CASE STUDY
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THE ROLE OF PROBIOTICS IN
HEALTHCARE: PAST, PRESENT,
AND FUTURE
PROBIOTICS AND GUT HEALTH
Gut health and how it impacts our overall health has been a growing topic of interest and
investigation for several years. What seems to be emerging from the research is that an
imbalance in the gut microbiome — not having enough healthy microbes to fight off less healthy
ones — can make us more susceptible to a wide range of illnesses.
Several factors can damage gut health. According to Rosemary Pauley, APRN, MS, FNP, pediatric
gastroenterology at Boys Town National Research Hospital, she sees the impact on children who
might not have had good microbiome colonization at birth, which can happen with cesarean
delivery. She says children who take a lot of antibiotics in their first year of life can also have gut
issues 10, 20, or 30 years down the road. Anesthesiologist and Critical Care Specialist, Dr. Paul
Wischmeyer, M.D., at Duke University Hospital, agrees, saying that evolutions in medicine and
even a Western diet have led to major disruptions of what the normal bacteria living in our gut
should look like. “That has set us up to be prime victims of gastrointestinal disorders, autoimmune
diseases, pandemics like COVID, allergies, obesity and more,” he says.
WHERE THE RESEARCH BEGAN
Pauley has been working in pediatric gastroenterology for nearly 40 years. In that time, she's seen
the research and attitudes toward the value of probiotics evolve. “When I started in the field, we
didn't know much about probiotics,” she explains. “So we just didn't use them.”
It wasn't until the early to mid-2000s that the research into various strains of probiotics started to
take off. That's when Pauley, and the doctor she still works with today, were asked to lead some
studies. “We were particularly interested in the effect of probiotics on Clostridioides difficile — or
C. diff – and antibiotic associate diarrhea,” she says.
Around this time, Wischmeyer began researching the effects of probiotics in critical care explicitly
related to pneumonia and peritonitis in animals. “We found that the animals we gave probiotics
to, before the illness had a chance to damage the gut, did not get nearly as sick as those that
had no probiotics.” What was really exciting, he says, is that they found no bacteria got into the
bloodstream at all. “Normally, when you have severe pneumonia or a leaky gut causing peritonitis,
bacteria will get into the bloodstream and lead to infection everywhere.” As his career progressed,
Wischmeyer was also involved in the first longitudinal study of microbiome changes in critically
ill patients. The multicenter trial found that ICU patients experienced dramatic losses of healthy
Rosemary Pauley,
APRN, MS, FNP
Pediatric Gastroenterology
Nurse Practitioner
~ Boys Town National
Research Hospital
John Damianos, M.D.
Internal Medicine,
Resident, Yale New
Haven Hospital incoming
Gastroenterology and
Hepatology
~ Fellow, Mayo Clinic
Paul Wischmeyer, M.D.,
E.D.I.C., FASPEN, FCCM
Professor of Anesthesiology
and Surgery, Associate Vice
Chair for Clinical Research,
Dept. of Anesthesiology,
Physician Director,
TPN/Nutrition Support
Service, DUH
~ Duke University, School
of Medicine
CASE STUDY
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bacterial families within a day of being admitted. “We saw incredible growth of pathogenic
bacteria that would just take over the gut and cause severe infection.”
PROBIOTICS IN ACTION TODAY
In his practice, Dr. John Damianos, M.D., Internal Medicine at Yale New Haven Hospital, works in
inpatient and outpatient environments. He recommends probiotics for people taking a course of
antibiotics, as many physicians do today, and for other GI-related issues such as irritable bowel
syndrome, functional dyspepsia, pouchitis, and more. He says there's also developing evidence
that probiotics can increase the likelihood of Helicobacter pylori eradication when combined with
the current standard of care of either triple or quadruple therapy. “So there are really multiple
specific indications that I'm recommending probiotics for — but I'm not recommending taking any
probiotic off the shelf. I'm recommending specific strains or mixes of strains that specify doses
based on clinical trial data for people.”
Pauley regularly uses probiotics for babies with allergic colitis due to an allergy to cow's milk
or sometimes even breast milk. “I've also found probiotics useful in treating post-COVID and
other post-viral diarrhea that seems to linger,” she says. Beyond that, she notes there is growing
research that indicates probiotics can affect the immune system in a way that makes people less
prone to viral infections. “This seems to be especially true for people — like some of the children,
teenagers, and young adults I see — who don't have great diets or access to whole foods, so the
daily use of a probiotic is interesting to me in those cases.”
In addition to his role as a critical care physician, Wischmeyer is also the director of the nutrition
team at Duke University Hospital and associate vice chair for clinical research for the department
of anesthesiology. As a result, he spends about half his time researching nutrition, exercise,
probiotics, and microbiomes to help people prepare for surgery and bone marrow transplants to
lower the risk of pneumonia and hospital-acquired infections. “We know, for instance, probiotics
can reduce C. diff by as much as 70%.” This is important, he explains, because C. diff is one of the
fastest-growing iatrogenic diseases he sees today.
