Benefits of Consuming Probiotics Based on Medical Evidence
Changes in the gut microbiota, also known as dysbiosis, are known to affect human health. Dysbiosis is significantly associated with pathological conditions, such as obesity, malnutrition, chronic systemic diseases such as diabetes mellitus, inflammatory bowel disease (IBD), ulcerative colitis, and Crohn’s disease. [3]
Probiotics
Probiotics are live bacteria that are managed in sufficient form and quantity, then added to certain food products or as a supplement. Most of the probiotics are found in yogurt, cheese, milk, and ice cream. Even probiotics come in single supplement form. The types of microorganisms that are generally used as probiotics are Bifidobacterium and Lactobacillus, which is the predominant strain found in the human gastrointestinal tract. [1,4,5]
The efficacy of using probiotics depends on several factors. We recommend that probiotics have the following properties:
- Contains non-pathogenic bacteria in sufficient quantities
- Not damaged by processing or exposure to stomach acid and bile acids
- Can attach to the gastrointestinal epithelium and stay in the gastrointestinal tract, even for a short time
- Produces antimicrobial substances, modulates the immune response, and assists metabolic activities in the body
- It has been proven by research in vivo and in vitro provide beneficial effects for health[6]
There are several mechanisms of action of probiotics in the human body. The main mechanism is to strengthen the function of the gastrointestinal epithelial barrier. In addition, probiotics also improve adhesion protection to the gastrointestinal mucosa by preventing the adhesion of pathogenic bacteria, competing with pathogenic microorganisms, producing antimicroorganism substances, and modulating the immune system and production. short chain fatty acids (SCFAs) and branched chain fatty acids (BCFAs) are known to be important in the energy homeostasis of enterocytes.[5,7]
Benefits of Probiotics Based on Medical Evidence
Therapeutic strategies with modulation of the gut microbiota are considered promising. Various medical studies have been conducted regarding the benefits of probiotics in health conditions, for example in patients with diarrhea, other gastrointestinal problems, obesity, critical illness, a history of allergies, and mental disorders.
Diarrhea
The effects of probiotics on diarrhea with various etiologies have been extensively studied. Therapy that includes probiotics is known to improve the clinical symptoms of diarrhea caused by viruses, bacteria, parasites, and even persistent diarrhea in children. However, Szajewska et al, on European Society for Pediatric Gastroenterology, Hepatology and Nutrition Working Group (ESPGHAN WG), has published recent recommendations regarding the use of probiotics and prebiotics in the management of acute diarrhea in children. Strong recommendations are given against the use of probiotics Lactobacillus helveticus R0052 and L. rhamnosus R0011. While the weak recommendation is aimed at the use of probiotic strains Saccharomyces boulardii, L. rhamnosus GG, L. reuteri DSM 17938, L. rhamnosus 19070-2, and L. reuteri DSM 12246.[6,8]
The administration of probiotics in the treatment of diarrhea has become a subject that is often studied. Now research is being developed up to giving synbiotics. A meta-analysis study by Yang et al, covering a total of 34 studies and 4911 patients, showed that administration of probiotics and synbiotics reduced the duration of acute diarrhea 3 days faster in children compared to the control group. Group Saccharomyces and Bifidobacterium known to be more effective when compared to Lactobacillus in decreasing the duration of the diarrhea. This meta-analysis also found that administration of synbiotics was much more effective when compared to probiotics alone.[9]
The same results are also shown in the meta-analysis with patient research subjects traveler’s diarrhea (TD). Of the 158 articles analyzed, giving Saccharomyces boulardii CNCM I-745 showed a more significant reduction in incidence (RR = 0.79, 95% CI 0.72–0.87, p <0.001), whereas L. rhamnosus GG and L. acidophilus did not give significant results (p = 0.16). Research related to the use of probiotics or prebiotics on the prevalence of BP is still limited, so further research is needed regarding other possible probiotic strains in the prevention of BP.[10]
Other Gastrointestinal Problems
The effectiveness of probiotics in gastrointestinal disorders such as inflammatory bowel disease (IBD), necrotizing enterocolitis (NEC), ulcerative colitis, Crohn’s disease, and reduced risk of colon cancer have also been extensively studied. The combination of probiotics with traditional IBD therapy is the most studied management, and shows the results of probiotics can be used as a supporting therapy. Meanwhile, studies related to ulcerative colitis show that it contains probiotics Lactobacillus, Bifidobacterium, and Streptococcus can reduce remission rates in children who are on steroid therapy.[11]
A meta-analysis study of 18 randomized controlled trials (RCT) involving 4356 pregnant women showed that probiotics significantly reduced the risk of death and the incidence of neonatal NEC. Evidence with similar results was reported in another study with pregnant female subjects on antenatal corticosteroid therapy. However, the results of studies related to the use of probiotics to reduce the risk of NEC are still inconsistent.[11]
Obesity
A meta analysis by Borgeraas et al collected RCTs conducted between 1946−2016. Of the 800 studies, only 15 met the criteria with a total of 957 subjects (63% women), and the study duration was less than 12 weeks. Probiotics showed a decrease in body weight, body mass index (BMI), and fat percentage when compared to the control group. However, the effect of probiotics on fat mass was found to be insignificant. The majority of bacteria studied were used Lactobacillus and Bifidobacterium.[12]
