De Vrese M. Health benefits of probiotics and prebiotics in women: A review. Menopause International 2009;15(1):35-40.
Among the numerous positive effects of probiotic microorganisms and prebiotic carbohydrates observed in clinical studies–the majority of which, however, does not fulfil the criteria of pharmaceutical verification–some are of specific relevance to female health.
The present review addresses–besides some notes concerning the potential microbiota-hormone interactions–the first line with preventive and/or therapeutic applications of probiotic bacteria in order to maintain a balanced intestinal and urogenital flora, as well as in the case of irritable bowel syndrome, constipation (idiopathic slow-transit) and urogenital tract infections.
Further aspects are the promotion of bone health and osteoporosis prevention brought about by inulin, oligofructose and galactooligosaccharides. Some further conditions, namely anorexia nervosa, the premenstrual syndrome as well as prevention or alleviation of climacteric and menopausal disorders, for which the use of probiotics is rather hypothetical or is largely studied by alternative medicine practising physicians, are addressed briefly.
Nutr Clin Prac ’09: Reviewing probiotics for use as preventive therapies in C-difficile associated diseases
Imhoff A, et al. Is there a future for probiotics in preventing Clostridium difficile-associated disease and treatment of recurrent episodes? Nutr Clin Prac 2009 24(1):15-32.
Due to morbidity, mortality, and high costs associated with eradicating Clostridium difficile once this organism causes colitis, this bacterium has been termed one of the most ecologically relevant microorganisms of the present day. Symptoms associated with C. difficile diarrhea often first present during or shortly after a course of antibiotic therapy.
During the past 5 years, the virulence of this organism has increased. C. difficile–associated disease (CDAD) has reached epidemic proportions in some hospital settings, prompting Medicare to propose adding CDAD to the list of hospital-acquired conditions for which reimbursements may be cut. Thus, it is imperative that effective preventive strategies be implemented in hospitals to decrease CDAD infections.
It is plausible that probiotic supplements may offer a safe and effective means of preventing both initial CDAD episodes as well as CDAD recurrences. This review critically examines the current literature in which probiotic supplements have been studied for efficacy in CDAD prevention.
This analysis will guide practitioners in applying available probiotic data to CDAD clinical scenarios and will assist researchers in the appropriate design of future studies as examination continues into the role that probiotics may have in CDAD prevention.
Inf Dis Obs Gyn ’07: Study assessing safety of using probiotic vaginal suppositories in women with recurrent urinary tract infections has good results
Czaja C, Stapleton A, Yarova-Yarovaya Y et al. Phase I trial of a Lactobacillus crispatus vaginal suppository for prevention of recurrent urinary tract infection in women. Inf Dis Obstet Gynecol 2007;(35387):1-8.
We performed a phase I trial to assess the safety and tolerance of a Lactobacillus vaginal suppository for prevention of recurrent UTI.
Premenopausal women with a history of recurrent UTI were randomized to use L. crispatus CTV-05 or placebo vaginal suppositories daily for five days.
30 women were randomized (15 to L. crispatus CTV-05). No severe adverse events occurred. Mild to moderate vaginal discharge and genital irritation were reported by women in both study arms. Seven women randomized to L. crispatus CTV-05 developed pyuria without associated symptoms.
Most women had high concentrations of vaginal H202-producing lactobacilli before randomization. L. crispatus, L. jensenii, and L. gasseri were the most common Lactobacillus species identified, with stable prevalence over time.
L. crispatus CTV-05 can be given as a vaginal suppository with minimal side effects to healthy women with a history of recurrent UTI. Mild inflammation of the urinary tract was noted in some women.
Hallén A, Jarstrand C, Påhlson C. Treatment of bacterial vaginosis with lactobacilli. Sex Transm Dis 1992;19(3):146-148.
60 women with bacterial vaginosis were entered into a double blind, placebo-controlled treatment trial with lyophilized Lactobacillus acidophilus. The lactobacilli used were producing H2O2.
Immediately after completion of treatment, 16 out of 28 women who were treated with lactobacilli had normal vaginal wet smear results, in comparison to none of the 29 women treated with placebo.
All women harboured Bacteroides at inclusion. Bacteroides was eliminated from the vagina of 12 out of 16 healthy women after treatment. Only three of the women who received the Lactobacillus suppository were free of bacterial vaginosis after the subsequent menstruation.
Petricevic L et al. Randomized, double-blind, placebo-controlled study of oral lactobacilli to improve the vaginal flora of postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2008;141(1):54-57.
