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CONTINUING PROFESSIONAL DEVELOPMENT
Researched probiotic strains
While all probiotics are considered safe
and friendly in a broad sense, not all
probiotics are the same, and some strains
have little evidence demonstrating their
health benefits in humans. Probiotic
activity differs according to genus,
species, and strain. It is becoming
increasingly apparent that probiotics
produce different effects within the body
that are not just determined by genera
and species, but that are also strain-
specific.19 It is important that there is a
sufficient body of evidence to support
the therapeutic actions of the chosen
probiotic strain for the specific indication
for which it is intended. Consequently,
the International Scientific Association
for Probiotics and Prebiotics (ISAPP)
states that the specific strain must be
clearly stated on the label, to allow
healthcare professionals and consumers
to select the most appropriate
formulation for their needs.20 Some
examples of extensively researched
probiotic strains that have been shown
to be beneficial to children include:
• Lactobacillus acidophilus (NCFM)
-- the most widely studied strain
of Lactobacillus acidophilus with
numerous human trials. Either alone,
or in combination with Bifidobacterium
lactis (Bi-07), Lactobacillus acidophilus
(NCFM) has been shown to help:
- reduce the frequency and duration
of colds and flu8 in children8,9
- maintain levels of Lactobacilli and
Bifidobacteria following the use of
antibiotics21 support lactase activity,
which facilitates the digestion of
lactose (milk sugar).22
• Lactobacillus rhamnosus GG (LGG) --
the most widely studied commercially-
available probiotic strain with
demonstrated benefits, for example in:
- significantly reducing the symptoms
of atopic dermatitis in children12
- reducing the incidence of eczema
and food allergy in infants and
children when taken during
pregnancy and breastfeeding13
- reducing the risk of gastrointestinal
infections by pathogenic organisms.23
Choosing an optimal strength
Although some might think that, as with
some vitamins, minerals and medicines,
a greater strength (i.e. dose) of probiotics
will elicit a stronger or more rapid
response, studies have indicated that
more bacteria is not necessarily better.
Researchers have instead suggested that
'probiotics can be ineffective or even
detrimental if not used at the optimal
dosage for the appropriate purpose.'24 In
fact, a number of recent clinical studies
have investigated the effects of various
strengths of commonly prescribed
probiotic strains and found that there
can be marked differences in clinical
outcomes depending on the doses used.
For example, LGG given at a dose of six
billion organisms twice daily has been
shown to reduce digestive symptoms
such as diarrhoea in infants,23 whilst LGG
given at a dose of 20 billion organisms
per day is effective for reducing the
incidence of eczema.25
In addition, when comparing different
doses of a particular probiotic strain,
researchers unexpectedly discovered
qualitative differences in the
immunological effects produced.26 As
probiotics appear to exert influence via
'cross-talk' with intestinal mucosal cells,
this may explain why the balance of
microbiota within the intestinal lumen can
exert either a pro- or anti-inflammatory
response at any given time.27 Of relevance
to clinical practice is that the same strain
at a different dose may produce an
entirely different outcome, highlighting
the importance of taking the researched
strength to confer expected benefits.
The combination of probiotic strains
may also influence the therapeutic
effect of a probiotic formulation.
Multiple probiotic strains are not always
effective or compatible in combination.
In fact, some strains have been observed
to inhibit each other's ability to function
optimally, therefore counteracting
each other's benefit.28 As such, strains
should ideally be clinically trialled
in combination to reduce the risk of
opposing effects occurring.
Are the bacteria alive and strong?
The other factor determining probiotic
strength, apart from dose, is the
conditions under which it has been
stored. Probiotics are live microorganisms
that may be freeze-dried to suspend them
in a state of dormancy until they reach
the intestinal lumen, where the more
hospitable host environment supports
their return to an active state.29 For
probiotics to be alive upon consumption,
they must remain dormant (therefore
metabolically inactive) inside the capsule.
Microbiological testing has shown that
some strains have reduced shelf-life
when exposed to conditions common in
Australia and New Zealand.
The metabolic activity of microorganisms
gradually elevates as temperature
increases.30 Therefore, a risk exists
that a previously dormant probiotic
could be 'revived' prematurely if stored
inappropriately. In this instance, starved
of nutrients, the bacteria may start
to die, leading to the introduction of
dead bacteria31 and affecting shelf-life.
Interestingly, the science in the area
of probiotics suggests that the dead
cells within the powder or capsule
may not necessarily be inert, and may
contribute to a variation in physiological
response to that seen with the live
culture.32 Refrigeration protects against
temperature elevation, providing a
stable temperature of 4--8°C, as well as
controlling ambient humidity.
1. Blaser M. The microbiome revolution. J Clin Invest
2. Moloney R, Desbonnet L, Clark G, et al. The microbiome:
stress, health and disease. Mamm Genome 2013;25:49--74.
3. Funkhouser LJ, Bordenstein SR. Mom knows best: the
universality of maternal microbial transmission. PLoS Biol
4. Dominguez-Bello M, Jesus-Laboy K, Shen N, et al. Partial
restoration of the microbiota of caesarean-born infants via
vaginal microbial transfer. Nature Medicine 2016;22:250--3.
5. Houghteling PD, Walker WA. From birth to "immunohealth",
allergies and enterocolitis. J Clin Gastroenterol 2015;49(1):S7--12.
6. Bäckhed F, Roswall J, Peng Y, et al. Dynamics and stabilization
of the human gut microbiome during the first year of life. Cell
Host Microbe 2015;17(5):690--703.
7. Ozdemir O. Various effects of different probiotic strains in
allergic disorders: an update from laboratory and clinical data.
Clin Exp Immunol 2010;160(3):295--304.
8. Leyer GJ, Li S, Mubasher ME, et al. Probiotic effects on cold
and influenza-like symptom incidence and duration in
children. Paediatrics 2009;124(2):e172--9.
9. Ouwehand A, Leyer G, Carcano D. Probiotics reduce the
incidence and duration of respiratory tract infection
symptoms in 3- to 5-year-old children. Pediatrics 2008;121:15.
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