Probiotics

Also indexed as: Acidophilus, Bifidobacterium bifidum, Bifidobacterium longum, Intestinal Flora, Lactobacillus acidophilus, Lactobacillus casei, Saccharomyces boulardii

What do they do? Beneficial bacteria, such as Lactobacillus acidophilus and Bifidobacterium bifidum, are called probiotics. Probiotic bacteria favorably alter the intestinal microflora balance, inhibit the growth of harmful bacteria, promote good digestion, boost immune function, and increase resistance to infection.1 2 People with flourishing intestinal colonies of beneficial bacteria are better equipped to fight the growth of disease-causing bacteria.3 4 Lactobacilli and bifidobacteria maintain a healthy balance of intestinal flora by producing organic compounds—such as lactic acid, hydrogen peroxide, and acetic acid—that increase the acidity of the intestine and inhibit the reproduction of many harmful bacteria.5 6 Probiotic bacteria also produce substances called bacteriocins, which act as natural antibiotics to kill undesirable microorganisms.7

Immune function tends to decline with age. Twice daily supplementation with Bifidobacterium lactis (a particular strain of bifidobacteria) in milk was found in a double-blind trial to significantly enhance various aspects of immune function in a group of healthy elderly people.8 Benefits were apparent after only six weeks of supplementation. Yogurt has been purported to support immune function, due to its inclusion of lactic-acid bacteria.9 While B. lactis is a different organism than that found in yogurt, effects on immunity may be similar.

Regular ingestion of probiotic bacteria may help prevent vaginal yeast infection.10 11 A review of the research concluded that both topical and oral use of acidophilus can prevent yeast infection caused by candida overgrowth.12

Diarrhea flushes intestinal microorganisms out of the gastrointestinal tract, leaving the body vulnerable to opportunistic infections. Replenishing the beneficial bacteria with probiotic supplements can help prevent new infections. The incidence of “traveler’s diarrhea,” caused by pathogenic bacteria in drinking water or undercooked foods, can be reduced by the preventive use of probiotics.13

Most people associate lactobacilli with L. acidophilus, the most popular species in this group of probiotic bacteria. However, research shows that other Lactobacillus species may be beneficial as well. For example, L. rhamnosus and L. plantarum appear to be protective intestinal bacteria. They are involved in the production of several “gut nutrients”, such as short-chain fatty acids, and the amino acids, arginine, cysteine and glutamine.14 These beneficial bacteria may also help remove toxins from the gut and exert a beneficial effect on cholesterol levels.15

One probiotic, Saccharomyces boulardii, has prevented diarrhea in several human trials.16 Double-blind research studying critically ill patients found this strain of yeast to prevent diarrhea when 500 mg is taken four times per day.17

Probiotics are important in recolonizing the intestine during and after antibiotic use. Probiotic supplements replenish the beneficial bacteria, preventing up to 50% of infections occurring after antibiotic use.18

Probiotics also promote healthy digestion. Enzymes secreted by probiotic bacteria aid digestion. Acidophilus is a source of lactase, the enzyme needed to digest milk sugar, which is lacking in lactose-intolerant people.19

Fructo-oligosaccharides (FOS) are naturally occurring carbohydrates that cannot be digested or absorbed by humans. They support the growth of bifidobacteria, one of the beneficial bacterial strains.20 Due to this effect, some doctors recommend that patients taking bifidobacteria also supplement with FOS. Several trials have used 8 grams per day. However, a review of the research has suggested that 4 grams per day appears to be enough to significantly increase the amount of bifidobacteria in the gut.21

Where are they found? Beneficial bacteria present in fermented dairy foods—namely live culture yogurt—have been used as a folk remedy for hundreds, if not thousands of years. Yogurt is the traditional source of beneficial bacteria. However, different brands of yogurt can vary greatly in their bacteria strain and potency. Some (particularly frozen) yogurts do not contain any live bacteria. Supplements in powder, liquid extract, capsule, or tablet form containing beneficial bacteria are other sources of probiotics.

Probiotics have been used in connection with the following conditions (refer to the individual health concern for complete information):

Rating Health Concerns
3Stars Diarrhea
Vaginitis
Yeast infection
2Stars Canker sores
Crohn’s disease (Saccharomyces boulardii)
Eczema
Food allergies
HIV support (Saccharomyces boulardii)
Immune function
Infection
Ulcerative colitis
1Star Chronic candidiasis
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

Who is likely to be deficient? People using antibiotics, eating a poor diet, or suffering from diarrhea are more likely to have depleted colonies of friendly bacteria.