The purpose of this randomized, double-blind, placebo-controlled study was to evaluate the influence of the orally administered probiotic strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on the quality of the vaginal flora in postmenopausal women.
Postmenopausal women with Nugent scores between 4 and 6 in initial vaginal swab, were randomized into two groups. Women in the intervention group received probiotic capsules containing 2.5×10(9)CFU (colony forming units) each of lyophilized L. rhamnosus GR-1 and L. reuteri RC-14 and women in the control group received an oral placebo once daily, in both groups for 14 days. Final vaginal swabs were taken 1 day after the last administration of the medication. The primary efficacy variable was a change in the Nugent score between baseline and the end of the study of at least two grades in each individual patient.
Seventy two women were recruited in the study, 35 assigned to the intervention group and 37 to the control group. Twenty-one of the 35 subjects (60%) in the intervention group and 6 of the 37 subjects (16%) in the control group showed a reduction in the Nugent score by at least two grades. The difference in the number of patients with improvement was highly significant (p=0.0001). The median difference in Nugent scores between baseline and the end of the study was 3 in the intervention group and 0 in the control group (p=0.0001).
Our results provide evidence for an alternative modality to restore the normal vaginal flora using specific probiotic strains administered orally.
Ya W, Reifer C, Miller L. Efficacy of vaginal probiotic capsules for recurrent bacterial vaginosis: a double-blind, randomized, placebo-controlled study. Am J Obstet Gynecol 2010;203(2):120.e1-6.
We assessed the effectiveness of vaginal probiotic capsules for recurrent bacterial vaginosis (BV) prevention.
One hundred twenty healthy Chinese women with a history of recurrent BV were assigned randomly to daily vaginal prophylaxis with 1 capsule (Probaclac Vaginal; Nicar Laboratories, Inc, Blainville, Quebec, Canada) that contained 8 billion colony-forming units of Lactobacillus rhamnosus, L acidophilus, and Streptococcus thermophilus (n = 58 women) or 1 placebo capsule (n = 62 women) for 7 days on, 7 days off, and 7 days on.
Probiotic prophylaxis resulted in lower recurrence rates for BV (15.8% [9/57 women] vs 45.0% [27/60 women]; P < .001) and Gardnerella vaginalis incidence through 2 months (3.5% [2/57 women] vs 18.3% [11/60 women]; P = .02). Between the 2- and 11-month follow-up period, women who received probiotics reported a lower incidence of BV and G vaginalis. Aside from vaginal discharge and malodor, no adverse events were reported in either study group.
Short-term probiotic prophylaxis is well tolerated and reduces BV recurrence and G vaginalis risk through 11 months after treatment.
Berg R. The indigenous gastrointestinal microflora. Trends Microbiol 1996;4(11):430-435.
The indigenous gastrointestinal (GI) tract microflora has profound effects on the anatomical, physiological and immunological development of the host.
The indigenous microflora stimulates the host immune system to respond more quickly to pathogen challenge and, through bacterial antagonism, inhibits colonization of the GI tract by overt exogenous pathogens.
Indigenous GI bacteria are also opportunistic pathogens and can translocate across the mucosal barrier to cause systemic infection in debilitated hosts.
JADA ’08: Experts publish science and practice-based guidelines for food and nutrition professionals
Douglas L, Sanders E. Probiotics and Prebiotics in Dietetics Practice. J Am Diet Assn 2008;108(3):510-521.
Probiotics and prebiotics share a unique role in human nutrition, largely centering on manipulation of populations or activities of the bacteria that colonize our bodies.
Benefits of regular consumption of probiotics or prebiotics include enhanced immune function, improved colonic integrity, decreased incidence and duration of intestinal infections, down-regulated allergic response, and improved digestion and elimination.
Research has shown that probiotics and prebiotics may be useful in achieving these and other positive effects, provided that proper strain, product selection, and dosing guidelines of commercial products are followed. There is a need to consolidate the basic and applied research on probiotics and prebiotics into useful tools for food and nutrition professionals.
Information on probiotic species, applications for specific strains, dosages and forms, safety, and shelf life is not sufficiently summarized to allow practical and consistent recommendations to be made by most food and nutrition professionals. In addition, prebiotic fibers—although providing nutraceutical and nutritional value—are a group of diverse carbohydrate ingredients that are poorly understood in regard to their origin, fermentation profiles, and dosages required for health effects.
