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Posts Tagged ‘probiotics’

 

Proactive Use of Probiotics

Tuesday, October 28th, 2014

by Sarah Winey, PharmD candidate

According to the World Health Organization (WHO), two leading causes of death in young children, under the age of 5, are respiratory infections and diarrhea.1 Both respiratory tract infections (RTIs) and severe diarrhea are often caused by a bacterial infection, so an effective prevention therapy could reduce the incidence of these infections.  Currently, strategies are rarely employed for the prevention of these disease states, except avoidance of foods and conditions that may have an impact, such as fatty foods and environmental irritants. Avoidance of environment irritants can include avoidance of individuals who may carry infection and appropriate hygienic measures, such as hand washing. However, medical treatment frequently occurs only when the patient becomes symptomatic. The standard treatment for diarrhea involves fluid and electrolyte replacement or zinc supplementation, while the standard treatment for bacterial respiratory tract infections often involves antibiotic therapy.1 Probiotic therapy has been suggested as a potential preventative strategy for combating bacterial infections, including those associated with diarrhea and RTI’s.

Probiotics are live, healthy bacteria that are ingested in the form of a dietary supplement or cultured dairy products.2 The human body holds a significant amount of natural healthy bacteria in various locations, including the gastrointestinal (GI) tract.  When harmful bacteria enters the body, it competes for limited space with the healthy bacteria.  In the case of infection, the harmful bacteria overwhelms the system. The goal of probiotic supplementation is to overwhelm at risk areas, such as the GI tract, with healthy bacteria; in fact, the labeled dose is in terms of number of live cells or colonies, usually upward of one million.  In clinical testing, most patients do not experience side effects or experience only minor GI effects such as gas.3 According to current guidelines, probiotics have not been determined to replace standard treatment; nevertheless, the 2007 National Health Interview Survey found that probiotic-type products were the fifth most used natural product for children.3

In March 2014, the Pediatrics journal published a trial with the goal of determining whether a probiotic, Lactobacillus reuteri, had a significant impact on incidence of diarrhea in preschool children. The study was a forward-looking, random-sample, placebo-controlled trial (placebo- an identical substance to probiotic but has no effect) occurring from April 2011-June 2012 in four different day care centers in southeast Mexico City. The study population was comprised of healthy children aged six months to three years, born full term, and of similar socioeconomic status. The primary outcome, or goal, of the study was to determine if the number of days children experienced diarrhea was impacted by probiotic intervention. In addition, the number of days children experienced RTI’s, days of absence caused by diarrhea or RTI, days of antibiotic use, days of medical visits and cost impact due to intervention were studied. The study’s limitations included the possible lack of generalizability based on study location and choice of probiotic species.4

This study provided additional support to the theory that probiotic therapy can impact the prevention of bacterial infections, specifically diarrhea and RTI’s. The results showed that the intervention significantly reduced the incidence of both diarrhea and RTI.4 Additionally, the days of absence, number of medical visits, and antibiotic use were also significantly reduced as a result of probiotic intervention.4 Several other studies have found similar results. For instance, according to a Cochrane research review, probiotics were found to be a beneficial prevention strategy for infection; specifically, this study found that upper respiratory tract infection rate was reduced with probiotic use.5 Another research review of Randomized Control Trials (RCT’s) showed a decrease in duration and stool frequency as a result of probiotic intervention for diarrhea.6

In conclusion, probiotic therapy is a safe and seemingly effective for the prevention of respiratory infections and diarrhea.  This form of therapy may prove especially useful to parents of young children in daycare centers who are constantly in a crowded environment, which could lead to increased infection.  An additional option is the use of yogurt or other cultured dairy products, which also have the capability to reestablish normal, healthy bacteria in the GI tract. Currently probiotics are not an officially approved recommendation for children, should they be?

