Saturday, April 23, 2016

Nurse Jen blogs about Probiotics

My 11 year old daughter recently laughed at the number of supplements I now set before her at mealtimes: Vitamin D (like many Americans, she is low) Magnesium (she has trouble sleeping) and Omega-3s (she hates “anything from the sea”) just to name a few! So I hesitated adding probiotics to the list because I’m concerned at what I am teaching her as she heads into puberty. Are supplements important building blocks for your body? Or does it not really matter what you eat because there is a pill for everything? The world of probiotics is overwhelming and confusing, it’s been a hot health topic in recent years and it’s still evolving. I’ve attempted to synthesize some of the research below, I hope it helps you make your own educated decision about probiotics and their role in your family’s health.

For recommended brands jump down to the end of the article.

What is going on in my gut?
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. These microorganisms (or microflora) generally don’t make us sick; most are actually helpful. Gut-dwelling bacteria do a lot to help us - they keep pathogens (harmful microorganisms) in check, aid digestion and nutrient absorption, and contribute to our immune function.

So it makes sense that we’d start supplementing! Data from a 2012 National Health Interview Survey (NHIS) show that about 4 million (1.6 percent) U.S. adults had used probiotics or prebiotics in the past 30 days. Among adults, probiotics or prebiotics were the third most commonly used dietary supplement other than vitamins and minerals, and the use of probiotics quadrupled between 2007 and 2012. The 2012 NHIS also showed that 300,000 children age 4 to 17 (0.5 percent) had used probiotics or prebiotics in the 30 days before the survey.

Breast milk is naturally full of both probiotics and prebiotics. So it’s not surprising that companies started adding both to infant formula. This introduction is designed to mimic breast milk and promote both a balance of bacteria in baby's intestines as well as offset the growth of "unfriendly" organisms that could cause infections and inflammation.

What are pre and probiotics?
The word ‘probiotic’ means ‘for life.’ It refers to an oral supplement or a food product that contains enough microorganisms to alter the microflora of the host - your digestive tract. The microorganisms we’re talking about are typically Lactobacillus and Bifidobacterium. Their innate biological features essentially allow them to dominate and overcome potentially pathogenic microorganisms in your digestive tract.

A ‘prebiotic’ is a  nondigestible food ingredient that benefits your body by selectively stimulating the growth and activity of probiotic bacteria. Although indigestible by humans, prebiotics in the digestive system enhance the growth of certain probiotic bacteria in the colon, especially Bifidobacteria species. Think of prebiotics as food allowing probiotics to thrive.

Possible Health Benefits of Probiotics
The best case for probiotic therapy has been in the treatment of diarrhea. Research has shown that Lactobacillus and Bifidobacterium are promising in preventing and/or effectively treating disorders such as acute infectious diarrhea, traveler’s diarrhea, and antibiotic-associated diarrhea as well upper respiratory infections. Other possible health benefits are being studied as well, including whether probiotics can lower your child's risk of food-related allergies and asthma, treat eczema, prevent urinary tract infections and dental caries and even improve the symptoms of infant colic. Proposed future studies include the treatment of rheumatoid arthritis, irritable bowel syndrome, diabetes and cancer prevention.

Until more research is done, probiotics should not be given to children who are seriously or chronically ill until the safety of administration has been established.

Acute Infectious Diarrhea
Research has indicated that there is a modest benefit of giving probiotics in preventing acute gastrointestinal tract infections (the typical ‘tummy bug’) in healthy infants and children. There seems to be stronger evidence to support the use of probiotics, specifically Lactobacillus GG (LGG - the most effective probiotic reported to date ) early in the course to treat diarrhea, reducing the number of diarrheal stools and the duration of the diarrhea by approximately 1 day. Probiotics are most helpful for otherwise healthy infants and young children with watery diarrhea related to viral but not bacterial infections. LGG is thought to be particularly effective in rotavirus diarrhea.

With diarrhea, the main risk to health is dehydration and so our management aims to improve and maintain hydration. However, rehydration fluids like Pedialyte and coconut water don’t reduce the stool volume or shorten the episode of diarrhea. Research has shown that probiotics do. The rationale for using probiotics in infectious diarrhea is that they act against pathogens by competing for available nutrients and binding sites, making the gut contents acid, producing a variety of chemicals, and increasing immune responses. As "friendly" bacteria, probiotics improve health and are not harmful in themselves.

Overall, probiotics reduced the duration of diarrhea by around 25 hours, the risk of diarrhea lasting four or more days by 59% and resulted in about one fewer diarrheal stool on day 2 after the intervention. I’d say it’s worth trying the next time my kids get diarrhea.

Traveler’s Diarrhea
The NVP nurses often get calls from concerned parents in advance of travel to places like Mexico and India. Parents want to know how to best prepare for taking their little ones to countries where visitors are likely to pick up a GI illness. Beginning probiotics about a week before you leave is a great idea, says Ashley Hathaway, Certified Nutritional Therapist and Certified GAPS Practitioner with a special emphasis on gastrointestinal health. “Boosting immune function will help prepare your body to fight off those unfamiliar micro-organisms found in food and water. The probiotics will add an extra layer of protection to populate the gut with more beneficial bacteria.” She advises everyone in the family begin a high quality, refrigerated probiotic supplement a week ahead of departure, as well as packing one you can bring along with you on your trip.

