As parents, we are constantly bombarded with new information on what we should or should not be doing with our children. Should we use a crib bumper? How long should we face our child’s car seat backwards? Information seems to be changing daily on what is or isn’t right. For me, one such word is probiotics. I feel like it exploded on the scene–all of a sudden there are probiotics for children, probiotic drinks, probiotic yogurt and much, much more. But what exactly are probiotics? What are the side effects of probiotics? And why should my family be ingesting them? Breezy Mama turned to G0-To Pediatrician, Dr. Jon Conti for help on deciphering what this newest food revolution is all about. (Want a hint? Turns out probiotics can help with everything from not getting this week’s cold to supplementing with antibiotics so your tummy stays healthy to soothing a colicky baby. . .)
From Dr. Conti:
From the outset of this post I want to express my cautious optimism about this topic. Many of us would like to do more to keep ourselves healthy, and the claims of probiotics are exciting. Yet this is an emerging health topic, and I urge patience while scientific research proves or disproves the variety of claims out there. This takes time, and that’s okay—it’s your child’s health we’re talking about.
We’ve read that probiotics are good for your digestive system—what exactly do they do?
The term probiotic is a relatively new term meaning “supporting life,” and the World Health Organization states that they are “live microorganisms, which, when administered in adequate amounts, confer health benefits.” You will commonly hear them referred to as “good bacteria,” although they can be yeasts too. These microbes are similar to the ones already inside our bodies.
Also I want to point out that ‘probiotics’ are different from the “live culture” label you see on some food products. Live cultures are microbes often used as food fermentation agents, say for example to create yogurt from milk. Many of these have not been directly tested for health benefits. On the other hand, ‘probiotics’ are microbes that are able to reach the intestine while still alive, and have been shown to have a health effect. Furthermore, although there is some overlap in species, typically probiotics contain higher concentrations of these microbes.
For completeness, other designations which you may see, but are not fully explored in this posting are; ‘prebiotics’ and ‘synbiotics.’ ‘Prebiotics’ are non-digestible food ingredients that selectively stimulate the growth and/or activity of beneficial microorganisms already in people’s colons. And ‘synbiotics’ are preparations of pre & probiotics together.
What are the names that I should look for? Why are their names so complicated?
There are a variety of probiotic microorganisms to choose from, and I’ve selected a few pictures of some of the more common ones below:
The names of probiotics sound complicated, but they are important to know. Probiotics are described by their genus (e.g., Lactobacillus), their species (e.g., rhamnosus), and their strain (e.g., GG).
The concept of a “strain” is similar to the breed of a dog – all dogs are the same genus and species, but different breeds of dogs are good at different tasks. So, different strains of even the same probiotic species may have different clinical/health effects. For example, the benefits of Lactobacillus rhamnosus GG are different from L. rhamnosus GR-1.
Why should we be taking probiotics?
Our intestines are home to about 1000 species of organisms—a proverbial ‘sea inside’ of us. The popular theory argues that by supplementing our diets with probiotics, we more favorably colonize the gut with ‘good’ microorganisms. Some strains might promote health by digesting food, producing vitamins, preventing infection, regulating the immune system as well as decreasing inflammatory illness. However there hasn’t been enough research on probiotics yet to answer this question definitively, particularly in infants and children.
For example, presently probiotics are frequently used in treating stomach bugs, having been shown to shorten the illness by about 40 hours. The fundamental question is: is it worth taking a pill for a few days to shorten the number of days with diarrhea from three to two days?
If a child is of good health, and eats well, can parents just provide probiotics naturally in the food they eat (e.g., yogurt) or is best to supplement with a capsule form as well?
For the full health benefits of probiotics, one should take a probiotic supplement that has been studied and its dose arrived at by research. Yogurt’s ‘live cultures’ are used for fermentation; they are not ‘probiotics’ per se and cannot claim to have the health benefits that probiotics do.
When I was growing up, whenever my family would travel to Mexico or Chile, my mom would have us take acidophilus pills so we wouldn’t get “Montezuma’s Revenge.” Are probiotics the same thing?