Critical Illness
Meta analysis by Manzanares et al conducted on 30 studies, and involved a total of 2972 patients. Probiotics were stated to be associated with a reduction in infection in critically ill patients, such as post-surgery patients, severe pancreatitis, sepsis, post-trauma, and also significantly associated with a decreased incidence. ventilator-associated pneumonia (VAP). However, no probiotic effect was found on mortality, diarrhea, or length of treatment. Subgroup analysis indicated a significant improvement with probiotic alone when compared to synbiotic admixtures. Although the results of this study are promising, until now there are no recommendations regarding the use of probiotics, because their properties are still controversial in critically ill patients, so further research is needed.[13]
Allergy History
Based on Tan-Lim’s research et al which includes 28 strains of probiotics, administration of several probiotic combinations can reduce the clinical symptoms of allergies for children aged 1 month to 18 years, diagnosed with atopic dermatitis. The combination of probiotics used is from the strain Bifidobacterium and Lactobacillus. It was found that the combination of Mix 1 and Mix 6 strains gave a better effect when compared to placebo.[14]
Mix 1 consists of strains Bifidobacterium animalis subsp. lactis 43 CECT 8145, Bifidobacterium longum CECT 7347, Lactobacillus casei CECT 9104), and Lactobacillus casei DN-114001. While Mix 6 consists of Bifidobacterium bifidum, Lactobacillus acidophilus, Lactobacillus casei, and Lactobacillus salivarius. This shows that the administration of certain strains of probiotics has a good effect on the clinical symptoms of atopic dermatitis in children.[14]
However, there were minor side effects reported such as respiratory tract infections, ear infections, conjunctivitis, gastroenteritis, fever, urticaria, inguinal hernias, dental problems, and non-atopic skin disorders. In addition, because the combination of probiotics during the study can be different from the types and doses on the market, it is still difficult to recommend probiotics as part of the treatment of atopic dermatitis in children.[14]
Mental Health
Probiotics are said to have beneficial effects on mental health. The results of several studies suggest that consumption of probiotics can reduce symptoms of depression, especially major depressive disorder (MDD). In addition, probiotics may also benefit healthy individuals by reducing levels of psychological stress and anxiety. However, research related to a reduction in anxiety symptoms was found to contradict Reis’s research et al which stated that probiotics were still not significant in reducing symptoms of anxiety (p = 0.151), although the results in experimental animals showed promising results.[15-17]
Recommended Dosage for Probiotic Consumption
Until now there have been no homogeneous results regarding how much the dose of probiotics is beneficial for health. Dose-dependent use of probiotics has been largely seen in studies of the use of probiotics for the treatment of antibiotic-induced diarrhea. Based on 15 studies with 10 different strains, probiotics with doses higher than 5×109 gives a better effect when compared to lower doses. Thus, the use of probiotics with doses of more than 1010 CFU is preferred because it is more profitable.[18]
Safety of Consumption of Probiotics
Even though a probiotic strain is stated to have been registered as a drug or supplement, it does not always guarantee the quality of its product. Every product needs to be registered in a country, and these recommendations of course differ in each country depending on the research results that are used as guidelines. The probiotic products used should be identified correctly, starting from the level of genus, species, to the strain.[8]
Generally, probiotics are declared safe for consumption by healthy populations. However, there are effects that need to be watched out for in individuals such as critically ill patients, immunosuppression, prematurity, cardiac structural disorders, patients with central venous catheterization, and patients hospitalized. Severe complications that need to be watched out for are bacteremia or fungemia, as well as bacterial translocation in the intestinal wall. This has been warned by European Medicines Agency, especially on usage S boulardii in patients with severe illness and immune deficiency which may lead to fungemia.[8]
Conclusion
The condition of the microbiota of the human gastrointestinal tract is influenced by many things, such as genetic factors, the birth process, breastfeeding, drug consumption, daily diet, frequency of defecation, physical activity, and smoking. Changes in the gut microbiota are known to be associated with health problems, so that supporting therapy using probiotics is considered beneficial based on the results of various studies. Until now, there has been no definite recommendation regarding the dosage of probiotics that should be given in sick conditions, except for acute diarrhea triggered by antibiotics. Probiotics with doses of more than 1010 CFU is said to be more beneficial in children with diarrhea caused by these antibiotics.
The use of probiotics in healthy individuals is declared safe, but there is no recommended dosage and duration of consumption that is recommended. The recommendation of probiotics in daily practice can be adjusted to the clinical condition of the patient, it is better to consider several risk factors such as critical illness and immunosuppression which can cause side effects.
First writing: dr. Hunied Kautsar