Antibiotic-Associated Diarrhea
Research of probiotic use in the prevention of antibiotic-associated diarrhea in children also indicates a beneficial effect. In most of these studies, probiotics were started when antibiotic therapy was prescribed for an ear infection. Treatment with probiotics compared with placebo reduced the risk of developing antibiotic-associated diarrhea from 28.5% to 11.9%. Approximately 1 in 7 cases of antibiotic-associated diarrhea was prevented by the use of a probiotic. Children in these studies received either a probiotic supplemented formula or a separate probiotic as preventive treatment. Thus, probiotics can be used to reduce the incidence of antibiotic-associated diarrhea. Again, if my kids ever need antibiotics, I will supplement them with probiotics (preferably on an empty stomach at a different time I give the antibiotic for maximum effect.)

There have been no published research trials of children that have investigated the effect of probiotics for treatment of antibiotic-associated diarrhea.

Upper respiratory tract infections (URTI)
Upper respiratory tract infections (URTIs) include the common cold and inflammation of the trachea and larynx, with symptoms including fever, cough, pain and headaches. Most acute URTIs are caused by viral infections and usually resolve after three to seven days.

Probiotics were found to be better than placebo in reducing the number of participants experiencing episodes of acute URTI by about 47% and the duration of an episode of acute URTI by about 1.89 days. Probiotics may even slightly reduce antibiotic use and cold-related school absence. However, their effects in preventing URTIs are still poorly understood. Side effects of probiotics were minor and gastrointestinal symptoms were the most common. With these numbers though, I’m inclined to try probiotics for colds as well.

Dosage and Diet
So how do we dose when we’re talking about billions of bacteria? It’s vague, so the best guidance we have is to follow the dosage on the package and use baby formula for babies, children formula for kids, and adult formula for adults. For babies under 3 months, talk to your doctor before giving probiotics. Although I plan to use probiotic supplements during an illness and in advance of travel, when it comes to daily maintenance, I am personally inclined to forgo probiotic supplements and make adjustments to our family’s diet.

Fermenting foods to enhance their taste and nutritional value is an ancient and widespread practice. Although the term probiotics is relatively recent, as are science-based investigations, the use of probiotic containing fermented foods in many cultures of the world predates the advent of refrigeration. The applied notion of improving health by supplementing the natural microflora of the human intestines with additional bacteria taken by mouth actually goes back to the late nineteenth century.

Foods such as raw fermented pickles, raw sauerkraut, kimchee, kombucha, milk or coconut kefir, homemade yogurt, fermented relish and raw milk cheese will all add healthy, potentially pathogen fighting bacteria to the gut in place of supplements. When it comes to kid foods, why not add some of these fermented and cultured foods to our kids’ plates? Nutritionist Ashley Hathaway, owner of SF Nutritional Therapy, recently added a spoonful of beet sauerkraut to my kids’ scrambled eggs and guess what… of my kids ate it and liked it! Try some of her recipes (link below) and see what your kids think.

Overall, probiotics appear to be here to stay as part of the physician's armamentarium for the prevention and treatment of disease; but more evidence-based research is required.

Recommended brands
Aim to give probiotics first thing in the morning before eating breakfast and away from hot liquids such as tea or coffee. This will enhance their absorption. Refrigerated probiotics are generally a higher quality than those found on the shelf. Common brands such as Culturelle Kids, Florajen 4 Kids and Gerber Soothe colic drops are fine but also include unnecessary additives like maltodextrin (Culturelle and Florajen) and sunflower oil and triglyderide oil (Gerber.)   Ashley says “Probiotics do not need added ingredients to be effective. Often a sugar source (maltodextrin for example) or a water soluble fiber source (inulin) will be added to provide ‘food’ for the bacteria - otherwise known as a prebiotic. Although these added ingredients may help the bacteria survive in the digestive tract, they aren’t required for the probiotic to be effective, and some can be undesirable for other aspects of health.”

Maltodextrin seems to be a common additive to probiotic supplements so I asked Ashley to explain why we might want to avoid it. She says “Maltodextrin is an artificial sugar used as an inexpensive food additive. It has a high glycemic index, which means it can spike blood sugar. Some recent studies found that maltodextrin promoted the growth of unhealthy bacteria within the GI tract, which seems quite counterintuitive to taking a probiotic!  In addition, it can have similar side effects and health risks as most food additives. These side effects include allergic reactions, unexplained weight gain, bloating and flatulence.” She strongly recommends seeking out supplements that do not include maltodextrin.

Below are links to some top rated brands for kids, starting with some of Ashley’s favorites:




Top rated brands:

For those with dairy sensitivities, there are dairy-free brands such as Florajen 4 Kids, Rainbow Light Probiolicious, Floratummies, and Kyo-Dophilus.

PS from Nurse Judy.

More and more, I am starting to include probiotics on my list of suggestions for a myriad of issues. I have found them to be very helpful, especially for my patients with acute tummy bugs. I have also been offering up some Gerber Soothe for young colicky babies. I had some free samples to hand out and I am getting good reports.

If you have a probiotic that has been working for you, feel free to stick with it. There are lots of good brands out there. If you have a young baby who is getting one of the probiotics in powder form, you can mix it with a bit of breast milk, apply that to your nipple and have the baby nurse it off.


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