Health Benefits of Probiotic Supplementation

[dvsness]

Current State of Science Review focusing on efficacy, safety and various uses for oral Probiotics

By Amy Fitzpatrick, MS, RD
Corporate Nutritionist & Research Consultant, Natural Health Solutions, Kingsport, TN 37665
Nutrition & Natural Products Research & Education


Summary
The word probiotic literally means ?for life? and is a term used to signify the health promoting properties of ?friendly bacteria? such as Lactobacillus acidophilus and Bifidobacterium bifidum, which naturally inhabit the human gastrointestinal system. Also known as lactic acid bacteria, probiotics have been consumed for as long as people have eaten fermented foods and were revered by many cultures as having the ability to improve health. Although the health benefits of probiotics weren?t discovered until the early 1900s, individuals world-wide have ingested probiotics through food and beverage preservation by fermenting certain dietary staples (eg, milk, cabbage, fruit, soybeans, etc) with lactic acid bacteria.

Today, probiotics are still consumed, primarily through fermented dairy products (eg, yogurt and kefir), but also in drug and supplement formulations. A growing body of evidence has emerged confirming the positive effects of probiotics in humans, primarily related to two major areas: gastrointestinal and immune health. The most commonly used and researched species belongs to the genera Lactobacillus, Bifidobacterium, and Saccharomyces, particularly L. casei, L. rhamnosus, L. acidophilus, L. plantarum, B. longum, B. breve, B. bifidum, and S. cerevisiae boulardii.


Background
The use of probiotics in foods has a long history. The use of microorganisms in food fermentation is one of the oldest methods for producing and preserving food. In fact, much of the world depends upon various fermented foods that are staples in the diet. In Europe, sauerkraut made from fermented cabbage is a regular side dish, and in Asia fermented soybean products such as miso and natto have been consumed for centuries. Interestingly, soured milks and cultured dairy products, such as kefir, were often used therapeutically before the existence of probiotic microorganisms was recognized.1 Currently, multiple strains of bacteria (eg, Lactobacillus, Bifidobacterium and Streptococcus) are commonly added to pasteurized dairy products to increase the digestibility of the lactose present in the dairy product.2 Today, one of the best selling brands of organic yogurt contains at least six strains of probiotic bacteria.3

Although a variety of bacteria have been commonly consumed through our food supply for millennia, it wasn?t until the turn of the century that ingested bacteria were proposed to have a positive influence on the normal microbial flora of the intestinal tract, which in turn, would affect the health of humans. Researchers have now estimated that microflora in the adult human body consist of an enormous biomass of > 100,000 billion bacteria of > 400 different species, which generate metabolic activity, and play an important physiologic role in humans.4


Health Benefits of Probiotics
There is increasing evidence that the composition and metabolic effects of the gastrointestinal microflora are of key importance for human health. Of the estimated 400 or more species of bacteria living within the intestinal tract, the most important to human health belong to two genera: lactobacillus and bifidobacteria. These genera of probiotics are the most reliable and well-researched probiotic organisms and their beneficial effects have been discussed for decades.2

These two groups of ?friendly? bacteria live symbiotically in our bodies in a beneficial relationship that enhances our health in a wide variety of ways. Lactobacillus organisms reside mainly in the small intestine, bifidobacteria in the large. The lactobacillus genus contains dozens of species, including such organisms as L. acidophilus, L. plantarum, L. casei, L. rhamnosus and L.reuteri. Some of the most important members of the bifidobacteria genus include B. longum, B. bifidum, B.breve and B. infantis. Scientists are now formulating products that contain one or more species from both genera to improve the colonization of probiotics in both the small and large intestine.

A variety of functions have been attributed to probiotic bacteria, including, inhibition of the growth of pathogenic bacteria in the gut; creation of substances that help fuel and reinforce the barrier defense of the gastrointestinal (GI) tract; assisting in the generation and absorption of certain vitamins; and influencing the maturation and maintenance of the immune system, among others.5

For instance, Lactobacillus acidophilus and Bifidobacterium bifidum appear to enhance nonspecific immune activity.6 Some other species, including L. plantarum, L. rhamnosus, L. casei and L. bulgaricus, have demonstrated a variety of immuno regulatory effects that could help bolster an individual?s immune protection.5

Other lactic acid bacteria, including strains of Lactobacillus acidophilus, Lactobacillus bulgaricus, Bifidobaterium longum and Streptococcus thermophilus, have also demonstrated antioxidant ability in preliminary research studies.7

Research shows that regular dietary intake of beneficial microflora must be sustained to maintain high enough levels for functional benefits. For instance, levels of bifidobacteria in the colon have been reported to decline with age.8 Preliminary research has found that supplementing the diet with several probiotic species can restore levels of important immune system markers comparable to levels in younger controls.


