Probiotics

Synonym(s): bifidobacteria, lactobacilli, reuterine lactobacillus, Lactobacteria, lactobacteria, lactobacilli, lactic acid bacteria, pylopass

Nutrient group: Probiotics & Fibers

Sources and physiological effects

Dietary sources
Probiotics are living microorganisms, which – if they are ingested in adequate quantity – demonstrate a health benefit. The best known and most common bacterial strains are lactobacilli (lactic acid bacteria) and bifidobacteria. In nutrition, probiotics are found primarily in dairy products such as yoghurt, milk drinks, curd cheese or in vegetables fermented with lactic acid such as sauerkraut. However, due to the microbe-hostile pH values in the stomach, very high amounts of the live organisms must be supplied so that an adequate number can reach the target site, the intestinal flora, and result in a health benefit. The regular supply of high-dose, highly active probiotics in the form of supplements - protected by acid-resistant capsules or special powder preparations - is therefore a clearly more effective medium for the desired preventive or therapeutic effects.
Physiological effects
Immune system	Approximately 60 % of the total body defense is localized in the intestine in the form of the intestine-associated immune system (GALT). The physiological intestinal flora has an essential protective effect on the mucosa.
Intestinal integrity	A healthy intestinal flora prevents the proliferation of pathogenic organisms.

Detailed information

Probiotic therapy to strengthen the intestinal flora

A number of clinical studies have proven that a therapeutic supply of probiotic microorganisms is effective for the treatment of gastroenteritis. This applies equally to bacteria- and virus-induced diarrhea, travel diarrhea and antibiotic-associated diarrhea.¹ Probiotic intervention, in particular with the patented strains Lactobacillus acidophilus LA-5® and Bifidobacterium lactis BB-12®, has demonstrated positive therapeutic effects with various indications. Probiotics can reduce the foreign colonization of the intestinal mucosa with pathogenic germs and restrict their growth. Hence, they demonstrated a high efficiency in diarrhea, gastroenteritis, non-specific, viral and antibiotic-induced diarrhea² in both adults³ and children.⁴ The barrier function of the intestinal mucosa is also promoted, so that fewer pathogenic germs can penetrate the body. This is particularly important in critically ill persons.⁵ The ingestion of antibiotics or radiation or chemotherapy can also cause considerable disturbances in the microbial colonies of the intestine, which in turn enables an increased number of pathogenic germs. This can be minimized by targeted support of the intestinal flora during treatment.⁴

Probiotic therapy for vaginal and urogenital infections

The close relationship between intestinal mucosa and urogenital flora is well documented and provides the scientific basis for the successful therapeutic use of probiotics in disorders of the microbial balance of the vaginal flora and the mucosa of the urinary tract. Probiotics can affect fungal infections of the vagina (especially Candida albicans), reduce the occurrence of bacterial vaginoses and reduce the frequency of urinary tract infections.⁶ In some studies, disturbed vaginal flora is also associated with fertility disorders, miscarriages and premature births.⁷ The preventive and therapeutic use of probiotics has become a safe and effective treatment instrument in gynecological practice.

Modulation of the immune system by probiotics

In addition to their ability to directly defend against pathogens, probiotic bacteria are also able to stimulate the intestinal immune system (GALT), which represents 70-80% of acquired immunity. This stimulates the proliferation of immune cells, the release of cytokines and the production of antibodies, as proven in numerous publications and clinical studies. For example, it was shown that a 4-week intake of probiotics significantly increased both the number of natural killer cells and interferon levels.⁸ A placebo-controlled, double-blind, randomized study in 281 children demonstrated the prophylactic effect of probiotics: Regular 3-month probiotic intake (109 CFU) significantly reduced the risk of upper respiratory diseases including rhinitis, pharyngitis, sinusitis, otitis and colds overall.⁹ The immune-boosting effects on other organ systems are due to the close interaction of the intestine-associated immune system with the other mucosal defense systems of the human body. Therefore, the colonization of the nasal cavity with pathogenic bacteria and the frequency of recurrence in chronic sinusitis (2) as well as the frequency, severity and duration of various respiratory diseases can be positively influenced by probiotics.^4,10

