When to use probiotics when taking antibiotics, their purpose

What are probiotics for?

• Probiotics such as Lactobacillus spp., Bifidobacterium spp. and Saccharomyces boulardii, are strains of living microorganisms that are components of the normal intestinal microflora and are largely responsible for our health. They are obtained from food or in the form of medications.
• Probiotics improve antibacterial therapy because they combat microbial adhesion and the growth of pathogenic flora, have immunomodulatory properties, and improve the integrity of the intestinal barrier. In patients treated with antibiotics, probiotics help restore the microbial flora and increase treatment tolerance.
• Probiotics should be used cautiously, in consultation with a doctor, especially in premature infants and patients with severe immunodeficiency

MODERN PROBIOTICS. ADVANTAGES AND DISADVANTAGES

Department of Gastroenterology and Dietetics. Northwestern State Medical University named after. I.I. Mechnikov.

Kondrashina Elina Aleksandrovna – candidate of medical sciences, associate professor

MODERN PROBIOTICS. ADVANTAGES AND DISADVANTAGES

Both in Russia and abroad, more and more products related to probiotics appear every year. They are actively studied and prescribed to patients with a wide variety of diseases. Thus, in a 2010 survey of American doctors, 86% of whom were gastroenterologists, 93% of respondents responded that at least some of their patients took probiotics. However, many of these remedies are very burdensome for the patient’s wallet and, moreover, are not always effective. Therefore, an important and often difficult task is to choose the most optimal probiotic for each specific patient.

Definition

The first assumption about the connection between microbes inhabiting the intestines and the spiritual and physical health of a person was first put forward back in 1907 in the works of the famous Russian scientist I.I. Mechnikov. But the term “ probiotic ” itself was first used in 1965 in the works of DM Lilly and RM Stiwell, which were devoted to the problems of correcting intestinal microflora in animals. It has been proposed as an antonym for antibiotics. In 1989, R. Fuller suggested that probiotics have a beneficial effect on the macroorganism.

In 1992, Havenaar R. et al. called probiotics viable cultures of microorganisms that are used in animals and people and have a beneficial effect on their body, improving the properties of the local intestinal microflora. Since 1995, probiotics have been classified as biotherapeutic agents (bacteria) with specific therapeutic properties that suppress the proliferation of pathogenic microorganisms on the mucous membranes of the digestive organs and urogenital tract.

Currently, in foreign literature, most authors refer to the recommendations of the World Organization of Gastroenterologists (2008, 2011). According to them, probiotics are live microorganisms that, when administered in adequate quantities, have a positive effect on the health of the host. This effect can be both local and systemic.

Often, some doctors confuse probiotics with prebiotics. Unlike probiotics, prebiotics do not contain live microorganisms. They are non-absorbable substances that have a positive effect on the human body, selectively stimulating the proliferation and functional activity of its own beneficial microflora.

In addition to probiotics and prebiotics, in the literature you can find such terms as symbiotics and synbiotics. Symbiotics are a combination of several probiotic species of bacteria (for example, ecoflor, bificol, bifidin, etc.). Synbiotics are complex preparations that include pre- and probiotics (floristin, bifiliz, kipacid, etc.).

Mechanisms of the positive effect of probiotics on the human body

The positive effect of probiotics on the human body is associated with the positive properties of the microorganisms they contain. Indeed, most of them include representatives of normal (indigenous) intestinal flora (bifidobacteria, lactobacilli, E. coli, etc.), and the presence of symbiont flora in the intestine is a necessary condition for the adequate existence of the macroorganism. The role of beneficial intestinal microflora for our body is multifaceted; miniature inhabitants of the intestine perform the following functions:

• protective, which consists in protecting the digestive tract from colonization by pathogenic and excessive opportunistic microorganisms (due to bacterial antagonism, production of bacteriocins, organic acids and polyhydric alcohols, creation of a protective microfilm on the surface of the intestinal mucosa);
• enzymatic (enzymes produced by intestinal bacteria take part in the digestion of carbohydrates and proteins, deconjugation of bile acids with the conversion of primary bile acids into secondary ones, cholesterol metabolism, modification of oxalates);
• synthetic (beneficial microflora produces vitamins B1, B2, B6, B8, B12, K, C, nicotinic, folic, pantothenic, lipoic acids, hormones, essential amino acids, antitumor protection substances, neuropeptides, P450-like cytochromes, antioxidants, etc. );
• immune, manifested in maintaining the activity of the phagocytic activity of macrophages and neutrophils, stimulating systemic and local production of secretory Ig A, modulating the Th1/Th2 response and cytokine response, destroying allergens;
• detoxification in the form of participation in the neutralization of exogenous and endogenous substrates and metabolites (nitrates, xenobiotics, histamine, mutagenic steroids, toxic products of protein metabolism: indole, skatole, phenol, etc., superoxide radicals, fecal microbial enzymes: β-glucuronidase, β-glucosidase , nitroreductases, etc.) due to their biotransformation and absorption by bifidobacteria and lactobacilli;
• regulation of absorption capacity, helping to increase the absorption of sodium and water, calcium, iron, magnesium, water, gases, vitamins D, E;
• participation in the regenerative activity of the colon mucosa (thanks to the short-chain fatty acids produced, beneficial intestinal bacteria ensure the regenerative capacity of the colon mucosa and normalize the processes of differentiation of its cellular structures).

