Probiotics are living microorganisms that are intended to benefit the body. While some microorganisms have a bad rap, like “germs” for example, many types are helpful.
Some help digest food, destroy disease-causing cells, and produce vitamins. There are many different types of beneficial microorganisms. This large network of microorganisms is collectively called your “microbiome”.
Microorganisms can even be found in amniotic fluid and the gut of an infant before they are born and continue to exist in the human gut for a lifetime.
Your microbiome changes and this can be good or bad.
When the microbiome becomes disturbed in a negative way sometimes additional probiotic products may help your body return to a better state of health by balancing out the community of microorganisms that lives in your gut.
Treatment for health conditions using probiotics is still being researched. It’s hard to say which probiotics are helpful, how much to take, and who would benefit from specific types.
Many of the microorganisms in probiotic products are the same as or similar to microorganisms that naturally live in our bodies. That is the point!
The seven microbial organisms most often used in probiotic products are:
Lactobacillus
Bifidobacterium
Saccharomyces
Streptococcus
Enterococcus
Escherichia
Bacillus.
Each of these have different health effects and different strains within each of these can also vary in their effects on the body.
Here are Dr. Trill’s favorite articles on probiotics:
What do probiotics have to do with breastfeeding parents with food allergy babies?
Human milk provides many of these good microorganisms to the infant's gut. They help with digestive and immune function in the developing baby. [1, 2] According to one study, the most commonly isolated species of probiotics in breastmilk belong to the genera Staphylococcus, Streptococcus, Lactobacillus, and Bifidobacterium. [3]
More sensitive studies have recovered an even higher diversity of microorganisms in breast milk including Enterococcus and Lactococcus, Veillonella, Gemella, Cutibacterium and Staphylococcus, Pseudomonas, and Sphingomonas, but these results differ significantly between individuals. [4, 5] These microorganisms in breastmilk seem to come from the maternal gut, breast tissue, and infant oral cavity. [6]
So, the gut microbiome can be one factor that contributes to shaping the microorganisms in our milk. These milk microorganisms then influence the baby’s microbiome and in turn, can impact allergy and immune responses.
There are several conditions in infants that are likely affected by probiotic microorganisms.
Colic
Some studies have shown differences in the types of microbes of babies who do have colic and those who don’t. A 2018 review of several studies involving the use of the probiotic Lactobacullus reuteri DSM 17938 to treat colic was successful in exclusively breastfed infants and no harmful effects were seen from giving babies this microbe. [7]
Necrotizing Enterocolitis
This condition can occur in premature infants and can have fatal consequences. A reaction to food components and the microorganisms that live in a premature baby’s digestive tract may contribute but the exact cause is still unclear. A 2017 review of several studies showed that probiotics helped to prevent necrotizing enterocolitis in very low-birth-weight infants. The results of each of the individual studies varied. Probiotics that included both Lactobacillus and Bifidobacterium seemed to produce the best results, but it was not possible to identify the most beneficial strains within these large groups of microorganisms. [8]
While no short-term side effects were seen, long-term effects of probiotics at a very young age are still uncertain. There have also been instances where babies developed bloodstream infections from the same microbes intended to be used for probiotic purposes. [9]
Sepsis
A serious illness in which the body has a harmful response to an infection causing major organs to stop working and can be life-threatening. The risk of sepsis is higher in infants. One group, particularly at risk for sepsis, is premature infants. A review of 37 studies (9,416 participants) found that probiotics helped reduce the risk of sepsis in premature infants. [10]
Asthma
New research is suggesting a link between milk microorganisms, pediatric asthma, and allergy by way of modulation of gut microorganisms. However, commercial probiotics for asthma prevention are still inconclusive. [11]
Eczema
Some studies and meta-analyses show that exposure to probiotics during pregnancy and in early infancy might reduce the risk of developing eczema in children. A 2018 meta-analysis included 27 randomized controlled trials (RCTs) and one controlled cohort study in a total of 6,907 infants and children exposed to probiotics in utero for 2 weeks to 7 months (via maternal oral supplementation) and/or by oral administration to the infants after birth for 2 to 13 months. Between ages 6 months and 9 years, probiotic treatment with single strains or mixtures that included Lactobacillus, Bifidobacterium, and Propionibacterium strains significantly reduced the risk of atopic dermatitis (eczema) from 34.7% in the control group to 28.5% in the probiotic group. [12]
Allergen-free options
Often, well-intentioned nursing parents do not realize that their probiotics contain allergens. Most over-the-counter probiotics are considered supplements and are therefore under less FDA scrutiny and regulations than food products. This can mean that standard procedures, such as allergen cross-contamination prevention, may be less stringent.[13]
After years of working with lactating parents, I’ve found dietary logs can be inadequate due to such hidden allergens. Often, when digging deeper into the dietary intake, we discover a culprit found in a seemingly benign supplement, beverage, or seasoning. Without a method to directly test human milk, families will often continue to methodically cut out whole food groups without realizing that the true problem is going undetected.
