Lactic acid bacteria: benefits, dosage, contraindications

Diarrhea
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Diarrhea can be caused by infections (viruses, parasites, bacteria), including acute diarrhea (gastroenteritis) and traveler's diarrhea caused by E. coli. Studies show that consuming at least 10 IU of lactic ferments (mixtures of lactobacilli and bifidobacteria) can prevent and/or treat (reduce the duration of) these diarrheas. Some clinical research shows that taking 250 mL of fermented milk containing a minimum of Lactobacillus rhamnosus GG 108 colony-forming units (CFU)/mL, Lactobacillus acidophilus La-5 107 CFU/mL, and Bifidobacterium Bb-12 108 CFU/mL orally every day for 14 days reduces the relative risk of antibiotic-associated diarrhea by 79% compared with the same dairy product containing heat-killed bacteria. Other clinical research shows that taking 49 grams of fermented milk containing at least 50 x 109 CFU of Lactobacillus acidophilus CL1285 and Lactobacillus casei (Bio-K+ CL1285, Bio-K+ International Inc) orally every day for 2 days, followed by 98 grams per day until the end of antibiotic treatment, reduces the relative percentage of patients suffering from antibiotic-associated diarrhea by 55% compared with placebo in hospitalized patients receiving systemic antibiotics. IU: billions of CFU

Posologie

Orally

108 IU

fermented milk

Vaginal infections
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Vaginal infections (bacterial or Candida) are characterized by an imbalance of the vaginal flora. Studies have shown that standard treatments are more effective when accompanied by supplementation with lactic acid bacteria. Consumption of lactic acid bacteria reduces the risk of vaginal infections in pregnant women by 81%. A meta-analysis of 10 clinical studies conducted in patients with bacterial vaginosis shows that taking a probiotic alone or with antibiotics increases the chances of cure by 39% around day 30 after the intervention, compared with the control group. Various species of probiotics have been evaluated; it is not known exactly which species, if any, might be the most beneficial.

Posologie

Orally

Fermented milk

Eczema
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The intestinal microflora plays a major protective role against the development of allergy because it reduces the transport of antigens across the intestinal mucosa and helps induce oral tolerance. Consequently, probiotics may have a protective role in the prevention and/or management of atopic dermatitis and eczema due to their proposed actions. A number of clinical trials have investigated probiotic therapy to prevent the development of atopic eczema, and some have evaluated the effectiveness of probiotic therapy in the treatment of eczema. Pelucchi et al (2012) performed a meta-analysis of randomized controlled trials to determine whether the use of probiotics during pregnancy and early life reduces the incidence of atopic eczema and IgE-associated atopic eczema in infants and young children. Eighteen publications based on 14 studies were included in the analysis. The meta-analysis showed that probiotic use reduced the incidence of atopic dermatitis. Although the overall evidence supports the use of probiotics to reduce the incidence of atopic dermatitis in infants and young children, some strains were not effective. For example, the LAVRI-A1 strain of Lactobacillus acidophilus was not effective at reducing the incidence of developing atopic dermatitis. In another randomized, placebo-controlled, double-blind trial, the efficacy of Lactobacillus paracasei F-19 was evaluated. In this trial, the probiotic was administered to the infant (n = 179) directly at the time of weaning (mixed with food). The infants consumed the probiotic (1 × 10^8 CFU/day) from 4 to 13 months. Probiotic supplementation resulted in a significant reduction in cumulative incidence of eczema at 13 months and an improvement in the Th1/Th2 ratio. In another double-blind trial, women (n = 415) were randomized to receive either a placebo or a probiotic milk (containing Lactobacillus rhamnosus GG, Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12) from 36 weeks' gestation to 3 months postnatal during breastfeeding. Probiotic milk reduced the likelihood that the child would develop atopic dermatitis at age 6 by about 52% compared with placebo milk. No significant effect was observed on rates of asthma or atopic sensitization.

