The clinical use of probiotics was originally mostly used to regulate intestinal flora, but in recent years, the marketing of probiotics on major online shopping platforms has been infinitely amplified, and the purpose of use is also varied, or to increase gastrointestinal vitality, or to improve constipation, or to eliminate bad breath, or to speed up body metabolism, or anti-allergies, or to maintain the health of women's private parts, and so on. The dazzling propaganda is all right on the "heart" of modern people. But is that really the case? Is it an IQ tax or is it effective? Learn about the past and present life of probiotics.
History and types of probiotics
As early as 1908, Eli · Mechnikov (Russia scientist, Nobel laureate) found that lactic acid bacteria in food have great benefits for human health, in 1953 the Germany Institute of Research Werner Claus named probiotics, in 1964 Lilly and Stillwell further defined these bacteria as any microorganisms that can promote the balance of intestinal bacteria and increase human health benefits, and have been widely used today. There are four types of common probiotics: Bifidobacteria, lactic acid bacteria, yeasts, and streptococcus.
Clinical application of probiotics
Probiotics affect gut bacteria by enhancing the number or activity of beneficial bacteria. This can lead to a decrease in the number of potentially pathogenic microorganisms or potentially harmful metabolic activity that reduces the host microbiota. Probiotics may also affect immune function.
Mechanism of action:
Health effects are modulated through one or more of the identified mechanisms. The gut ecosystem can be affected by influencing mucosal immune mechanisms, interacting with commensal or potentially pathogenic microorganisms, producing metabolic end products such as short-chain fatty acids, and communicating with host cells through chemical signaling. These mechanisms can lead to antagonism of potential pathogens, improve the intestinal environment, strengthen the intestinal barrier, reduce the regulation of inflammation, and improve the immune response to antigenic challenges. These phenomena are thought to be vectors for most beneficial effects, including reducing the incidence and severity of diarrhea, which is one of the most widely recognized uses of probiotics.
Positive understanding of probiotic applications
The health benefits of probiotics are now variously discussed, and there is a "fairy fight" situation. Online platforms say that it is godly, but the scientific community maintains a more rational attitude towards it. Although a large number of studies have been conducted on the role of probiotics in various diseases, these studies vary widely, including differences in microbial strains used, dosage and route of administration, and study methods, including differences in endpoints and results reporting. In addition, probiotics are not considered drugs in the United States or Europe and are regulated differently than pharmaceuticals. The probiotics industry is largely unregulated, and products are often marketed directly to consumers without providing direct and consistent proof of effectiveness. This has led to the widespread use of probiotics, but the evidence for clinical efficacy is mixed. Therefore, we have compiled and listed some authoritative guides at home and abroad for your reference.
Yale/Harvard Symposium "Consensus on the Use of Probiotics" (2015)
(1) For children with a family history of allergies or asthma, the use of probiotics in the late maternal pregnancy and infancy can reduce the risk of disease, but there is a lack of evidence to recommend specific strains, dosages and treatment courses. It is not routinely recommended for families with no high-risk family history.
(2) The relevant guidelines for necrotizing enterocolitis do not propose the routine use of probiotics, and more consideration should be required when using them.
(3) Metabolic diseases (obesity), this consensus does not give a recommended probiotic. (4) The popularization and application of probiotics in liver disease still needs large-sample multicenter randomized controlled trials. (5) Clinical studies of probiotics for the treatment of irritable bowel syndrome differ in design, probiotic dosage, and strains, making it difficult to compare the results of the studies, so the recommendations that can be provided are limited.
United States Gastroenterology Association guidelines (2020)
(1) It is suggested that certain strains and combinations of probiotics can be used to prevent antibiotic-associated Clostridium difficile and to prevent necrotizing enteritis infection in preterm infants with gestational age less than 37 weeks and low birth weight;
(2) it is recommended to use probiotics only in adults and children with Crohn's disease, ulcerative colitis, irritable bowel syndrome in the context of clinical trials;
(3) Probiotics are not recommended for children with acute infectious gastroenteritis.
Expert Consensus on the Clinical Application of Microecological Regulators in China (2020 Edition)
(1) Eradication of Helicobacter pylori, probiotics can not further improve the eradication rate of Hp, but can reduce the adverse reactions of treatment.
(2) For non-alcoholic fatty liver disease, probiotic adjuvant therapy can improve liver enzymes and blood lipids.
(3) Metabolic diseases (obesity), the effectiveness and safety of different probiotic strains need to be further studied and verified.
(4) For patients with cirrhosis and hepatic encephalopathy, it is recommended to use Clostridium butyricum, Bifidobacterium, Lactobacillus, etc. as adjuvant treatment.
(5) The microecology of liver transplantation still needs to be studied in depth to accumulate more data for clinical application.
(6) Probiotics are recommended for the prevention and treatment of antibiotic-associated diarrhea.
(7) For irritable bowel syndrome, probiotics can be used as one of the treatment methods, but appropriate probiotic preparations should be selected according to the specific condition of the patient, and further multi-center clinical evidence verification is required.
(8) Crohn's disease, no studies have found that probiotics have a definite curative effect.