References:

  1. World Health Organization.Children: Reducing mortality. Media centre: Fact Sheets Web site. http://www.who.int/mediacentre/factsheets/fs178/en/. Updated 2014. Accessed September 20, 2014.
  2. EBSCO CAM Review B. Probiotics. Salem Press Encyclopedia Of Health [serial online]. January 2014;Available from: Research Starters, Ipswich, MA. Accessed August 31, 2014.
  3. National Center for Complementary and Alternative Medicine. Oral probiotics: An introduction. 2012.
  4. Gutierrez-Castrellon P, Lopez-Velazquez G, Parra M, et al. Diarrhea in Preschool Children and Lactobacillus reuteri: A Randomized Controlled Trial. Pediatrics [serial online]. n.d.;133(4):E904-E909. Available from: Science Citation Index, Ipswich, MA. Accessed September 24, 2014.
  5. Hao Q. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Of Systematic Reviews [serial online]. July 26, 2011;(9)Available from: Cochrane Database of Systematic Reviews, Ipswich, MA. Accessed September 20, 2014.
  6. Applegate J, Fischer Walker C, Ambikapathi R, Black R. Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children. BMC Public Health [serial online]. October 2, 2013;13(Suppl 3):1-8. Available from: Academic Search Complete, Ipswich, MA. Accessed September 1, 2014.

Are you “Pro” Probiotic Supplements?

Thursday, December 5th, 2013

by Heather Evankow, PharmD student

In recent years, the popularity of probiotic supplements has risen. Probiotics are bacteria that help maintain the natural balance of organisms (microflora) in the intestine.1 The idea of probiotics is not a new concept. The idea was first developed around 1900 by the Nobel Prize-winning recipient Elie Metchnikoff. Metchnikoff theorized that the fermented milk products Bulgarian citizens ingested were a major factor in their longer life spans when compared with other countries.2 It was not until the year 1989 when R. Fuller popularized the term “probiotics”.3 Today, probiotics can be seen in the news claiming to improve the immune system, aid in skin health, defend against depression, clear up a bloated gut, prevent urinary tract infections, and even delay allergies.4

The Daily Herald recently released the article, Probiotics are all the rage, and experts say there are results behind the hype. The author, Gabriella Boston, Boston combines the opinions of several healthcare professionals to emphasize the health benefits behind the evolving topic of probiotics.

The first healthcare provider, Megan McCusker, is a dermatologist who believes probiotics are an important treatment therapy for treatment of anything from acne to psoriasis.4 While the Federal Drug Administration (FDA) does not approve any health claims for this supplement, McCusker could recommend 5-20 billion units per day depending on the patient’s needs. There were no clinical research references to show how McCusker developed these recommendations.

A nutritionist Boston featured, Jared Rice, also believes in the benefits of probiotics. Rice has not observed any downsides with his patients taking probiotics, but still advises patients to seek medical attention before taking high doses. Rice believes it is essential to buy the healthiest probiotic supplement. Also, he believes it is important to create a probiotic-friendly body by eating whole grains, bananas, and onions while steering clear of nondigestible carbohydrates.4 Unfortunately, there was no data referenced to confirm the benefits of Rice’s claims.

Ebeth Johnson, a nutritionist and chef, also gave her expert advice for this article. She believes this probiotic trend is here to stay. She encourages incorporating probiotics into your diet by consuming unpasteurized miso, live cultured pickles, tempeh, unsweetened kefir and yogurt, and kombucha teas.5 It is unclear how Johnson came up with these supplement sources. In addition, she also did not mention any specific research to validate the quality of these sources.

While the experts in Boston’s article seem confident in their recommendations of probiotics supplements, the clinical research is still limited for probiotics. The varieties of strains make it problematic in understanding the health benefits.

One of the most researched probiotic strains is Lactobacillus rhamnosus GG (LGG). LGG has been proven to help pediatric patients with pain-related gastrointestinal (GI) disorders in many clinical studies.5 In a 2011 meta-analysis, researchers systematically searched for randomized controlled trials assessing LGG supplementations in children with functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine and functional abdominal pain (FAP).5 The major limitations for this analysis included incomplete outcome data and the number of trials with a small sample size. The results revealed a decrease in severity in pain with the overall study population and the IBS subgroup.5 The frequency was also decreased in the IBS subgroup.

Another hopeful probiotic strain is Streptococcus thermophilus VSL #3. A multicenter, randomized, placebo-controlled, double-blind, crossover study has shown VSL #3 to be successful and safe in helping the lives of children with IBS.6  59 patients from ages 4-18 years of age completed the study with no untoward adverse effects reported. Researchers found no significant difference was found in the stool pattern of patients, but abdominal pain, abdominal bloating, and family life disruption were all significantly more effective to the placebo.6

Have you had any encounters with probiotic supplements? Comment and share your experiences. Please include the main therapy goal, specific probiotic strains, and the dosage.

