Probiotics
WHO Definition: “A probiotic contains live monocultures or mixed cultures of microorganisms that act beneficially on the host organism (animal or human) by improving the characteristics of the microflora residing there.”
Canadian resource: Dragana Skokovic-Sunjic, pharmacist. Reference document for our studies and products available on the site: https://scienceofprobiotics.ca/ .
Pharmacology
Figure: Regulation of host homeostasis by probiotics 1
Key: DC = dendritic cell; IL = interleukin; M = mucin cell (mucus producer); Hsp = heat shock protein
Probiotics induce several beneficial responses in the host which include: 1
- Block the pathogenic effects of bacteria by producing antibacterial substances and competing with pathogens for binding to epithelial cells;
- Define the balance between necessary immune defense and excessive defense by increasing natural immunity, enhancing the production of anti-inflammatory cytokines and inhibiting the production of pro-inflammatory cytokines;
- Promote intestinal epithelial cell homeostasis by increasing survival, barrier function, and cytoprotective responses.
Concept of "Quorum Sensing" 2: Bacteria communicate with each other. Pathogenic bacteria only become virulent if they reach a certain concentration, a "quorum." From the moment they recognize each other and gather in sufficient numbers, their behavior changes and the secretion of toxin (or other pathogenic mechanism) appears. One of the functions of the microbiota is to hinder this communication and prevent the development of behaviors hostile to the host. A parallel can easily be drawn with street gangs. Each member taken individually does not cause much damage. However, in a group, the troubles begin.
Possible role as an adjuvant in the eradication of H. Pylori.Rosania
Probiotics can be regarded as the single most powerful alternative option under clinical development for the prevention and treatment of chronic infection. Borchert
Protection of the genitourinary tract by probiotics
By-products of lactobacilli metabolism that have an antagonistic effect against urinary and vaginal pathogens. Biosurfactants inhibit adhesion; acids, bacteriocins, and hydrogen peroxide inhibit growth; and coaggregating molecules block the spread of pathogens. Source : Reid G. Am J Clin Nutr . 2001. Reid 2001
- Promising for improving urogenital health. Waigankar
- Oral use of lactobacilli appears to provide some protection. Reid2003
- A complex product ( Lactobacillus acidophillus, Lactobacillus rhamnosum, Bifidobacterium longum, Bifidobacterium bifidum, Saccharomyces boulardi, Saccharomyces thermophilus, fructo-oligosaccharides ) helps reduce the proliferation of Candida in children in intensive care. Kumar
- Studies on single strains:
- L. crispatus , intravaginal (5 X 108 CFU per vaginal ovule; 1 ovule per day for 5 days and 1 ovule per week for 10 weeks): approximately 50% reduction in the frequency of recurrent urinary tract infections; 15% culture-verified infection vs. 27% in the placebo group (RR, 0.5; 95% CI 0.2-1.2). Stapleton
- L. crispatus vaginal ova: side effects similar to placebo Czaja; significant effect on recurrences (p=0.0007). Uehara
- Russian study on Bacillus subtilis : acceleration of pathogen elimination. Pushkarev
- L. rhamnosus GG does not appear to be useful.Colodner, Reid FEMS 2001
Indications
Antibiotic-associated diarrhea (AAD) (prevention and treatment)
Rotavirus and infectious diarrhea (prevention and treatment)
C. difficile (prevention and adjuvant)
Turista (prevention and treatment)
Vaginitis / vaginosis (prevention and treatment, but mainly adjuvant)
Irritable Bowel Syndrome (IBS) / Colic (Prevention and Symptom Reduction)
Inflammatory bowel disease (IBD) (adjuvant)
Oral hygiene (gingivitis, plaque, etc.): local use – gum, lozenge, etc.
Constipation, especially in Parkinson's disease.18
2 emerging indications:
- Gut-brain axis, linked to stress tolerance (microbiota-gut/immune system-central nervous system triangle).17,19-21
- Impact on systemic inflammation 1 and the immune system 22,23: prevention of infections and reduction of dull inflammation / leaky gut.24,25
Dosages
The minimum effective dose for treating diarrhea appears to be 10 billion.26 Except in exceptional circumstances, 10 billion and above, up to 100 billion can be used safely.
For irritable bowel syndrome (IBS): 1 to 50 billion Ritchie, more likely between 10 and 50 billion. Favor multi-strain products.
The ability to penetrate the intestine, and therefore to pass through the stomach and duodenum (bile), varies from one strain and family to another. Thus, bifidobacteria (BB536) pass these barriers more easily. Bifidobacteria can therefore be as effective, at lower doses, as lactobacilli. On the other hand, lactobacilli can survive in the stomach and are therefore more interesting for stomach disorders, gastritis, H. Pylori.
Leaky gut: Clinical studies are rare and strains are unidentified. Several different strains act at different sites in the intestine. It is best to work with multi-strain products.
Urinary tract infection prevention and/or adjuvant. Head
- Prefer complex formulas, rich in lactobacilli.
- For best results, combine oral and vaginal forms: long-term oral use (6 months or even several years); vaginal form for approximately 10 weeks (1 ovule at bedtime for 5 to 7 days, then 1 ovule per week for approximately 10 weeks).
- Oral dose: minimum 1 billion CFU; 6 to 10 billion is preferred to colonize the vaginal/pelvic flora. Reid FEMS 2001
Side effects
Transient bloating. If this occurs, stop or reduce the dose for about a week.
Interactions
No known interaction or transmissible resistance.
Pregnancy and breastfeeding
Safe
Contraindication
None known. Theoretically, acute inflammatory bowel disease with ulceration would be a contraindication, according to some. But there is no evidence of harm.
Notes
It is often said that the risk of infection is increased by taking probiotics. This is false.27 Lactobacillus bacteremia occurs with or without taking probiotics. However, the risk of translocation of the yeast S. boulardii is possible and documented. Note, however, that probiotics are for outpatients, not for those in intensive care, with some exceptions.
Probiotic bacteria are extremely sensitive to antibiotics.28
We don't rely on the number but on the quality of probiotics, no need for a horse dose if the bacteria pass into the stomach! 1.3 billion is enough. 54
References
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