From the Guidelines
For inflammation, the most effective probiotic formulation is the 8-strain combination of L. paracasei subsp paracasei, L. plantarum, L. acidophilus, L. delbrueckii subsp bulgaricus, B. longum subsp longum, B. breve, B. longum subsp infantis, and S. salivarius subsp thermophilus, as suggested by the AGA guidelines 1.
Key Points to Consider
- This formulation has been specifically studied for inflammatory conditions and has shown potential benefits in maintaining remission in chronic pouchitis and preventing acute pouchitis 1.
- Look for supplements containing multiple strains with at least 10-15 billion CFUs (colony-forming units) per serving.
- For general anti-inflammatory benefits, take probiotics daily for at least 8-12 weeks to see results, preferably on an empty stomach in the morning or before bed.
- These beneficial bacteria work by balancing gut microbiota, strengthening the intestinal barrier, and modulating immune responses that drive inflammation, as seen in studies on preterm infants where probiotics accelerated metabolic transition towards a term infant profile and facilitated a less pro-inflammatory state 1.
- They produce short-chain fatty acids like butyrate that have direct anti-inflammatory effects and can reduce inflammatory markers such as C-reactive protein and cytokines.
Important Considerations
- For specific inflammatory conditions like inflammatory bowel disease or rheumatoid arthritis, higher doses (up to 100 billion CFUs) may be needed, but consult with a healthcare provider before starting high-dose regimens, especially if you're immunocompromised or have serious health conditions.
- The use of probiotics in children and adults with irritable bowel syndrome is not recommended outside of a clinical trial due to significant heterogeneity in study design, outcome, and probiotics used, and the overall quality of evidence being very low 1.
- In children with acute infectious gastroenteritis, the use of probiotics is not suggested due to moderate quality of evidence showing no benefit in the United States and Canada 1.
From the Research
Probiotics for Inflammation
- Probiotic bacteria may confer several benefits, including prevention against intestinal inflammation, by inhibiting pathogen adhesion and maintaining the correct organization of the tight junction and cytoskeleton proteins 2
- The combination of Lactobacillus acidophilus and Bifidobacterium animalis subsp. lactis has been shown to have a stronger anti-inflammatory effect than individual strains in HT-29 cells, by modulating TLR2-mediated NF-κB and MAPK signaling pathways 3
- A fixed combination of probiotics, vitamins, and herbal extracts has been found to have a favorable effect on intestinal inflammation, improving the integrity of Occludin and Zonula Occludens-1 (ZO-1) proteins, and reducing paracellular permeability 4
Specific Probiotic Strains
- Lactobacillus acidophilus, Bifidobacterium lactis, and Lactobacillus salivarius have been found to reduce abdominal pain and inflammatory biomarkers in acute uncomplicated diverticulitis, when used in combination with conventional antibiotics 5
- VSL#3, a probiotic mixture, has been found to be effective in inducing remission in active ulcerative colitis (UC), and may be as effective as 5-aminosalicylates (5-ASAs) in preventing relapse of quiescent UC 6
Mechanisms of Action
- Probiotics may exert anti-inflammatory effects by modulating the gut immune system, and preventing hypersensitivity reactions to food proteins and normal microflora 2
- Probiotics may also modulate T regulatory cells, and induce interleukin 10 and interleukin 10-dependent T regulatory cells, to reduce inflammation 2
- The combination of probiotics and other nutrients, such as vitamins and herbal extracts, may have a synergistic effect in reducing inflammation 4