By David Kiefer, MD
Research about the human microbiome and the therapeutic effect of probiotics is changing fast. It can be difficult to know how to counsel our patients about this important topic. The following table is a summary of some of the recent Integrative Medicine Alert articles as well as some additional recent intriguing and/or seminal works that, I would argue, should be at your fingertips when the topic comes up with your patients. Consider this a "Part 1." Part 2 will add some of the intriguing results surrounding the prevention and treatment of bacterial vaginosis and candidiasis. Table 1 provides a summary of recent research, with diagnoses (and positive or negative effect), type of study, dosing, species (strains) used, and references, including when the topic was covered in Integrative Medicine Alert.
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Table: Summary of Recent Research on Probiotics and the Microbiome
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Diagnosis
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Study type
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Dose
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Species
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Reference
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Atopic dermatitis prevention
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Human RCT
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4.8 billion cfu daily
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Blend of Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus
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Kim, 2010 (IMA,
February 2012)
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Atopic dermatitis prevention
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Human RCT
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10 billion cfu daily
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Lactobacillus rhamnosus strain GG ATCC 53103 (mixtures used in other studies)
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Kalliomaki, 2007 (IMA,
February 2012)
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Brain effects (less response to negative imagery)
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Human RCT
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15 billion cfu daily
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Bifidobacterium animalis subsp lactis I-2494, Streptococcus thermophiles I-1630, Lactobacillus bulgaricus I-1632 and I-1519, and Lactococcus lactis subsp lactis I-1631
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Tillisch, 2013 (IMA,
February, 2014)
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Central nervous system connections with microbiome
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Review
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N/A (discussed microbiome)
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Numerous discussed
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Catanzaro, 2014
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Clostridium difficile eradication
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Case report
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N/A (stool
transplant)
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Numerous species
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Aas, 2003; Petrof, 2013
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Crohn’s, inducing remission (no benefit)
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Humans, review
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Variety
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Several species used in reviewed studies
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Butterworth, 2008
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Crohn’s, prevention of exacerbation
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Review
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Variety
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Lactobacillus rhamnosus GG, Lactobacillus johnsonii
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Jonkers, 2012
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Decreased inflammatory response with supplementation
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Animal
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100 million cfu per kg per day
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Lactobacillus plantarum CECT 7315/7316
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Vilahur, 2014
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Diarrhea, acute, treatment
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Meta-analysis of 34 studies
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Variety
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Numerous species
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Sazawal, 2006 (IMA,
February, 2012)
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Diarrhea, antibiotic-associated
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Review
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Variety
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Lactobacillus species,
Streptococcus species,
Saccharomyces boulardii
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Hidding, 2005 (IMA,
February, 2012)
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Gastrointestinal
(several diagnoses)
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Review
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Variety (direct fecal delivery discussed)
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Numerous species
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IMA, July, 2014
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Glucose intolerance correlation with artificial sweetener intake
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Animal, and human (observational)