Benefits of Multiple Strains


The Research
Although single strains of bacteria were originally isolated and studied for their health benefits, today, scientists have an interest in the benefits that a combination of probiotic strains can offer. As a result, there have been a variety of clinical studies evaluating the efficacy and safety of multiple strain probiotic formulations in various populations.10,11,12,13,14,15 In fact, some researchers have suggested that a mixture of probiotics may have a greater effect on the intestine than the individual strains.16,17

Not only have research studies found that multiple strains of probiotics can increase the richness and diversity of the bacterial microbiota in the gut, but these combinations offer functional benefits as well.18 Preliminary evidence suggests that a combination of strains19 rather than a single organism 20 may alleviate symptoms of specific gastrointestinal concerns. The multi strain formula contained four strains of lactobacilli, three strains of bifidobacteria, and one strain of Streptococcus salivarius subsp. thermophilus opposed to just a single strain of lactobacilli.

Other studies have found similar results. For example, combinations of lactobacilli, bifidobacteria, and Streptococcus salivarius have been shown to reduce the relapse of recurrent gastrointestinal symptoms.21 Also, Institut Rosell Lallemand has conducted research presented at the 20th International Symposium on Neurogastroenterology and Motility held in Toulouse, France, which showed its probiotic formulation containing Lactobacillus acidophilus and Lactobacillus rhamnosus may reduce gastrointestinal complaints.

The immune enhancing benefit of probiotic combinations has also been reported in the scientific literature. A combination of Bifidobacterium bifidum and Lactobacillus acidophilus was found to exhibit a positive modulation of the immunological and inflammatory response in healthy elderly subjects.13 Recently, the combination of Lactobacillus gasseri, Bifidobacterium longum, and Bifidobacterium bifidum taken for 3 months significantly enhanced specific cells involved in the immune response compared to placebo. Fecal levels of lactobacilli and bifidobacteria increased after probiotic supplementation suggesting that these live bacteria were administered to the gut.10


Expert Opinion
Currently, there is an increasing trend of combining strains to target specific health benefits. The following experts have reported their opinion on the topic:

Dr. Jacques Goulet, scientific director, Institut Rosell, Montreal, Canada, suppliers of L.acidophilus Rosell-52 and L.rhamnosus Rosell-11, commented, ?From a scientific point of view we are noticing that a single strain won?t do the best job in improving health. Scientists are suggesting that probiotic supplements be a mixture of four, five and even eight strains to get the most benefit.?23

Researchers from the Canadian Research and Development Centre for Probiotics, The Lawson Health Research Institute, and Departments of Microbiology and Immunology, University of Western Ontario write that ?based upon the evidence to date, future advances with single- and multiple-strain therapies are on the horizon for the management of a number of conditions.?24

Dr. S. Bengmark, from Lund University in Sweden, Dr. G. Reid of the University of Western Ontario in Canada and Dr. Gionchetti from the University of Bologna, Italy, reported their scientific findings at the Probiotics and Health Symposium in Montreal, Canada. They said that ?blends of various probiotic strains seem to present the best chances of success in most therapeutic applications of probiotics.?25

(CONTINUED)

[dvsness]

Stability of Probiotic Foods & Supplements
The effectiveness of probiotics is related to their ability to survive a wide variety of environmental influences. For instance, high temperatures, oxygen, moisture and the acidic stomach environment can all affect the survival of probiotics. Furthermore, the viability of probiotics depends on the pH of the environment, the length of the exposure to stomach acid, and the species and strains used.26

Because many variables can determine the degree to which probiotics survive during 1) the manufacturing process, 2) storage and transport and 3) passage through the stomach and upper gastrointestinal tract, manufacturers of fermented dairy products and probiotic dietary supplements have attempted to improve the viability of the probiotics in their products so that they provide a health benefit to the consumer. A variety of techniques (eg, microencapsulation, enhancement with nutrients, enteric coating, etc) have been used to help improve the survival of probiotics through harsh environmental conditions.27,28

One such technique to develop an effective and shelf-stable probiotic product is a patented process that encases the probiotics in a triple shell beadlet. This encapsulation technology effectively prevents oxygen, moisture and stomach acid from damaging the vulnerable bacteria.29 It also helps ensure the stability of the probiotic bacteria throughout a product?s shelf-life, which can be difficult given the relative sensitivity of probiotics. This encapsulation technology has been licensed to develop commercially available dietary supplements.


