Probiotics: Are They as Good as is Claimed
In childhood, recurrent abdominal pain in children is a common complaint. The reason behind it is what needs further investigation as it affects approximately 10% of children. It is a descriptive umbrella term and accounts for many visits to primary, secondary, and emergency care facilities. It is now referred to as one of four functional abdominal pain disorders; dyspepsia, abdominal migraine, irritable, bowel syndrome and functional abdominal pain. One thing most parents need to keep in mind is when was the last time the child had a bowel movement. This author pointed out that there are many conditions of abdominal pain that require no intervention. Routine use of pharmacotherapy for functional abdominal pain is not well supported or suggested. In fact, in some cases, medications can mask the signs and symptoms needed to monitor for a more serious condition. It is felt some doctors will prescribe probiotics just so the parents will feel something is being done in a condition that needs no treatment at the time and will be sell limiting (Edwards, 2018).
Probiotics for Childhood Diarrhea
Gastroenteritis accounts for approximately 1.7 million visits to the emergency room departments by children each year. Information to determine if the use of probiotics help with the children’s outcomes has been seriously lacking up to now. The researchers looked at two outcomes; one was moderate to severe gastroenteritis (verified after admission to the trial) and the other was the duration of diarrhea and vomiting. Unscheduled doctor visits and the presence of adverse events were also included.
The results showed there was no difference between the placebo group and the probiotic group for any of the outcomes. This included if the probiotic helped shorten the time the children were troubled with diarrhea, unscheduled visits to their doctor, or if they developed vomiting as well. So this study has rightfully concluded that twice daily (usual dosing) doses of probiotic did not prevent the development of moderate to severe gastroenteritis within 14 days after enrollment (Freedman et al, 2018).
What are Probiotics
Probiotics are micro-organisms that are harmless when consumed but can affect the gut health of the person ingesting them. The human intestinal tract is home to more than 500 different species of bacteria. And while some have a positive effect on human health some 35% to 50% are actually bacteria that can cause illnesses if the conditions in the bowel are right. Probiotics can influence both human and animal health by modulating microbiota of the intestine.
Different strains of bacteria differ on the basis of who takes them. According to this study use of probiotics can repair and prevent damage to the intestine. There is expanding evidence that a couple of probiotics can produce defensive immune response enough to raise resistance to microbial pathogens. In about 20% of antibiotic taking patients, reports of suffering diarrhea afterward are a common complaint.
It is due to an imbalance of the microbes that can cause a decrease in flora with the result of decreasing capacity of fermentation of the bowel-needed for proper breakdown of food. The study also found that the use of probiotics can reduce the length of diarrhea in children and adults. In addition, there are different studies that show irritable bowel syndrome can also be assisted with the use of probiotics.
The studies the authors looked at show some significant difference between probiotic compared to placebo. Probiotics the authors found are helpful and progressively used in the treatment of various gastrointestinal diseases. But there are two big shortcomings. One is that not all probiotics are made the same so there seems to be conflicting data as to what organisms are helped with probiotic and what ones or mixes of them work for others. The other is that most of these studies were conducted using small groups of test subjects (less than 100) so results need to be taken with a grain of salt (Konain et al, 2018).
But Probiotics Useful With Childhood Diarrhea
Probiotics are a huge money-making industry. Claims have been made that these substances are an alternative effective treatment for a multitude of ailments, including diarrhea. The problem is that the recent study done by the University of Calgary, Canada. It showed that the most popular product sold to help children with what is wrongly referred to as stomach flu (gastroenteritis) has no more effective than the placebo did.
Hundreds of children were followed when parents brought them in with complaints of diarrhea and vomiting. After the study of some 900 children conducted across six sites in Canada and an additional ten sites in the US; the results were surprising. The researchers at first conducted the larger study after a smaller one showed promise.
Using a larger sample the researchers used two commercially available brands of probiotics. Half of the children, age range of three months to 48 months, received the probiotic for their illness and half were given a placebo. According to the researchers, the findings in both studies were consistently negative regardless of how the data was analyzed. Up to now most studies of probiotics have been small and industry-funded. Health care products marketers need to have claims verified and have a central body to oversee quality and dosages of the individual probiotics as they are produced (University of Calgary, 2018).
