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Pharmamum’s Ultimate Guide: Probiotics
Probiotics are certainly the ‘in thing’ at the moment, and I’m often asked, ‘should I give my child probiotics?’ From walking down the supermarket aisles to listening to the television or radio, we constantly hear about probiotics being added to food to boost our immune system and aid in digestive health. Our friends and family tell us that ‘probiotics treat colic’ or ‘prevent eczema’ or ‘cure asthma’ but are these statements really true? Should we be giving them to our children? who do we believe? Before answering these questions, you need to know what probiotics are? What they do and why do we need them? In this post, I want to present you with the latest research in this area, as well as provide you with information that sorts out the evidence from the myths.
On the surface of our skin lies an ecosystem containing millions and trillions of microorganisms called Flora. The flora have important health functions, and for our bodies to function properly, normal flora must be present. Intestinal flora help with digestion, the making of certain vitamins (ie biotin, vitamin B12, folic acid, and thiamine) and plays a crucial role in our immune system.
1. What are probiotics and what do they do?
Probiotics according to the world health organisation is defined as “live microorganisms that, when administered in adequate amounts confer a health benefit on the host.” There are different types of probiotics which act in different ways and have different effects in the body. The most common groups of probiotics are: Lactobacillus, Bifidobacterium, Streptococcus and Saccharomyces boulardii. Probiotics come in different forms. They can be added to foods ie yogurts or they can be given as a supplement in the form of a powder or capsule. At birth, babies introduce bacteria to their gut through breast milk, formula, and eventually through the food they eat. Probiotics increase the amount of good friendly bacteria to the intestinal tract and this has many benefits. The medical experts believe that Probiotics aid digestion, boost the body’s natural defenses, fight off harmful bacteria and restore the Flora when it has been disrupted (ie by a virus or antibiotics).
2. The evidence:
There is an abundance of studies exploring probiotics potential, as well as speculation about the benefits of Probiotics. There are a lot more studies on probiotics in adults than there are in children but strong evidence shows the following:
1) Probiotics coadministered with standard rehydration therapy decrease the duration of infectious diarrhoea by approximately 30 hours with 2 particular strains of probiotics having the most evidence. ( Lactobacillus rhamnosus GG and Saccharomyces boulardii )
2)Antibiotic associated diarrhoea occurs when there is unexplained diarrhoea occurring whilst taking antibiotics or even up to six weeks after a course of antibiotics has been completed. It affects about 25% of patients taking antibiotics. Several probiotics have been evaluated in treating or preventing antibiotic associated diarrhoea but there are two strains of probiotics which have the strongest evidence in preventing antibiotic associated diarrhoea. (Lactobacillus rhamnosusGG and S.boulardii )
Children in day care centres have an increased risk of developing gastrointestinal and respiratory tract infections when compared to children cared for at home or in small family day care groups. The following studies and although the numbers were not in the 1000’s are very good studies showing strong evidence for the use of probiotics:
i)A trial measured the effect of 2 different probiotic strains (Lactobacillus acidophilus and Bifidobacterium lactis) over a 6 month period on immunity in 326 children aged between 3 and 5 years old. Results showed a significant reduction in the frequency of colds and flu as well as the duration of cold and flu-like symptoms in the children who were taking the probiotic combination. Other observations included an overall decrease in the use of antibiotics and an increase in general attendance at both school and day care.
ii) A review of 8 different trials with 988 infants aged up to three years showed a significant improvement in duration of diarrhoea when one strain of a probiotic was given.
Probiotics have shown promising potential in reducing the risk of eczema in infants. There was a trial of 241 mother-infant pairs who were randomly assigned to receive one of two different probiotics or a placebo, beginning 2 months before delivery and during the first 2 months of breast-feeding. The infants were followed until the age of 24 months and the results concluded that the risk of developing eczema during the first 24 months of life was significantly reduced in infants of mothers receiving the probiotic combination.
The researchers found that a particular strain of probiotic (L. rhamnosus HN001) reduced eczema prevalence by a half at the age of two years but the other probiotic had no effect on eczema. It was found that the effect on eczema persisted at four years, that is two years after they stopped the probiotics or placebo, suggesting that when they stopped taking the probiotic they didn’t get a rebound effect where eczema occurred. In other words, it’s been shown to have quite long-term benefits on the children. The research team is currently preparing results from its six year follow-up for publication. With the exception of one other study from Finland, all other probiotic studies have started the intervention at about 35 weeks’ gestation, but for this new study we are starting at between 14 and 16 weeks. Hopefully this way we can influence the underlying allergic status of the child.The main aim with this new study would be to influence that whole spectrum of diseases from eczema and food allergy, to asthma and hayfever.
