Natural Products

Probiotics

Efficacy

• Efficacy confirmed for the following indications:
  Prevention and treatment of diarrhea
• Efficacy possible for the following indications:
  Acne
  Infant colic
  Preventing the recurrence of C. difficile infection
  Preventing relapses of pouchitis and ulcerative colitis
  Preventing and treating atopic eczema in children
  Boosting the immune system
  Treating H. pylori infection (in combination with standard treatment)
• Efficacy unproven, is also used for other indications:
  Crohn's disease
  Irritable bowel syndrome
  Treating or preventing vaginal infections
  

Safety

• Potential for drug interactions: Low
• Adverse effects: Low

Description

Microbial colonization of the intestine begins at birth and continues until the age of 2 years. The intestinal flora consists of more than 400 microbial species which vary from person to person. Contrary to pathogenic bacteria which are responsible for infections, healthy bacteria assist the body in its natural functions.

When we talk about probiotics, we generally refer to supplements that contain bacteria or active yeasts that may or may not already be present in the normal flora and that have a beneficial or preventive effect when ingested in large enough quantities. To be effective, probiotics must resist stomach acid, adhere to the intestinal cells, change the microbial flora, block pathogenic bacterial, produce antimicrobial substances and have desirable health benefits. Additionally, they must not pose any health risk. It would also seem that probiotics help stimulate the body's own defense mechanisms.

Strains of lactic acid bacteria such as bifidobacterium and lactobacillus are the most widely used probiotic bacteria, while Saccharomyces boulardii is the most commonly used yeast. Finding one's way in the world of probiotics is not an easy feat since each bacterial species consists of a variety of different strains. The properties of these strains vary and the bacteria from a certain strain are not necessarily the same from one manufacturer to another. Furthermore, probiotics can contain a combination of bacteria and yeasts.

Generally speaking, probiotics are sold in capsule form or as fermented dairy products. It is important to read the labels as they will indicate the strain and quantity of bacteria in the product. Although fermented dairy products like yogurt contain lactic bacteria, most of these bacteria do not survive in the digestive tract.

Probiotics are also added to countless products, such as juice, but there is no legislation in place to control their use.

Warning

In 2004, Canada adopted new regulations that control the manufacturing, packaging, labeling and importing of natural health products. The new regulations also include an adverse reaction reporting system. Products that conform to the regulation's criteria are identified with a natural product number (NPN) or homeopathic medicine number (DIN-HM) and can be legally sold in Canada. This number indicates that the product meets specific criteria for safety and purity, not that it is effective for any indication.

Medicinal plants content varies naturally from plant to plant – just as fruits from the same package may vary in taste and texture. There is no standard to measure the active content of each plant. Thus, efficacy of natural products should be expected to vary from brand to brand as well as from bottle to bottle of the same brand.

For more information about the Natural Health Products Regulations, or to check if a product has been assessed, visit the Health Canada website at http://www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php.

Do They Work?

Probiotics colonize the intestinal flora and help prevent diarrhea by preventing the proliferation of infection-causing microbes. They are also used to treat diarrhea by restoring the intestinal flora.

• Preventing diarrhea:
  Taking certain strains of probiotics, particularly lactobacillus, may reduce the risk of developing diarrhea or its duration. One can take between 2 to 10 billion lactic acid bacteria, once daily, before a meal.

  When we take antibiotics, we destroy both good and bad bacteria. This can lead to an imbalance within the intestinal flora, resulting in diarrhea. Taking probiotics helps restore the flora. To prevent antibiotic-associated diarrhea, probiotics should be taken for three days to two weeks after completing the course of antibiotics.

  Although data is limited, probiotics may help prevent traveler's diarrhea in those who visit high risk areas, as well as diarrhea associated with intubation and diarrhea caused by abdominal or pelvic radiotherapy. If possible, one should begin taking the probiotics two to five days before the risk period.

  With regards to the treatment of Helicobacter pylori, probiotics could reduce treatment-related diarrhea and help eradicate the bacteria.

• Treating diarrhea:
  The efficacy of probiotics has been ascertained but the sheer diversity of studies and the range of findings have prevented the establishment of clear and concise indications for use. Nonetheless, the safety of probiotics makes them harmless in most cases. The recommended dosage is usually 2 to 10 billion bacteria, particularly lactobacillus, three times daily, before meals.

  In the event of infectious diarrhea, lactobacillus reduces the duration of the diarrhea, especially if it is caused by a rotavirus.

  As for antibiotic-associated diarrhea, we recommend taking probiotics three times a day, for the full duration of the antibiotic course. Once treatment is completed, we recommended taking 2 to 10 billion bacteria, once daily, for at least two weeks. This will help reduce symptoms of diarrhea, abdominal distension, pain and flatulence.

• Preventing the recurrence of C. difficile:
  In addition to antibiotic therapy, it would seem that a daily dose of 1 g of saccharomyces boulardii, for four weeks, may help prevent the recurrence of C. difficile.

  The combination of lactobacillus and bifidobacteria could have a similar effect.

• Infant colic:
  In a small study, nursing infants with colic were given a probiotic by the name of lactobacillus reuteri (100 million/5 drops once a day, 30 minutes after nursing) for 4 weeks. Mothers also avoided drinking cow's milk. Response to treatment was 95%.

Are they Harmful?

• Flatulence is the most common adverse effect associated with probiotics. It is usually temporary and gradually increasing the dose can help prevent it. Probiotics taken orally or vaginally, for therapeutic purposes, are safe. They are most likely safe when taken by children and by women who are pregnant or breastfeeding.
• Those taking medications aimed at suppressing the immune system should use probiotics under medical supervision as they could cause an infection. The same applies to patients whose immune systems are compromised for other reasons. The use of probiotics in newborns and premature babies must also be done with caution.

Notes

• Regular use of probiotics in healthy people is not necessary.
• If taking probiotics and antibiotics, it is important to wait two hours between taking one and the other.
• It is important to check the expiry date and follow the manufacturer's recommendations with regards to storing the product.
• You will also find prebiotics on the market. It is important not to confuse prebiotics and probiotics. Prebiotics are made up of fibre and certain sugars that are used as nutrients for probiotics.
• In several studies, researchers used probiotics and specific dosages that are not always available.

References

1. Barbeau, G. Les probiotiques. L'actualité Pharmaceutique, sept 2004, formation continue
2. Natural Medicines Comprehensive Database, Therapeutic Research Faculty, 2007
3. Passeportsanté.net. Les probiotiques. http://www.passeportsante.net
4. 4. Savino, F et al. Lactobacillus reuteri Versus Simethicone in the Treatment of Infantile Colic: A Prospective Randomized Study, Pediatrics Vol. 119 No. 1 January 2007
5. Probiotics. Pharmacist's Letter, No. 220704 July 2006