What are the most effective probiotics to reduce systemic inflammation?

From the Guidelines

The most effective probiotic for reducing systemic inflammation in patients with recurrent pouchitis is the De Simone formulation of multistrain probiotics, as suggested by the AGA clinical practice guideline on the management of pouchitis and inflammatory pouch disorders 1.

Key Considerations

• The De Simone formulation has been used in clinical trials for the prevention of pouchitis, and its effectiveness is supported by the AGA guideline, although with a conditional recommendation and very low certainty of evidence.
• When selecting a probiotic, it is essential to choose a product with a multistrain formulation, as this may provide a broader range of benefits.
• The optimal dosage and duration of probiotic supplementation are not well established, but a daily dose of at least 10-30 billion CFUs (colony-forming units) for at least 8-12 weeks may be beneficial.

Implementation Considerations

• Patients with compromised immune systems should consult healthcare providers before starting probiotics.
• Results may vary between individuals, and some may experience temporary digestive adjustments like mild bloating when first starting supplementation.
• Probiotics should be stored according to package instructions, as many require refrigeration to maintain potency.

Evidence Summary

• The AGA guideline suggests using probiotics for preventing recurrent pouchitis in patients with UC who have undergone IPAA and experience recurrent episodes of pouchitis that respond to antibiotics 1.
• A 2020 technical review on the role of probiotics in the management of gastrointestinal disorders found that the evidence for the use of probiotics in reducing systemic inflammation is limited and of low certainty 1.
• A 2017 review of existing meta-analyses on the use of probiotics in clinical practice found that there is insufficient evidence to demonstrate the effectiveness of probiotics in maintaining remission in patients with IBD 1.

From the Research

Most Effective Probiotics for Reducing Systemic Inflammation

The most effective probiotics for reducing systemic inflammation include:

• Lactobacillus acidophilus and Bifidobacterium animalis subsp. lactis, which have been shown to have a stronger anti-inflammatory effect when combined than when used individually 2
• VSL#3 and Escherischia coli Nissle 1917, which have been found to be effective in inducing remission in patients with mild to moderate ulcerative colitis (UC) 3
• Bifidobacterium lactis, Lactobacillus acidophilus, Lactiplantibacillus plantarum, and Saccharomyces boulardii, which have been found to regulate wound healing and chemokine responses in human intestinal subepithelial myofibroblasts 4
• B. longum subsp. infantis, which has been found to decrease colonic lipopolysaccharide concentrations and reduce the proinflammatory tone 5

Key Findings

Key findings from the studies include:

• The combination of Lactobacillus acidophilus and Bifidobacterium animalis subsp. lactis has been shown to reduce interleukin (IL)-8 secretion and the expressions of phosphorylated p65 nuclear factor-kappa B (p-p65 NF-κB), phosphorylated p38 mitogen-activated protein kinase (p-p38 MAPK), vascular cell adhesion molecule-1 (VCAM-1), and cyclooxygenase-2 (COX-2) 2
• Probiotics have been found to have a positive effect on the treatment and maintenance of UC, and may also be beneficial in the treatment of other associated pathologies such as pouchitis and cholangitis 6
• The use of probiotics, prebiotics, and synbiotics may become an alternative form of therapy for inflammatory bowel diseases (IBD) 3
• Specific probiotic bacteria, such as B. longum subsp. infantis, may decrease colonic lipopolysaccharide concentrations and reduce the proinflammatory tone 5

Probiotic Strains and Their Effects

Different probiotic strains have been found to have different effects on systemic inflammation, including:

• Lactobacillus acidophilus and Bifidobacterium animalis subsp. lactis, which have been shown to have a stronger anti-inflammatory effect when combined than when used individually 2
• Bifidobacterium lactis, Lactobacillus acidophilus, Lactiplantibacillus plantarum, and Saccharomyces boulardii, which have been found to regulate wound healing and chemokine responses in human intestinal subepithelial myofibroblasts 4
• B. longum subsp. infantis, which has been found to decrease colonic lipopolysaccharide concentrations and reduce the proinflammatory tone 5