If you have had no experience with probiotics, based on the information above, would you personally try probiotic supplements? Share your rational.

References

1. “Probiotics – Topic Overview.” WebMD. Healthwise, 04 FEB 2011. Web. 29 Nov 2013. <http://www.webmd.com/digestive-disorders/tc/probiotics-topic-overview>.

2. Parvez, S. and Kang S. “Probiotics and their fermented food products are beneficial for health.” Volume 6. Web. 29 Nov. 2013. <http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2006.02963.x/pdf>.

3. Ouwehand, A., S. Salminen, and E. Isolauri. “Probiotics: an overview of beneficial effects.” Vol 82.Issue 1-4 (2002): 279-289. Web. 29 Nov. 2013. <http://link.springer.com/article/10.1023

4. Boston, Gabriella. “Probiotics are all the rage, and experts say there are results behind the hype.” Daily Herald. N.p., 28 Oct 2013. Web. 29 Nov 2013. <http://www.dailyherald.com/article/20131028/entlife/710289977/>.

5. Horvath, A., P. Dziechciarz, and H. Szajewska. “Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood.” Alimentary Pharmacology & Therapeutics. Vol 6.Issue 12 (2011): 1302-1310. Web. 29 Nov. 2013. <http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2011.04665.x/full>.

6. Guandalini S., G. Magazzu, and A. Chiaro. “VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study.” J Pediatrics Gastroenterol Nutr. 2010 Jul;51(1):24-30. Web. 04 Dec. 2013. http://www.ncbi.nlm.nih.gov/pubmed/20453678.

Over the Counter Probiotics May Be Able to Sooth Baby’s Colic

Thursday, December 5th, 2013

by Mallory Martin, PharmD student

This article posted by the BBC, “Probiotics ‘soothe some babies with colic’”,1 explores an option into easing or possibly preventing your baby’s colic. The article describes an analysis of 12 studies looking into probiotics as a treatment for colic. The analysis was done by a team of scientists in Australia and reported in the Jama Pediatrics Journal. However the article didn’t cite where in the journal this article was found. This seemed uncharacteristic and it made it difficult to evaluate their findings. All this aside, their findings were quite exciting because although colic is not a harmful condition to babies and resolves itself after 3-4 months1, it can be quite stressful for caretakers. An option for soothing baby’s colic would be highly valued for this reason.

When attempting to sooth colic, parents can be scared away by ambiguity, not wanting to give something to their baby unless it is proven. “Research shows” is a phrase that may be thrown around a lot, but what people really want to know is whether a treatment is safe for their child and if it is effective. Taking these people into consideration and with the incomplete citation by the BBC article, I wanted to explore several articles published on this topic in an attempt to come to a conclusion on whether or not to recommend probiotics for colic.

Probiotics must first be understood on their own before exploring them as a treatment for colic. Probiotics are a mixture of different microorganisms that when orally ingested are considered to have several overall health benefits.1 The word itself means “promoting life”.2 They generally have very low risk in normal adults because the cultures so closely resemblethe natural flora of the gut. 3 Probiotics are also naturally present in food. Some foods that contain probiotics are fermented vegetable such as sour kraut and most commonly yogurt.2 Probiotics contain many different types of bacteria but among the most common is Lactobacillus reuteri. It is this strain of bacteria that is considered to have the most health benefits. 2

Certain health benefits have been discovered with probiotic use. Probiotics, L. reuteri specifically, has been shown to lower LDL levels, kill bacteria that causes tooth decay, lessen the harmful effects of gingivitis, and lower your likelihood of developing episodic diarrhea or traveler’s diarrhea. Some reports even show that this bacterium can lessen a child’s risk of developing eczema through probiotic-filled breast milk. Studies in women’s health showed that it may help balance the bacteria present in the vagina and lower the risk of yeast infections, bacterial vaginosis, and urinary tract infections. Some additional benefits include its ability to reduce upper respiratory infections when compared to placebo, provide relief to baby’s colic, and reduce bloating and gas.2