Probiotics for use in allergies

The immunomodulating properties of probiotics can alleviate the symptoms of allergic diseases such as atopic dermatitis, hay fever and asthma. Probiotics may have a positive effect on allergy-induced inflammatory reactions through stimulation of cytokine formation (11). In addition, probiotics normalize the impaired balance of the TH1 and TH2 helper cells. Since TH2 helper cells play a major role in the development of immediate type allergic reactions, the intake of probiotics can reduce the allergic reaction.¹² Selected probiotic strains in combination with prebiotic substances are also suitable for the prevention and the treatment of food allergies.¹³ The mechanism of action is seen as the interaction between intestinal flora and GALT, which can also have a modulating influence on the activation of the immune defense.¹⁴ Studies of pregnant and nursing women who received probiotic microorganisms before and after childbirth showed a significant correlation between probiotic intake and a reduction in the frequency of neurodermatitis in children.¹⁵

Protective effects in colon and rectal cancer

A high fiber intake reduces the risk of malignant tumors of the colon. The faster excretion of potentially carcinogenic compounds reduces their contact with the epithelial cells. Increased synthesis of protective short-chain fatty acids by intestinal bacteria, which can inhibit cell proliferation and induce apoptosis, also contributes to reduced risk of cancer.¹⁶ By strengthening the intestinal flora with the help of prebiotics and probiotics, a modulated immune response may also be able to prevent the development of cancer in other tissues.^17,18

Probiotics in the therapy of irritable bowel syndrome

A new approach to the treatment of irritable bowel syndrome (IBS) involves optimizing the intestinal flora with probiotics. In this context, a clinical study from 2021 was able to document the effectiveness of probiotics in 51 patients diagnosed with IBS. One group received probiotics containing a total of 2.5 billion colony-forming units from ten different bacterial strains twice daily for a period of eight weeks. Symptom change was recorded using the IBS-Severity Scoring System (IBS-SSS) and IBS-Global Improvement Scale (IBS-GIS) questionnaires. After the eight-week intervention period, the IBS-SSS score was decreased in both groups, but with an approximately 60% greater relative reduction in the probiotics group and a significant difference between the two patient groups. In addition, a statistically significant improvement was also observed with probiotics compared to placebo with respect to quality of life and pain severity. Using the IBS GIS score, significantly better symptom relief was also documented for the probiotics group. Significantly, patients in the severe IBS group decreased from 4 to 0 subjects in the moderate IBS group from 21 to 10 subjects after taking probiotics. At the end of the study, 60% of the participants in the probiotics group suffered only from mild IBS, compared to 30% in the placebo group.¹⁹

Lactobacillus reuteri to support Helicobacter pylori infection

Helicobacter pylori infections are the most common cause of peptic ulcers and can lead to gastric cancer if left untreated.²⁰ Antibiotic therapy is not suitable or feasible for all population groups and is often accompanied by some side effects, such as diarrhea and taste disorders. Studies also show that the number of antibiotic-resistant H. pylori strains is increasing worldwide. Lactobacillus reuteri is a probiotic bacterial strain found mainly in meat, dairy products and breast milk, and is one of the most important representatives of the lactobacterial strains. In addition to its general antimicrobial effect, a study with 100 H. pylori positive patients showed that the administration of L. reuteri alone has an inhibitory effect on H. pylori and significantly reduces the side effects of antibiotics when administered concurrently.²¹ This result was consistent with earlier results from in vivo studies.^23,23 Given the link between H. pylori infection and mental stress in gastrointestinal diseases²⁴, a short-term reduction of H. pylori may also be another viable option during stressful life events, such as trials, excessive workload or other mental stress.²⁵

Probiotics for stress

Stress has been proven to have a negative impact on the composition of intestinal bacteria and permanently changes our intestinal flora. The targeted supply of probiotics with different lactobacilli and bifidobacteria helps to restore the balance of the intestinal flora and increase the stress resistance of the body. Thus, probiotics alleviate negative emotions in stressful events, improve cognitive functions, and show great potential in mitigating psychological stress. A randomized controlled trial with 46 healthy college students showed that a specific strain of lactobacilli, namely Lactobacillus rhamnosus CNCM I-369, reduced stress perception and was able to protect the gut from stress-induced damage.²⁶

