Probiotic Applications: Pulse and Rotation

Townsend Letter for Doctors and Patients,  Oct, 2001  by Mark A. Brudnak

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Probiotics: Viable single or mixed culture of microorganisms which when applied to animal or human, beneficially affects their host by improving the properties of the indigenous microflora. [1]

Over the last decade, other definitions have been applied to the term, but they all basically agree, at least in general terms. The increased interest in defining exactly what probiotics are has arisen, in large part, from the increasing demand for them. Probiotics have found application in a wide variety of products including, yogurt, dietary supplement capsules, tablets, milk, butter, cheese, salami, soy sauce, sour dough. [2] They-are even being used as antimicrobials for the poultry industry due to their ability to inhibit salmonella growth in chickens.

Probiotics are clearly here to stay and the market, despite its incredible growth over the last few years, is still in its infancy. Presently, there are identifiable trends in the use of probiotics. These trends can be generalized as a heightened awareness of differing quality in the organisms. From the manufacturing side, that includes such things as production of-well-documented, clinically-backed strains, ability to survive gastric acid and bile salts, adherence, long-term stability. Also issues such as milk/casein-free are important for consumers. [3,4]

From the end-user or medical perspective all the above are important, but there are additional considerations. The additional considerations all boil down to; what is the best way to use the probiotics in the most clinically efficacious manner?

Ten years ago, most probiotic products contained either Lactobacillus acidophilus or Bifidobacterium lactis (bifidum). If one was really lucky, they could find a combination of the two and possibly a couple of yogurt strains (i.e., Lactobacillus bulgariucus) thrown in. Many of these contain only a few hundred million viable cells at the time of manufacture. While that may sound like a lot of organisms, especially when we are conditioned to think of bacteria as being "bad," current data tells us that those numbers were probably far too low to be doing very much good. At least in the short-term, therapeutic application of the probiotics.

As more and more data comes in, it is becoming apparent that at least a billion organisms are needed per dose to achieve any real clinical significance. In a recent study, ten billion Bifidobacterium in milk per day were given and immune markers measured. [5] A significant increase in phagocytic activity of granulocytes was observed.

In a randomized, double-blind placebo controlled study, the prophylactic effect of probiotics on infections in neutropenic patients undergoing cytoreductive chemotherapy for acute leukemia was studied. Thirty patients (35 episodes) were included in the study. The lactobacilli were given as two capsules thrice daily for 30 days, starting at the initiation of chemotherapy. The occurrence of fever was significantly (P = 0.033, Mann-Whitney rank sum test) postponed from a median time of 8 days to 12 days. Capsules contained 50/50 Bifidobacterium lactis / lactobacillus acidophilus containing 4 billion/capsule. [6]

In addition to immune parameters, the reduction of circulating ammonia has also been observed by Deguchi et al, using 5 billion organisms of either B. lactis or B. breve in caecal contents. [7] They also observed a corresponding drop in the pH of the caecal. contents. This lends support for the use of probiotics in detoxification protocols, which has been reported elsewhere. [8]

Probiotic supplementation has been demonstrated to be very safe and effective for a wide variety of disturbances including antibiotic side effects, diarrhea/constipation, lactose malabsorption, and cholesterol reduction. Dosages ranging from one to almost 500 billion organisms have been used without complications. [9,10] Current trends seem to indicate a range of 10100 billion live organisms as being efficacious for the variety of conditions mentioned above. At least two different companies have "high-dose" products on the market with 20 and 30 billion organisms per capsule. [11,12] These products should serve as a portent for the market as they were both originally designed for different markets, the environmentally challenged and autism (and Down's syndrome), respectively. These are excellent demonstrations of two principles that are developing. First, is a need for high-dose probiotics to treat selective conditions. Second, is the need for a variety of products.

What we are learning is that while a low-dose run-of-the-mill L. acidophilus (providing it is well produced) can be great for a general maintenance program, oftentimes a much higher dose is required to achieved clinical significance. Additionally; it is becoming increasingly apparent that the inclusion of other strains, such as Lactobacillus rhamnosus or Lactobacillus plantarum (an exciting up-and-coming star) can have a dramatic effect. [13-15] The inclusion of multiple strains is not only beneficial for the specific conditions, but also may play another--important role in the application of probiotics.