There was a study carried out by researchers from the Royal Children’s Hospital, Murdoch Childrens Research Institute and the University of Melbourne. The study included 167 babies with colic and looked at whether giving them daily drops of the probiotic (Lactobacillus reuteri) improved symptoms, in comparison to giving them inactive placebo drops. The researchers found the treatment did not help. However this study was with only one strain of probiotic and more studies being conducted in this area so watch this space.
Can probiotics prevent asthma? Researchers examined this question in a thorough review of 20 different trials (primarily from developed countries) involving 4866 infants who were followed for 24 months. The bottom line is that probiotics are not helpful when used during pregnancy and early infancy to prevent childhood asthma.
3. What age can you start taking Probiotics?
Probiotics can be given at any age and research suggests that good tolerance has been observed in premature infants and very low birth weight infants. Probiotics are also safe to use in late pregnancy and there is good evidence for a pregnant mother who is at risk of their child suffering with eczema (ie the mother or spouse suffered with eczema as a child or later in life) to take probiotics pre and post-natally. A great probiotic and I wish it was around when I was pregnant is made by Bioceuticals called UltraBiotic pregnancy care.
The first time I had to give my daughter Probiotics was when she was only one month old. I suffered with mastitis very early on and my doctor put me on a course of antibiotics, the next thing I knew was, I had nipple thrush, and passed on oral thrush to my daughter. My lactation consultant who was also a GP, put me on a concoction of medication and supplements and told me that it’s important for both you and the baby to take a probiotic because the antibiotics have gone through the breastmilk and has also wiped out the good bacteria in your daughter’s gut. So off I went to get my daughter a probiotic powder.
The best way to give a baby probiotics
Using a teaspoon or a plate, dampen the probiotic powder with a couple of drops of cool boiled water and use the back of a teaspoon to mix it into a paste and either:
i)paste on the nipple before feeding,
ii) paste on the teat (not in the hole) immediately before feeding
iii) insert the paste into the baby’s cheek or between the bottom lip and gum immediately before feeding.
4.Are probiotics safe?
The Murdoch childrens research institute says, ‘Research does indicate that probiotics are safe and well tolerated in normal healthy infants and children’. Probiotics are not safe in children who are immunocompromised or have severe underlying illness (ie short bowel syndrome) as there have been reports of bacteraemia and fungaemia caused by probiotics. So if your child does suffer with a chronic illness I would check with your child’s GP if they recommend giving probiotics to your child.
5. How much Probiotics do I need to give my child and can’t I just give them yogurt?
In Australia and New Zealand, the Food Standards Australia and New Zealand requires that fermented products contain certain number of good bacteria per gram of yogurt ie 1 million good bacteria per gram(scientific term is 1 million cfu) so for example if you give your child one of those squeezy yogurt packs which contain between 70-100g of yogurt, they usually contain 1 billion cfu. Giving your child yogurt everyday which contains probiotics is excellent because you are not just giving your child good bacteria but you are also giving your child nutrients such as protein and calcium, which is very important for your child’s health and well being. I often tell my customers that we recommend a particular probiotic with antibiotics because there is a chance they may get antibiotic associated diarrhoea after taking the course of antibiotics and it is also important to re-introduce good bacteria in your child’s gut after it has been wiped out by the antibiotics? Often I hear, ‘oh that’s ok, i’ll just give my child some yogurt, that will do the trick.’ All yogurts are not the same and contain different strains of probiotics at low doses and it’s not well known to the public which probiotic strains help which condition. For example Lactobacillus rhamnosus is only found in one particular yogurt and that is the Vaalia brand. Each tub of yogurt contains approximately 1 billion cfu and the evidence for treating viral diarrhoea and antiobiotic associated diarrhoea were at the dose of 10-20 billion cfu. So I personally recommend to give your child yogurt which will continuously be adding good bacteria to their guts but if you want to give them probiotics to treat or help prevent a certain condition then probiotic powders/capsules are a lot stronger and at the right dose.