Taking into account the diversity of the listed functions, the use of probiotics is not just a replacement therapy for deficient intestinal dysbiosis. These funds can be used to solve more complex problems; their impact on various systems of our body is multifaceted and not well studied.

According to modern ideas, the mechanisms of the positive effect of probiotics on the macroorganism include:

• suppression of pathogenic and excess conditionally pathogenic flora;
• stimulation of reproduction of representatives of indigenous flora as a result of the production of growth-stimulating factors;
• influence on metabolic processes;
• stimulation of the immune system of the macroorganism;
• antiallergic effect;
• anticarcinogenic effect;
• potentiation of the therapeutic effects of drugs (antibacterial, lipid-lowering, antihistamines, regulators of intestinal motility, etc.);
• prevention of reinfections.

Types of probiotics

Currently, probiotics are available in the form of:

• food;
• dietary supplements;
• medicines.

The number of bacteria in different probiotics varies significantly depending on the genus, type and strain of microorganisms, since their effect on the human body is not the same. Probiotic dosages are calculated in colony-forming units (CFU) - the number of viable microorganisms capable of forming colonies on agar medium. To realize therapeutic effects, the number of microbial bodies must be at least 107 in one gram or milliliter.

Probiotic foods

Products with probiotics can rightfully be considered representatives of functional nutrition, which is widely used in Japan and many other developed countries. The term “functional nutrition” was first introduced in 1989. It implies the use of food products that are intended for systematic consumption by all age groups of a healthy population in order to reduce the risk of diet-related diseases, maintain and improve health due to the presence of physiologically active food ingredients. By exerting a regulatory effect on physiological functions, biochemical reactions and psychosocial behavior of a person, these products support physical and spiritual health and reduce the risk of diseases (Shenderov B. A., 2006). The first probiotic functional food product specifically designed to preserve and restore health was a fermented milk product containing lactobacilli, which was introduced to the Japanese market in 1955.

The raw materials for the production of medical food products are most often milk mixtures fermented with bifidobacteria and lactobacilli in combination with kefir starter. Casein hydrolysis products stimulate the proliferation of bifidobacteria, promote the formation of short-chain fatty acids and other metabolites by the microflora, which reduce the intestinal pH and inhibit the growth of excess conditionally pathogenic microflora. Foreign scientists believe that effective medicinal yoghurts should contain at least 108 CFU per 1 ml. Currently, in order to prevent and treat intestinal dysbiosis, not only a wide variety of fermented milk products are produced, but also juices, cereals, pastes, confectionery products, ice cream, and infant formula. Bifidogenic factors based on fructose-oligosaccharides are used as a food additive in more than 500 traditional food products.

In our country, every year more and more products enriched with beneficial microflora appear on the consumer market. Accordingly, for obvious reasons, there is active advertising in the media. However, when talking with patients about choosing a particular fermented milk product, it is advisable to draw their attention to the timing and storage conditions. One should also take into account the fact of pasteurization, which has a detrimental effect on beneficial microflora, since the optimal temperature for the existence of representatives of normal intestinal microflora does not exceed 37 - 400 C. All kinds of flavoring additives, stabilizers, preservatives and dyes also have a negative effect on the microflora. But even if these conditions are met, it must be remembered that the therapeutic effect of probiotic functional food products is quite modest and is possible only with long-term use in patients with dysbacteriosis of exclusively nutritional origin, deficient in the content of representatives of normal microflora.

It seems much more justified to prepare fermented milk products enriched with beneficial microflora at home. For this you need milk and starter cultures containing lactobacilli, bifidobacteria, and thermophilic streptococci. This method allows for better control over the composition of the resulting probiotic product, since the patient independently adds jam, fruits, berries and milk of a certain fat content.

Probiotics – dietary supplements and medications

Depending on the time of creation and improvement, several generations of probiotics are distinguished:

I generation - classic monocomponent preparations, consisting of one strain of microorganisms - typical inhabitants of the intestines (bifidumbacterin, lactobacterin, etc.);

II generation - self-eliminating antagonists (bactisubtil, enterol, biosporin, etc.);

III generation – multicomponent preparations (symbiotics), consisting of several (from 2 to 30) strains of bacteria (Bifilong, etc.) or several types of bacteria (Linex, Bifikol, etc.);

IV generation - combined preparations (synbiotics), consisting of a strain of bacteria and ingredients that promote their growth, reproduction and metabolic activity (bifiliz, kypacid, etc.);

V generation – multicomponent combination preparations (synbiotics), consisting of several types of bacteria and ingredients that promote their growth, reproduction and metabolic activity (floristin, bifiform, etc.).

