A big, successful trial of probiotics

Problem solved http://sci-hub.io/10.1038/nature23480

Spasiba Russia.

Not a GI specialist here, but I've read plenty of randomized controlled trials. The one-liner here might be "high quality[1] study shows substantial reduction in infant infections in rural India[2]." The biological mechanism makes sense, and as discussed in the article could be more than just good bacteria fighting off bad bacteria. A cynic may say the immunomodulation stuff is kind of hand-wavy and not being a GI specialist, pediatrician or immunologist myself I don't know. That would be an important point because all infections were reduced (not just GI infections), which may point to confounding variables. More on that later.

[2] As far as how the study applies to most of Europe and the US where infant mortality is 10x less, hard to say. The number of infants needed to treat to prevent a single infection was 27 which is low assuming these drugs are cheap and without side effects. Immediate side effects are unlikely given the low and comparable drop out rates among control and treatment groups. However, long-term effects are unknown given the timeframe of the study. Forming a recommendation for countries with more rigorous pasteurization/food preparation/etc, perhaps more access to care and well-child checkups, and much lower infant mortality in general isn't particularly easy here. I'm not up to date on other studies with probiotics. Again, not my specialty.

[1] The study quality looks sound and exclusions were reasonable, the control (placebo) and treatment groups matched up well in many ways and were sizable. There wasn't very much in the way of dropouts. The study looked at too small a population to determine differences in infant deaths, if there is one at all.

Pediatric MD PhD. These are exciting results.

Sepsis among neonates is a major concern, even in the developed world. Babies new to the world have very weak immune systems, particularly with regard to antibody response which is initially almost entirely composed of waning amounts of transplacental IgA. This paper points out the the developing world has even higher rates of infant mortality from bacterial sepsis. So this is a big problem and impactful solutions have been tough to come by.

This is a large double-blind placebo controlled trial. They gave eligible babies 7 consecutive daily doses of either placebo or the study agent. Table 1 shows that both study groups are very similar, so we should not be too concerned with confounding variables. Table 2 shows the striking data re: sepsis death rates, with this "synbiotic" (probiotic bacteria + bacterial food) reducing death from sepsis by almost half(!). Table 3 looks at all causes of death and importantly, significant differences in other causes of death were not observed between the two groups--it wouldn't be all that helpful if this synbiotic group seemed to get some other serious problem as a side effect. It is a pretty straight-forward study and no major flaws in their methods or conclusions jump out at me.

While exciting overall, the authors point out some important points at the end. I think the most interesting is that they used this particular species of lactobacillus after studying babies in India about 20 years ago and finding differences in the rates of colonization with this and other probiotic species. In other words, they didn't just throw any sort of "good bacteria" at these babies--they had strong evidence to show that it actually colonized them and therefore could , in theory, have an effect on rates of sepsis. If they had used lactobacillus GG (one of the other species that they found had low rates of colonization), it would stand to reason that they wouldn't have gotten such an impressive effect or maybe none at all. Then the media would say, "probiotics don't save babies from sepsis." Basically I'm just applauding their careful selection of this bacterial species.

One final important note is that this result should not be generalized to other populations without future studies showing similar effects. The gut microbiome is influenced by geography and other environmental factors and interacts heavily with out immune systems, large parts of which vary by genetic background. To put it another way, just because this bacterial species works well in rural India does not mean it will work well in Peru or anywhere else.

Just did a quick online search, and it seems that D-lactic acid might be responsible for Chronic Fatigue Syndrome too. This is something I'm going to read up more in the next few days.

Are there any good resources on this?

In my opinion, the word antibiotic is even more problematic.

In a recent survey, 13% of practitioners admitted to having used sedatives or antibiotics as placebos:

https://www.sciencedaily.com/releases/2008/10/081023195216.h...

To me, antibiotics are an example of dangerous superstition rearing its nasty head right there smack in the middle an institution that prides itself as rational and superior.

I think pre-med and med school students should be required to take courses in chaos theory and ecology, as well as open minded primers on alternative and preventative medicines, not so much to advocate or practice them, but so they can have a better sense of medicine as an artform.

It may be that because of diet or other factors, this just wouldn't be as useful in the US.

The US generally has clean water. The third world, and India in particular, frequently do not.

That said, the other immune boosts are interesting here. And what would be doubly interesting is to figure out probiotics that prevent allergies.

We've known for years that a child who is exposed to real illnesses in a dirty environment may die from that, but won't generally go on to develop asthma. In the developed world we have a lot of health problems coming from the immune system looking so hard for threats that it starts attacking your own body.

There is very, very good reason to believe that the right probiotics would solve this problem. However discovering what those probiotics are is not so simple...

That's standard procedure for clinical trials.

But a single strain of bacteria can do that? I would say that’s pretty surprising and if so a major discovery. I don’t currently have any such magic pills that I’m taking...

The researchers and their parents won't be though.

It's a double-blind study. The people conducting the study should not know who is in which group. They should be randomly administering either a probiotic or an identical looking placebo.

It really depends on what you need. I would be careful around soil based species, and avoid D-lactic acid producers (which eliminates a whole lot of probiotics), but apart from that you can just get what you need. E.g. if you have a problem with histamine intolerance you could go for strains that eat/reduce histamine. If you want better mood, you could try L Plantarum 299v or Bifidobacterium Longum or L casei shirota.

I've had a lot of luck with this brand: https://www.amazon.com/Dr-Mercola-Complete-Probiotics-Supple.... Take 2 each AM.

By "luck" I mean I haven't got the common cold in over 2 years since I started taking them. I'm sure there are other variables I'm not taking into account, e.g., exercise and healthy eating, my age (35), etc. but they're inexpensive and I don't see any reason not to take them.

EDIT: here are the strains that this brand includes (notably Lactobacillus plantarum, as mentioned in the study):

Lactobacillus acidophilus DDS-1, Bifidobacterium lactis, Lactobacillus plantarum, Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus brevis, Bifidobacterium longum, Lactobacillus salivarius, streptococcus thermophilus, and Bifidobacterium bifidum

I can recommend https://en.wikipedia.org/wiki/Lactobacillus_reuteri . Try these ones: https://www.biogaia.com/

99.8% and 99.7% of the births were vaginal for those receiving the placebo and the probiotics, respectively.

https://www.nature.com/articles/nature23480.epdf

are there any though? From the article, it seems that they had to cultivate the colonies themselves.

This strain is in milk kefir, no? Easy to cultivate at home.

See also: http://www.bbc.co.uk/news/health-38800977

Water kefir is also available :)

When my son was born I did a bunch is research on probiotics with good scientific evidence of efficacy. I ended up getting him these which contain most of the promising/researched strains. It's also a liquid which helps in giving it to a baby. I'm pretty convinced that a good probiotic and Onega3 supliment are extremely beneficial.

https://www.amazon.com/BIOAMICUS-COMPLETE-Toddler-Probiotic-...

But 115-strain is not the strain mentioned in this study, isn't it? So your point of bringing up this product is??!! I meant, isn't one major point of this study is "not all probiotics are the same and finally someone found one is actually very helpful to new born babies"?