6. Which brand of yogurt should I give my child?
I mix it up and give my children the following brands:
Jalna-they have added in three different strains of probiotics and would contain three times the concentration of good bacteria than most other yogurts.
Chobani-adds in 5 different strains of probiotics not as highly concentrated as Jalna, but still adds a variety of probiotics.
Vaalia- It is the only food source of LGG® currently available in Australia. LGG is the probiotic Lactobacillus rhamnosus which has the most amount of evidence in preventing antibiotic associated diarrhoea as well as reducing the duration of infectious diarrhoea.
Vaalia tends to have more sugar than Jalna and chobani yogurts, but tend to be more palatable and less tart, however Jalna and Chobani brands of yogurt from a nutritional point of view is better.
7. Would I give my own children Probiotics?
My children, thank goodness to date have been well, they have definitely had their share of colds, coughs, gastro, ear infections, you name it, they have had most childhood viruses, but they are healthy children. From the information that I have presented above in terms of the actual evidence available and the most up to date information on probiotics I would (and do) give my children probiotics supplements for the following:
1) If they are taking a course of antibiotics, ie whilst they are taking antibiotics and for at least six weeks following a course of antibiotics.
2) Whilst suffering with an upset stomach causing diarrhoea (ie during and after gastro). I myself had a personal experience with gastro a few years back, where I had severe gastro that lasted 3 to 4 days and I just couldn’t stop running to the toilet. I had had enough by the third day of drinking water/rehydration solutions, I said to my mum, ‘Can you just go and ask the Naturopath working in the pharmacy if there is anything else she would recommend.’ The naturopath gave my mum some probiotics to give me which I could hardly bring myself to swallow them, but from going 7 to 8 times a day, I got to the end of the day after taking 2 doses of the probiotic without going to the toilet. Since studying and researching probiotics, that personal experience has stuck in my head, because I remember feeling pleasantly surprised when they had worked for me.
3) Whilst at creche/daycare, I have given my children added probiotics on top of their regular everyday yogurt. I purchase Bioceuticals BabyBiotics and sprinkle the powder on their cereal in the morning, and my kids don’t even know they are taking them.
8. Which brand of Probiotic supplement do I recommend?
In order for a probiotics to be effective it must first survive the acidic conditions in the stomach and then be able to survive in the small intestine. Good brands of probiotics include Bioceuticals, Ethical nutrients ie Inner Health Plus, Metagenics etc. I do advise you to speak with a health professional before supplementing because they will recommend the correct dose and strain of probiotics best suited for your child. I tend not to recommend any probiotics unless it is in the fridge because I personally don’t believe they can survive the conditions on the shelf and remain alive for very long.
9. What does a leading paediatric dietician have to say…
Miriam Raleigh, a leading paediatric dietitian who works closely with paediatric gastroenterologists, would recommend probiotics to at least 90% of her patients. Most of her patients often present with irritable bowel symptoms ie constipation issues, diarrhoea issues, fructose or lactose intolerance etc. She will often suggest a probiotic like Inner health Plus kids, because it contains the appropriate strain of probiotics at the right dose for what she is treating and is also very accessible and reasonably priced. Once the patient has a trial of the probiotics then she will assess whether her patient requires a higher dose or different combination of probiotics. Miriam said from her personal experience and the feedback she receives from parents is very positive. Miriam gave me a personal story when her eldest son started solids, he became very constipated, so she gave him a probiotic and within two weeks, his bowel habits completely changed and became very regular again. Miriam Raleigh runs her own practice called Child Nutrition in Windsor and Moonee Ponds Melbourne. For more details: www.childnutrition.com.au
10. A couple of extra tips:
1) Taking probiotic supplements with meals, when the stomach is less acidic, boosts bacterial survival. However, timing is less of an issue if you buy an enteric-coated (slow release) supplement, which is designed to survive transit through the stomach. Look for the words ‘stomach acid resistant’ on the label.
2) Because probiotics are living organisms, they need to be stored properly to ensure their potency. Most of them require refrigeration or they won’t survive, so follow the instructions on the packet, and also because they are temperature sensitive, avoid adding probiotic yoghurts to hot dishes (ie hot porridge).
Probiotics promise to have important roles in wellness and we are looking forward to hearing what the future research holds to help treat and/or prevent many health conditions.
Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.