Probiotics should not be used blindly, but with mandatory consideration of all their components. To help the practitioner select probiotics depending on the microorganisms they contain, we have listed some of them in the table below.

Table

Probiotics and representatives of microflora contained in them

Depending on the technological methods used to create probiotic products, they are divided into:

• dry probiotics (bifidumbacterin, lactobacterin, colibacterin, etc.);
• liquid forms (floristin, trilact, bifidum BAG, liquid bifido- and lactobacterins, biovestin, biovestin-lacto, lactoflor, etc.);
• sorption forms (ecoflor, bifidobacterin forte, probifor, bificol forte, etc.);
• capsules with enteric coating (bifiform, linex).

Let's look at the features of each of these groups of probiotics.

Dry probiotics

Just a decade ago, dry probiotics were especially popular. These bacterial preparations contain live microorganisms, both in the form of monocultures and in various combinations, in a freeze-dried state.

Unfortunately, dry probiotics are characterized by low efficiency (Mayansky A., 1999; Zimmerman Ya. S., 2000). The lyophilization process negatively affects the beneficial properties and viability of bacteria. In dry forms, microbes are in a state of suspended animation, so they need up to 8–10 hours to enter an active state. By this time, most of them are eliminated from the intestines (especially in patients with increased intestinal motor activity). After the freeze-drying process, microbial cells lose some of the specific receptors that help them reliably attach to the intestinal mucosa. Such microorganisms have reduced antagonistic activity.

In addition, a significant part of living bacteria dies in the acidic environment of the stomach, the remaining ones are exposed to an alkaline environment, bile acids and pancreatic enzymes in the duodenum, which causes the bacterial membranes to dissolve and the sorption ability of microorganisms, which allows them to fix on the intestinal villi, to further suffer.

But even bacteria that have reached the intestine and are activated in it are not always capable of further colonization of the intestinal mucosa. Moreover, they may be foreign to the patient’s microbiocenosis. Only about a third of the administered dry biological products remain in the human intestine. Another significant drawback of probiotics in this group is the initially low titers of microorganisms contained in them. Therefore, most dry forms of probiotics are characterized by a “delayed” effect of their therapeutic activity (20–30 days or more), moreover, it is often temporary, and after the cessation of maintenance therapy, artificially introduced strains quickly disappear from the intestine and are replaced by random microflora.

In order to increase the effectiveness of therapy with dry probiotics, some authors (Novokshonov A.A. et al., 2001) suggest increasing the daily dose of drugs. However, treatment with megadoses, which consists of increasing the doses of lacto- and bifidobacterins by 1.5 - 3 times in a course of 2 weeks, poses a danger of sensitization. The fact is that laboratory strains of bacteria, especially at excessive doses, are often potential allergens. In addition, they can provoke the development of diarrhea in individuals with subcompensated lactase deficiency. Dry preparations containing E. coli can contribute to the development of not only allergic but also autoimmune reactions.

Liquid Probiotics

In liquid forms of probiotics, bacteria are in a biologically active state, fully retain their antagonistic properties towards pathogenic and conditionally pathogenic flora and are capable of colonizing the intestines within 2 hours. Accordingly, microorganisms realize their therapeutic effect faster than freeze-dried ones.

A valuable component of liquid probiotics are the waste products of bacteria - metabolites (essential amino acids, organic acids, interferon stimulants, vitamins, enzymes, peptides, bacteriocins), which are useful for both microbes and the macroorganism. They:

• reduce the pH of the intestinal contents, thereby improving the action of digestive enzymes and creating an unfavorable environment for pathogenic microbes;
• are an energy substrate for the colon epithelium;
• prevent atrophic and dystrophic processes in the intestinal mucosa;
• regulate differentiation and proliferation of intestinal epithelium;
• improve the absorption of water, gases, calcium, restoring the water-electrolyte balance in the intestinal lumen;
• modulate local immunity;
• have a local anti-inflammatory effect;
• promote the growth, reproduction and metabolic activity of intestinal microflora.

Foreign experts call metabolites of intestinal microflora postbiotics and are actively studying their potential in the treatment of inflammatory bowel diseases.

Liquid forms of probiotics can not only be taken orally, but also used for intraintestinal irrigation, local applications (for example, for stomatitis or cracked nipples), nasal instillation, rinsing and instillation.