Probiotics for excess body weight

The effects of probiotics on overweight and obesity are still being researched, but the study evidence is promising. In a randomized, double-blind, placebo-controlled study of 100 overweight and obese subjects, administration of Limosilactobacillus fermentum MG4231 and MG4244 showed significant reductions in body fat mass, body fat percentage, and body weight after 12 weeks.²⁷

Deficiency symptoms

Impact on	Symptoms
Metabolism	Micronutrient deficiency, obesity
Immune system	Increased allergy tendency General immunodeficiency
Digestion	Disturbed intestinal permeability (Leaky Gut Syndrome), impaired absorption, dysbiosis

Indications

Effect	Indication	Dosage
Physiological effects at a low intake	For gastrointestinal complaints such as specific and unspecific diarrhea	10 billion CFU/d
	Complementary therapy for recurrent mucosal infections in the vaginal and urogenital tract	10 billion CFU/d
	To strengthen a weakened immune response and in people with increased susceptibility to infections	10 billion CFU/d
	Complementary therapy for allergic diseases such as atopic dermatitis, eczema, heuschnupfen, asthma	10 billion CFU/d
	Adjuvant therapy during and after treatment with antibiotics-, radiotherapy or chemotherapy	10 billion CFU/d
	Preventive therapy for increased needs in pregnancy and lactation to optimize the initial colonization of the child's intestinal flora	10 billion CFU/d
	Prevention of growth and development disorders in children	10 billion CFU/d
	For Irritable bowel syndrome	20 billion CFU/d
	For weight loss	20 billion CFU/d

Administration

General mode of administration
When	Probiotics should be taken before meals with plenty of liquid (preferably lukewarm water). This accelerates the passage through the stomach, shortens the contact time with the stomach acid and thus increases the survival rate of probiotic microorganisms. The duration of treatment depends on the indication and can range from 6 days (diarrhea), 14 days (bacterial vaginosis) and several months (infection prophylaxis, strengthening of the intestinal flora). Intake during antibiotic, radiation or chemotherapy is recommended to prevent a weakening of the intestinal flora. When taking medication, e.g. antibiotic therapy, there should be a time interval of 2-3 hours between taking the medication and probiotics. The amount taken can be increased individually and depending on the degree of disease. For children the same dosage as for adults applies.
Side effects
Certain probiotic strains may lead to increased release of histamines. Consideration should be given by a doctor if histamine intolerance is known.
Contraindications
No contraindications are known to date.

Interactions

Drug interactions
Antibiotics (all)	Disturb the biological balance of the intestinal flora and promote the growth of pathogenic germs. An intake of probiotics reduces the occurrence of antibiotic-induced diarrhea or candida infections.
Nutrient interactions
Prebiotics	Support the effect of probiotics by promoting growth and activity.

