Probiotics and Your Child’s Health

What are probiotics?
Beneficial bacteria, and sometimes beneficial yeast, that live in the gut. The common ones fall into two groups, Lactobacillus or Bifidobacterium. Additionally, Saccharomyces boulardii, yeasts, are considered probiotics.
They can be taken in foods, such as yoghurt, sauerkraut, miso, and tempeh. They can also be taken, in larger doses, in supplements.

What do they do?
A number of studies have shown that they can improve allergies, eczema, diarrhea from viruses, diarrhea from antibiotics, inflammatory bowel disease, and possibly chronic sinusitis.

How do they work?
There are a number of theories. Since there are immune cells in the gut, it is possible that the friendly bacteria modulate those immune cells somehow. Another possibility is that having friendly bacteria in the gut makes it harder for unfriendly bacteria to get a foothold. A third possibility is that the friendly bacteria produce substances that improve health.

Tell me more about the studies.

Viral Diarrhea:
• Overall, there is the most research support for L. rhamnosus GG and B. lactis BB-12 for prevention, and L. reuteri SD2222 for treatment of viral diarrhea.

• 286 children in daycare in Taiwan took 5 capsules a day, 5 days a week, for 7 months, of a multi-probiotic preparation (12 types of beneficial bacterial strains for the large and small intestines, including 7 different species of Lactobacilli (Neoangelac® 12A Lactobacilli, Multipower Enterprise Corp, Taipei, Taiwan). One capsule of the Neoangelac 12A Lactobacilli series contained 3 types of Bifidobacteria (2.4×109 cfu B. bifidum, 2.4×109 cfu B. infantis, 2.4×109 cfu B. longum); 7 types of Lactobacilli (2×109 cfu L. casei, 1.2×109 cfu L. salivarius, 1.6×109 cfu L. brevis, 2×109 cfu L. plantarum, 1.2×109 cfu L. acidophilus, 8×108 cfu L. helveticus, 2×109 cfu L. rhamnosus); 1 type of Streptococcus (1×109 cfu S. thermophilus) and 1 type of Enterococcus (1×109 cfu E. faecium). (cfu: colony forming units, a measure of the dose of the probiotic) Compared to those who took a single strain of probiotics and those who took nothing (all together, over 500 other children), these children had less diarrhea and vomiting illnesses during the time they took the probiotics.

• 40 babies aged 6 to 36 months of age hospitalized with diarrhea were given L. reuteri (1010 to 1011 CFU) for up to 5 days or placebo. Those who took the probiotic had a shorter illness (1.6 versus 2.9 days in the placebo group). (Placebo: sugar pill or false treatment) In a related study, another group was given a lower dose of the same probiotic (107 CFU of L. reuteri SD2222). These children had shorter illnesses than those on placebo, but longer than those with the higher dose.
Diarrhea from Antibiotics or other causes:
• Overall, there is the most research support for Lactobacillus GG, Lactobacillus sporogenes, Saccharomyces boulardii at 5 to 40 billion colony forming units/day for preventing or treating diarrhea from antibiotics.
• Lactobacillus GG prevented antibiotic-associated and traveler’s diarrhea in adults.
• Undernourished, non-breast-fed, Peruvian children, aged 18-29 months, who took Lactobacillus rhamnosus strain GG preventively had fewer episodes of diarrhea than those who did not.
• Lactobacillus GG was shown to significantly reduce stool frequency and increase stool consistency during oral antibiotic therapy by the 10th day of antibiotic therapy compared with a placebo group.

Constipation and Irritable Bowel Syndrome:
44 infants aged 6-14 months with functional constipation were given lactobacillus reuteri or placebo. Those with the probiotics had increased frequency of stools, though no improvement in consistency of stool or amount of crying.

In a review of studies on children, it was found that L. casei rhamnosus Lcr35, but not L. rhamnosus GG, showed a beneficial effect.

203 children aged 4-18 with IBS were given probiotics; 82% reported improvement in symptoms after 40-50 days.

Necrotizing Enterocolitis in Premature Infants
• 180 preemies were given either placebo or lactobacillus acidophilus. Those with the probiotics had an 18% reduction in incidence of NEC, a severe gut problem common to preemies.
• 434 very low birth weight preemies were given either lactobacillus acidophilus and bifidobacterium bifidum or nothing. 4 of those who received the probiotics and 14 of those with nothing developed NEC.
• A combined analysis of all studies on NEC and preemies included 2176 participants, and showed a 30% reduction in the incidence of NEC in those receiving probiotics. Further, no significant adverse events were reported in any of these studies.
Inflammatory bowel disease:
In children and adults, a combined probiotic preparation has been used to maintain remission in ulcerative colitis and to prevent the onset of certain surgical complications. No such effect is seen in Crohn’s disease.