A promising modern liquid probiotic is Floristin . It contains lactobacilli (L. acidofilus), bifidobacteria (B. longum, B. bifidum) and their metabolites. Along with other positive qualities inherent in all liquid probiotics, the special advantages of Floristin can be considered:

• a large number of microorganisms contained in it (about 109 CFU of viable and functionally active lactobacilli and bifidobacteria are found in 1 ml of this probiotic);
• the domestic origin of the pharmacopoeial strains of microorganisms contained in Floristin, which have not been subjected to any drying;
• resistance of the B. bifidum BAG strain used for the preparation of Floristin to the effects of aggressive components of gastric juice (hydrochloric acid, enzymes) and bile acids;
• absence of artificial colors, preservatives, flavoring additives, genetically modified components;
• convenient release form (bottle capacity with Floristin - 250 ml).

The survival of biologically active bifidobacteria cells was tested at the Moscow Research Institute of Experimental Microbiology. Gabrichevsky. Floristin is approved for use in children from 1 year of age. Data are emerging on its successful use in children with gastroenteritis of rotavirus etiology, post-infectious enterocolitis, and atopic dermatitis (Ryabchuk F.N., 2014, Nezabudkin S.N. et al., 2014). It should be remembered that the temperature regime for storing liquid probiotics ranges from 2 to 6 0C. This temperature ensures the preservation of a high titer of microorganisms for 3–12 months and is necessary to slow down the growth of microflora. When the ambient temperature rises to room temperature and above, bacteria are activated and produce metabolites that affect the biochemical properties of the environment, which leads to a decrease in the concentration of living microbial cells, and, consequently, a decrease in their therapeutic effect.

Sorption forms

The advantage of sorption forms is the association of microorganisms in microcolonies (20–180 living cells purified from the growing medium), which are fixed on a special sorbent carrier. Coal and carbon-mineral compounds can act as sorbents. Desorption of microorganisms occurs already in the large intestine, where they realize their effect.

Thanks to this structure, due to chemical and electrostatic forces, the interaction of bacteria with the parietal layer of the intestinal mucosa increases and their antagonistic activity increases. Survival increases when bifidumbacteria pass through the acidic environment of the stomach, and high local concentrations are created on the surface of the intestinal mucosa. Sorbent carriers adsorb and remove endo- and exotoxins, pathogenic bacteria and their metabolic products from the body, which helps accelerate the reparative process in the intestinal mucosa. The listed features of sorption forms contribute to a more rapid colonization of the intestines with the bacteria they contain compared to dry lyophilized forms of probiotics.

Enteric-coated capsules

The use of probiotics supplied in enteric capsules is also preferable to the administration of dry forms. The capsules of such drugs are coated with a special enteric coating resistant to hydrochloric acid, which protects the bacteria contained in the drug from destruction when passing through the stomach. As the name suggests, this capsule dissolves in the small intestine, where the microorganisms contained in the preparations are released unchanged without reducing their initial titer. In addition, the capsular shell of some probiotics contains a special nutrient medium necessary for the growth and reproduction of lactic acid bacteria.

Indications for prescribing probiotics

Most Russian specialists invariably associate probiotics with intestinal dysbiosis. Meanwhile, taking into account the various mechanisms of the positive effect of probiotics on the human body, foreign researchers are seriously studying the effectiveness of bacterial preparations in a wide variety of pathological conditions of intestinal and extraintestinal localization.

Thus, there is quite convincing data (Lee MC et al., 2001; Allen SJ et al., 2004; Sazawal S. et al., 2006) on the effectiveness of the use of probiotic strains, including L. reuteri ATCC 55730, L. rhamnosus GG, L casei DN-114 001 and Saccharomyces cerevisidae (boulardii), in children with acute infectious diarrhea. Their use reduced the severity and duration of diarrhea by approximately 1 day. The effectiveness of the use of these probiotic strains of microorganisms in viral gastroenteritis was more convincing compared to bacterial or parasitic infection. There is also evidence of the effectiveness of the use of these same strains for the prevention of acute diarrhea in children and adults.

For antibiotic-associated diarrhea, a positive effect in children and adults was observed with the administration of S. boulardii or L. rhamnosus GG. Research by Plummer S. et al. (2004), Hickson M. et al. (2007) showed the effectiveness of L. casei DN-114 001 in hospitalized adult patients in the prevention of antibiotic-associated diarrhea and diarrhea caused by C. difficile.

According to Isolauri E. et al. (2002) the therapeutic effect of probiotics in inflammatory bowel diseases is multifaceted. It is due to the fact that the introduced bacteria stabilize the immunological barrier of the intestinal mucosa, reducing the local production of pro-inflammatory cytokines, have antagonistic activity towards an unknown bacterium that causes inflammatory bowel diseases, produce antimicrobial substances, promote the restoration processes of the colon mucosa and affect pH intestinal environment. However, often this information is still contradictory and requires further in-depth study.