Traveler’s diarrhea, sometimes referred to as “Montezuma’s revenge,” is defined as three or more unformed (non bloody) stools in a 24 hour period, and commonly accompanied by abdominal cramps, nausea, & bloating. The symptoms occur within the first week of travel, but may occur at any time while traveling, and even after returning home. The primary source of infection is ingestion of fecally contaminated food or water. The most common causative agents are enterotoxigenic Escherichia coli and Shigella (other notable organisms; Salmonella, Campylobacter, and the parasites Giardia & Cryptosporidium).
Acidophillus (better known as Lactobacillus acidophilus) is one of the most common bacteria used in probiotic supplements. According the Center for Disease Control’s Travelers Health site, “The use of probiotics, such as Lactobacillus GG and Saccharomyces boulardii, has been studied in the prevention of TD in small numbers of people. Results are inconclusive, partially because standardized preparations of these bacteria are not reliably available.”
So although probiotics may help, still the best means of prevention is to avoid questionable foods or beverages (learn the mantra “Boil it, cook it, peel it, or forget it”), good hygiene, specific vaccines, and in certain situations, prophylactic medications. Before going on a trip abroad with your family, consult with your pediatrician or local travel clinic.
So then what should I look for when I purchase one?
First, pick a product from a trusted manufacturer. Some companies that have been making probiotics for a while are Culturelle, Dannon, Florastor, Kraft, Nestle, Procter & Gamble, VSL Pharmaceuticals and Yakult.
Also look for this information on the label:
• Strain: What probiotic(s) is/are used?
• CFU (Colony Forming Units): How many live microorganisms are in each serving? When does it expire? Packaging should ensure a ‘potency’ through the “end of shelf life” (not “at time of manufacture”).
• Suggested serving size: How much should you take? More is not better!
• Proper storage conditions: Where do I keep it to ensure maximum survival of the probiotic?
• Corporate contact information: Where can I go for more information?
• Health benefits: What can this product do for me? And what are the supporting research studies?
• How is it clinically proven:
You might have to do some homework, but the pay off is huge.
1. Product claims of health benefits must be based on sound research done on that particular probiotic strain.
2. The product should contain the specific strain(s) of organism, used at the same levels as in the published research.
3. The studies should be performed in humans and published in peer-reviewed, reputable journals.
4. It is very important to be aware of the study design because it tells you about the strength and power of the results. It sounds good, but should I believe it? What you’re looking for and considered to be ‘the gold standard’ (the best of these) are placebo-controlled, double–blinded, randomized controlled (RCT’s) studies. Ask your physician to help you sort through the scientific language if you have any questions.
I see probiotics being advertised in everything from sports drinks to yogurt to ice cream, and I know it can be ingested as a capsule form as well. What should one consider when choosing a probiotic?
Probiotic content is generally more important than the way in which you consume them. I like to think of this answer like this: if you need a sports car, get one. If you need a truck to haul around stuff, get one. But a sports truck won’t perform either of those functions well. If you want a probiotic, find a good quality product, and use it as directed.
I’ve read that probiotics help those who are lactose intolerant—how?
Some people who consume milk products afterwards experience discomfort. In some of those individuals, their bodies may be unable to digest the milk sugar ‘lactose’ via the stomach’s enzyme ‘lactase.’ The microbes S. themophilus and L. bulgaricus can enhance lactose digestion and may reduce symptoms of lactose intolerance in lactose sensitive people—but not all, or not completely. You’ll find these two organisms in many probiotics and yogurts.
What is the link between probiotics and colic?
Colic is where an otherwise healthy infant, during the first 4 months of life, cries and cannot be comforted for three hours or more every day. It affects about 20% of all infants and has no known cause or cure.
The primary cause of colic remains unknown. Yet some researchers believe that colic could be alleviated using probiotic therapy. The thought here is that when there exists a balance of creatures in the gut, the gut absorbs nutrients well. However when there is an overgrowth of one or another bacteria, digestion is disrupted, excess gas created, inflammation ensues, and cramping results. By introducing “healthy” microbes into the digestive tract, we can help to restore bacterial balance in the gut, and minimize an infant’s discomfort.