The science and practice-based guidelines presented here will enhance clinician and client understanding of probiotics and prebiotics, with the aim of improving appropriate recommendation and informed use of these emerging dietary ingredients and the products containing them.
FAO/WHO Expert Consultation. Health and Nutritional properties of probiotics in food including powder milk with live lactic acid bacteria. Cordoba, Argentina; 2001.
A joint Food and Agriculture Organization of the United Nations/World Health Organization (FAO/WHO) expert Consultation on Health and Nutritional properties of powder milk with live lactic acid bacteria was held in Amerian Córdoba Park Hotel, Córdoba, Argentina from 1 to 4 October, 2001.
The Consultation, which was the first meeting of this group, focused on the evaluation of the scientific evidence available on the properties, functionality, benefits, safety, and nutritional features of probiotic foods.
A total of 11 experts from 10 countries participated in the Consultation. The complete list of participants is given in Annex 1.
The Minister of Production of the Province of Córdoba, Mr. Juan Schiaretti opened the Consultation.
He acknowledged the need for sound scientific evidence to substantiate health benefits associated with probiotic foods. The Secretary of Agriculture of the Province of Córdoba Mr. Victor Faraudo; the President of the Córdoba Science Agency, Mr. Carlos Debandi and the Coordinator of the National Codex Committee Mr. Eduardo Echaniz also gave welcome addresses. Dr. Jorgen Schlundt and Dr. Maya Pineiro spoke on behalf of the World Health Organization and the Food and Agriculture Organization of the United Nations. In their statements, the importance of probiotics to the health of the human population was indicated, with particular reference to their potential in developing countries.
The beneficial effects of food with added live microbes (probiotics) on human health, and in particular of milk products on children and other high-risk populations, are being increasingly promoted by health professionals. It has been reported that these probiotics can play an important role in immunological, digestive and respiratory functions and could have a significant effect in alleviating infectious disease in children.
As there are no international consensus on the methodology to assess the efficacy and the safety of these products, at present, it was considered necessary to convene an Expert Consultation to evaluate and suggest general guidelines for such assessments.
The Consultation evaluated the latest information and scientific evidence available on the functional and safety aspects of probiotics, as well as the methodology to assess such aspects, by bringing together worldwide scientific experts in the field.
- The experts agreed that adequate scientific evidence exists to indicate that there is potential for the derivation of health benefits from consuming food containing probiotics. However, it was felt that additional research data are needed to confirm a number of these health benefits in humans, applying a systematic approach and following the guidelines for the assessment of probiotics suggested in this report.
- There is good evidence that specific strains of probiotics are safe for human use and able to confer some health benefits on the host, but such benefits cannot be extrapolated to other strains without experimentation.
- The health benefits for which probiotics can be applied include conditions such as gastrointestinal infections, certain bowel disorders, allergy, and urogenital infections, which afflict a large portion of the world’s population. The application of probiotics to prevent and treat these disorders should be more widely considered by the medical community.
- In addition, there is emerging evidence to indicate that probiotics can be taken by otherwise healthy people as a means to prevent certain diseases and modulate host immunity.
- The regulatory status of probiotics as a component in food is currently not established on an international basis. In only a few countries, regulatory procedures are in place or sufficiently developed to enable probiotic products to be allowed to describe specific health benefits.
Lee J, O’Sullivan D. Genomic Insights into Bifidobacteria. Microbiol Mol Biol Rev 2010;74(3): 378–416.
Since the discovery in 1899 of bifidobacteria as numerically dominant microbes in the feces of breast-fed infants, there have been numerous studies addressing their role in modulating gut microflora as well as their other potential health benefits. Because of this, they are frequently incorporated into foods as probiotic cultures.
An understanding of their full interactions with intestinal microbes and the host is needed to scientifically validate any health benefits they may afford.
Recently, the genome sequences of nine strains representing four species of Bifidobacterium became available. A comparative genome analysis of these genomes reveals a likely efficient capacity to adapt to their habitats, with B. longum subsp. infantis exhibiting more genomic potential to utilize human milk oligosaccharides, consistent with its habitat in the infant gut. Conversely, B. longum subsp. longum exhibits a higher genomic potential for utilization of plant-derived complex carbohydrates and polyols, consistent with its habitat in an adult gut.
An intriguing observation is the loss of much of this genome potential when strains are adapted to pure culture environments, as highlighted by the genomes of B. animalis subsp. lactis strains, which exhibit the least potential for a gut habitat and are believed to have evolved from the B. animalis species during adaptation to dairy fermentation environments.