Although the results are promising, research in this area is not concrete. Probiotics may have both risks and benefits for different people. Risk for special populations, such as small children and older adults, is unclear since there is little to no research done on these groups.2 So far, healthy, full-term babies who have received high doses of probiotics have not presented with any negative effects.4 However there is some evidence that young children who are pre-term or not fully healthy, such as children with weakened immune systems, catheters or other medical devices inside them, may be at risk if taking probiotics.4 When considering L. reuteri in treatment of colic, one study by Savino concluded that it is inconclusive whether L. reuteri reduces colic but it appears to reduce levels of harmful E. coli. 5,6 Savino performed a follow up study after comparing L.reuteri with simethicone and compared the bacteria against a placebo in treatment of colic.7 This study had a better study design for its desired outcome because the infants involved were chosen based on Wessel’s Criteria, a more systematic approach than the first study. The results concluded that L. reuteri DSM 17 938 at a dose of 108 colony-forming units per day in early breastfed infants improved symptoms of baby’s colic and was well tolerated and safe.7 Some factors that could contribute to the varying results in these studies include the differences in the care the infants received in different homes and different study designs. An article put out by Fox News article reported on this as well. The conclusion was that probiotics may not be effective. However in young infants, they can potentially reduce risk of asthma and eczema.4 This positive effect, while unrelated, is something to consider when evaluating probiotics for your child.

Considering all this information, I would recommend probiotics as a means of treatment for infantile colic. The best option would be for a nursing mother to start a regimen of daily probiotics and allow the probiotics to transfer through the breast milk. However, L. reuteri is available for infants to ingest. Gerber has a colic relief drop that specifically has L. reuteri in it which includes sunflower oil. Gerber also has a powder for formula around 30 dollars for 24 ounces. BioGaia has a straight L. reuteri drop for around 20 dollars for 5 mLs. There are options. Even if it may not be 100% guaranteed to be effective, if your colicky baby is becoming too much to handle and you have tried many other options, I would say it is worth a try. Especially considering no bad effects have been found and several unrelated positive effects have been suggested. Probiotics would be a safe and natural way to go in your attempt to soothe your baby and get a good night’s rest yourself. Some may not agree with me. With the lack of research and uncertainty, risks could exist. Just because no negative effects have been found does not mean that it is completely safe. Would you take that risk with your own child?

References

1. Roberts, M. Probiotics ‘soothe some babies with colic’. The BBC. October 7, 2013. http://www.bbc.co.uk/news/health-24426623. Accessed December 3, 2013.

2. Maier, R. Surprising Benefits of Probiotics. Healthine Web site. April 13, 2013. http://ask.healthline.com/health-slideshow/surprising-benefits-probiotics. Accessed December 3, 2013.

3. Probiotics – Topic Overview. Webmd Web site. February 04, 2011. http://www.webmd.com/digestive-disorders/tc/probiotics-topic-overview. Accessed September 15, 2013.

4. Rettner, R. Are Probiotics Safe for Kids?. Livescience Web site. October 06, 2011. http://www.livescience.com/16426-probiotics-safe-kids.html. Accessed December 3, 2013.

5. Woznicki, K. Probiotics May Reduce Crying From Colic. Webmd Web site. August 16, 2010. http://www.webmd.com/parenting/baby/news/20100816/probiotics-may-reduce-crying-from-colic. Accessed October 15, 2013.

6. Savino F, Cordisco L, Tarasco V, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics. 2010;126(3):e526-33.

7. Savino F, Pelle E, Palumeri E, Oggero R, Miniero R. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics. 2007;119(1):e124-30.

Can Probiotics Help Prevent the Common Cold?

Monday, December 2nd, 2013

by Andrea Bashore, PharmD student

There are many types of illnesses caused by respiratory tract infections. One that we are all familiar with is the common cold. About 22 million school days are lost in America due to this sickness, and it is the leading cause of doctor’s visits and missed days of work.1 It is common for adults to contract three to four colds each year, while the elderly and young have a higher risk of catching four to six colds annually.1 An article on Natural Standard has proposed that probiotics, or “good” bacteria, can help reduce the risk for upper respiratory tract infections.2 Common ways to prevent a cold may be washing one’s hands frequently, getting plenty of rest, or dressing appropriately for cold weather. In addition to these things, it has now been found that probiotics can be an added measure against catching a cold. Most of us have probably seen probiotics advertised on yogurt such as Activia. There have been several health benefit claims about these good bacteria, and one of the most common uses is for gastric and intestinal illnesses.3 Other benefits are alleviation of lactose intolerance and food allergies, blood pressure control, and control of inflammation in arthritis.3 Along with these benefits, research has found a new use for probiotics.

