# JAMA: A Bit of Culture for Children: Probiotics May Improve Health and Fight Disease



## JeanG (Oct 20, 1999)

This is from the Sept. 20, 2000 issue of JAMA: Medical News and Perspectives.The url for this artical is: http://jama.ama-assn.org/issues/current/ffull/jmn0920-1.html A Bit of Culture for Children: Probiotics May Improve Health and Fight Disease M. J. Friedrich Boston - One of the hallmarks of a healthy ecosystem is the presence of a diversity of organisms. This is true not only for tropical rain forests and coral reefs, but also for the complex ecosystem of the human intestinal tract, an environment populated by as many as 500 microbial species, many of which are nonpathogenic organisms that exist in symbiosis with their human hosts.The observation that adding certain microorganisms to the diet can improve microbial functioning and benefit health has led to the concept of probiotic therapy. Such an approach is not new. As Sherwood Gorbach, MD, of Tufts University School of Medicine, pointed out at the World Congress on Pediatric Gastroenterology, Hepatology, and Nutrition in August, the scientific study of probiotics began with Russian microbiologist Elie Metchnikoff almost a century ago. And for thousands of years prior to Metchnikoff's work, people consumed yogurts and fermented milk for their health.In the last decade, interest in these potentially beneficial microorganisms has increased. A number of replicable, well-controlled trials have been published that demonstrate the potential uses of probiotic therapy, with Bifidobacterium and Lactobacillus by far the best studied of these probiotic agents, said Jose Saavedra, MD, of Johns Hopkins Medical Center. But he emphasized that much work remains to be done before recommendations for the clinical application of these or any other probiotics can be made. GUT REACTIONS"In terms of demonstrated effects, it's clear that if you ingest any live bacteria that produce lactase you can improve lactase malabsorption," said Saavedra. Aside from this one, however, there are a number of other therapeutic applications for which certain probiotics show promise. Of particular note, he said, is the use of Lactobacillus and Bifidobacterium in the treatment and prevention of diarrhea in children.Lactobacillus has been shown in a number of studies to decrease the duration and severity of episodes of acute diarrhea, particularly in cases caused by rotavirus, said Saavedra.One of the largest of these is a multicenter European trial involving 287 children with acute diarrhea of rotaviral origin (J Pediatr Gastroenterol Nutr. 2000;30:54-60). In this study, children with diarrhea who were randomly assigned to receive an oral rehydration solution containing a live preparation of Lactobacillus GG (LGG) showed a significant reduction in the duration of disease and in hospital stays compared with children who received the rehydration solution with placebo.Prevention of diarrhea with probiotics has also been achieved in clinical trials. Saavedra described two studies in which LGG or Bifidobacterium were taken for an extended period of time (weeks to months) prophylactically. One study involved a group of undernourished Peruvian children in whom the incidence and severity of diarrhea was significantly decreased with LGG (J Pediatr. 1999;134:15-20). And in a group of children hospitalized for causes unrelated to diarrhea, a significant decrease in the incidence of diarrheal disease was observed in children receiving Bifidobacterium bifidum (Lancet. 1994;344:1046-1049). In this study, not only was the course of diarrheal disease shortened with these probiotics, said Saavedra, but rotaviral shedding was also reduced in both symptomatic and asymptomatic children in high-risk populations.Saavedra said another potential use for probiotics is to counteract episodes of diarrhea that can occur with antibiotics. In one placebo-controlled study (J Pedeatri. 1999;135:564-568), LGG was coadministered with antibiotics to children treated for minor bacterial infections, resulting in a reduction in the severity and incidence of diarrhea in the children receiving the probiotic. EFFECTS BEYOND THE GUTProbiotics also may be useful in ameliorating some allergic reactions. Tufts' Gorbach discussed evidence from a controlled study showing that infants with atopic dermatitis and challenge-proven milk allergy who received formula supplemented with LGG had significant improvement in the severity of their eczema compared with children who did not receive LGG (J Allergy Clin Immunol. 