Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial

Probiotics are usually defined as microbial food supplements with beneficial effects on the consumers. Most probiotics fall into the group of organisms' known as lactic acid-producing bacteria and are normally consumed in the form of yogurt, fermented milks or other fermented foods. Some of the beneficial effect of lactic acid bacteria consumption include: (i) improving intestinal tract health; (ii) enhancing the immune system, synthesizing and enhancing the bioavailability of nutrients; (iii) reducing symptoms of lactose intolerance, decreasing the prevalence of allergy in susceptible individuals; and (iv) reducing risk of certain cancers. The mechanisms by which probiotics exert their effects are largely unknown, but may involve modifying gut pH, antagonizing pathogens through production of antimicrobial compounds, competing for pathogen binding and receptor sites as well as for available nutrients and growth factors, stimulating immunomodulatory cells, and producing lactase. Selection criteria, efficacy, food and supplement sources and safety issues around probiotics are reviewed. Recent scientific investigation has supported the important role of probiotics as a part of a healthy diet for human as well as for animals and may be an avenue to provide a safe, cost effective, and 'natural' approach that adds a barrier against microbial infection. This paper presents a review of probiotics in health maintenance and disease prevention.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2672.2006.02963.x

Probiotics and their fermented food products are beneficial for health.

Probiotic bacteria: safety, functional and technological properties

Background
Over the last two decades the incidence of allergic diseases has increased in industrialized countries, and consequently new approaches have to be explored.

Objective
The potential of probiotics to control allergic inflammation at an early age was assessed in a randomized double-blind placebo-controlled study.

Methods
A total of 27 infants, mean age 4.6 months, who manifested atopic eczema during exclusive breast-feeding and who have had no exposure to any infant or substitute formula were weaned to probiotic-supplemented, Bifidobacterium lactis Bb-12 or Lactobacillus strain GG (ATCC 53103), extensively hydrolysed whey formulas or to the same formula without probiotics. The extent and severity of atopic eczema, the growth and nutrition of infants, and concentrations of circulating cytokines/chemokines and soluble cell surface adhesion molecules in serum and methyl-histamine and eosinophilic protein X in urine were determined.

Results
The SCORAD score reflecting the extent and severity of atopic eczema was 16 (7–25) during breast-feeding, median (interquartile range). After 2 months, a significant improvement in skin condition occurred in patients given probiotic-supplemented formulas, as compared to the unsupplemented group; χ2 = 12.27, P = 0.002. SCORAD decreased in the Bifidobacterium lactis Bb-12 group to 0 (0–3.8), and in the Lactobacillus GG group to 1 (0.1–8.7), vs unsupplemented 13.4 (4.5–18.2), median (interquartile range), in parallel with a reduction in the concentration of soluble CD4 in serum and eosinophilic protein X in urine.

Conclusion
The results provide the first clinical demonstration of specific probiotic strains modifying the changes related to allergic inflammation. The data further indicate that probiotics may counteract inflammatory responses beyond the intestinal milieu. The combined effects of these probiotic strains will guide infants through the weaning period, when sensitization to newly encountered antigens is initiated. The probiotic approach may thus offer a new direction in the search for future foods for allergy treatment and prevention strategies.

https://www.medicatrix.be/download/etude.clin.placebo_allergy.eczema.pdf

Probiotics in the management of atopic eczema.

The use of probiotics to enhance intestinal health has been proposed for many years. Probiotics are traditionally defined as viable microorganisms that have a beneficial effect in the prevention and treatment of specific pathologic conditions when they are ingested. There is a relatively large volume of literature that supports the use of probiotics to prevent or treat intestinal disorders. However, the scientific basis of probiotic use has been firmly established only recently, and sound clinical studies have begun to be published. Currently, the best-studied probiotics are the lactic acid bacteria, particularly Lactobacillus sp. and Bifidobacterium sp. However, other organisms used as probiotics in humans include Escherichia coli, Streptococcus sp., Enterococcus sp., Bacteroides sp., Bacillus sp., Propionibacterium sp. and various fungi. Some probiotic preparations contain mixtures of more than one bacterial strain. Probiotics have been examined for their effectiveness in the prevention and treatment of a diverse spectrum of gastrointestinal disorders such as antibiotic-associated diarrhea (including Clostridium difficile-associated intestinal disease), infectious bacterial and viral diarrhea (including diarrhea caused by rotavirus, Shigella, Salmonella, enterotoxigenic E. coli, Vibrio cholerae and human immunodeficiency virus/acquired immunodeficiency disorder, enteral feeding diarrhea, Helicobacter pylori gastroenteritis, sucrase maltase deficiency, inflammatory bowel disease, irritable bowel syndrome, small bowel bacterial overgrowth and lactose intolerance. Probiotics have been found to inhibit intestinal bacterial enzymes involved in the synthesis of colonic carcinogens. There are many mechanisms by which probiotics enhance intestinal health, including stimulation of immunity, competition for limited nutrients, inhibition of epithelial and mucosal adherence, inhibition of epithelial invasion and production of antimicrobial substances. Probiotics represent an exciting prophylactic and therapeutic advance, although additional investigations must be undertaken before their role in intestinal health can be delineated clearly.

