FOOD INTOLERANCE NETWORK FACTSHEET
Probiotics
Probiotics and the elimination diet
Probiotics and irritable bowel symptoms
Probiotics and allergy prevention
Probiotic strains in brands mentioned by readers
The
beneficial effects of probiotics have only recently been accepted in mainstream
medicine, and are currently the subject of numerous studies.
Probiotics
are live microorganisms – mostly bacteria - that are largely identical to the
beneficial microorganisms found in the human gut. Some probiotic foods such as
fermented foods and cultured milk products have been used for centuries.
Probiotics are often lactic acid bacteria from the Lactobacillus or Bifidobacterium groups. Within each group, there are
different species such as Lactobacillus
acidophilus and Bifidobacterium bifidus, and
within each species there are different strains or varieties. Less commonly,
probiotics such as Saccharomyces boulardii are yeasts, which are different from
bacteria.
It is
becoming obvious in medical research that some strains are more beneficial than
others, with effectiveness depending on a number of factors, so there is
currently a great deal of confusion about which probiotics are best and whether
they should be recommended for certain conditions.
With the
recent discovery that antibiotics can have a much more devastating effect on
friendly bacteria in the gut than previously realised (1) it seems likely that
probiotics will soon become more widely used.
Although
probiotics are generally thought to be safe, there are some concerns about the
risk of infection from probiotics for people with compromised immune systems or
integrity of the intestinal mucosa, and in the presence of a central venous
catheter (2,3).
Probiotics
and the elimination diet
Probiotics -
as freeze dried capsules, in yoghurt, kefir or other
fermented products - are not suitable for use during the strict elimination
phase of the RPAH Elimination Diet as they are likely to contain biogenic
amines (3). Note that yoghurt which was previously permitted on the strict
elimination diet has recently been upgraded to moderate in amines.
Amine
responders can trial probiotics as a challenge following the elimination diet,
by using a diet and symptom diary and otherwise sticking to the diet. For
people who need to avoid dairy products, it is essential to use a dairy-free
source of probiotics.
Probiotics
and Irritable bowel symptoms
There is
strong evidence that probiotics may be beneficial for the prevention of
antibiotic-associated diarrhoea (2,4,5) and traveller’s diarrhoea (6), but
studies regarding probiotics for IBS have produced contradictory results (7,8).
It is now
understood that individual gut flora varies and that for a particular patient,
effectiveness may depend on the strain, the size of the dose and the condition.
Despite variable results, irritable bowel specialist and Manchester University
Professor Peter Whorwell considers that probiotics
are ‘worth trying’ due to their beneficial effect on bloating (9,10). Eating commercial yoghurt containing common live
cultures appears to be less effective than taking probiotic capsules for the
prevention of antibiotic-associated diarrhoea (11). Probiotics that have been
useful for antibiotic associated and traveller’s diarrhoea include Lactobacillus GG, Bacillus coagulans, Lactobacillus plantarum,
Saccharomyces boulardii and a mixture of Lactobacillus acidophilus and Bifidobacterium bifidum (2,4,5,6).
Probiotics
for the prevention or treatment of allergy
Early
studies showing that childhood eczema could be reduced by probiotics (12,13) raised hopes of a cure for the current allergy epidemic
and treatment of allergic conditions but a meta analysis
of studies using a wide range of probiotics on a wide range of conditions
failed to show clear preventive effects
and there were no benefits for any other form of allergy than eczema (14). Most
studies reporting significant benefits used probiotic supplements containing Lactobacillus rhamnosus
(13, 14).
[981] Reflux and GI issues: dairy free probiotic made
a huge difference (October 2010)
I was just reading in your newsletter a reference
to probiotics and thought I would share my daughter's story briefly. In short,
she was diagnosed with dairy allergy at 8 weeks, and was finally skin prick
tested at 12 months (after Dr's said it would never
show up). She had a huge reaction to the skin prick and was promptly issued
with an epipen etc. She is also allergic to soy. Her
very understanding and experienced gastroenterologist (she has reflux and GI issues as well) suggested that Lactobacillus
GG (available in Aust in Vaalia
Yoghurt only) had been shown to assist resolution to food allergy. We imported
some from the US (called Culturelle there) and she
tolerated it very poorly. Her Dr found out that there
was a tiny trace of dairy and this reacted with my daughter.