The article “Probiotics May Reduce the Risk of Respiratory Tract Infections” discusses a study with new findings. Researchers recruited 465 people to participate in the study.3 They separated the participants into three different groups with the first receiving a probiotic, the second receiving a different probiotic, and the third receiving a placebo.3 The group who took probiotic BI-04 showed a significantly lower risk for an upper respiratory illness compared to the placebo group.3 Because of this comparison the researches concluded that it was an effective supplement for preventing colds.

Along with this research, there has been more evidence that supports this idea of cold prevention with probiotics. Bacteria in the nasal cavity cause upper respiratory infections, and a study in Switzerland took this into account when testing probiotics.4 They concluded that probiotics decrease the amount of this potentially illness causing bacteria.4 Another study focused on children in day care centers. They tested the same probiotics as the Switzerland study, and their results showed that use of the probiotics substantially reduced the number of respiratory tract infections in the study’s population.1

Though the conclusions from each of these articles support the claim of probiotics preventing respiratory tract infections, they cannot make the claim that probiotics directly cause this prevention. This is what the evidence shows, but we cannot say that this is a cause and effect since the articles do not give a full explanation of how this kind of good bacteria is working to prevent infection. The probiotics do not make any direct contact with the nasal cavity, though the results showed prevention of bacteria in this area.1 Even with this limitation, I would agree that probiotics are helpful and would suggest this to others. A meta-analysis done on probiotic therapy for diarrhea reported that out of four different studies no serious adverse effects were reported.5 While I believe that more studies need to be done on the safety and adverse effects of probiotics, they have not been reported to be harmful. If simply eating yogurt everyday or taking a probiotic supplement can help someone’s health through the cold season, I would gladly suggest this. I don’t think it is necessary for every person to do this, but it is something that I would recommend. There are many other ways to help prevent colds, and this is simply and additional preventative measure. Encouraging patients to take probiotics to prevent colds also opens the door to inform them of other health benefits that they may not have known.

The common cold puts a damper on our everyday lives, and using probiotics to prevent respiratory tract infections is a step towards a healthier population. This is such a simple way that we can help our communities fight the cold season.3 As pharmacists, we can easily encourage our patients to take probiotics to help prevent a cold. Can we confidently tell patients that this will be effective? How as pharmacist can we properly inform patients on probiotics and the benefits they provide? Through research and educating ourselves on this topic we can hope to better the health of our community.

 

References

  1. Snovak N, Abdović S, Szajewska H, Mišak Z, Kolaček S. Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers: A randomized, double-blind, placebo-controlled trial. Clinical Nutrition. 2010; 29: 312-316. Available at: http://www.clinicalnutritionjournal.com/article/S0261-5614(09)00203-9/fulltext. Accessed November 2, 2013.
  2. Probiotics May Reduce the Risk of Respiratory Tract Infections. Natural Standard. 2013. Available at: http://www.naturalstandard.com/news/news201310010.asp. Accessed November 2, 2013.
  3. Parvez S, Malik KA, Kang A, Kim Y. Probiotics and their fermented food products are beneficial for health. Journal of Applied Microbiology. 2006; 100: 1171-1185. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2006.02963.x/full. Accessed November 2, 2013.
  4. Glück U, Gebbers J. Ingested probiotics reduce nasal colonization with pathogenic bacteria (Staphylococcus aureus, Streptococcus pneumoniae, and hemolytic streptococci). The American Journal of Clinical Nutrition. 2003;77: 517-520. Available at: http://ajcn.nutrition.org/content/77/2/517.short. Accessed November 2, 2013.
  5. Nandini D, Costa V, MacGregor M, Brophy J. Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review. Canadian Medical Assiciation Journa. 2005; 173: 167-179. Available at: http://www.cmaj.ca/content/173/2/167.full. Accessed November 25, 2013.