Studies with Lactobacillus reuteri have provided support to this theory that probiotics may help relieve colic. However to date, confirmatory RCT’s, which are required to clinically recommend routine use of probiotics in the treatment of infantile colic, have not been conducted. So at present, it is on the basis of limited information that probiotics may be of some benefit in the treatment of colic, but more studies are needed before they can be recommended. And as always, please check with your doctor before starting ANY supplement with an infant.
How do probiotics help with infant reflux?
Probiotics may aid an infant’s maturing gut to breakdown and absorb milk. The theory is that the more rapid digestion, the less time the milk is physically in the gut, and less time it can be burped up into the throat (reflux). Anecdotally this may be the case, yet few studies have examined this effect, and no RCTs have tested the theory.
My doctor just gave my son antibiotics for a sinus infection, and wants him to start probiotics as well. Why?
Meta-analysis of published RCTs of probiotic use in the prevention of antibiotic-associated diarrhea in children shows a beneficial effect. A strong antibiotics taken over time may kill off ‘good’ organisms that aid digestion. Poorly digested food can cause cramping, bloating, flatulence, and diarrhea. Probiotics may aid in maintaing the gut’s normal floral balance.
What is the connection between probiotics and antibiotics? If someone takes a healthy, daily dose of probiotics, will they need to be on antibiotics if an illness took place?
Antibiotics kill bacteria—mostly the bad ones, yet collaterally the good ones can die off too. The problem is when this creates an imbalance in the ‘sea inside,’ and other bad organisms could take over. We hope that by reintroducing probiotics—helpful organisms—while we are taking the antibiotics, we are keeping our guts happy. If probiotics are started concurrently to antibiotic therapy, there could be a 30% reduction in gastrointestinal problems.
If an infant is breastfed, do they receive more natural probiotics than one who is formula fed?
Yes. Breast milk is not ‘sterile;’ it contains a number of useful organisms. An infant who is breastfed reaches a more adult-like flora in number & diversity far sooner than a formula-fed infant. Studies show that levels of Lactobacillus & Bifidobacteria in breast fed infants easily outnumber Enterobacter & E. coli as early as the first week of life! Understandably some formula companies have now introduced probiotics into their formulas, yet it is unclear whether or not this will be of clinical benefit.
To keep our natural probiotics healthy, do we need to cut down on the anti-bacterial hand soap and sanitizers?
The “Hygiene Hypothesis” says that many of our modern day “improvements” (e.g., sterile processed food/formula, fewer naturally fermented foods, increased hygiene/hand washing, urban life, C-sections & antibiotics) may actually decrease challenges to our immune systems, altering our ‘sea inside” and possibly leading to an increase in allergic disease. Reintroduction of probiotics into our systems may be a way to address the microbial imbalance that our modern lives have created in our guts. However this theory has not been fully tested in RCT’s, and cannot be recommended.
Anything you’d like to add that I’ve missed?
Please before you start ANY supplement, including probiotics, talk to your doctor. Probiotics should be safe for the generally healthy population to consume. However you SHOULD ALWAYS consult a physician before administering probiotics—ESPECIALLY to infants & children, people with compromised immune systems, or others with major underlying illnesses. Read “Warning” labels and “Other Information” on the product package. Be aware of any unexpected symptoms, and should any untoward effects occur, stop the probiotic immediately & seek medical attention.
About Jon Robert Conti, MD FAAP: Dr. Conti earned both a BA in Psychology and a BS in Biological Sciences from the University of California, Irvine. He went to medical school in Michigan, and completed his pediatric residency from the Children’s Hospital of Los Angeles in 2001—consistently ranked by US News-‘Nation’s Best Hospitals’ since the 1990’s. Dr. Conti is Board Certified in Pediatrics & Adolescent Medicine and presently cares for patients & their families at Sea View Pediatrics in Laguna Hills & San Clemente. He can be reached for consultation at Sea View Pediatrics: (949) 951-KIDS (5437)
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