. Usually derived from plants, prebiotics are generally oligosaccharides or carbohydrates that can serve to support and stimulate the growth and/or activity of probiotics in the human digestive tract. Prebiotics will not be discussed in this mini-review. The digestive tract is the major beneficiary of probiotics. Probiotics appear to help control the population of pathogenic microorganisms in the digestive tract by outgrowing, out adhering or otherwise inhibiting the growth of pathogenic microorganisms. Benefits to the digestive tract include control of stomach upset, diarrhea and constipation. Probiotics may also be a good way to replace microorganisms to the digestive during or after treatment with antibiotics. Evidence also indicates that probiotics may help control candidiasis and urinary tract infections, again by out populating problematic or pathogenic microorganisms. Finally, there are also claims that probiotics may lower cholesterol, alleviate rheumatoid arthritis, atopic dermatitis and Crohn’s disease, exert anti-cancer activity and modulate the immune system. Each of these © Copyright 2009. Nutraceutical Medical Research, LLC – All Rights Reserved. 2
  • 3. Volume 2, Issue 8, Nov/Dec 2009 proposals and claims will be briefly examined in this mini-review. In addition, the safety and adverse effects profile will be briefly evaluated. Finally, recent concerns regarding probiotic claims will be reviewed using an example involving yogurt. Probiotics have shown benefit with the control of diarrhea caused by antibiotics and some infections. A small number of basic, randomized clinical trials have shown that the administration of probiotics with standard rehydration therapy decreases the duration of acute diarrhea (1-6). However, not all cases of infectious diarrhea can be alleviated by the use probiotics. For example there is no significant evidence that diarrhea resulting from infection by Clostridium difficile is alleviated by probiotics (7-8). Clinical trials with traveler’s diarrhea have been mixed (9-11) probably reflecting the large variety of microorganisms that cause traveler’s diarrhea as well as the variety of probiotic strains used to treat it. Antibiotic treatment of infectious diseases is known to cause diarrhea in many patients. Several studies have shown that taking probiotics with antibiotics decreases the chances of antibiotic associated diarrhea by about 10 to 50% (6, 12-14). Again the range of efficacy is probably due to different strains of probiotics used in different clinical trials as well as differences in the microorganism types found in the digestive tracts of different groups of people. Data regarding stomach upset and the resulting symptoms show that probiotics delivered orally in functional foods (or as capsules or powders) are helpful for alleviating some, but not all, © Copyright 2009. Nutraceutical Medical Research, LLC – All Rights Reserved. 3
  • 4. Volume 2, Issue 8, Nov/Dec 2009 causes of stomach upset. As with any health situation, if the condition does not clear up, then the individual should see their health care provider. In the case of stomach upset, this means no more than two days. A role for probiotics in the treatment of inflammatory bowel diseases and related conditions has also been proposed and tested in a preliminary manner. Thus far results have been mixed (15-22). Clinical trials using probiotics to treat Crohn’s disease have been inconsistent and indicate the need for well controlled clinical trials. Data from clinical trials with ulcerative colitis is more consistent; it appears that probiotics may prevent relapse and may also be useful to treat mild to moderate attacks and symptoms of ulcerative colitis. Evidence also exists showing that probiotics can also help manage pouchitis and diverticulitis. However, as with Crohn’s disease, more research is needed to define exactly which conditions can be treated and exactly which strains of bacteria should be used. Probiotics may also function outside the digestive tract. Preliminary evidence is very promising; data indicates that probiotics may be useful in preventing urinary tract infections and bacterial vaginosis in women (23-25). In these cases, the probiotics were applied topically, not orally. Again, additional clinical trials are needed before a precise role for probiotics in the treatment or prevention of urinary tract infections can be developed. Probiotics have also been proposed as a treatment for a large variety of other ailments, conditions and diseases including colon cancer, lowering cholesterol and blood pressure, aiding © Copyright 2009. Nutraceutical Medical Research, LLC – All Rights Reserved. 4
  • 5. Volume 2, Issue 8, Nov/Dec 2009 relief from lactose intolerance, improving immune function, treating ulcers caused by Helicobacter pylori, relieving rheumatoid arthritis, allergy, and atopic dermatitis. However, research into these areas is in the very early stages; rigorous clinical trials are required before any conclusions can be made regarding a role for probiotics in the treatment of any of these conditions, ailments or diseases. In many of these situations, probiotics may be altering immune responses (possibly activating or redirecting the response) or by crowding out pathogenic species. Additional research will tell. Probiotics are generally considered to be safe. Reports of adverse reactions with common probiotics are rare. The species most often used in probiotic formulations, bactobacillus and Bacillus, are normally found in the digestive tract of humans. In some cases, when candidate probiotics are isolated from infections, special precautions must be taken to ensure that such species are safe to use as a probiotic (26). However, for some unique conditions, well known probiotics that have been considered safe have caused sepsis. For example, neonates treated for necrotizing enterocolitis with probiotics developed sepsis (27-28). Observations of this sort define the requirement for well performed clinical studies before certain treatments with probiotics are attempted. Indeed, probiotics are safe with very few reports of adverse reactions. However, as with any agent, probiotics should not be used in people with severe illness or who are immune compromised. © Copyright 2009. Nutraceutical Medical Research, LLC – All Rights Reserved. 5
