Reflections on sequencing probiotics

A reader sent me a list of the probiotics that she took every day. The list is a nice collection, but she disclosed that she was taking ALL of them every day, with about 2 hours between each. She was legitimately concerned that one probiotic was reducing the effect of others. The size of the list shows that there are many PubMed studied probiotics available without prescriptions — but only a few available in your local health food store…

Bifidobacterium Longum BB536
Femdophilus (Lactobacillus thramnosis GR-1 and Lactobacillus reuteri RC-14)
Securil (Propionibacterium freudenreichii)
Mutaflor (E.Coli Nissle 1917)
Yakult ( Lactobacillus casei Shirota strain)
Probiotic 3 AOR (Streptococcus faecalis T-110, Clostridium butyricum TO-A, Bacillus mesenericus TO-A)
Align (Bifidobacterium infantis 35624)
Miyarisan (clostridium butyricum MIYAIRI 588)
Culturelle (Lactobacillus Rhamnosus GG)
Prescript Assist (many families and species)
DanActive (L.Casei Immunitas aka L.Casei DN-114 001, L. Bulgaricus, S.Thermophilus)
Microbiome Plus (L.Reuteri NCIMB 30242)

What we know

There is a lot of “common sense” out there — separate them by 2 hours from antibiotics, etc. As readers are aware, I tend to check common sense — because it is often wrong. The reality is that therapeutic probiotics such as the above produces antibiotics effective against other species. The bacteria in probiotics actually tries to build a consensus of like-minded bacteria – think of a political party – you may get some Mormons, Jews, Blacks, Spanish, Asians etc in the party. Many may actually be working against the “common or dominating behavior” of their ethic community. The same things happen with bacteria.

The ideal situation is when there have been studies of two probiotics taken together: Have there been an amplification or reduction of observed changes? For drugs, this happen, for example Heparin + Piractem has greater effect than adding the effect of Heparin and Piracetam taken separately.

With 9 bacteria, it means doing 9 x 8 = 72 PubMed searches to see if there have been ANY studies. I removed the stains to do a wider search. I did get some hits, of which the significant ones are below:

  • Propionibacterium freudenreichii and Lactobacillus reuteri both impact Meticillin-resistant Staphylococcus aureus [2013]
  • Lactobacillus reuteri, Lc. lactis and P. freudenreichii reduced viability of adherent Staph. aureus by 27-36%, depending on the strain,“[2006]

  • “Some trials showed a significant improvement of irritable bowel syndrome-related constipation via Lactobacillus casei Shirota and E. coli Nissle 1917.” [2005]

  • “data suggests a favourable effect of treatment with Bifidobacterium lactis DN-173 010, Lactobacillus casei Shirota, and Escherichia coli Nissle 1917 on defecation frequency and stool consistency.” [2010]
  • “heat treatment increased the adhesion of Propionibacterium freudenreichii and gamma-irradiation enhanced the adhesion of Lactobacillus ç.”[2000]
  • Bifidobacterium longum subsp. infantis M-63 and B. longum subsp. longum BB536..was significantly higher than that in the one-species group at weeks 1 and 6. [2013]
  • “The antimicrobial activity of the intraurethrally administered probiotic Lactobacillus casei strain Shirota against Escherichia coli …L. casei Shirota exerted significant antimicrobial effects… L. reuteri JCM 1112(T), had no significant antimicrobial activity.” [2001]
  • “Bifidobacterium infantis 35624 preferentially induced IL-10. Escherichia coli Nissle 1917 induced both IL-10 and IL-12p70.. When combining these microorganisms with the Th1-promoting cocktails, E. coli Nissle 1917 and B. infantis 35624 were potent suppressors of IL-12p70 secretion in an IL-10-independent manner, indicating a suppressive effect on Th1-inducing antigen-presenting cells.” [2011]
  • The rat strain Lactobacillus reuteri R2LC, but not the human strain Lactobacillus rhamnosus GG, is of benefit in reducing the severity of acetic acid-induced colitis in rats. [2001]

  • Two strains (Lactobacillus rhamnosus strain GG and L. reuteri) were found to exhibit disease-specific adhesion to intestinal tissue. All tested strains, with the exception of L. rhamnosus strain GG, displayed disease-specific adhesion to intestinal mucus. [2003]

  • while both Lb. reuteri and Lb. rhamnosus GG reduced the acetaldehyde to ethanol [2004]

  • We found that mice that received GG and PJS[Propionibacterium freudenreichii] exhibited significantly lower numbers of intestinal mast cells compared with control mice.[2013]

  • Shirota and GG similar impact on bladder tumors [2010]
  • “This is reflected in the solid evidence for the effect of E. coli Nissle 1917 (Mutaflor) in the maintenance of remission of ulcerative colitis, and of VSL#3(contains L. Bulgaricus, S.Thermophilus)  in preventing the recurrence of pouchitis.”[2006]
  • “Four probiotic bacteria, Lactobacillus rhamnosus, Propionibacterium freudenreichii subsp. shermanii 56, P. freudenreichii subsp. shermanii 51, and P. freudenreichii subsp. freudenreichii 23, were evaluated individually or in coculture with traditional yogurt cultures (Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus salivarius subsp. thermophilus)…Texture and flavor attributes of fermented milks produced with propionibacteria were significantly different than the fermented milks processed with yogurt cultures.. in coculture with yogurt cultures demonstrated similar acidity, texture, and flavor as the fermented milk produced with yogurt cultures.”[2005] i.e. evidence that the yogurt cultures may have eliminated the others…

From the above, I concluded that the following groups are more likely to be friendly to each other than fight each other (based on similarity of action in many cases – same action implies similar chemicals being produced):

  • Propionibacterium freudenreichii x Lactobacillus reuteri x Lactobacillus casei Shirota x Lactobacillus rhamnosus GG
  • E. coli Nissle 1917 x Lactobacillus casei Shirota x Lactobacillus reuteri B. infantis 35624 x Lactobacillus rhamnosus GG
  • Bifidobacterium longum infantis M-63 and B. longum subsp. longum BB536

Suggested schedule

The goal is to get healthy bacteria established. Many PubMed studies used a 14 day study to detect impacts of probiotics [2014][2014] suggesting that clinical study experience has been that this duration is essential.

Do each for 1-2 weeks:

  • Mutaflor with Yakult and Femdophilus and Culturelle and Microbiome Plus and DanActive
  • Securil with Yakult and Femdophilus and Culturelle and Microbiome Plus but NOT DanActive or any yogurts
  • Bifidobacterium Longum BB536 and Align
  • Probiotic 3 AOR and Miyarisan
  • Prescript Assist

Why are strains important?

Only six probiotic Lactobacillus strains isolated from human intestinal microbiota, i.e., L. rhamnosus GG, L. casei Shirota YIT9029, L. casei DN-114 001, L. johnsonii NCC 533, L. acidophilus LB, and L. reuteri DSM 17938, have been well characterized with regard to their potential antimicrobial effects against the major gastric and enteric bacterial pathogens and rotavirus.” [2014]

Taking a different strain may have zero effect (except for reduced bank account). Also, as a FYI “Lactinex(®), Align(®), Bio-K+(®), and Culturelle(®) had viable colony counts that were similar to those stated on the package.” [2014]