(9) For ulcerative colitis, the selection and compatibility of strains and strains, the timing and dosage of administration, and the efficacy and safety still need further research.
World Organization of Gastroenterology (2024)
(1) For acute diarrhea, probiotic treatment may be safe and effective.
(2) To prevent diarrhea in adults and children, certain probiotics are effective in some specific situations.
(3) To prevent and treat radiation-induced diarrhea, probiotics may be beneficial.
(4) Eradication of H. pylori, there is no evidence to support the effectiveness of probiotics alone without concomitant antibiotic treatment. However, probiotics appear to increase the eradication rate of H. pylori by reducing the side effects associated with eradication treatments, rather than by acting directly on H. pylori.
(5) No difference was observed in the prevention and treatment of hepatic encephalopathy, mortality, but the authors suggested that probiotics could improve rehabilitation, quality of life, and plasma ammonia concentrations.
(6) Immune response, suggestive evidence suggests that several probiotic strains and probiotic fructooligosaccharides can help improve.
(7) For ulcerative colitis, certain probiotics may be safe, but the level of evidence is low.
(8) Crohn's disease, there is no evidence that probiotics are beneficial in inducing or maintaining remission in Crohn's disease.
(9) Lactose intolerance, Streptococcus thermophilus and Lactobacillus Bulgaria can improve lactose digestion and reduce symptoms related to mild lactose intolerance.
(10) Necrotizing enterocolitis occurs in premature neonates, and probiotic supplementation can reduce the risk.
(11) For non-alcoholic fatty liver disease, further research is needed to confirm its long-term benefits.
(12) To prevent systemic infection, there is currently insufficient evidence to support the use of probiotics or synthetic probiotics in adult critically ill patients in intensive care units.
Probiotic selection and medication education
The selection of probiotics should consider the formula, effective dose, process quality control, applicable disease types and storage methods.
Probiotic Product Quality:
is a particularly important issue. These include a guarantee of potency (viability during the shelf life, usually expressed in colony-forming units), purity (sufficient reduction of any pathogens of concern during production), and identity (current nomenclature used to indicate genera, species, and subspecies (if applicable), as well as the species name for each strain in the product.
Probiotic Effective Dosage:
It varies depending on the culture and product. Although many over-the-counter drug products are dosed between 10-10 billion cfu/dose, some products show efficacy at lower levels, while others require a significant increase. It is not yet possible to state the general dosage required for probiotics; Dosage should be based on human studies showing health benefits.
Probiotic Storage:
Probiotics are live and tend to die during product storage. Manufacturers often add excess quantities so that at the end of the product's shelf life, it does not fall below the potency stated on the label. Responsible producers will indicate the expected dosage within the expiration date, not at the time of manufacture. Therefore, it is crucial to purchase the product from a reliable manufacturer and keep it in accordance with the storage conditions it specifies.
How to take probiotics:
The amount of probiotics that reach the gastrointestinal tract after consumption and whether they multiply or not will be affected by various factors such as dosage, formula, gastrointestinal pH, peristalsis and concomitant food. Gastric acid is high on an empty stomach, which is easy to kill probiotics, so it is not recommended to take it on an empty stomach, and it is recommended to take it half an hour after a meal for better results. In terms of food, eat more high-fiber foods, because high-fiber foods can promote the activity of probiotics, make probiotics grow more, and avoid irritating, high-fat, high-protein foods. In terms of drugs, if it is taken with antimicrobial drugs, an interval of 2-3 hours is required; Do not adsorb live bacteria with bismuth, tannic acid (such as tannic acid protein), medicinal charcoal (such as acete), tincture (such as belladonna tincture) and other preparations, which will affect the efficacy of probiotics.
It is worth noting that:
Probiotics are safe and tolerated for most people, but if they are premature infants with poor immune function, malignant tumors, and acquired immunodeficiency syndrome, bacteria may be weakened due to intestinal barrier function, and bacteria metastasize through epithelial cells and mucosa to the mesenteric lymphatic system and other organs, resulting in bacteremia, but these patients have immunosuppression or chronic diseases and are weak and weak, so the use of probiotics for the above types of patients needs special attention.
Tips: Probiotics & Prebiotics & Synbiotics
Probiotics:
Microorganisms that are beneficial to the health of the host. When a sufficient number of live microorganisms are administered, there are benefits to host health.
Prebiotics:
A dietary supplement. Cannot be digested by the host, it provides health benefits to consumers by positively influencing the resident beneficial microorganisms. It can be simply understood as a "fertilizer" for intestinal probiotics. These include fructooligosaccharides, inulin, galacto-oligosaccharides, lactose, and human milk oligosaccharides, while other substances are being studied, such as resistant starch, conjugated linoleic acid, and polyphenols.
Biostime:
These include complementary synbiotics and synergistic synbiotics. Complementary probiotics are simply defined as a mixture of probiotics and prebiotics; A synergistic synbiotic is described as a mixture of live microorganisms that have been selected to utilize co-administered substrates that collectively deliver documented health benefits.
Author: Zhang Ping, chief pharmacist of Shanghai Tongren Hospital
Reviewer: Li Ling, Chief Pharmacist, Shanghai Tongren Hospital