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Ask Dr. Sue
PROBIOTICS
Dear Dr. Sue,
My three year old is in daycare and gets the usual
increased number of infections because of it. She
has had several episodes of diarrhea over the last year,
and also more than her share of colds, which then lead
to ear infections, requiring antibiotics, and then more
diarrhea. Besides making her miserable, the diarrhea
means she can’t go to her daycare, which then means even
more days missed from work for me. I’ve been
reading about probiotics, and would like to know if they
are safe for her age and if they would help when she
gets diarrhea, either from a stomach bug or because of
antibiotics.
Dear Parents,
There is increasing interest in probiotics from many
families, physicians and researchers. There is a
growing amount of information about supplementing these
“good” bacteria that normally populate the intestine and
about conditions in which such supplementation might
prove useful. There may indeed be a place for them
in treating and/or preventing diarrhea. There may
even be a place for them in treating and/or preventing
allergy-based diseases such as asthma and eczema.
They are also being evaluated as part of the treatment
for inflammatory bowel disease (Crohn’s disease and
ulcerative colitis) and irritable bowel syndrome. (1)
How might swallowing these bacteria help, whether in
food or in supplement form? A number of mechanisms
might be involved. Several probiotics produce
substances that make it harder for more toxic organisms
to survive in the intestine. They also appear to
compete both for space along the lining of the intestine
and for available nutrients, working in both ways to
squeeze out invaders. They may change receptors in the
gut that are necessary for viral toxins to create their
havoc. They probably also enhance antibody
productions and other immune processes that help to
protect the intestine.
Are they safe? A large number of studies as well
as many years of experience with probiotics (in food,
particularly) suggest that they are. Bacterial
infections caused by probiotics are extremely rare, and
usually are confined to people who are at higher risk to
begin with, including those with suppressed immune
systems and those with a condition called short gut
syndrome.
It appears from a number of studies that if the right
probiotic is given, and if it is given early enough, an
acute episode of viral diarrhea is likely to end about
one day earlier than it would have otherwise. This
has been especially well-studied for the most severe
viral diarrhea, that caused by Rotavirus.
Rotavirus infects about 70% of children by the age of
five, and causes about 50,000 hospitalizations per year
in that age group. Diarrhea caused by Rotavirus
can last up to nearly two weeks. One probiotic in
particular, Lactobacillus rhamnosus GG, has repeatedly
been shown to decrease the chance of diarrhea persisting
for longer than one week and to shorten hospital stays
by one full day. (2)
More than a third of children receiving a strong (broad
spectrum) antibiotic will develop diarrhea. At a recent
symposium presented by the Harvard Medical School
Division of Nutrition, Dr. Cornelius Van Niel, a Seattle
area physician, stated that this number is decreased by
60% in children given Lactobacillus GG. (3)
Dr. Van Niel’s review of the available literature led
him to suggest that children with viral diarrhea and
children being treated with antibiotics should be
considered for treatment with Lactobacillus GG, with the
following guidelines:
-
The product given should contain at
least 100 billion colony forming units per dose.
These numbers should be present at the time of use,
not just the time of production.
-
The total dose should be divided into
three daily doses, and given for four days.
-
If used for viral illness, probiotics
should be started as early as possible, preferably
before the child had been sick for 60 hours
-
If used with antibiotics, the
probiotic should be divided into the same number of
daily doses as the antibiotic, and should be given
throughout the course of antibiotics. (He
doesn’t advise probiotics for every child he treats
with antibiotics, saving them instead for children
who have a history of antibiotic-associated
diarrhea, for those being treated with antibiotics
more likely to cause diarrhea, and for those on
longer than typical courses of antibiotics.)
One significant problem with probiotics,
as is true with most dietary supplements, is the lack of
quality control. It is very difficult for the
consumer to really know what they are buying.
Consumer Reports magazine evaluated a number of
different sources of probiotic bacteria, including
yogurts and supplements. Most of the yogurts
containing live culture bacteria had much greater counts
of those bacteria than the supplements. They also
had the benefits of low cost and good nutrition!
They tested the following strawberry yogurts: Breyer’s
Fruit on the Bottom Lowfat yogurt, Dannon Fruit on the
Bottom Lowfat yogurt, Stonyfield Farm Organic Lowfat
yogurt, and Yoplait Original Lowfat yogurt. All
had more than adequate bacterial counts. Among
yogurt drinks, Dannon Light and Fit Smoothie and Yoplait
Nouriche Light Breakfast Smoothie made the grade.
The supplements they tested all fell short of the counts
provided by yogurt, but a few still had adequate counts
of beneficial bacteria. County Life Power-Dophilus,
Natrol Acidophilus, Nature Made Acidophilus and Nature’s
Bounty Extra Strength Acidophilus with Pectin were among
the better choices. (4)
Not all of these may have pediatric doses listed, of
course.
The American Academy of Pediatrics has not yet made any
recommendations about the use of probiotics, but I
certainly think that it would be worthwhile for you to
give your daughter live-culture yogurt daily (divided
into two or three doses as described above), starting
with the first dose of antibiotics or at the onset of an
illness with diarrhea.
References:
1. Markowitz, J. and Bengmark, S. Probiotics in Health
and Disease in the Pediatric Patient. Pediatric Clinics
of North America 49 (1), February 2002:127-141.
2. Guandalini, J., J Pediatr Gastroenterol Nutr 30 (1),
January 2000: 54-60.
3. The Harvard medical School Division of Nutrition
Presents an American Academy of Pediatrics Symposium:
Probiotics and Intestinal Health in Children, October,
2005. Available as a Webcast at http://nutrition.med.harvard.edu/CME.html.
4. Consumer Reports, July 2005 issue.
 
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