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And there's likely to be a huge difference between the pharmaceutical-grade probiotics that show promise in clinical trials and the yoghurts and supplements sold in shops. Healthy bacteria are required to support both the digestive tract and the urogenital tract in women. For example, most urinary tract infections (UTIs), often referred to as cystitis, are caused by a species of bacteria called Escherichia coli ( E. coli), which generally live happily alongside the good bacteria in the gut and urogenital tract, but can sometimes grow and cause infection. International Scientific Association for Probiotics and Prebiotics. Deciphering a probiotic label . 2017.
A meta-analysis of 30 RCTs with 1,624 participants (mostly adults age 18 years or older) demonstrated that those treated with probiotics for 3 to 12 weeks had 7.8 mg/dL lower total cholesterol and 7.3 mg/dL lower LDL cholesterol concentrations than those treated with placebo [ 54]. In subgroup analyses, the benefits of probiotics were slightly greater in studies that lasted 8 weeks or longer and in participants who had baseline cholesterol levels higher than 240 mg/dL. Among the strains included in more than three studies, Lactobacillus acidophilus, a mixture of Lactobacillus acidophilus and Bifidobacterium lactis, and Lactobacillus plantarum were associated with significant reductions in total and LDL cholesterol concentrations, but Lactobacillus helveticus and Enterococcus faecium were not. In a smaller meta-analysis of 11 RCTs in 602 adults with normal or high cholesterol levels, those treated with probiotics for 2 to 10 weeks had 6.6 mg/dL lower total cholesterol and 8.5 mg/dL lower LDL cholesterol levels than those treated with placebo, but the probiotic treatment had no significant effects on HDL cholesterol levels [ 55]. The effects were most pronounced with consumption of probiotics for more than 4 weeks by participants with hypercholesterolemia and those age 45 or older. In both meta-analyses, participants included both healthy adults and adults with hypercholesterolemia, CVD, diabetes, or obesity. Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 2014;11:506-14. [ PubMed abstract] The urogenital tract comprises both the urinary tract and the vagina and both contain a microbiome (bacteria) in the same way as the gastrointestinal tract. Lactobacillus is the primary bacteria of the vagina of healthy women and the growth of too many other strains can lead to an imbalance in the natural bacteria of the vagina. Wilkins T Sequoia J. Probiotics for gastrointestinal conditions: a summary of the evidence. Am Fam Physician 2017; 96: 170-8. [ PubMed abstract]
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Iheozor-Ejiofor Z, Kaur L, Gordon M, Baines PA, Sinopoulou V Akobeng AK. Probiotics for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev 2020; 3: Cd007443. [ PubMed abstract] Because probiotics are strain-, disease-, and symptom-specific, no single probiotic is more effective overall than others. The microbiome is made up of many different species of bacteria, some of which are considered friendly and others termed pathogenic. The bacteria line the gut wall and help to stop toxins and harmful substances passing through the gut into the body – so ideally, we need a lot more good than bad. The ideal ratio has been estimated at 85% good to 15% bad bacteria and if this balance is affected it may lead to digestive symptoms such as bloating or irritable bowel syndrome (IBS). Though more research in humans is needed, some studies suggest that phages, including the phages in Culturelle Women’s 4-in-1 Protection, could be used as an alternative treatment for UTIs, including antibiotic-resistant UTIs.