  • 6. Volume 2, Issue 8, Nov/Dec 2009 Although there is ample volume of evidence that shows probiotics are useful for digestive health and for the immune system, producers still must be very careful about the wording of statements regarding health claims. Dannon recently settled a class action lawsuit regarding claims about its probiotic products, Activia yogurt and DanActive yogurt drinks (29). Dannon claimed that these products could help regulate digestion and stimulate an immune response. As part of the settlement, Dannon agreed to change wording on its probiotic products to better reflect that Avtivia yogurt and DanActive yogurt drinks are not cures or treatments for any medical disorder and that if a consumer has concerns about their digestive tract, they should consult with a health care provider. The reason Dannon settled this class action lawsuit was to avoid further litigation. However, Dannon continues to stand by its health claims that Activia and DanActive products are scientifically proven to help regulate the digestive tract when used as part of a balanced diet and a healthy life style. Dannon, which is a company that produces products of excellent quality and performs excellent research to support claims regarding its products, plans to present additional research that will support health claims regarding its probiotic products. Probiotics are an exciting area of the functional food industry. Probiotics have already provided important contributions to maintaining health of the digestive tract without adverse © Copyright 2009. Nutraceutical Medical Research, LLC – All Rights Reserved. 6
  • 7. Volume 2, Issue 8, Nov/Dec 2009 effects. Further research is expected to prove that there are additional health benefits to probiotics. Probiotics are an excellent example of how research, both scientific and clinical, is able to be used to prove the benefits of a functional food. References 1) Szajewska H, Mrukowicz JZ. 2001. J Pedatr Gastroenterol Nutr 33Supp2:S17-S25. 2) Huang JS, Bousvaros A, Lee JW, Diaz A, Davidson EJ. 2002. Dig Dis Sci 47:2625-2634. 3) Van Neil CW, Feudtner C, Garrison MM, Christakis DA. 2002. Pediatrics 109:678-684. 4) Allen SJ, Okoko B, Martinez E, Gregario G, Dans LF. 2004. Cochrane Database Sys Rev 2:CD003048. 5) Sazawal S, Hiremath PL, Gorbach SL. 2006. Lancet Infect Dis 6:374-382. 6) Doran SI, Hibberd PL, Gorbach SL. 2008. J Clin Gastroenterol 42Supp2:S58-63. 7) Dendukuri N, Costa V, McGregor M, Brophy JM. 2005. CMAJ 175:167-170. 8) Segerra-Newnham M. 2007. Ann Pharmacother 41:1212-1221. 9) DeDios Pozo_Olano J, Warram JH, Gomez RG, Cavazos MG. 1978. Gastroenterology 74:829-830. 10) Oksanen PJ, Salminnen S, Saxelin M, Hamalainen P, Ihantola-Vormisto A, Muurasniemi-Isoviita L, Nikkari S, Oksanen T, Porsti I, Salinen E et al., 1990. Ann Med 22:53-56. 11) McFarland LV. 2007. 2007. Travel Med Infect Dis 5:97-105. 12) Vanderhoof JA, Whitney DB, Antonson DL, Hanner TL, Lupo, JV, Young RJ. 1999. J Pediatr 135:564-568. 13) D’Souza AL, Rajkumar C, Cooke J, Bulpitt CJ. 2002. Br Med J 324:1361-1364. 14) Hickson M, D’Souza AL, Muthu N, Rogers TR, Want S, Rajkumar C, Bulpitt CJ. 2007. Br Med J 335:80-84. 15) Rembacken BJ, Snelling AM, Hwkey PM, Chalmers DM, Axon AT. 1999. Lancet 354:635-639. 16) Venturi A, Gionchetti P, Rizzello F, Joahnsson R, Zucconi E, Brigidi P, Matteuzzi D, Campieri M. 1999. Aliment Pharmacol Ther 13: 1103-1108. 17) Gupta P, Anrew H, Kirschner BS, Guandalini S. 2000. J Pediatr Gastroenterol Nutr 31:453-457. © Copyright 2009. Nutraceutical Medical Research, LLC – All Rights Reserved. 7
  • 8. Volume 2, Issue 8, Nov/Dec 2009 18) Guslandi M, Giollo P, Testoni PA. 2003. Gastroenterol Hepatol 15:697-698. 19) Fric, Zavoral M. 2003. Eur J Gastroenterol Hepatol 15:313-315. 20) Kruis W, Fric P, Pokrotnieks J, Lukas M, Fixa B, Kascak M, Kamm MA, Weismueller J, Beglinger C, Stolte M, Wolff C, Schulze J. 2004. Gut 53:1617-1623. 21) Bousvaros A, Guandalini S, Baldassano RN, Bothelho C, Evans J, ferry GD, Goldin B, Hartigan L, Kugathasan S, Levy J, Murray KF, Oliva-Hemker M, Rosh JR, Tolia V, Zholudev A, Vanderhoof JA, Hibberd PL. 2005. Inflamm Bowel Dis 11:833-839. 22) Gionchetti P, Rizzello F, Lammers KM, Morselli C, Sollazzi L, Davies S, Tambasco R, Calabrese C, Campieri M. 2006. World J Gastroenterol 12:3306-3313. 23) Reid G. 2001. Am J Clin Nutr 73Supp2:437S-443S. 24) Farmularo G, Perluigi M, Pieluigi M, Coccia R, Mastroiacovo P, DeSimone C. (2001) Med Hypotheses 56:421- 430. 25) Reid G, Bruce AW. 2006. World J Urol 24:28-32. 26) Ishisbashi N, Yamazaki S. 2001. Am J Clin Nutr 73Supp: 465S-470S. 27) Bin-Nun A, Bromiker r, Wilschanski M, Kaplan M, Radensky B, Caplan M, Hammerman C. 2005. J Pediatr 147:192-196. 28) Lin HC, Su BH, Chen AC, Lin TW, Tsai CH, Yeh TF, Oh W. 2005. Pediatrics 115:1-4. 29) Parker-Pope T. 2009. New York Times, September 29. © Copyright 2009. Nutraceutical Medical Research, LLC – All Rights Reserved. 8