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The potential health benefits of probiotics are the focus of a great deal of scientific research. This section focuses on research on the use of probiotics to prevent or treat seven health conditions: atopic dermatitis, pediatric acute infectious diarrhea, antibiotic-associated diarrhea (AAD), inflammatory bowel disease, irritable bowel syndrome, hypercholesterolemia, and obesity. Atopic dermatitis Numerous probiotic studies have evaluated the effects of various species and strains of bacteria on the prevention of atopic dermatitis, and several meta-analyses have synthesized the findings of these studies. These studies and meta-analyses show that exposure to probiotics during pregnancy and in early infancy might reduce the risk of developing atopic dermatitis in children. For example, a 2018 meta-analysis included 27 randomized controlled trials (RCTs) and one controlled cohort study in a total of 6,907 infants and children exposed to probiotics in utero for 2 weeks to 7 months (via maternal oral supplementation) and/or by oral administration to the infants after birth for 2 to 13 months [ 13]. Between age 6 months and 9 years, probiotic treatment with single strains or mixtures that included Lactobacillus, Bifidobacterium, and Propionibacterium strains significantly reduced the risk of atopic dermatitis from 34.7% in the control group to 28.5% in the probiotic group. A meta-analysis of 30 RCTs with 1,624 participants (mostly adults age 18 years or older) demonstrated that those treated with probiotics for 3 to 12 weeks had 7.8 mg/dL lower total cholesterol and 7.3 mg/dL lower LDL cholesterol concentrations than those treated with placebo [ 54]. In subgroup analyses, the benefits of probiotics were slightly greater in studies that lasted 8 weeks or longer and in participants who had baseline cholesterol levels higher than 240 mg/dL. Among the strains included in more than three studies, Lactobacillus acidophilus, a mixture of Lactobacillus acidophilus and Bifidobacterium lactis, and Lactobacillus plantarum were associated with significant reductions in total and LDL cholesterol concentrations, but Lactobacillus helveticus and Enterococcus faecium were not. In a smaller meta-analysis of 11 RCTs in 602 adults with normal or high cholesterol levels, those treated with probiotics for 2 to 10 weeks had 6.6 mg/dL lower total cholesterol and 8.5 mg/dL lower LDL cholesterol levels than those treated with placebo, but the probiotic treatment had no significant effects on HDL cholesterol levels [ 55]. The effects were most pronounced with consumption of probiotics for more than 4 weeks by participants with hypercholesterolemia and those age 45 or older. In both meta-analyses, participants included both healthy adults and adults with hypercholesterolemia, CVD, diabetes, or obesity. Many probiotic strains derive from species with a long history of safe use in foods or from microorganisms that colonize healthy gastrointestinal tracts. For these reasons, the common probiotic species—such as Lactobacillus species ( acidophilus, casei, fermentum, gasseri, johnsonii, paracasei, plantarum, rhamnosus, and salivarius) and Bifidobacterium species ( adolescentis, animalis, bifidum, breve, and longum)—are unlikely to cause harm [ 3]. Overall, research suggests that the use of multiple probiotic strains in combination as well as of probiotics containing Lactobacillus acidophilus, a mixture of Lactobacillus acidophilus and Bifidobacterium lactis, or Lactobacillus plantarum might reduce total and LDL cholesterol levels. However, more research is needed to confirm these findings. Obesity
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Szajewska H, Horvath A. Lactobacillus rhamnosus GG in the primary prevention of eczema in children: a systematic review and meta-analysis. Nutrients 2018;10. [ PubMed abstract] Principi N, Cozzali R, Farinelli E, Brusaferro A, Esposito S. Gut dysbiosis and irritable bowel syndrome: The potential role of probiotics. J Infect 2018;76:111-20. [ PubMed abstract] The International Scientific Association for Probiotics and Prebiotics defines probiotics as "live microorganisms that, when administered in adequate amounts, confer a health benefit on the host" [ 1]. These microorganisms, which consist mainly of bacteria but also include yeasts, are naturally present in fermented foods, may be added to other food products, and are available as dietary supplements. However, not all foods and dietary supplements labeled as probiotics on the market have proven health benefits.Wilkins T Sequoia J. Probiotics for gastrointestinal conditions: a summary of the evidence. Am Fam Physician 2017; 96: 170-8. [ PubMed abstract]
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The gut microbiota play an important role in nutrient and energy extraction from food. Research in mice suggests that the gut microbiota affect not only use of energy from the diet, but also energy expenditure and storage within the host [ 58]. Whether these effects translate to humans is unknown. Davis CD. The gut microbiome and its role in obesity. Nutr Today 2016;51:167-74. [ PubMed abstract]
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Sairenji T, Collins KL Evans DV. An update on inflammatory bowel disease. Prim Care 2017; 44: 673-92. [ PubMed abstract] Contains Lab4 friendly bacteria with Lactobacillus gasseri, which forms a normal part of the vaginal flora Several meta-analyses have assessed the role of probiotics in patients with IBS [ 42-46]. Most have found that probiotics have a positive, although modest, beneficial effect. For example, a meta-analysis of 23 RCTs in a total of 2,575 patients found that, overall, probiotics reduced the risk that IBS symptoms would persist or not improve by 21% [ 42]. Various species and strains of probiotics had beneficial effects on global IBS symptoms, abdominal pain, bloating, and flatulence scores, but the quality of the studies was low. Some combinations of probiotics were superior to individual strains in this analysis, but no specific combination was superior to another. A second meta-analysis of 15 RCTs in a total of 1,793 patients with IBS found that probiotics reduced overall symptoms and abdominal pain more than placebo after 8 to 10 weeks of therapy; in children, these supplements also improved mucosal barrier function [ 43]. In contrast, the most recent systematic review and meta-analysis, which included 19 randomized trials in 1,412 participants, found that supplementation with probiotics or synbiotics reduced waist circumference slightly (by 0.82 cm) but had no effect on body weight or body mass index, although the quality of evidence was low to moderate [ 63]. The findings from another meta-analysis of 14 trials in 881 adults, 5 trials in 726 children, and 12 trials in 1,154 infants suggested that probiotics promote loss of a mean of 0.54 kg in adults, gain of a mean of 0.20 kg in children, and no significant weight loss or gain in infants [ 64].
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Lorenzo-Zuniga V, Llop E, Suarez C, Alvarez B, Abreu L, Espadaler J, et al. I.31, a new combination of probiotics, improves irritable bowel syndrome-related quality of life. World J Gastroenterol 2014;20:8709-16. [ PubMed abstract] Szajewska H, Skorka A, Ruszczynski M, Gieruszczak-Bialek D. Meta-analysis: Lactobacillus GG for treating acute gastroenteritis in children--updated analysis of randomised controlled trials. Aliment Pharmacol Ther 2013;38:467-76. [ PubMed abstract] For individuals with compromised immune function or other serious underlying diseases, the World Gastroenterology Organisation (WGO) advises restricting probiotic use to the strains and indications that have proven efficacy [ 3]. Probiotic Selection and Use Researchers have studied the use of probiotics to improve lipid profiles. The mechanisms of their effects on cholesterol concentrations include catabolism of cholesterol by increasing:Our digestive system (gut) is central to supporting our health – it contains more than 70% of the body’s immune system and 10 times more bacteria than we have cells in our whole body (the gut microbiome). Probiotics usually exert their effects in the gastrointestinal tract, where they may influence the intestinal microbiota. Probiotics can transiently colonize the human gut mucosa in highly individualized patterns, depending on the baseline microbiota, probiotic strain, and gastrointestinal tract region [ 4]. Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 2014;11:506-14. [ PubMed abstract]
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