- Email: [email protected]
Can probiotics prevent or improve common cold and influenza?
Nutrition 29 (2013) 805–806
Contents lists available at ScienceDirect
Nutrition journal homepage: www.nutritionjrnl.com
Editorial
Can probiotics prevent or improve common cold and influenza? The common cold, influenza, and probiotics The common cold and influenza are two of the most common respiratory tract infections that, because of loss in productivity and high medical costs, impose a considerable economic burden on governments [1]. Though the causative factor in these two distinct cases is viral, they are often treated with antibiotics. Antibiotic resistance, which is in large part attributed to antibiotic overuse, has encouraged investigators to seek for alternative methods for either preventing or treating the common cold and influenza [2]. During the last decade, much attention has been paid to probiotics in this regard. Probiotics are defined as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host” by the Food and Agriculture Organization/World Health Organization [3]. Immune system regulation is among the most recognized benefits of probiotics [4]. The intestine, its microbiota, and the associated immune system have been the principle targets for consumed probiotics; thus, investigations and clinical studies of nonintestinal infections are rather limited. However, new applications for probiotics outside of the intestine have been taken into consideration recently. Common viral infections, such as the common cold and influenza, are among the fairly new targets for probiotics [5]. The respiratory tract is a suitable area for probiotic immune stimulation, because its mucosal surfaces are functionally linked to other mucosal surfaces of the common mucosal-associated lymphoid tissues [6]. There is some evidence that consumption of probiotics by infants may be protective against common respiratory tract infections [7–9]. Vaccination against influenza has become increasingly popular among aged people because of the high prevalence of the disease in the elderly; probiotics have been shown to increase antibody response to vaccination in a substantial number of trials conducted in this respect [10–14]. Effect of probiotics on influenza prevention in adults The number of clinical trials investigating the effects of probiotics on the prevention of cold and influenza episodes in adults is rather limited. Two major outcomes that have been measured in these clinical trials are the number of cold or influenza episodes in the ensuing weeks after probiotic supplementation, as well as how efficiently the symptoms are alleviated once the disease develops. In a randomized clinical trial, de Vrese, et al. [15] supplemented 479 adults with a 5 107 colony forming unit (CFU) (Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, and Bifidobacterium 0899-9007/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.nut.2012.10.009
bifidum MF 20/5, spray dried with vitamins and minerals) and evaluated cellular immune parameters as well as symptom score, duration of common cold episodes, and days of fever during an episode. Patients having received at least 3 months of probiotic supplements had shorter cold episodes by 2 d and experienced less severe symptoms. When administered orally at a dose of 2 109 CFU/d for 30 d, Bacillus coagulans GBI-30 (GanedenBC30) increased TNF-a production on exposure to a strain of influenza A, which was an advantage to the patients. No assessments were made on the influenza episodes and severity of the symptoms in patients affected by influenza. This may be due to the short period of supplementation [16]. Twelve wk of a probiotic product consumption containing 109 CFU Lactobacillus plantarum HEAL and Lactobacillus paracasei was shown to reduce the risk of developing common cold infections. Furthermore, the proliferation of Blymphocytes was greater in the probiotic group than the control group [17]. Conclusion It may be too soon to judge the role that probiotics may play in the prevention of the common cold and influenza because there are many strains of probiotics with established immune modulatory effects yet to be tried with the particular goal of seeking their effects on these two common respiratory infections. However, on the basis of the available evidence, it appears that probiotics (at least those investigated thus far in clinical trials), when administered at a dose between 107 and 109 CFU/ d for at least 30 d, can decrease the incidence and the duration of the common cold and influenza, as well as decrease the severity of the symptoms. The underlying mechanism for such effect is, without a doubt, associated with the impact that probiotics have on different arms of the immune system [18]. It is also noteworthy that probiotic foods have been claimed to be of more significance when public health promotion is targeted [19]. Thus, it may be reasonable to take this into account in future trials. Furthermore, prebiotics tend to be better fields to invest in, due to some particular reasons [20]; this could be a potentially important point to consider as well, when studies with the aim of improving public health are planned. References [1] Heikkinen T, J€ arvinen A. The common cold. Lancet 2003;361:51–9. [2] Vouloumanou EK, Makris GC, Karageorgopoulos DE, Falagas ME. Probiotics for the prevention of respiratory tract infections: A systematic review. Int J Antimicrob Agents 2009;34:197.e1–197.e10.