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N/A: analyzed changes in
microbiome
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NA
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Suez, 2014 (IMA,
January, 2015)
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Irritable bowel
syndrome treatment
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Human
s, review
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100000-10 billion cfu daily
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Bifidobacterium infantis 35624
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Brenner, 2009
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Lipid improvements with supplementation
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Human SBRCT
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2 billion cfu daily
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Lactobacillus salivarius UBL S22
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Rajkumar, 2014
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Obesity
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Animal
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N/A (stool
transplant)
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Numerous species
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Ridaura, 2013
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Pouchitis, prevention
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Human, RCT
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3.2-9.6 billion cfu daily
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Lactobacillus acidophilus, Lactobacillus delbrueckii subsp. bulgaricus, and
Bifidobacterium bifidus
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Tomasz, 2014 (IMA,
July, 2014)
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Pouchitis, prevention
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Review
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1800 billion cfus
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VSL #3 (Lactobacillus casei, L. plantarum, L. acidophilus and L. delbrueckii subsp. bulgaricus)
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Jonkers, 2012
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DBRCT: double-blind, randomized, placebo-controlled trial; SBRCT: single-blind, randomized, placebo-controlled trial; RCT: randomized, controlled trial; IMA: Integrative Medicine Alert
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Table 2: Summary of Recent Research on Probiotics and the Microbiome (cont.) |
Diagnosis |
Study type |
Dose |
Species |
Reference |
Ulcerative colitis treatment |
Review |
900-3600
billion cfu |
VSL #3 (Lactobacillus casei, L. plantarum, L. acidophilus, and L. delbrueckii subsp. bulgaricus) |
Jonkers, 2012 |
URTI prevention in adults (no effect) |
Human DBRCT |
10 billion cfu daily |
Lactobacillus acidophilus NCFM and Bifidobacterium animalis subsp. lactis Bi-07 |
West, 2014 (IMA,
September, 2014) |
URTI prevention in adults
(positive) |
Human DBRCT |
2 billion cfu daily |
Bifidobacterium animalis subsp. lactis Bl-04 |
West, 2014 (IMA,
September, 2014) |
DBRCT: double-blind, randomized, placebo-controlled trial; SBRCT: single-blind, randomized, placebo-controlled trial; RCT: randomized, controlled trial; IMA: Integrative Medicine Alert |
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References
Aas J, et al. Recurrent Clostridium difficile colitis: Case series involving 18 patients treated with donor stool administered via a nasogastric tube. Clin Infect Dis 2003;36:580-585.
Brenner DM, et al. The utility of probiotics in the treatment of irritable bowel syndrome: A systematic review. Am J Gastroenterol 2009;104:1033-1049.
Butterworth AD, et al. Probiotics for induction of remission in Crohn’s disease. Cochrane Database System Rev 2008;(3):CD006634.
Catanzaro R, et al. The gut microbiota and its correlations with the central nervous system disorders. Panminerva Med 2014 Nov 12.
Hidding I, Koning C. Probiotics in the prevention and treatment of antibiotic associated diarrhoea. Agro Food Industry Hi-Tech 2005;16:18-20.
Kalliomaki M, et al. Probiotics during the first 7 years of life: A cumulative risk reduction of eczema in a randomized, placebo-controlled trial. J Allergy Clin Immunol 2007;119:1019-1021.
Kim JY, et al. Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: A double-blind, randomized, placebo-controlled trial. Pediatr Allergy Immunol 2010;21(2 Pt 2):e386-e393.
Petrof EO, et al. Stool substitute transplant therapy for the eradication of Clostridium difficile infection: RePOOPulating’ the gut. Microbiome 2013;1:3.
Rajkumar H, et al. Effect of probiotic Lactobacillus salivarius UBL S22 and prebiotic fructo-oligosaccharide on serum lipids, inflammatory markers, insulin sensitivity, and gut bacteria in healthy young volunteers: A randomized controlled single-blind pilot study. J Cardiovasc Pharmacol Ther 2014 Oct 20.
Ridaura VK, et al. Gut microbiota from twins discordant for obesity modulate metabolism in mice. Science 2013;341(6150).
Sazawal S, et al. Efficacy of probiotics in prevention of acute diarrhoea: A meta-analysis of masked, randomised, placebo-controlled trials. Lancet Infect Dis 2006;6:374-382.
Suez J, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature 2014;514:181-186.
Tillisch K, et al. Consumption of fermented milk product with probiotic modulates brain activity. Gastroenterology 2013;144:1394-1401.
Tomasz B, et al. Long-term use of probiotics lactobacillus and bifidobacterium has a prophylactic effect on the occurrence and severity of pouchitis: A randomized prospective study. Biomed Res Int 2014;2014:208064.
Vilahur G, et al. Lactobacillus plantarum CECT 7315/7316 intake modulates the acute and chronic innate inflammatory response. Eur J Nutr 2014 Nov 19.
West NP, et al. Probiotic supplementation for respiratory and gastrointestinal illness symptoms in healthy physical active adults. Clin Nutr 2014;33:
581-587.