Posologie

Oral administration

108 IU

has been fermented

Cold
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A clinical study conducted among children aged 3 to 6 years attending daycare shows that taking a fermented dairy product containing Lactobacillus casei at a dose of 200 g per day for 3 months reduces the risk of developing a cold, the most common upper respiratory tract infection in these children, by about 18.5% compared with a control dairy product. In healthy, middle-aged male office workers, a preliminary clinical study shows that consumption of a fermented milk containing Lactobacillus casei Shirota for 12 weeks reduces the incidence and duration of the common cold by 59% compared with a control milk.

Posologie

Oral administration

Fermented milk

Helicobacter pylori infection
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Oral probiotics, when added to most standard H. pylori eradication regimens, appear to be beneficial for improving eradication rates. Several meta-analyses show that taking probiotics in conjunction with standard H. pylori eradication therapy can increase eradication rates by 1.1 to 2 times compared with standard eradication therapy alone. Clinical research shows that Saccharomyces boulardii, Lactobacillus species, and bifidobacterial species may improve eradication rates. However, this effect appears to depend on the probiotic species or strain used, as well as on the eradication regimen. A meta-analysis shows the greatest benefit is obtained when a probiotic is added to quadruple therapies containing bismuth. Some research indicates that taking a combination of lactobacilli and bifidobacteria at the same time as the eradication treatment can double the eradication rate, while taking a probiotic containing lactobacilli alongside eradication therapy improves the eradication rate by 1.2. However, the effectiveness of lactobacillus appears to depend on the eradication regimen. Taking lactobacillus at the same time as an eradication regimen composed of a proton pump inhibitor, clarithromycin, and amoxicillin appears to improve eradication rates, but taking lactobacillus with a quadruple therapy, sequential therapy, or a therapy that does not include amoxicillin does not appear to improve eradication. Similarly, taking lactobacilli without antibiotics does not improve eradication rates in adults. Research on the use of yogurts or dairy products containing probiotics is more mixed.

Posologie

Orally

fermented

Irritable bowel syndrome
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Several species of probiotics have been evaluated to improve IBS symptoms. In general, clinical research shows that probiotics moderately improve IBS symptoms, particularly abdominal pain. The best evidence to date concerns a specific strain of bifidobacteria, called Bifidobacterium infantis 35624 (Align or Bifantis). Clinical research shows that taking this strain reduces abdominal pain, bloating and difficulty with bowel movements in the week following treatment. Clinical research also shows that daily intake of Bacillus coagulans for 56 to 90 days improves quality of life and reduces bloating, vomiting, abdominal pain and stool frequency compared with placebo. The American College of Gastroenterology conditionally recommends the use of probiotics, particularly combination probiotics, to improve overall symptoms, as well as bloating and flatulence, in patients with IBS.

Posologie

Orally

fermented milk

Respiratory infections
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Probiotics may be effective in strengthening the immune system and combating seasonal respiratory infections.nnA double-blind, placebo-controlled study was conducted on 479 healthy individuals for more than three months, who orally took a mixture of Lactobacillus. gasseri PA 16/8, Bifidobacterium longum SP 07/3, B. bifidum MF 20/5. The aim was to clinically evaluate the influence of these probiotic strains in relieving the severity of symptoms and the duration of colds.nnThe results revealed that the group treated with probiotics showed a reduced duration of symptoms with milder symptoms. In addition, their cytotoxic T lymphocytes and CD8+ cells were significantly strengthened compared with the control group. nnThe study thus shows that L. gasseri, combined with other lactic cultures, reduces the duration and severity of symptoms of seasonal viral respiratory illnesses. nnPreliminary studies suggest that consumption of lactobacilli reduces the incidence of the common cold by about 12% in adults and reduces the incidence of respiratory disorders and infections in patients with cystic fibrosis from 37% to 3%. Certain strains of lactobacilli (rhamnosus GG) would notably reduce pulmonary exacerbations and hospital admission in children suffering from cystic fibrosis, notably through an anti-inflammatory action.nn

Posologie

Orally

was fermented

Infant colic
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Clinical research shows that L. reuteri DSM 17938 may be beneficial for the TREATMENT of colic in breastfed infants. Administration of this specific strain for 21 to 28 days can reduce daily crying time in breastfed infants. Symptoms appear to improve within a week following treatment. In some clinical studies, the reduction in colic symptoms was greater in infants who received this strain than with simethicone 60 mg once or twice daily over a 28-day period. A meta-analysis of the available clinical research shows that probiotics do not appear to PREVENT the development of colic in infants. Research evaluating other Lactobacillus species or other probiotics is lacking.