Those who can take probiotic supplements without infant allergic symptoms can certainly continue to do so. Those who have removed suspected food culprits should review ALL supplements to ensure the eliminated food is not sneaking in undetected. Specialized supplements with a “Free From” explicit statement (i.e. “Soy Free”) may be the easiest route. Consult your baby’s physician for nursing and supplementation best practices and questions.
Main Takeaways For Breastfeeding Parents About Probiotics
Microorganisms are shown to improve many common infant food allergy symptoms and more. Not only does the above research show the role these "bugs" play in specific conditions, but it’s also interesting to consider maternal digestion's impact. Additional research is needed to determine if improved maternal digestion would reduce the number of consumed food molecules that transfer to breast milk.
If you’re trying to find your baby’s trigger, the Free to Feed app was made with you in mind. It not only tracks your baby’s symptoms but also your food intake. We’re here to help and remind you, you’re doing a great job!
Authors
Katie Plummer, M.S. & Trill Paullin, Ph.D.
References:
Andreas NJ, Kampmann B, Mehring Le-Doare K. Human breast milk: a review on its composition and bioactivity.Early Hum Dev. (2015) 91:629–35. doi: 10.1016/j.earlhumdev.2015.08.013 21.
Ardeshir A, Narayan NR, Mendez-Lagares G, Lu D, Rauch M, Huang Y, et al. Breast-fed and bottle-fed infant rhesus macaques develop distinct gut microbiotas and immune systems.Sci Transl Med. (2014) 6:252ra120. doi: 10.1126/scitranslmed.3008791 22. Munblit D, Peroni DG, Boix-Amoro
Heikkila MP, Saris PEJ. Inhibition of Staphylococcus aureus by the commensal bacteria of human milk. J Appl Microbiol. (2003) 95:471–8.doi: 10.1046/j.1365-2672.2003.02002.
Moossavi S, Khafipour E, Sepehri S, Robertson B, Bode L, Becker AB, et al. Maternal and early life factors influencing the human milk microbiota in the child cohort. In: Poster Session Presented at: Canadian Society of Microbiololists. Waterloo, ON: (2017).
McGuire MK, McGuire MA. Got bacteria? The astounding, yet not-so-surprising, microbiome of human milk. Curr Opin Biotechnol. (2017) 44:63–8. 10.1016/j.copbio.2016.11.013
Fernandez L, Langa S, Martin V, Maldonado A, Jimenez E, Martin R , et al. The human milk microbiota: origin and potential roles in health and disease.Pharmacol Res. (2013) 69:1–10. doi: 10.1016/j.phrs.2012. 09.001 52.
Dryl R, Szajewska H. Probiotics for management of infantile colic: a systematic review of randomized controlled trials. Arch Med Sci. 2018;14(5):1137–1143. doi:10.5114/aoms.2017.66055
Thomas JP, Raine T, Reddy S, et al. Probiotics for the prevention of necrotizing enterocolitis in very low-birth-weight infants: a meta-analysis and systematic review. Acta Paediatrica. 2017;106(11):1729-1741.
Didari T, Solki S, Mozaffari S, et al. A systematic review of the safety of probiotics. Expert Opinion on Drug Safety. 2014;13(2):227–239.
Rao SC, Athalye-Jape GK, Deshpande GC, et al. Probiotic supplementation and late-onset sepsis in preterm infants: a meta-analysis. Pediatrics.2016;137(3):e20153684.
Moossavi, S., Miliku, K., Sepehri, S., Khafipour, E., & Azad, M. B. (2018). The Prebiotic and Probiotic Properties of Human Milk: Implications for Infant Immune Development and Pediatric Asthma. Frontiers in pediatrics, 6, 197. https://doi.org/10.3389/fped.2018.00197
Li L, Han Z, Niu X, Zhang G, Jia Y, Zhang S, et al. Probiotic supplementation for prevention of atopic dermatitis in infants and children: a systematic review and meta-analysis. Am J Clin Dermatol 2018.
Bravender, Terrill. "Dietary Supplements: Caveat Emptor Redux." Journal of Adolescent Health 65.4 (2019): 433-434.