Probiotics: The Powers of Supermicrobes

Often used to promote digestive health, probiotics may have several protective health effects.

In the past decade, there has been great interest in the possible health benefits associated with the use of probiotics. Research is ongoing to find out more about these “super” microbes.

As a result, multiple probiotic supplements have been introduced to the dietary supplement market. Pharmacists are likely to encounter questions from patients regarding the use of probiotics, and can provide patients with pertinent information to make informed decisions.

According to the National Institutes of Health National Center for Complementary and Alternative Medicine and the World Health Organization, probiotics can be defined as “live microorganisms (eg, bacteria) that are either the same as or similar to microorganisms found naturally in the human body and when administered in sufficient amounts may be beneficial to health.”^1-5 Classification of probiotics is typically based on the genus, species, and strain, and a range of studies have investigated various strains of probiotics to explore different health effects.^2-7

While probiotics are often used to promote digestive health, various studies have postulated that the use of probiotics may have several protective health effects (Table 1^1-10).

Examples of potential proprotective effects associated with probiotics include gastrointestinal barrier function, inhibition of the growth of potential pathogens, alteration of epithelial cell cytokine production, enhancement of antiviral activity, and regulation of T cell induction.^1-4 Ongoing research has also provided compelling evidence regarding the role of probiotics in decreasing the incidence of certain diarrheal illnesses, enabling those with lactose intolerance to better digest the enzyme lactose, and enhancing immune function.^1-7 Results of a study published in May 2013 showed a moderate amount of evidence that probiotics were safe and effective for preventing Clostridium difficile—associated diarrhea.⁸

Probiotic Supplements

Probiotics are often present in fermented products such as dairy products (eg, yogurt, yogurt drinks, buttermilk), some juices and soy beverages, and plants (sauerkraut and miso), as well as in dietary supplements, which are available in various dosage forms, such as capsules, tablets, and powders. In probiotic foods and dietary supplements, the bacteria may be present already or added during the preparation process.^1-7

Probiotic supplements may contain 1 or more species of Lactobacillus, Bifidobacterium, or Saccharomyces.⁷ Within the Lactobacillus genus, Lactobacillus reuteri is the most prevalent in the human body; however, supplements on the market may contain the following Lactobacillus species: rhamnosus GG, reuteri, acidophilus, bulgaricus, or fermentum.^3,7 Species of Bifidobacterium found in supplements include longum, bifidum, breve, infanti, or lactis. Saccharomyces boulardii, which is yeast, is the only Saccharomyces species used in dietary supplements.¹ Lactobacillus and Saccharomyces products are recommended for antibiotic-associated diarrhea, and L rhamnosus GG is recommended for atopy and dermatitis.⁷

Counseling Tips

Patients should be reminded to only use products from reputable companies and to adhere to the manufacturer’s dosage guidelines and directions for use. Before recommending the use of any probiotic supplement, pharmacists should advise patients, especially those with medical conditions, to seek advice from their primary health care provider. Women who are pregnant or breast-feeding should always consult their primary health care provider before using any supplement. Although data on probiotics are not prevalent, there are no reports of harmful effects associated with the use of probiotics in late-term pregnancy or in women who are breast-feeding.¹

Concurrent administration of a probiotic supplement and an antibiotic or antifungal agent is typically not recommended, and dosing intervals of these agents should be spaced at least 2 hours apart.^1,7 While probiotic supplements are typically well tolerated, adverse effects are possible, including mild bloating and flatulence, which tend to decrease over time.^1-7 Adverse effects can be minimized if dosing is titrated slowly in small increments. Diarrhea has been reported within the pediatric population and should be monitored. ^1-7 Patients who have concerns about adverse effects should be encouraged to seek advice from their primary health care provider. According to the National Institutes of Health, patients with compromised immune systems should be advised not to use probiotics because of potential systemic infection, and those with serious medical conditions should be monitored closely for adverse effects while taking probiotics.^1-7

Research on the possible benefits of probiotic use is ongoing. For information on the current clinical trials on probiotic use, visit the National Institutes of Health Clinical Trials website at www.clinicaltrials. gov/ct2/results?term=probiotics.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References

• Oral probiotics: an introduction. National Center for Complementary and Alternative Medicine website. http://nccam.nih.gov/health/probiotics/introduction.htm. Accessed June 30, 2014.
• Rollins C. Functional and meal replacement foods. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington, DC: American Pharmacists Association; 2012.
• Williams N. Probiotics. Medscape website. www.medscape.com/viewarticle/719654. Accessed June 30, 2014.
• Oral probiotics: an introduction. National Center for Complementary and Alternative Medicine website. nccam.nih.gov/health/probiotics. Accessed June 30, 2014.
• Najm W, Lie D. Dietary supplements commonly used for prevention. Prim Care. 2008;35(4):749-767.
• Probiotic basics. California Dairy Research Foundation website. http://cdrf.org/home/checkoff-investments/usprobiotics/probiotics-basics. Accessed June 30, 2014.
• McQueen C. Nonbotanical natural medicines. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington, DC: American Pharmacists Association; 2012.
• Goldenberg JZ, Ma SS, Saxton JD, et al. Probiotics for the prevention of Clostridium difficile—associated diarrhea in adults and children. Cochrane Database Syst Rev. 2013;May 31:5.
• Dilli D, Aydin B, ZenciroÄŸlu A, Özyazici E, Beken S, OkumuÅŸ N. Treatment outcomes of infants with cyanotic congenital heart disease treated with synbiotics. Pediatrics. 2013;132(4):e932-e938.
• Dwyer JP, Dwyer PL. Lactobacillus probiotics may prevent recurrent UTIs in postmenopausal women. Evid Based Med. 2013;18(4):141-142.