The Role of Probiotic Cultures in the Control of Gastrointestinal Health

To determine the effect of a human Lactobacillus strain (Lactobacillus casei sp strain GG, Gefilac) on recovery from acute diarrhea (82% rotavirus), 71 well-nourished children between 4 and 45 months of age were studied. After oral rehydration, the patients randomly received either Lactobacillus GG-fermented milk product, 125 g (10(10-11) colony-forming units) twice daily (group 1); Lactobacillus GG freeze-dried powder, one dose (10(10-11) colony-forming units) twice daily (group 2); or a placebo, a pasteurized yogurt (group 3) 125 g twice daily; each diet was given for 5 days, in addition to normal full diet otherwise free of fermented dairy products. The mean (SD) duration of diarrhea after commencing the therapy was significantly shorter in group 1 (1.4 [0.8] days) and in group 2 (1.4 [0.8] days) than in group 3 (2.4 [1.1] days); F = 8.70, P less than 0.001. After rehydration, each dietary group maintained a positive weight trend. The urinary lactulose-mannitol recovery ratios (means [95% confidence intervals]) on admission were 0.09 (0.03, 0.24) in group 1, 0.12 (0.07, 0.22) in group 2, and 0.08 (0.04, 0.18) in group 3; no significant alterations in intestinal permeability were observed at retesting after 2 days of realimentation. The result indicates that early nutritional repletion after rehydration causes no mucosal disruption and is beneficial for recovery from diarrhea. It is further suggested that Lactobacillus GG in the form of fermented milk or freeze-dried powder is effective in shortening the course of acute diarrhea.

A Human Lactobacillus Strain (Lactobacillus Casei Sp Strain GG) Promotes Recovery From Acute Diarrhea in Children

The effects of early home management of acute diarrhea followed by rapid in-hospital realimentation on intestinal permeability were studied in 41 children aged 3-25 months with acute gastroenteritis (73% rotavirus). After oral rehydration, a 100 ml oral load containing 4 g of lactulose and 0.8 g of mannitol was administered, and an aliquot of urine excreted in the subsequent 5 h was analyzed with gas-liquid chromatography. The mean lactulose/mannitol recovery ratio was significantly higher than in 28 nondiarrheal controls, which was due to decreased mannitol excretion. The gastroenteritis patients who had received uninterrupted feeding in addition to adequate fluid replacement before hospitalization had a normal urinary lactulose/mannitol ratio, with a mean of 0.04, and a 95% confidence interval (CI) of [0.03, 0.07], whereas in fasted children with inadequate or adequate fluid replacement, the respective mean ratios were 0.24, 95% CI of [0.14, 0.43], and 0.14, 95% CI of [0.09, 0.20] (F = 12.63, p less than 0.001). The fasting-associated rise was caused by increased lactulose excretion. At retesting of gastroenteritis patients after 2 days of in-hospital realimentation, the lactulose/mannitol ratios did not differ significantly from the level on admission. The study indicated that fasting maintains the increased intestinal permeability associated with acute gastroenteritis whereas early feeding at home may promote reduction of permeability and hasten recovery.

Intestinal permeability changes in acute gastroenteritis: effects of clinical factors and nutritional management

To determine the effect of a human Lactobacillus strain GG (Gefilac™) on the clinical outcome and recovery from mucosal damage of acute diarrhoea (82 % rotavirus) 71 well-nourished children between 4 and 45 months of age were studied After oral rehydration, the patients were randomly assigned to receive either Lactobacillus GG-fermented milk product 125 g (1010-11 CFU) twice daily (Group 1), Lactobacillus GG-freeze dried powder one dose (1010-11 CFU) twice daily (Group 2) or a placebo milk product (Group 3) with no lactic acid bacteria 125 g twice daily, each for 5 days In addition, normal full diet otherwise free of fermented dairy products was given Intestinal permeability was assessed by urinary recovery ratios of orally-administered lactulose (4g) and mannitol (08 g) The mean (SD) duration of diarrhoea after commencing the therapy was significantly shorter in Group 1, 14 (08) days, and in Group 2, 14 (08) days, than in Group 3, 24 (11) days; F= 870, p < 0001 The decrease in the number of diarrhoeal stools became apparent after the first day of therapy in Group 1 and Group 2 After rehydration, each dietary group maintained a positive weight trend The urinary lactulose/manniiol recovery ratios (means [95 % confidence intervals]) were on admission in Group 1, 009 [003,024]; Group 2, 012 [007, 022]; Group 3, 008 [004,018], and no significant alterations were observed at retesiing after 2 days of realimentation The result indicates that early nutritional repletion after rehydration causes no mucosal disruption, and is beneficial for the recovery from diarrhoea We suggest that fermented dairy products, with viable lactic acid bacteria that are able to colonize the gut, are effective in shortening the course of acute diarrhoea

/pdf/a-human-lactobacillus-strain-lactobacillus-gg-promotes-2kyo0wltym.pdf

M Juntunen

Papers

A Human Lactobacillus Strain (Lactobacillus Casei Sp Strain GG) Promotes Recovery From Acute Diarrhea in Children

Intestinal permeability changes in acute gastroenteritis: effects of clinical factors and nutritional management

A human lactobacillus strain (lactobacillus gg) promotes recovery from acute diarrhoea in children