At the end of last year, in desperation
because my daughter's quality of life was so poor, we thought we would give
Inner Health Plus dairy free a go. It made an enormous difference to her- she
started eating again and was not in constant pain. Today she was skin prick
tested again with no reaction to dairy. We are about to do patch tests to look
for non IG-E allergies- but this is at least a step in the right direction. As
dairy allergy is largely outgrown by the age of four, it could just be a
natural resolution, but I wonder if the probiotics helped, because it certainly
made a huge difference to her life in many other ways. – Sara, by email
[980]
Probiotics seemed to change son’s behaviour and
tolerance (October 2010)
The introduction of VSL#3 probiotic seems
to have changed my 6 yo son’s behaviour
and tolerance. The teachers noticed the difference in his learning at school
and we too noticed his improvement at home. - by
email, NSW
[979]
Couldn’t tolerate probiotics due to amines (October
2010)
I am using the RPA diet for management of
chronic UTI pain and have found I am extremely sensitive to everything. I used
the VSL#3 (probiotic) again) and bammm - burning
pain. I think I have learnt my lesson. Just the diet nothing
else. - by email, Sydney
[978]
Probiotics for antibiotic-associated diarrhoea
(October 2010)
After a course of antibiotics I had diarrhoea for weeks but probiotics (Inner Health) sorted me
out in a week. - by email, Qld
Probiotic strains in brands
mentioned by readers (note
contents may change with new formulations)
Inner Health Plus
Dairy Free
Lactobacillus Acidophilus
Bifidobacterium Lactis
Inner Health for Kids
Lactobacillus Rhamnosus
GG
Lactobacillus Acidophilus
Bifidobacterium Lactis
http://innerhealth.com.au/content/product/inner-health-for-kids
VSL#3
Bifidobacterium breve
Bifidobacterium longum
Bifidobacterium infantis
Lactobacillus acidophilus
Lactobacillus plantarum
Lactobacillus paracasei
Lactobacillus delbrueckii
subspecies bulgaricus
Streptococcus thermophilus
1. Dethlefsen L, Relman DA. Microbes
and Health Sackler Colloquium: Incomplete recovery and
individualized responses of the human distal gut microbiota
to repeated antibiotic perturbation. Proc Natl Acad Sci
U S A. 2010 Sep 16.
In this
study from Stanford University in California, more than 50 stool samples were
collected from three healthy volunteers over a 10-month period that included
two 5-day courses of the antibiotic ciprofloxacin (considered more
bowel-friendly than most antibiotics). Microbial strains present in each sample
were identified by gene sequencing. Researchers found that the unique set of
microbial flora in each person was disrupted by each course of antibiotics
despite a lack of symptoms such as diarrhoea and some strains were permanently
altered by the end of the trial. Each round of antibiotics is a roll of the
dice that could lead to lasting changes in a person’s gut microbes, the full
consequences of which remain unknown, say the researchers who recommend that
antibiotics should be used only when truly necessary. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586385/?tool=pubmed
2. Doron SI and others. Probiotics for
prevention of antibiotic-associated diarrhea. J Clin Gastroenterol.
2008;42 Suppl 2:S58-63.
Lactobacillus GG, Saccharomyces boulardii, and
certain probiotic mixtures have been shown to be effective for precention of AAD in adults. In children, Lactobacillus GG,
Bacillus coagulans, and S. boulardii
appeared to be most effective. Probiotics are generally thought to be safe, however, they should be used with caution in patients
who have compromise of either the immune system or the integrity of the
intestinal mucosa, and in the presence of a central venous catheter. http://www.ncbi.nlm.nih.gov/pubmed/18542041
3. Mullan WMA. (2002) . Probiotic microorganisms in food. Properties, benefits,
safety and enumeration - European Community Regulation no 1924/2006 and health
and nutrition claims. [On-line]. Available from: http://www.dairyscience.info/probiotics/50-probiotics.html?start=14.
Accessed: 8 November, 2010. last
update December 2008. On page 8, this article discusses how some lactic acid
bacteria can produce biogenic amines such as putrescine,
cadaverine, histamine, tyramine
and 2-phenylethylamine, which can cause reactions in people with reduced
monoamine oxidase (MAO) activity like us or those taking MAO inhibitors.
According to Mullan, if strains are screened properly
biogenic amine formation should not be a problem.
4. Kale-Pradhan PB and others. Role of Lactobacillus in the
prevention of antibiotic-associated diarrhea: a
meta-analysis. Pharmacotherapy. 2010;30(2):119-26.
The use of a Lactobacillus single-agent in varying doses throughout the entire
antibiotic treatment (5-14 days) reduced the risk of developing antibiotic
associated diarrhoea compared with placebo in adults but not children.
5. Lönnermark E and others. Intake of Lactobacillus plantarum reduces certain gastrointestinal symptoms during
treatment with antibiotics. J Clin Gastroenterol. 2010;44(2):106-12.
This study showed that intake of L. plantarum could
have a preventive effect on milder gastrointestinal symptoms during treatment
with antibiotics.
6. McFarland
LV. Meta-analysis of probiotics for the prevention of traveler’s
diarrhea. Travel Med Infect Dis. 2007;5(2):97-105. Probiotics were found to significantly prevent
traveller’s diarrhoea, in particular Saccharomyces boulardii
and a mixture of Lactobacillus acidophilus and Bifidobacterium
bifidum.