Peptic Ulcer disease with Helicobacter Pylori:
In adults, 991 patients with ulcer disease and infection with helicobacter pylori were given antibiotics to eradicate the infection. 1/3 were also given Saccaromyces boulardi. 72% of those just given antibiotics and 80% of those with the probiotics were cleared of infection.

• 230 infants with eczema were given Lactobacillus GG or a placebo. At 4 weeks, those infants with positive skin or blood tests for allergy-associated eczema who took the probiotic were improved, compared to the others.
• 62 pregnant and lactating mothers were given probiotics or placebo. Children of those who took the probiotic were less likely to develop eczema during the first two years of life.

• 132 pregnant mothers with a relative with allergies or asthma, and their babies, after birth until 6 months of age, were given either two capsules containing 1010 Lactobacillus sp. strain GG or placebo. The babies who took the probiotic were much less likely to develop eczema.

Respiratory infections:
• Over 250 pre-schoolers who took L. casei rhamnosus containing 1×108 cfu twice a day, five days a week, for 3 months over the winter, had fewer doctor-diagnosed viral infections and fewer respiratory infections than those who took nothing.

• 479 healthy adults were supplemented daily with vitamins plus minerals with or without probiotic lactobacilli and Bifidobacteria. There was no effect on how often they got the common cold but those on probiotics had shorter and less severe colds.

• 281 daycare attenders were randomized to receive either Lactobacillus GG or placebo; Those who took probiotics had nearly half the number of upper respiratory infections as the placebo group.
Other infections:
• Over 1000 Finnish children under age 6 were put in two groups, with one group taking Lactobacillus rhamnosus strain GG three times a day, five days a week, with snacks for 7 months, over the winter . The group with the probiotic had no fewer days spent with diarrhea or respiratory symptoms, but did have fewer numbers of days absent from day care, and fewer complications such as otitis media, and fewer antibiotic prescriptions.
• Over 250 pre-schoolers who took L. casei rhamnosus containing 1×108 cfu /g twice a day, five days a week, for 3 months over the winter, had fewer doctor-diagnosed bacterial infections (such as ear infections) than those who took nothing.

Bacterial vaginosis and UTI in adult women:
• Daily oral intake of 109 to 1010 L. rhamnosus GR-1 and L. fermentum RC-14 leads to transfer of the organisms from the rectum to the vagina as well as an overall decrease of unfriendly organisms (coliforms and yeasts) in the vagina
• Once-weekly vaginal administration of a suppository containing 109 L. rhamnosus GR-1 and L. fermentum B-54 for 1 year lowered women’s rate of UTI compared to their own rate the year before.
• Daily ingestion of capsules containing L. rhamnosus GR-1 and L. fermentum RC-14 by 19 women with a bacterial vaginosis led to normalization in 81% of cases, compared to 50% in women given placebo
Future areas:
A study was recently completed evaluating the L.rhamnosus R0011 strain in treating patients with chronic sinusitis. Results are pending.
Probiotics have been proposed as possible treatments or preventive measures for dental cavities, chronic diarrhea, Chrohn’s disease, and other diseases.

Is this a sure thing?
No. Many of the studies are too small to be definite. Many of the studies use different doses, and are conducted in different ways, so combining them (to get a larger number) isn’t possible. Very few of the studies were done in children. There are strong placebo effects in many of the studies. More research is needed!
Are probiotics safe to use?
Probably, for most people. When you take in bacteria, you do have a theoretical risk of getting infected by the bacteria, rather than having it live happily in your gut helping you out. There have been 2 cases of babies getting badly infected by probiotics, and 2 cases of adults getting infected as well. In each case, the person who got infected was already immunocompromised, meaning their immune systems were not working, or debilitated in some way. There have been no cases of healthy people getting sick from probiotics. So, if a child has HIV, or gets recurrent bacterial infections (meaning, perhaps, they have an undiagnosed immune deficiency), it would be wise to be cautious about using probiotics. On the other hand, probiotics have been given to people with HIV without problems.
Another theoretical risk: Probiotics could possibly cause unhealthy metabolic activities, too much stimulation of the immune system, or gene transfer (insertion of genetic material into a cell). This has not been proven.
What about side effects?
The most common are gas and bloating. Most people have no side effects.

If I want to give probiotics to my child, which ones should I give and how much?
Since there are no studies that test the dose needed for children to get a beneficial effect, to some extent, this answer has to be a guess. Most clinicians, when giving probiotics to children, give half an adult dose, and when giving to infants, give a quarter of the adult dose. But, since there aren’t dose studies in adults either, this, too, is a guess. (Again, more research is needed!)
As far as which to give, certain strains have been shown to help with certain disease states, while other strains have been shown to have no effect. So, check the strains used in the studies listed above, whether in a supplement or yoghurt, depending on the effect you hope to have.

What if my child isn’t sick, but I want to promote health with probiotics?
Using a low dose, such as that found in yoghurt, is certainly safe. Using a supplement on a weekly or twice weekly basis is probably also safe, and, perhaps, would be beneficial.

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