Dosage
Typical doses of probiotics range from one to ten billion colony-forming units (CFU) a few times a week or more. Some studies have administered up to several hundred billion CFUs daily. Probiotics need to be consumed at least a few times a week to maintain their effect on the intestinal microecology.


Safety
Published studies and extensive safety reviews on probiotics reveal a virtual absence of reported adverse events associated with the consumption of various probiotic strains. While there have been a few isolated reports linking probiotics with adverse effects, these incidents occurred in individuals with severe underlying conditions. 5,30,31 The most common side effect with probiotic supplements in healthy individuals is bloating, flatulence or constipation.5

Although some evidence suggests that probiotics are safe for consumption during pregnancy and lactation, pregnant women and nursing mothers should only use probiotic nutritional supplements if recommended or approved by their physician. Furthermore, immunocompromised individuals or any person with serious underlying disease should not use probiotics unless recommended by their physician.


References
1. Shortt C. The probiotic century: historical and current perspectives. Trends Food SciTechnol. 1999;10:411-417.

2. Rolfe RD. The role of probiotic cultures in the control of gastrointestinal health. J Nutr. 2000;130:396S 402S.

3. Stoneyfield Farm. Multiple Organisms Guaranteed. Available at: http://www.stonyfield.com/OurProduct...Guaranteed.cfm Accessed on June 9, 2006.

4. Bourdiox P, Koletzko B, Guarner F, Braesco V. The intestine and its microflora are partners for the protection of the host: report on the Danone Symposium "The Intelligent Intestine," held in Paris, June 14, 2002. Am J Clin Nutr 2003;78:675-683.

5. Thompson Healthcare. Probiotics Monograph. Available at: http://www.pdrhealth.com/drug_info/n...pro_0034.shtml Accessed on July 12, 2006.

6. Erickson KL, Hubbard NE. Probiotic Immunomodulation in Health and Disease. J Nutr. 2000;130:403S 409S.

7. Lin MY, Yen CL. Antioxidative ability of lactic acid bacteria. J Agric Food Chem. 1999; 47:1460-1466.

8. Reuter G. The Lactobacillus and Bifidobacterium microflora of the human intestine: composition and succession. Curr Issues Intest Microbiol. 2001;2:43-53.

9. Muscettola M., Massai L., Tanganelli C., Grasso G. Effects of lactobacilli on interferon production in young and aged mice. Ann. N.Y. Acad. Sci. 1994;717:226-232

10. de Vrese M, Winkler P, Rautenberg P, et al. Effect of Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, B. bifidum MF 20/5 on common cold episodes: A double blind, randomized, controlled trial. Clinical Nutrition. 2005; 24: 481-491.

11. Reid GD, Beuerman C, Heinemann et al.. Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. FEMS Immuno. Med. Microbiol. 2001;32:37-41.

12. Reid GD, Charbonneau J, Erb B et al. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunol. Med. Microbiol. 2003;35:131-134.

13. De Simone C, Ciardi A, Grassi A, et al. Effect of Bifidobacterium bifidum and Lactobacillus acidophilus on gut mucosa and peripheral blood B lymphocytes.Immunopharmacol Immunotoxicol 1992;14:331-340.

14. Biblioni R, Fedorak RN, Tannock GW, et al. VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol. 2005;100:1539-1546.

15. Margreiter M, Ludl K, Phelps W, Kaehler S. Therapeutic value of a Lactobacillus gasseri and Bifidobacterium longum fixed bacterium combination in acute diarrhea: a randomized, double-blind, controlled clinical trial. Int J Clin Pharmacol Ther. 2006;44:207-215.

16. Campieri, M. & Giochetti, P. Probiotics in inflammatory bowel disease: new insight to pathogenesis or a possible therapeutic alternative?.Gastroenterology 1999;116:1246-1250.

17. Ouwehand AC, Isolauri E., Kirjavainen PV, et al. The mucus binding of Bifidobacterium lactis Bb12 is enhanced in the presence of Lactobacillus GG and Lact. delbrueckii subsp. bulgaricus. Lett. Appl. Microbiol. 2000;30:10-13.

18. Kuhbacker T, Ott SJ, Helwig U, et al. Bacterial and fungal microbiota in relation to probiotic therapy (VSL#3) in pouchitis. Gut. 2006;55:833-841.