The use of probiotics containing lactobacilli as one of the drugs used for the eradication of Helicobacter pylori also seems promising. Lactobacilli are not only resistant to most antibiotics used in eradication regimens, but also, due to their antagonistic activity, contribute to the elimination of Helicobacter pylori, while simultaneously having a positive effect on the intestinal microbiocenosis and preventing the side effects of antibiotic therapy ( Kabir AM . 1997; Coconnier M.-H. et al .,1998; Sgouras D. et al., 2004; Sheu B.-S. et al., 2006; Tong JL et al., 2007).

Lactase deficiency (primary or secondary) is currently a problem for 70% of the world's population. These individuals have low levels of intestinal β-galactosidase activity. In this case, lactose acts as an indigestible, osmotically active carbohydrate ( Roberfroid M., 2000). Administration of probiotics containing Streptococcus thermophilus and Lactobacillus delbrueckii bulgaricus, according to Sanders ME (1993), Montalto M. et al. (2006) improves the enzymatic activity of intestinal microorganisms and, accordingly, increases the digestion of lactose, reduces the symptoms of lactase deficiency, slowing down the transit of contents through the digestive tract.

Evidence is accumulating on the use of certain probiotics for the prevention of atopic dermatitis. Thus, in their study, Osborn DA and Sinn JK (2007) showed the effectiveness of prescribing probiotics to pregnant women and newborns under 6 months of age.

There is evidence that some strains of probiotics and prebiotic oligofructose have immunostimulating effects (Schumann C. et al., 2002). Indirect evidence of this was obtained in studies aimed at preventing acute infectious diseases (nosocomial diarrhea in children, influenza), as well as in studies assessing the antibody response to vaccines.

It is assumed that probiotics reduce the duration of acute respiratory infections ( Lenoir-Wijnkoop I, 2007) , sensitivity to pain ( Konturek PC, 2011) , and increase the effectiveness of other drugs for bacterial vaginosis ( Senok AC, 2009) .

The problem of low effectiveness and side effects of probiotics

Unfortunately, probiotics do not always demonstrate sufficient effectiveness. Often the lack of the expected result is due to insufficient examination of patients. Thus, doctors often attribute all the patient’s problems to intestinal dysbiosis, forgetting about more serious diseases hiding under its mask and requiring a different therapeutic approach.

In other cases, bifido- and lactose-containing drugs are prescribed “blindly”, without first destroying opportunistic bacteria. The latter occupy all free adhesion sites on the mucous membranes, so the microorganisms introduced as part of the probiotic simply have nowhere to colonize. Some patients (for example, those with severe intestinal dysbiosis) require longer treatment than that indicated in the instructions, creating large concentrations of microorganisms in the intestines.

In addition, it should be taken into account that in the intestines of a healthy person various types of bifidobacteria, lactobacilli, and Escherichia coli are found, and the individual predominance of different strains in different patients is a proven fact. Therefore, it would be optimal to first determine in vitro the dominant strains of one or another type of normal microflora and their biocompatibility with the strains of probiotic microorganisms, and only then carry out treatment with probiotics selected in this way. Otherwise, the implanted strains of beneficial microflora may be genetically and phenotypically foreign to a given patient and have competitive antagonism to his normal microflora.

Unfortunately, there are no ideal drugs. The lack of description of side effects and contraindications for the use of a drug or dietary supplement only demonstrates the fact that this drug has not been thoroughly studied. Any probiotic can provoke the phenomenon of individual intolerance. Bacterial preparations with lactobacilli may be poorly tolerated by patients with lactase deficiency and allergies to cow's milk protein.

Moreover, some drugs contain strains of bacteria (for example, enterococci) with the potential ability to cause purulent-inflammatory processes in a weakened body. Moreover, according to some data (Shenderov B.A., 2001; Saarela M. et al., 2002), with long-term intake of live probiotic microorganisms, various complications began to be identified (laccidemia in infants, autoimmune diseases, allergic manifestations, opportunistic infections, dysbiotic conditions caused by the administration of large doses of probiotic drugs, etc.). A meta-analysis of 72 publications on the clinical use of probiotics confirmed the possibility of the development of associated bacteremia. Risk factors for this side effect were the presence of a central venous catheter, severe immunodeficiency and short bowel syndrome (Whelan K., 2010).

Requirements for modern probiotics

The effectiveness of treatment with probiotics and their tolerability largely depend on the choice of drug. A modern probiotic product must meet a number of requirements listed below:

• natural origin;
• safety during long-term use;
• resistance to hydrochloric acid and bile;
• preservation of microorganisms in an adequate dose by the end of the probiotic shelf life;
• high colonization potential of bacteria;
• effectiveness proven in controlled clinical trials;
• The microorganisms included in the probiotic must be isolated from healthy donors and be geno- and phenotypically classified.