Ingredients: We looked for products that are made from high quality ingredients and free of artificial additives and fillers. Certain unfermented foods, such as milks, juices, smoothies, cereals, nutrition bars, and infant and toddler formulas, have added microorganisms. Whether these foods are truly probiotics depends on the microorganism levels they contain when they are eaten, whether they survive intestinal transit, and whether their specific species and strains have health effects. Dietary supplements Good products. Digestive system seems to be more efficient with the inclusion of these probiotic multis.Jafarnejad S, Shab-Bidar S, Speakman JR, Parastui K, Daneshi-Maskooni M, Djafarian K. Probiotics reduce the risk of antibiotic-associated diarrhea in adults (18-64 years) but not the elderly (>65 years): a meta-analysis. Nutr Clin Pract 2016;31:502-13. [ PubMed abstract] Each serving of Culturelle Women’s 4-in-1 Protection contains 15 billion CFUs of the following probiotic strains: Borriello SP, Hammes WP, Holzapfel W, Marteau P, Schrezenmeir J, Vaara M, et al. Safety of probiotics that contain lactobacilli or bifidobacteria. Clin Infect Dis 2003;36:775-80. [ PubMed abstract]
Tsai CC, Lin PP, Hsieh YM, Zhang ZY, Wu HC, Huang CC. Cholesterol-lowering potentials of lactic acid bacteria based on bile-salt hydrolase activity and effect of potent strains on cholesterol metabolism in vitro and in vivo. ScientificWorldJournal 2014;2014:690752. [ PubMed abstract] Several meta-analyses have assessed the role of probiotics in patients with IBS [ 42-46]. Most have found that probiotics have a positive, although modest, beneficial effect. For example, a meta-analysis of 23 RCTs in a total of 2,575 patients found that, overall, probiotics reduced the risk that IBS symptoms would persist or not improve by 21% [ 42]. Various species and strains of probiotics had beneficial effects on global IBS symptoms, abdominal pain, bloating, and flatulence scores, but the quality of the studies was low. Some combinations of probiotics were superior to individual strains in this analysis, but no specific combination was superior to another. A second meta-analysis of 15 RCTs in a total of 1,793 patients with IBS found that probiotics reduced overall symptoms and abdominal pain more than placebo after 8 to 10 weeks of therapy; in children, these supplements also improved mucosal barrier function [ 43]. While products are not routinely tested for purity and potency by a third-party lab, the company states that it takes multiple measures to ensure quality and safety. Research into the role of the microbiome in health has to date included studies on digestive issues such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), immunity (including allergy, respiratory tract infections and autoimmunity), the gut-brain axis and general areas of health, such as energy and weight.Overall, research suggests that the use of multiple probiotic strains in combination as well as of probiotics containing Lactobacillus acidophilus, a mixture of Lactobacillus acidophilus and Bifidobacterium lactis, or Lactobacillus plantarum might reduce total and LDL cholesterol levels. However, more research is needed to confirm these findings. Obesity In contrast, another meta-analysis of five randomized clinical trials with a total of 889 participants found that Lactobacillus rhamnosus GG (LGG) supplementation did not reduce the risk of eczema in children up to age 4 years, regardless of the timing of administration (to the mothers during pregnancy and/or during breastfeeding or to the infants directly) [ 14]. Principi N, Cozzali R, Farinelli E, Brusaferro A, Esposito S. Gut dysbiosis and irritable bowel syndrome: The potential role of probiotics. J Infect 2018;76:111-20. [ PubMed abstract] Whether different strains of probiotic bacteria have beneficial effects on IBS probably depends on the IBS symptom being evaluated [ 48]. In a meta-analysis of 10 RCTs with a total of 877 adults treated with probiotics or placebo for 4 weeks to 6 months, pain scores improved significantly with administration of probiotics containing Bifidobacterium breve, Bifidobacterium longum, or Lactobacillus acidophilus species compared with placebo treatment [ 49]. In contrast, Streptococcus salivarius ssp. thermophilus, Bifidobacterium animalis, Bifidobacterium infantis, Lactobacillus casei, Lactobacillus plantarum, Lactobacillus bulgaricus, and Saccharomyces boulardii had no significant effect. The abdominal distension scores improved with use of probiotics containing Bifidobacterium breve, Bifidobacterium infantis, Lactobacillus casei, or Lactobacillus plantarum species. Flatulence declined with use of all tested probiotics, but the studies showed no positive effect of probiotics on quality of life.
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