19. Gionchetti PF, Rizzello A, Venturi P, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology 2000;119:305-309.

20. Prantera, C., M. L. Scribano, G. Falasco, A. Andreoli, and C. Luzi. Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohns disease: a randomised controlled trial with Lactobacillus sp. strain GG. Gut 2002;51:405-409.

21. Sartor RB. Probiotic therapy of intestinal inflammation and infections. Curr Opin Gastroenterol. 2005;21:44-50.

22. Sheu BS, Wu JJ, Lo CY, et al. Impact of supplement with Lactobacillus- and Bifidobacterium containing yogurt on triple therapy for Helicobacter pylori eradication. Aliment Pharmacol Ther. 2002;16:1669-1675.

23. Madley R. Probiotics, prebiotics and synbiotics: harnessing enormous potential. Nutraceuticals World. September 2001.

24. Reid G, Jass J, Sebulsky MT, McCormick JK. Potential uses of probiotics in clinical practice. Clin Microbiol Rev. 2003;16:658-672.

25. 'Probiotics and Health: Biofunctional Perspectives',Symposium held October 24-25 2002 Montreal, Canada.

26. Bezkorovainy A. Probiotics: determinants of survival and growth in the gut. Am J Clin Nutr. 2001; 73: 399S-405s.

27. Shah NP. Probiotic bacteria: Selective enumeration and survival in dairy foods. J Dairy Sci. 2000;83:894-907.

28. Kailasapathy K.Microencapsulation of probiotic bacteria: technology and potential applications. Curr Issues Intest Microbiol 2002;3:39-48.

29. Sunohara et al. Process for producing capsule and capsule obtained thereby. Patent Number 5,478,570. December 26, 1995.

30. Elmer GW. Probiotics: ?Living Drugs?. Am J Health-Syst Pharm 2001;58:1101-1109.

31. Tufts EBCAM. Safety of Probiotics. Available at: http://www.tufts.edu/med/ebcam/nutrition/safety.html. Accessed on March 31, 2006.

[RaferAlston26]

Nice post. I was thinking about adding plain FF yogurt into my diet after reading T-Nations 13 power foods and this definitely supports it so I have no reason now not to add it.

[dvsness]

Nice post. I was thinking about adding plain FF yogurt into my diet after reading T-Nations 13 power foods and this definitely supports it so I have no reason now not to add it.

Probiotics, whether from food or supplement sources, should be a staple of any bb'ers diet, imo.

[NO HYPE]

Probiotics, whether from food or supplement sources, should be a staple of any bb'ers diet, imo.

Good post ness, and I completely agree.

I just wanted to throw this link in here, as it may answer some questions for anyone reading, relating to various manufacturing processes, intestinal adhesion, and the survival/usefullness of the products in question.

Probiotic supplement survival

[dvsness]

Good post ness, and I completely agree.

I just wanted to throw this link in here, as it may answer some questions for anyone reading, relating to various manufacturing processes, intestinal adhesion, and the survival/usefullness of the products in question.

Probiotic supplement survival

Thanks Good posts there as well. This is a new area of interest to me, as I was surprised to find a better product at a lower cost (I just switched from UltraZyme to BioBeads) and was interested in the patented triple layer shell (see stability in early post #2).

Note: While Prolab IS owned by Natrol, I do not get free Natrol products. My last Bb.com order was for DS Vigor and Natrol BioBeads.

[NO HYPE]

Thanks Good posts there as well. This is a new area of interest to me, as I was surprised to find a better product at a lower cost (I just switched from UltraZyme to BioBeads) and was interested in the patented triple layer shell (see stability in early post #2).

Note: While Prolab IS owned by Natrol, I do not get free Natrol products. My last Bb.com order was for DS Vigor and Natrol BioBeads.

In reference to the "triple layer shell", please read this....

ENTERIC COATING IS ALL YOU NEED.

[NO HYPE]

(I just switched from UltraZyme to BioBeads)

I use a probiotic formula called Primadophilus Optima by Nature's Way. This product has the highest amount of intestinal flora than any other product I've found (14 strains at 35 billion CFU).

[dvsness]

In reference to the "triple layer shell", please read this....

Intersting. UZ isn't eteric coated iirc, and may be the reason I noted such a difference. Also, I think there may be some products containing ahigher amount of bacteria just because of inefficient delivery methods (or none at all).

Another concern is that though coated, some of the tablet form probiotics are still heat pressed, which would tend to kill the active bacteria, no? I would think the reason that the label claims of "_____ live cells at time of production" is stated that way because the raw material is much more bioactive than the end product.