List of used literature

1. Baranovsky A.Yu., Kondrashina E.A. Intestinal dysbiosis. - St. Petersburg: Peter, - 2007. - 240 p.
2. 2. Nezabudkin S.N., Nezabudkina A.S., Antonova T.I. The role of probiotics in the treatment of atopic dermatitis in young children with intestinal dysbiosis syndrome. – St. Petersburg. – 2014. – p.
3. Ryabchuk F.N. Modern liquid symbiotics and synbiotics in the correction of microbiocenosis in acute and chronic diseases of the digestive system. – St. Petersburg. - 2014. - 42 p.
4. Shenderov B. A. State and prospects of the concept of “Functional nutrition” in Russia: general and isolated sections of the problem // Pharmateka. – 2006. – No. 1. – P. 41 – 47.
5. Allen SJ, Okoko B., Martinez E., Gregorio G., Dans LF Probiotics for treating infectious diarrhea // Cochrane Database Syst Rev. – 2004. – No. 2. - CD003048.
6. Guarner F., Khan AG, Garisch J.et al. World gastroenterology organization global guidelines: probiotics and prebiotics // J Clin Gastroenterol. – 2012. – V. 46(6). – P.468-481.
7. Hickson M., D'Souza AL, Muthu N. et al. Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomized double blind placebo controlled trial // BMJ - 2007. - V.335. – P. 7610:80.
8. https://nccam.nih.gov/health/probiotics/introduction.htm. Updated November 2011. Accessed July 24, 2012.
9. Konturek PC, Brzozowski T., Konturek SJ Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options // J Physiol Pharmacol. – 2011. V.62(6). – P.591-599.

10. Lee MC, Lin LH, Hung KL, Wu HY Oral bacterial therapy promotes recovery from acute diarrhea in children // Acta Paediatr Taiwan - 2001. - V. 42. - P. 301–305.

11. Montalto M., Curigliano V., Santoro L., et al. Management and treatment of lactose malabsorption // World J Gastroenterol - 2006. - V.12. – P.187–191.

12. Plummer S, Weaver MA, Harris JC et al. Clostridium difficile pilot study: effects of probiotic supplementation on the incidence of Clostridium difficile diarrhea // Int Microbiol – 2004. – V.7. – P.59–62.

13. Roberfroid MB Global view on functional foods: European perspectives // Br J Nutrition - 2002. - V. 88 (suppl. 2). – P.133-138.

14. Saavedra JM Clinical applications of probiotic agents // Am. J. Clin. Nutr. - 2001. - V. 73(6). —P. 1147S—1151S.

15. Schumann C. Medical, nutritional and technological properties of lactulose // Eur J Nutr – 2002. – V. 41(Suppl 1). – P. 17–25

16. Tong JL, Ran ZH, Shen J., Zhang CX, Xiao SD Meta-analysis: the effect of supplementation with probiotics on eradication rates and adverse events during Helicobacter pylori eradication therapy // Aliment Pharmacol Ther - 2007. - V. 25 . – P.155–168.

17. Whelan K., Myers CE Safety of probiotics in patients receiving nutritional support: a systematic review of case reports, randomized controlled trials, and nonrandomized trials // Am J Clinc Nutr. – 2010. V. 91(3). – P. 687-703.

18.Williams MD, Ha CY, Ciorba MA Probiotics as therapy in gastroenterology: a study of physician opinions and recommendations //J Clin Gastroenterol. – 2010. – V. 44(9). – P. 631-636.

When is a probiotic prescribed?

Taking antibiotics is necessary for treatment (if prescribed by a doctor). But antimicrobial drugs kill all bacteria. Thus, along with pathogens, the drugs kill the good bacteria in the gut, leaving the body defenseless against pathogens such as the fast-growing Candida albicans. After a course of antibiotics, this yeast can quickly become dominant in the small intestine.

Taking probiotics before, during, and after a course of antimicrobials can help maintain the balance of microorganisms in the digestive system. Many Candida sufferers doubt this, thinking that antibiotics will quickly kill off the good bacteria in probiotics. However, research has shown that probiotics are extremely effective during antibiotics.

What are prebiotics

Prebiotics, in their structure and functional significance, are biologically active components that stimulate the growth and reproduction of beneficial intestinal microflora. These components are not affected by digestive enzymes and are not broken down by gastric juice. In simple terms, prebiotics are substances that create a favorable environment in the lumen of the large intestine for restoring the balance of intestinal microflora.

