By Emily Gutierrez, DNP, CPNP
“70-80% of the body’s immune system dwells in the digestive tract, and a well functioning digestive system is essential to maintaining overall health.”
Probiotics have become very popular as a medicinal tool to optimize health or target a specific health concern. Probiotics improve the balance of normal intestinal bacterial flora in the gastrointestinal system, and also have efficacy for improving microbial colonization and diversity in other areas such as the skin and in mucous membranes. These live microorganisms have numerous functions, but are most commonly known for facilitating digestion and enhancing immunity. Probiotics can be used for a targeting treatment in a variety of disease states. There is an abundance of literature to support probiotics in the use of antibiotic associated diarrhea, acute infectious diarrhea, irritable bowel syndrome, yeast infections (vaginal, oral and systemic), and eczema. The National Institute of Health’s Human Microbiome Project is the largest nationally funded effort to continue to study the role of probiotics in human health and disease.
Lifestyle, diet, age, stress level, exercise and antibiotic use all have an impact on the balance of human microflora. A diet high in sugars, fried and processed foods can also have a negative impact. Judicious use of antibiotics is imperative due to its negative consequences it has on a humans microflora balance. In addition, ingesting nonorganic foods (in particular meat and dairy) that have been treated with antibiotics can also have unintended negative consequences on the microbiotia.
Dietary sources of probiotics are an important part of a healthy diet. Foods containing probiotics are usually fermented and may have added live active cultures. This includes yogurt, kefir, cottage cheese, kimchi, kombucha, pickled vegetables, sauerkraut, tempeh and miso. In addition to ingesting probiotic foods, it is important to nourish the microbes with prebiotic fiber so that the probiotics can continue to thrive. Sources of prebiotic fiber can include onions, bananas, honey, garlic, leeks, inulin, and dandelion greens. Many probiotic supplements on the market contain both probiotics and prebiotics.
Grocery and health food stores are flooded with probiotic supplements in the form of capsules, powders, and foods. As clinicians, we need to know how to prescribe probiotics to our patients, and guide them in product selection. Due to the regulatory laws around dietary supplements in the US, not all probiotics manufacturers adhere to the rigorous practices for product potency and purity. It is judicious to recommend products that have been third product verified through agencies such as NSF-International and good manufacturing practice certified (GMPc). Over the counter brands that meet this criteria for children include Culturelle, VSL, and Florastor. Pharmaceutical grade brands that are pediatric friendly include Klaire, Masters Supplements, and Jarrow.
The current consensus for generalized health maintenance with probiotics is to recommend products that have a variety of lactobacillus and bifidobacterium strains, taken several times a week. Saccharomyces boulardii should be recommended if yeast overgrowth is a concern. Products should be rotated in order to facilitate strain diversity. Additional condition specific strains and dosages are beyond the scope of this report. See the reference section for additional resources.
References
- Allen SJ, Okoko B, Martinez E, Gregorio G, Dans LF. Probiotics for treating infectious diarrhoea. Cochrane Database Syst Rev 2004;(2):CD003048. PMID 15106189
- Committee on Nutrition, American Academy of Pediatrics. Frank Greer and Dan Thomas. Probiotics and Prebiotics In Pediatrics, 2010. http://pediatrics.aappublications.org/content/126/6/1217.long
- Natural Medicines Database- Gold standard clinical tool for integrative health management. Subscription required.
- National Institute of Health, Human Microbiome Project; https://commonfund.nih.gov/hmp/index
- Lee MC, Lin LH, Hung KL, Wu HY. Oral bacterial therapy promotes recovery from acute diarrhea in children. Acta Paediatr Taiwan 2001;42:301–5. PMID 11729708
- Sazawal S, Hiremath G, Dhingra U, Malik P, Deb S, Black RE. Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebocontrolled trials. Lancet Infect Dis 2006;6:374–82. PMID 16728323