7. McFarland
LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel
syndrome. World J Gastroenterol.
2008;14(17):2650-61. Studies of probiotics for IBS
have yielded contradictory results, which may be due to a variety of factors:
small sample size; variability in trial design; heterogeneity of probiotic
strain, dose and treatment duration; and patient characteristics. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709042/?tool=pubmed
8. McFarland
LV. Systematic review and meta-analysis of Saccharomyces boulardii
in adult patients. World J Gastroenterol.
2010;16(18):2202-22. In adults, Saccharomyces boulardii (S. boulardii) can be
strongly recommended for the prevention of antibiotic associated diarrhoea and traveler's diarrhea; S. boulardii also shows promise for the prevention of C. difficile disease recurrences; treatment of irritable bowel
syndrome, acute adult diarrhea, Crohn's
disease, giardiasis, and human immunodeficiency virus-related diarrhea. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868213/?tool=pubmed
9. Agrawal A and others. Clinical trial: the effects of a
fermented milk product containing Bifidobacterium lactis DN-173-010 on abdominal distension and
gastrointestinal transit in irritable bowel syndrome with constipation. Aliment
Pharmacol Ther. This study
showed that this particular probiotic was helpful for symptoms of bloating and
distension. http://www.ncbi.nlm.nih.gov/pubmed/18801055?dopt=Abstract&holding=npg
10.
Whorwell PJ and others. Efficacy
of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome.
Am J Gastroenterol. 2006 Jul;101(7):1581-90.
A four week
trial of freeze dried Bifidobacterium infantis 35624 at three dose levels for 362 women with
irritable bowel symptoms found that the middle dose (1 x 10(8) cfu) was significantly superior to placebo and the higher
and lower bifidobacterium doses for abdominal pain,
bloating, bowel dysfunction, incomplete evacuation, straining, and the passage
of gas. These researchers say ‘probiotics are worth a try’ but note that not
all species or dosage will necessarily have the same therapeutic potential in a
particular condition.
11. Conway S
and others, Does eating yogurt prevent
antibiotic-associated diarrhoea? A placebo-controlled randomised controlled
trial in general practice. Br J Gen Pract.
2007;57(545):953-9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2084134/?tool=pubmed
12. Weston S
and others. Effects of probiotics on atopic dermatitis: a randomised controlled
trial. Arch Dis Child. 2005;90(9):892-7.
Fifty six children with moderate or severe atopic dermatitis were given a probiotic
(1x10(9) Lactobacillus fermentum VRI-033 PCC; Probiomics) or an equivalent volume of placebo, twice daily
for 8 weeks. The probiotic supplement was found to be beneficial in improving
the extent and severity in young children with moderate or severe atopic
dermatitis.
13. Wickens K and others. A differential effect of 2 probiotics
in the prevention of eczema and atopy: a
double-blind, randomized, placebo-controlled trial. J Allergy
Clin Immunol. 2008;122(4):788-94. This Wellington NZ based study was a
double-blind, randomized placebo-controlled trial of nearly 500 infants at risk
of allergic disease. Pregnant women were randomized to take Lactobacillus rhamnosus HN001 (L rhamnosus), Bifidobacterium animalis subsp lactis strain HN019 or
placebo daily from 35 weeks gestation until 6 months if breast-feeding, and
their infants were randomized to receive the same treatment from birth to 2
years. The researchers found that supplementation with L rhamnosus,
but not B animalis subsp lactis, substantially reduced the cumulative prevalence of
eczema, but not atopy, by the age of 2 years.
14. Osborn
DA, Sinn JK. Probiotics in infants for prevention of allergic
disease and food hypersensitivity. Cochrane Database Syst
Rev. 2007;(4):CD006475. Meta-analysis of five studies
reporting the outcomes of 1477 infants found a significant reduction in infant
eczema. However, when the analysis was restricted to studies reporting atopic
eczema (confirmed by skin prick test or specific IgE),
the findings were no longer significant. All studies reporting significant
benefits used probiotic supplements containing L. rhamnosus
and enrolled infants at high risk of allergy. No other benefits were reported
for any other allergic disease or food hypersensitivity outcome. http://www.ncbi.nlm.nih.gov/pubmed/17943912
Introduction
to food intolerance
Books by Sue
Dengate: Fed Up and The Failsafe Cookbook by Sue Dengate, available in
libraries and bookstores and at www.fedup.com.au
The information
given is not intended as medical advice. Always consult with your doctor for
underlying illness. Before beginning dietary investigation, consult a dietician
with an interest in food intolerance. You can write for our list of supportive
dietitians (confoodnet@ozemail.com.au)
© Sue Dengate November 2010