These substances are of particular value for young children. From the moment of birth, the baby's intestines are sterile. After contact with the external environment, the mucous membrane of the large intestine of a newborn is populated by microorganisms of a bacterial nature. During the first year of life, the ratio of beneficial to opportunistic microorganisms is 9:1. Often, infants experience dysbiosis, which leads to the development of severe symptoms and digestive disorders. Products containing prebiotics help prevent the development of dysbiosis in newborns

The group of prebiotics includes the following components:

1. Monosaccharides (sorbitol, raffinose, xylobiose).
2. Oligosaccharides (fructooligosaccharides, soy oligosaccharides, galactooligosaccharides).
3. Disaccharides (lactulose).
4. Polysaccharides (hemicellulose, cellulose, gums, dextrin, mucus). Despite their benefits to the human body, probiotics and prebiotics perform different functions.

Features of therapy when taking antibiotics

To maximize the benefits of probiotics, space your intake with your antibiotics by at least two hours. In this case, less “good bacteria” will be killed by antibiotics in the intestines.

There is a lot of confusion about whether probiotics should be taken before, during, or after meals. Luckily, a 2011 study looked at exactly this question. The researchers created a synthetic digestive system in the laboratory and tested it in different scenarios using a commercial probiotic. They found that probiotics survived best when taken with meals, or 30 minutes before meals. When you take these medications or foods, just be sure to drink or eat them with or just before your next meal.

Side effect of antibiotics

A course of strong antibiotics can kill virtually all the bacteria in your digestive system, eliminating competition and clearing the way for fast-growing pathogenic flora to immediately try to fill the gap. Taking probiotics during antibiotic treatment can help slow the growth of pathogens by replenishing the gut with beneficial, healthy bacteria. Beneficial bacteria maintain balance and reduce the side effects of antibiotics. A 2008 study published in the Journal of Clinical Gastroenterology found that probiotics significantly reduced diarrhea in patients taking antibiotics.

If you do need to take antibiotics, a course of good probiotics will help and will provide two types of benefits: relief from the side effects of antibiotics, and protection of microflora balance in the long term.

Use of dietary supplements for therapy

• Probiotic preparations in liquid, capsules, powder or tablets are not a medicine. These are biologically active food supplements that can establish balance and bring the body into a normal state. Therefore, such drugs do not require a prescription.
• In any case, if the doctor, when prescribing antibiotics, did not suggest that you drink live bacteria, you should ask him the appropriate question. But which probiotics are best?
• It is believed that liquid probiotics are better because they take live bacteria, not frozen or put into a dormant state, allowing you to start working on restoring your gut flora immediately. This is especially important when it comes to the health of a child. The drug must contain strains of lacto- and bifidobacteria, which are what the gastrointestinal tract requires after treatment with antibiotics.

Colonization assessment

In 2015, Elinav and his colleague Eran Segal, a computational biologist, demonstrated that the same food can have different effects on blood sugar in different people without diabetes, depending in part on the microflora their intestines.

These scientists developed a method for predicting postprandial blood glucose peaks based on a wide range of clinical and laboratory parameters, including stool microbiota. Predicted changes in blood glucose were used to develop a personalized diet to help reduce postprandial blood glucose peaks. Subsequently, this approach was registered as an innovation in the field of nutrition.

Elinav and Segal, in their latest work, suggest that the most effective means of restoring gut microflora is one that is personalized. In their new study, they, along with Zamir Halpern, chief of internal medicine at the Institute of Gastroenterology at Sourasky Medical Center in Tel Aviv, Israel, revisited key issues that they feel they did not adequately address in their previous studies. works: to what extent do probiotics colonize the human intestine and what effect do they have on it?

In the first study, nineteen healthy volunteers took either a commercially available 11-strain probiotic supplement or a placebo twice daily for 4 weeks. According to Elinav, the supplement included the 4 main genera of bacteria used in probiotics around the world.

Rather than relying solely on stool studies (which is common practice in gut microbiota studies), the researchers also examined sites throughout the gastrointestinal tract, both before and during a course of probiotics. Using colonoscopy and deep endoscopy of the upper digestive tract, the scientists collected samples of the contents and lining of the intestine, and also performed a biopsy of its tissue. The samples were then subjected to extensive genetic sequencing to determine microbiota composition, function, and gene expression of host intestinal cells.

Gut lining samples taken 3 weeks after starting a course of probiotics showed that subjects taking antibiotics could be divided into 2 camps: “susceptible” and “resistant”. Susceptible volunteers demonstrated significant levels of probiotic strains in the intestinal lining, whereas no significant colonization was detected in the intestines of resistant volunteers. Susceptible individuals also showed changes in the indigenous microbiome and gene expression profile throughout the intestine, which was not observed in resistant subjects or in the placebo group.