Are Probiotics Really Helpful
World Health Organization has said that probiotics are live organisms that given in proper amounts could induce a bettering of health problems by generating intestinal microflora in the host. The authors have found past studies attribute the benefits of probiotics from helping immunity to decreasing the inflammatory response in the intestines that often leads to diarrhea. They also found that different strains of probiotics made at different companies can have differing effects on the person’s intestines.
In recent years there have been more and more allergies being treated. Some reasons are thought to be consumption of germ-free foods, cleaner water, smaller family size, overuse of antibiotics when children are small and generally a lower exposure of children to microbes while young. Lactobacillus is one of the most popular probiotics used for diarrhea in children. In fact, it is often taken either after or while the patient is taking the antibiotic to help decrease the chance of acquiring diarrhea.
Quality of Probiotics in Question
Some strains of lactobacillus tend to be more effective than others. Again, the authors found that efficacy of the different probiotics and what to use them for can differ greatly according to the manufacturer of the product. Unfortunately, there isn’t a single regulatory group to make sure that all probiotics are created equal or even contain the same ingredients. Probiotics have been found in some studies to be very helpful while in others containing the same probiotics have a different one.
These differences in results are being investigated as for results from a study to be valid the results need to be reproducible. Because there is no universality of ingredients this poses a problem. And while clinical findings do show a correlation between allergy and intestinal microflora there continues to be the difficulty of repeatable results secondary to lack of universal amounts of probiotics from company to company (Hajavi et al, 2018).
Lack of Knowledge
Colic, regurgitation and functional constipation are common functional gastrointestinal disorders. And while the children with these disorders grow up and out of these, it can cause frequent parental concerns leading to heavy personal and economic costs to families and even cause a financial burden on public healthcare systems.
Information available to parents from social media exchanges is passing on questionable advice or suggestion of substances that have debatable usefulness and can in truth be harmful. Proper parental education can go a long way in reassurance and nutritional advice. This includes but is not limited to use of formula what type of formula and limiting the number of over the counter remedies.
Information, Instruction, Communication
Most parents don’t realize unless taught, one infant out of two shows at least one functional gastrointestinal disorder or related symptoms. In fact, excessive crying can lead to damaged relationships between parents and child. Most parents especially first-time parents, just want to know what is going on and why they are seeing the distress in their child. In order to impart proper information to the parents, clarification needs to be found between physiological changes during maturation of the gastrointestinal tract, the natural evolution of specific disorder and the parental coping mechanisms.
Examples are like for reflux and regurgitation includes feeding large amounts of liquids over a short amount of time, short intra-abdominal esophagus, or feeding in a horizontal position and the position of the infant after feeding. For colic, there is an existing theory for it. It includes immaturity of the gut function, dysmotility, imbalance of intestinal microbiota, changes in gut hormones and food sensitivities, and/or allergies. Parents, especially mom, need to be made aware that when the child cries it doesn’t always indicate pain (Salvadore et al, 2018).
As food additives increase studies must also be done to document the long-term effects they have on the human digestion. Increased studies must be done to show what effects if any probiotics have in decreasing the effects of intestinal issues like diarrhea. In order to utilize the probiotics and pair them with the various disorder, it has become clear to this group that the proper use of them need to be a personalized diet and probiotic use according to their individual gut microbiota. A study done using a randomized trial of one-week long dietary intervention showed significant interpersonal variability in glycemic response depending on the type of bread eaten. Given the current gaps in knowledge more clinical evidence is needed to be able to translate the results to clinical process (Valdes et al, 2018).
Edwards S.E. (2018). Recurrent abdominal pain in children. Pediatrics and Child Health,28(1).
Freedman, S.B. et al. (2018). Multicenter trial of a combination probiotic for children with gastroenteritis. New England Journal of Medicine,379(21).
Hajavi, J. et al. (2018). The immunomodulatory role of probiotics in allergy therapy. Journal of Cellular Physiology.
Konain, K. et al. (2018). Importance of probiotics in gastrointestinal tract. Journal of Asian Scientific Research,8(3).
Salvadore, S. et al. (2018). Review shows that parental reassurance and nutritional advice help to optimize the management of functional gastrointestinal disorders in infants. ACTA Pædiatrica-Nurturing the Child, 107(supp 1).
Valdes, A.M. et al. (2018). Role of gut microbiota in nutrition and health. The BMJ: Science and Politics of Nutrition.
University of Calgary. (2018). New Study reveals probiotics do not help children with intestinal infections. University of Calgary.