References

¹ Pham, M. et al. 2008. Probiotics: Sorting the evidence from the myths. Med J Aust. 188(5):304–308.
² Kajander, K. et al. 2008. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes Intestinal microbiota. Alimentary Pharmacology & Therapeutics. 27(1):48–57.
³ Wollowski, I., Rechkemmer, G. Physiologische Funktionen der Darmflora. In: Deutsche Gesellschaft für Ernährung. Ernährungsbericht. 2000.
⁴ Schrezenmeir, J. et al. Beeinflussung der Darmflora durch Ernährung. In: Deutsche Gesellschaft für Ernährung. Ernährungsbericht. 2004
⁵ Jain, P. K. et al. 2004. Influence of synbiotic containing Lactobacillus acidophilus La5, Bifidobacterium lactis Bb 12, Streptococcus thermophilus, Lactobacillus bulgaricus and oligofructose on gut barrier function and sepsis in critically ill patients: A randomised controlled trial. Clin Nutr. 23(4):467–75.
⁶ Hoesl, C. E., Altwein, J. E. 2005. The probiotic approach: An alternative treatment option in urology. Eur Urol. 47(3):288–96.
⁷ Verstraelen, H., Senok, A. C. 2005. Vaginal lactobacilli, probiotics, and IVF. Reprod Biomed Online. 11(6):674–5.
⁸ De Simone, C. et al. 1993. The role of probiotics in modulation of the immune system in man and in animals. Int J Immunother. IX,23–8.
⁹ Hojsak, I., et al. 2010. 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. Clin Nutr. 29(3):312–6
¹⁰ Berggren, A. et al. 2010. Randomised, double-blind and placebo-controlled study using new probiotic lactobacilli for strengthening the body immune defence against viral infections. Eur J Nutr.
¹¹ Miraglia del Guidice, M., De Luca, M. G. The role of probiotics in the clinical management of food allergy an atopic dermatitis. J Clin Gastroenterol. 38:84–5.
¹² Bjorksten, B. 2005. Evidence of probiotics in prevention of allergy and asthma. Curr Drug Targets Inflamm Allergy. 4(5):599–604.
¹³ Forsberg, A. et al. 2016. Pre- and probiotics for allergy prevention: Time to revisit recommendations? Clinical & Experimental Allergy.
¹⁴ Smith, D. W., Nagler-Anderson, C. 2005. Preventing intolerance: The induction of nonrespondiveness to dietary and microbial antiagens in the intestinal mucosa. J Immunol. 174(7):3851–7.
¹⁵ Rautava, S. et al. 2002. Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant. J Allergy Clin Immunol. 109(1):119–21.
¹⁶ Singh, B. 2007. Psyllium as therapeutic and drug delivery agent. Int J Pharm. Apr 4;334(1–2):1–14
¹⁷ Konishi, H. et al. 2016. Probiotic-derived ferrichrome inhibits colon cancer progression via JNK-mediated apoptosis. Nature Communications. 7:12365.
¹⁸ Kumar, M. et al. 2010. Cancer-preventing attributes of probiotics: An update. Int J Food Sci Nutr.
¹⁹ Skrzydło-Radomańska, B. et al. 2021. The Effectiveness and Safety of Multi-Strain Probiotic Preparation in Patients with Diarrhea-Predominant Irritable Bowel Syndrome: A Randomized Controlled Study. Nutrients. 13(3):756.
²⁰ Gröber, U. Orthomolekulare Medizin. Ein Leitfaden für Apotheker und Ärzte. Wissenschaftliche Verlagsgesellschaft Stuttgart. 2008.
²¹ Francavilla, R. et al. 2013. Lactobacillus reuteri strain combination in Helicobacter pylori infection: A randomized, double-blind, placebo-controlled study. J Clin Gas-troenterol.
²² Mehling, H., Busjahn. 2013. A Non-viable Lactobacillus reuteri DSMZ 17648 (Pylopass™) as a new approach to Helicobacter pylori control in humans. Nu-trients. 5(8):3062-73.
²³ Kafshdooz, T. et al. 2016. Role of probiotics in managing of Helicobacter pylori Infection: A review. Drug Research.
²⁴ Konturek, P. et al. 2011. Stress and the gut: Patho-physiology; clinical consequences; diagnostic approach and treatment options. J. Physiol. Pharmacol. 62:591–599.
²⁵ Mehling, H., Busjahn. 2013. A Non-viable Lactobacillus reuteri DSMZ 17648 (Pylopass™) as a new approach to Helicobacter pylori control in humans. Nu-trients. 5(8):3062-73.
²⁶ Wauters, L. et al. 2022. Lactobacillus rhamnosus CNCM I-3690 decreases subjective academic stress in healthy adults: a randomized placebo-controlled trial. Gut Microbes. 14(1):2031695. doi: 10.1080/19490976.2022.2031695.
²⁷ Cho, Y. G. et al. 2022. Effect of MED-02 Containing Two Probiotic Strains, Limosilactobacillus fermentum MG4231 and MG4244, on Body Fat Reduction in Overweight or Obese Subjects: A Randomized, Multicenter, Double-Blind, Placebo-Controlled Study. Nutrients. 30;14(17):3583.

References interactions
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