According to Colleen Kelly, a gastroenterologist and professor at Warren Alpert Medical School at Brown University who was not involved in the study, the work is the first to demonstrate that in some people the intestinal lining is resistant to probiotic colonization , “where all the action happens.” "

The baseline natural gut microbiome of volunteers largely determines whether they will be susceptible or resistant to probiotics. Interestingly, no such difference was found in stool samples: both susceptible and resistant subjects showed comparable amounts of probiotic bacteria, with more bacteria found in the stool of placebo-treated volunteers.

According to Elinav, these results suggest that " our current approach to probiotics is probably wrong ." This variability between individuals means that some people may benefit from taking probiotics and others may not.

This result is not surprising, said Rob K., Ph.D., director of the Innovative Microbiome at the University of California, San Diego, who was not involved in the study. He noted that different people react differently to the same foods, drugs and pathogens “This extends to beneficial organisms,” he said of the study, adding that previous work had found similar variability.

There is a general consensus among doctors and the public that ingesting “good” bacteria can crowd out “bad” bacteria and improve gut health even in a healthy person. Most clinical studies published so far on healthy volunteers have not found significant changes in gut microflora. With the publication of the Weizmann Institute of Science study, the health claims of probiotics are more controversial than ever. Kelly says, " The idea that people take probiotics just to improve their overall health may be a waste of money ."

How to Increase Probiotic Bacteria If You're Lactose Intolerant

Lactose intolerance occurs with lactase deficiency. Lactase is an enzyme that breaks down lactose in the small intestine. When this enzyme is low, lactose enters the large intestine and begins to interact with microbiota bacteria, which causes unpleasant symptoms.

Can a Genetic Test Detect Gluten Intolerance?

Lactose intolerance manifests itself differently in different people. Some people cannot drink cow's milk, but can tolerate fermented milk products and cheese, while others cannot tolerate anything that contains lactose. In the latter case, you can ask your therapist or nutritionist about enzyme preparations that help the body break down lactose.

Lactobacilli and bifidobacteria, like many other beneficial bacteria, feed on prebiotics—certain types of fiber. Therefore, if for some reason you cannot or do not want to eat probiotic foods, you can add prebiotic-rich foods to your diet.

Onions, tomatoes, bananas, leeks, apples, asparagus, garlic and rye bread contain a type of prebiotic that bifidobacteria feed on.

Side effects

Probiotics contain bacteria that would normally already be present in the body. However, some problems can arise if probiotics are taken in the hope of quickly getting rid of unpleasant symptoms that accumulate over a long period of time. Chronic diseases, immunodeficiency, hormonal disorders, long-term treatment with antibiotics can create a situation in the body where probiotics will not have a very noticeable effect. In this case, step-by-step therapy should be carried out, including various measures to eliminate symptoms and restore the microflora.

Prebiotics should be used with caution for certain gastrointestinal diseases. Prebiotics can also cause enzymatic disorders in the intestines and an osmotic effect in the liver. Abuse of food containing prebiotics may result in diarrhea, flatulence, and intestinal colic.

Do bacteria survive in the stomach?

The human stomach is an unfavorable environment for probiotics. Therefore, the more bacteria there are in a product, the higher the likelihood that some of them will survive and reach the intestines.

Research shows that the survival of bacteria in gastric juice is improved in the presence of simple carbohydrates: glucose, fructose, sucrose and lactose. Lactose is a sugar found in dairy products.

Plain yogurt or kefir with enough microorganisms can be a good source of probiotics.

You should not add sugar specifically to improve the survival of bacteria, since it does not contain useful microelements. You can add fruit instead and get an extra dose of vitamins and fiber.

Lists of probiotics and prebiotics contained in foods

Prebiotics include fructooligosaccharides such as inulin and galactooligosaccharides. But instead of focusing on these difficult words, include probiotics in your diet by eating more fruits, vegetables such as bananas, onions, garlic, leeks, asparagus, artichokes, soybeans, and whole grains.

To get more probiotics, look to fermented dairy products, including yogurt, kefir, and aged cheeses, that contain live cultures (such as bifidobacteria and lactobacilli). Don't forget non-dairy foods that also contain healthy crops, including sauerkraut, miso, tempeh, and cultured non-dairy yogurts.

Which drugs should you prefer?

The best probiotics for the vagina: Bifidumbacterin, Lactobacterin (vaginal suppositories), Linex (capsules for oral administration), Gynoflor (vaginal tablets). For intestinal microflora the following are used:

• bifidobacteria (“Bifidumbacterin”, “Bifiform”, “Probifor”, “Bifiliz”, “Bifikol”);
• lactobacilli (“Laktobacterin”, “Acipol”, “Gastrofarm”, “Biobakton”, “Acilact”);
• beneficial yeast-like fungi (“Sporobacterin”, “Baktisubtil”, “Enterol”, “Biosporin”, “Bactisporin”);
• enterococci (“Bifiform”, “Linex”);
• coli-containing ones (“Bifikol”, “Colibacterin”, “Bioflor”).