One of the layers ensures that the product isn't damaged in transport or on the shelf by environmental elements. Most ground shipping take place on trucks that aren't climate controlled (my actual job is shipping/freight - I can expand more if necessary); environmental contributions should be taken in to account given the nature of probiotic sensitivity.

[NO HYPE]

Another concern is that though coated, some of the tablet form probiotics are still heat pressed, which would tend to kill the active bacteria, no?

Tablets suck.

[NO HYPE]

Also, I think there may be some products containing ahigher amount of bacteria just because of inefficient delivery methods (or none at all).

You've got a point there.... but I guess it's a good thing they are adding more, and not taking any away.

[NO HYPE]

One of the layers ensures that the product isn't damaged in transport or on the shelf by environmental elements. Most ground shipping take place on trucks that aren't climate controlled (my actual job is shipping/freight - I can expand more if necessary); environmental contributions should be taken in to account given the nature of probiotic sensitivity.

Well in terms of environmental conditions during shipping (e.g. temperature/humidity).... I have viewed studies of manufacturing methods using basic spray-drying techniques, which indicated that the survival of bifidobacteria was not significantly compromised at a coating pan intlet temperature of around 212 degrees F.

Of course, the bacteria was not exposed to these extreme temperatures for long durations of time.... but then again, the temperatures that the bacteria are exposed to during shipping, are not that extreme either.

[dvsness]

I dunno. How hot does the interior of a vehicle get when it sits in the sun for hours on end?

[NO HYPE]

Well in terms of environmental conditions during shipping (e.g. temperature/humidity).... I have viewed studies of manufacturing methods using basic spray-drying techniques, which indicated that the survival of bifidobacteria was not significantly compromised at a coating pan intlet temperature of around 212 degrees F.

Of course, the bacteria was not exposed to these extreme temperatures for long durations of time.... but then again, the temperatures that the bacteria are exposed to during shipping, are not that extreme either.

I dunno. How hot does the interior of a vehicle get when it sits in the sun for hours on end?

Would you consider this to be a common practice amongst the 3 major shipping companies? I was under the impression that these guys have limited time to be parked in the sun, for hours on end? Just curious.

Just the same.... IMO, the "triple layer shell" will do jack for conditions like that.

[lbarber4]

Nice post, ness... I just ordered some more Probiohealth Ke-99 Lacto capsules a few minutes ago!

[Cable Curling CincoUno]

interesting reading. I was wondering how effective these probiotics are when included in protein powders? for example Dorian Yates Approved has protein cultured with bifidus, acidophilus, and yogurt organisms

[j_neatherlin]

probiotics are awesome. it's one of the few supplements that i actually use. i prefer to consume Kefir to get my probiotics, but I haven't been able to find Kefir anywhere since I've moved back to Louisiana...not even at Whole Foods!!

[The Lone Wolf]

Probiotics, whether from food or supplement sources, should be a staple of any bb'ers diet, imo.

QFT

[GeneGnomeX]

There is little doubt in my mind that probiotics in general are the most researched supplement in this website's store and the research is only accelerating. There is an overwhelming positive clinical status with little to no safety issues.

I wrote an MM article on this a half year ago, it goes a bit more in depth on some of the other interesting research: http://www.mindandmuscle.net/article...and/probiotics

Since then I have found so much more, so next version I will put into a pdf to distribute, should be one of the most comprehensive free papers available (more like a short book probably), thank you for the reminder that I have to get back to work on it. The goal is to compile an effectiveness spreadsheet by strain, as much data that I can get through, and when available (some studies only list species).

And leaving out meta-analyses, or at least identifying them clearly, since they are often unreliable.

[dvsness]

Would you consider this to be a common practice amongst the 3 major shipping companies? I was under the impression that these guys have limited time to be parked in the sun, for hours on end? Just curious.

What 3? If you're thinking USPS, UPS, etc, I'm thinking way before that, the freight trucks from the manufacturing plant to the wholesalers, not from WS to retail. If distance trucks go over hours in their logbooks, the cops can ground them for 12 hours regardless of the content of the load.

[Quelly]

I can personally attest to the effectiveness of a good probiotic....after my contest prep, and probably only eating almond butter, fish oils, tuna, turkey, yams, broccoli and oats....lets just say switching to regular food left me with some MAJOR bloating gas and unpleasantness in the bathroom...once I started my probiotic supplementation I was able to eat and digest pretty much anything...good stuff