The Science of Digestive Health (Digesting the Facts: Probiotics, Prebiotics and Enzymes for Improved Digestion)

A study out of the University of Naples Federico II compared the efficacy of five probiotic preparations: an oral rehydration solution (control group); Lactobacillus rhamnosus GG; Saccaromyces boulardii, Bacillus clausii; a mix of L. delbrueckii var bulglaricus, Streptococcus thermophilus, L. acidophilus and B. bifidum; or Entrerococcus faecium SF69.¹² The study mentioned that its preparations had already been tested but in different settings and end points^{13,14,15,16,17} and in other meta-analyses of probiotic efficacy and a Cochrane review,^18,19,20,21 but it aimed to offer additional feedback on the subject. The focus of the study was to identify the most effective preparations and whether the efficacy of probiotic preparations for the treatment of children with acute diarrhea was related to the strain of bacteria. The researchers found the median duration of diarrhea was significantly shorter in children who received L. rhamnosus strain GG or the four bacterial strains than in children who received the control. One day after the first probiotic administration, the number of stools was lower in children who received L. rhamnosus GG and in those who received the probiotic mix. The other preparations did not affect primary outcomes.

Antibiotics are commonly used to treat children with respiratory and skin infections, which can result in antibiotic-associated diarrhea (AAD). A systematic review published in The Cochrane Database Library noted between 11 and 40 percent of children suffer from AAD.²² Furthermore, the review analyzed 10 studies that tested 1,989 children who received antibiotics to treat a medical condition along with probiotics, such as Lactobacillus GG, Lactobacillus sporogenes, Streptococcus thermophilus and Saccaromyces boulardii, to prevent ADD. Results showed probiotics reduced the incidence of AAD. The reviewers concluded there was not sufficient evidence to advise physicians to recommend probiotics to prevent AAD routinely; however, Lactobacillus GG or Saccaromyces boluardii appear to be the most effective.

Feeding the Flora

Depending on genetic makeup, dietary habits, age, medications, stress levels and physiological conditions, the composition of intestinal microflora will vary from person to person.

Probiotics continue to lead the pack when it comes to proactive nutraceutical treatments; they are ideal for individuals who consume little fiber or fermented foods, are taking antibiotics, have repeated intestinal or vaginal infections or travel frequently, according to Peilin Guo, M.S., R.D., vice president of Functional Foods, Clinical Research and Asian Market Development Research, Jarrow Formulas. Probiotics have been well researched and heavily advertised, and their major functions are metabolic activities that salvage nutrients, support immune health and protect the body against pathogenic microbes. A review published in the Journal of Applied Microbiology suggested probiotics play an important role in a healthy diet and provide a safe, cost effective and natural approach that adds a barrier against microbial infection.²³

The role of probiotics in the management of IBS is well documented; however, the etiology and pathophysiology of the disease is poorly understood, according to a review from the University of Alberta that discusses the evidence from trials and the mechanisms of action of probiotics as they apply to IBS.²⁴ Another study from S. Raffaele University Hospital, Milan, Italy, noted data on probiotics for IBS is still limited and contradictory since trials have been performed using different species, dosages, treatment durations and end-points for results evaluation.²⁵ An analysis of randomized controlled trials evaluating probiotics for IBS found B. infantis 35624 (Bifantis®, from Proctor&Gamble), an ingredient in A Lign®, was one probiotic to demonstrate improvement in IBS symptoms based upon the reviews study design.²⁶

A review of IBS and therapeutic approaches suggested treatment options are rapidly evolving beyond traditional symptom-based therapies toward agents with organ-specific receptors selectively directed at specific gastrointestinal functions.²⁷ Another meta-analysis on the efficacy of probiotics in IBS found these nutrients improve symptoms of IBS and can be used as a supplement to standard therapy.²⁸

Individual strains continue to be researched and evaluated for possible synergistic effects in the treatment of IBS. Researchers at the M. Curie Regional Hospital assessed the efficacy of Lactobacillus plantarum 299V (LP299V) in patients with IBS.²⁹ After four weeks, the patients who received the probiotic said their abdominal pain was resolved; a trend toward normalization of stool frequency in constipated patients was also noted in six out of 10 patients who received the probiotic. With regard to all IBS symptoms, an improvement was noted in 95 percent of the 20 patients who received LP299V vs. 15 percent of the patients who received the placebo.