Posologie

Orally

has been fermented

Constipation
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A meta-analysis of clinical research in adults with functional constipation shows that taking probiotics increases stool frequency compared with placebo.nnA specific probiotic species, L. reuteri DSM 17938 (BioGaia), has the strongest evidence of benefit. Other single-strain or combined probiotic products containing species of lactobacilli and/or bifidobacteria have also shown benefits in clinical research. Overall, the evidence for using probiotics to reduce constipation symptoms in adults is promising.nnHowever, because most available studies evaluate different probiotic strains, further research is needed to confirm which strains might be most beneficial.nnHowever, research conducted in children shows that taking probiotics does not improve constipation symptoms compared with placebo, as demonstrated by a meta-analysis of four clinical trials.nn

Posologie

Orally

was fermented

Allergic rhinitis
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Some clinical research shows that fermented milk may reduce certain symptoms of allergic rhinitis in adults. The consumption of 100 ml of heat‑treated fermented milk containing the L‑92 strain of Lactobacillus acidophilus (3 x 10^10 colony-forming units (CFU)/100 ml) per day for 8 weeks appears to reduce subjective nasal symptoms, but not ocular symptoms, compared with placebo in patients with allergic rhinitis. A clinical study conducted in adults suffering from allergic rhinitis caused by Japanese cedar pollen shows that the consumption of 80 ml of fermented milk containing the Shirota strain of Lactobacillus casei (4 x 10^8 colony-forming units (CFU)/ml) per day for 8 weeks does not improve allergic nasal symptoms compared with consumption of non‑fermented milk. Other studies suggest that fermented milk may also decrease the incidence of allergic rhinitis in children and adolescents. A clinical study conducted in preschool‑aged children with allergic rhinitis shows that taking 100 ml of fermented milk containing Lactobacillus casei, Lactobacillus bulgaricus and Streptococcus thermophilus orally once daily for 12 months reduces the annual number of rhinitis episodes by 1.6 compared with placebo. While other clinical research shows that consuming 200 to 400 ml of fermented milk containing Streptococcus thermophilus and Lactobacillus bulgaricus for 30 days does not improve allergic rhinitis symptoms in children and adolescents with allergic rhinitis, fortifying the product with Lactobacillus paracasei improves quality of life compared with consuming fermented milk that does not contain Lactobacillus paracasei. Fermented milk has also been studied for the prevention of allergic rhinitis in newborns. Clinical research conducted in pregnant women shows that consuming 250 ml of fermented milk containing Lactobacillus rhamnosus GG, Lactobacillus acidophilus and Bifidobacterium animalis during pregnancy, from the 36th week of gestation until 3 months after delivery, does not reduce the risk that the child will develop allergic rhinitis at age 6 years, compared with placebo milk. 

Posologie

Orally

has fermented

Chronic inflammatory bowel diseases
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Probiotics are used as an adjuvant therapy for Crohn's disease and ulcerative colitis. Overall, current research indicates a limited role for probiotics in Crohn's disease; results for ulcerative colitis are more promising, and there appears to be a beneficial effect on pouchitis (inflammation of the ileal pouch). Meta-analyses of clinical research show that taking probiotics increases the remission rate by a factor of 1.4 to 1.8 compared with placebo. The strongest evidence concerns a probiotic formulation containing species of lactobacilli, bifidobacteria, and streptococci (VSL#3). A meta-analysis also suggests that combination products containing bifidobacteria may be more effective than probiotics that do not contain bifidobacteria. Although a meta-analysis of three clinical trials shows that taking probiotics prevents relapses in 40% more patients than taking a placebo, most clinical research shows that probiotics containing lactobacilli or bifidobacteria, including VSL#3, do not prevent relapses in patients in remission. Given that most available studies are small and of low quality and that some have shown no benefit for induction of remission or prevention of relapses, further research is needed to confirm which probiotics, if any, might be beneficial for this use.

Posologie

Orally

VSL#3