1997;99:179-185). Commenting on the study, Gorbach said, "Here's an example of a food allergy reflected in the skin by eczema, which is improved by administration of healthy bacteria." He added that LGG may help ameliorate the allergic reaction by restoring intestinal permeability, which is disrupted in children with food allergy.Although there are fewer studies in this area, probiotics also may be useful in treating respiratory infections in children. Gorbach described a recent unpublished report from Helsinki in which 571 children in 18 day care centers received milk containing LGG or a placebo. A significant reduction in respiratory infections, including sinusitis, bronchitis, and pneumonia, was seen in the children taking LGG, he said. There was also a reduction in the amount of antibiotics administered to these children by the physicians.It seems, then, said Gorbach, that two mucosal surfaces, the gastrointestinal tract and the respiratory tract, may be benefited and protected by oral administration of a probiotic. How bacteria may improve intestinal and systemic conditions is not entirely clear, but clues to possible mechanisms are emerging.Gorbach described a number of immune effects that have been demonstrated in animal models. These effects include enhancement of macrophage activity and phagocytosis, and stimulation of the humoral immune response. Probiotics also can alleviate intestinal inflammation, as shown by reduced cytokines in the mucosa, he said. And probiotics help degrade dietary antigens, particularly milk protein antigens, which may be helpful in preventing allergy to milk.There is also evidence that probiotics can induce expression of mucin proteins, the large glycoproteins secreted by epithelial cells in the intestinal tract that provide protection from bacteria and viruses, said David Mack, MD, of Nebraska Medical Center, Omaha, who presented evidence for this mechanism at the meeting. He and his colleagues have shown that certain lactobacilli strains can increase the expression of MUC3 messenger RNA expression and MUC3 protein translation in cell culture and also inhibit adherence of enteropathogenic Escherichia coli to intestinal mucosal cells in culture. They hypothesize that by inducing mucin gene expression, probiotic agents may be able to minimize the interaction of other microbes with intestinal mucosal cells and lessen intestinal inflammation. THE ROAD AHEADPreliminary data suggest that there are a number of other conditions in children for which probiotics may prove useful, said Johns Hopkins' Saavedra. These include inflammatory disorders of the gastrointestinal tract, such as inflammatory bowel disease and necrotizing enterocolitis. Treatment of hypercholesterolemia also has been reported, but there have been no major studies. And if immunoenhancing effects can be definitively demonstrated in humans, he said, probiotics could be used to reduce vaccine doses.Other important areas of study include colon carcinogenesis. Because a number of changes in the intestinal medium can lead to a decrease in concentration of potential carcinogens, probiotics may be useful in cancer prevention, said Saavedra.Aside from administering live bacteria, another potential intervention is to boost resident nonpathogenic bacteria with prebiotics, said Saavedra. Prebiotics are nondigestible food ingredients that somehow selectively stimulate the growth of specific bacteria and thereby elicit a probiotic effect. A number of factors, such as fructo-oligosaccharide, have been recognized both from human secretionseg, breast milkand dietary foodstuffs that could modify the intestinal flora in a way that is easier and less costly than using live agents. The investigator noted that much less work has been done in this area than in probiotic research.Are probiotics safe? Saavedra said that many reports and the fact that for centuries people have ingested fermented milk products with apparently no ill effects seem to indicate that these agents are safe. He stressed that more research needs to be done to standardize and regulate "what benefits we're getting from what strain and at what dose" for the full clinical potential of probiotics to be realized. [This message has been edited by JeanG (edited 09-25-2000).][This message has been edited by JeanG (edited 09-25-2000).][This message has been edited by JeanG (edited 09-25-2000).][This message has been edited by JeanG (edited 09-25-2000).][This message has been edited by JeanG (edited 09-25-2000).]


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## moldie (Sep 25, 1999)

Thanks for posting this Jean. Sounds like a good thing to be on the rest of your life.


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## JuliaNYC (Apr 20, 2000)

Jean, Thanks so much for posting this. My doctor recommended Lactobacillus GG (sold in the US as Culturelle) to me many months ago, and I have found it helpful in keeping my IBS symptoms in check and it even seems to help my lactose intolerance. On the down side, it's not that easy to find in pharmacies (but it can be ordered on line)and the price keeps going up!


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## Mike NoLomotil (Jun 6, 2000)

TO ANY READERS WITH ATOPIC CHILDREN:these and other recent findings of potential efficacy of the use of LGG in atopic children are extremely encouraging, as the only current therapies for atopy and pharmacotherpies with inherent undesireable side effects, esp. for children, and avoidance which can be difficult to maintain for children. And if you have an eczematous chilod you know the suffering that can occur.For parents with atopic children who may read this I would personally encourage providing LGG supplementation to your child, as no harm can come from it that anyone can see, and the potential of an outcome which will inhibit atopic reactions without pharmacotherapy is highy desireable. Just an "encouraging opinion"MNL_______________ www.leapallergy.com


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