How much is usually taken? The amount of probiotics necessary to replenish the intestine varies according to the extent of microbial depletion and the presence of harmful bacteria. One to two billion colony forming units (CFUs) per day of acidophilus is considered to be the minimum amount for the healthy maintenance of intestinal microflora. Some Saccharomyces boulardii research has used 500 mg taken four times per day.

Are there any side effects or interactions? There are at least nine case reports of severe, invasive (internal) fungal infections developing in people treated with the yeast organism Saccharomyces boulardii. All of these people were debilitated or had impaired immune function prior to receiving Saccharomyces boulardii.22 23 No such adverse reactions have been reported with other probiotic supplements or in people with normal immune systems.

Acidophilus and bifidobacteria may manufacture B vitamins, including niacin, folic acid, biotin, and vitamin B6.

Are there any drug interactions? Certain medications may interact with probiotics. Refer to the drug interactions safety check for a list of those medications.

References:

1. Smirnov VV, Reznik SR, V’iunitskaia VA, et al. The current concepts of the mechanisms of the therapeutic-prophylactic action of probiotics from bacteria in the genus bacillus. Mikrobiolohichnyi Zhurnal 1993;55:92–112.

2. Mel’nikova VM, Gracheva NM, Belikov GP, et al. The chemoprophylaxis and chemotherapy of opportunistic infections. Antibiotiki i Khimioterapiia 1993;38:44–8.

3. De Simone C, Vesely R, Bianchi SB, et al. The role of probiotics in modulation of the immune system in man and in animals. Int J Immunother 1993;9:23–8.

4. Veldman A. Probiotics. Tijdschrift voor Diergeneeskunde 1992;117:345–8.

5. Kawase K. Effects of nutrients on the intestinal microflora of infants. Jpn J Dairy Food Sci 1982;31:A241–3.

6. Rasic JL. The role of dairy foods containing bifido and acidophilus bacteria in nutrition and health. N Eur Dairy J 1983;4:80–8.

7. Barefoot SF, Klaenhammer TR. Detection and activity of Lactacin B, a Bacteriocin produced by Lactobacillus acidophilus. Appl Environ Microbiol 1983;45:1808–15.

8. Arunachalam K, Gill HS, Chandra RK. Enhancement of natural immune function by dietary consumption of Bifidobacterium lactis (HN019). Eur J Clin Nutr 2000;54:263–7.

9. Perdigon G, Alvarez S, Rachid M, et al. Immune system stimulation by probiotics. J Dairy Sci 1995;78:1597–606.

10. Hilton E, Isenberg HD, Alperstein P, et al. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med 1992;116:353–7.

11. Reid G, Millsap K, Bruce AW. Implantation of Lactobacillus casei var rhamnosus into vagina. Lancet 1994;344:1229.

12. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents.JAMA 1996;275:870–6.

13. Scarpignato C, Rampal P. Prevention and treatment of traveler’s diarrhea: a clinical pharmacological approach. Chemotherapy 1995;41:48–81.

14. Bengmark S. Econutrition and health maintenance: A new concept to prevent inflammation, ulceration and sepsis. Clin Nutr 1996;15:1–10.

15. Bengmark S. Colonic food: pre- and probiotics. Am J Gastroenterol 2000;95(1 Suppl):S5–7 [review].

16. Golledge CL, Riley TV. “Natural” therapy for infectious diseases. Med J Aust 1996;164:94–5 [review].

17. Bleichner G, Blehaut H, Mentec H, Moyse D. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A multicenter, randomized, double-blind placebo-controlled trial. Intensive Care Med 1997;23:517–23.

18. Loizeau E. Can antibiotic-associated diarrhea be prevented? Ann Gastroenterol Hepatol 1993;29:15–8.

19. McDonough FE, Hitchins AD, Wong NP, et al. Modification of sweet acidophilus milk to improve utilization by lactose-intolerant persons. Am J Clin Nutr 1987;45:570–4.

20. Williams CH, Witherly SA, Buddington, RK. Influence of Dietary Neosugar on Selected Bacterial Groups of the Human Faecal Microbiota. Microb Ecol Health Dis 1994;7:91–7.

21. Gibson GR. Dietary modulation of the human gut microflora using probiotics. Br J Nutr 1998;80(Suppl 2):S209–S12.

22. Bassetti S, Frei R, Zimmerli W. Fungemia with Saccharomyces cerevisiae after treatment with Saccharomyces boulardii. Am J Med 1998;105:71–2.

23. Perapoch J, Planes AM, Querol A, et al. Fungemia with Saccharomyces cerevisiae in two newborns, only one of whom had been treated with Ultra-Levura. Eur J Clin Microbiol Infect Dis 2000;19:468–70.