A large meta-analysis has also indicated that using a probiotic can reduce the risk of upper
respiratory infection by as much as 50%. This led Wischmeyer and his team to study the effect
of probiotics to help minimize the spread of COVID-19. Funded through the FDA's Investigational
New Drug (IND) program, the study used Culturelle® probiotics, delivering the probiotic strain
Lactobacillus rhamnosus GG. “Although the study was small, we had some encouraging signals,”
he says. “Our initial data showed that we could significantly reduce the symptoms from COVID-19
and the actual time to diagnosis.”
CHOOSING THE RIGHT PROBIOTIC
“The thing to understand is that not all probiotics are the same,” says Pauley. “You need to
know you're using the right one for the right condition.” And that, she says, comes down to
the data. Damianos, who serves on the Scientific Advisory Committee for the Alliance for
Education on Probiotics (AEProbio), an international organization focused on advancing the
science of probiotics, agrees. “One of the challenges in the field is that probiotics are considered
supplements, so they aren't regulated in the same way as medications.” Although there's a lot of
research and funding going into the field, there's a lot of misinformation out there as well. He says
this leads many people to write probiotics off as a class.
That's one of the reasons as part of his work with AEProbio, Damianos writes a quarterly
research review about the latest science as it pertains to probiotics. “I encourage people to
consider probiotics like any other medication.” He uses antibiotics as an example. “Doctors don't
“
“
I encourage
people to consider
probiotics like any
other medication.”
We know, for
instance, that
probiotics can
reduce C. diff by
as much as 70%.”
John Damianos, M.D.
Internal Medicine
~ Yale New Haven Hospital
Paul Wischmeyer, M.D.
Anesthesiologist, Critical
Care Specialist
~ Duke University Hospital
CASE STUDY
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just prescribe antibiotics — they diagnose an infectious disease syndrome first, identifying a
particular bug. Then they treat the patient empirically, picking an antibiotic with a unique action
mechanism that targets the specific pathogen.” The same goes for probiotics, he says. How do
we know what works best for a particular indication? By taking the same steps as with any other
pharmacological intervention. “We analyze the data from well-designed clinical trials that ideally
have been replicated,” he explains. “Then, at some point, you have meta-analyses for a particular
strain.”
Another challenge Damianos points out is that because of the current regulatory environment,
there's no accountability for companies. “There have been numerous studies looking at this,”
he says. “One took 16 commercially available probiotics off the shelf that claimed to contain
some sort of Bifidobacterium.” The result? Only a single probiotic out of the 16 contained what
it claimed. That's one of the reasons he, Pauley, and Wischmeyer all recommend Culturelle®
probiotics. “L. rhamnosus GG is the best studied probiotic strain,” he says. “And Culturelle as a
company adheres to rigorous FDA-level standards so people — and doctors — can be confident in
the stability and purity.”
LOOKING AHEAD — WHAT MORE CAN WE LEARN
All three would like to see more robust and broader-ranging clinical trials. “There's a much greater
appreciation today for the gut-brain axis and a recognition of the microbiome's impact outside of
uniquely gastrointestinal disorders,” says Damianos. “So now we're seeing people in dermatology,
rheumatology, and neurology studying the importance of gut health.”
“Forty years ago, we really didn't understand the interaction between gut health and all these
conditions,” says Pauley. “But today, we know how important a healthy gut is to our overall health.”
She feels there could be something to learn about the role of probiotics in treating oral thrush.
“It isn't only babies who get oral thrush. It happens to adults — especially those undergoing cancer
treatments, and I'd love to see a placebo-controlled trial studying that,” she says.
Wischmeyer agrees, saying he thinks there's an opportunity to look at preventing pandemic
viruses in particular. “COVID is still a big issue, and there are a lot of probiotic studies in animals
that indicate a normal microbiome can make vaccines for viruses more effective. I think we need
to look at how combining probiotics with vaccines in the winter can help prevent these pandemic
infections.”
FIND OUT MORE
Visit the refreshed Culturelle® probiotics healthcare professional website for more information and
resources relating to the portfolio.
PubMed is a good resource for keeping up-to-date on research in the field. In addition, AEProbio
publishes The Clinical Guide to Probiotic Products each year, which details probiotic strains and
related applications.
Culturelle® probiotics: https://culturellehcp.com/
PubMed: pubmed.ncbi.nlm.nih.gov
The Clinical Guide to Probiotic Products: usprobioticguide.com
“
The thing to
understand
is that not all
probiotics are
the same ... You
need to know
you’re using the
right one for the
right condition.”
Rose Pauley, APRN
Pediatric Gastroenterology
~ Boys Town National
Research Hospital
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