806
Editorial / Nutrition 29 (2013) 805–806
[3] Homayouni A. Letter to the editor. Food Chemistry 2009;114:1073. [4] Ejtahed HS, Mohtadi-Nia J, Homayouni-Rad A, Niafar M, Asghari-Jafarabadi M, Mofid V. Probiotic yogurt improves antioxidant status in type 2 diabetic patients. Nutrition 2012;28:539–43. [5] de Vrese M, Schrezenmeir J. Probiotics and non-intestinal infectious conditions. Br J Nutr 2002;88:S59–66. [6] Hatakka K, Saxelin M. Probiotics in intestinal and non-intestinal infectious diseasesdClinical evidence. Curr Pharm Des 2008;14:1351–67. [7] Rautava S, Salminen S, Isolauri E. Specific probiotics in reducing the risk of acute infections in infancydA randomised, double-blind, placebo-controlled study. Br J Nutr 2009;101:1722–6. [8] Leyer GL, Li S, Mubasher ME, Reifer C, Ouwehand AC. Probiotic effects on cold and influenza-like symptom incidence and duration in children. Pediatrics 2009;124:e172–9. [9] Kukkonen K, Savilahti E, Haahtela T, Juntunen-Backman K, Korpela R, Poussa T, et al. Long-term safety and impact on infection rates of postnatal probiotic and prebiotic (synbiotic) treatment: Randomized, double-blind, placebo-controlled trial. Pediatrics 2008;122:8–12. [10] Aubin J, Remigy M, Verseil L, Bourdet-Sicard R, Vaudaine S, van der Werf S, et al. A probiotic fermented dairy product improves immune response to influenza vaccination in the elderly. Proceedings of the Nutrition Society 2008;67: 205–20. migy M, Vaudaine S, Tanguy J, Bourdet-Sicardc R, van der Werf S. [11] Boge T, Re A probiotic fermented dairy drink improves antibody response to influenza vaccination in the elderly in two randomised controlled trials. Vaccine 2009;27:5677–84. ndez M, Pe rez M, Farran M, Fuentes MC, Cun ~e J. Lactoba[12] Bosch M, Me cillus plantarum CECT7315 and CECT7316 stimulate immunoglobulin production after influenza vaccination in elderly. Nutr Hosp 2012;27: 504–9. [13] Davidson LE, Fiorino AM, Snydman DR, Hibberd PL. Lactobacillus GG as an immune adjuvant for live-attenuated influenza vaccine in healthy adults: A randomized double-blind placebo-controlled trial. Eur J Clin Nut 2011;65: 501–7. [14] Namba K, Hatano M, Yaeshima T, Takase M, Suzuki K. Effects of bifidobacterium longum BB536 administration on influenza infection, influenza vaccine antibody titer, and cell-mediated immunity in the elderly. Biosci Biotechnol Biochem 2010;74:939–45. [15] de Vrese M, Winkler P, Rautenberg P, Harder T, Noah C, Laue C, et al. Effect of Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, B. bifidum MF 20/5 on common cold episodes: A double blind, randomized, controlled trial. Clin Nutr 2005;24:481–91. [16] Baron M. A patented strain of Bacillus coagulans increased immune response to viral challenge. Postgrad Med 2009;121:114–8.
€ n I, Larsson N, Onning [17] Berggren A, Lazou Ahre G. Randomised, doubleblind and placebo-controlled study using new probiotic lactobacilli for strengthening the body immune defence against viral infections. Eur J Nutr 2011;50:203–10. [18] Delcenserie V, Martel D, Lamoureux M, Amiot J, Boutin Y, Roy D. Immunomodulatory effects of probiotics in the intestinal tract. Curr Issues Mol Biol 2008;10:37–54. [19] Homayouni Rad A, Vaghef Mehrabany E, Alipoor B, Vaghef Mehrabany L, Javadi M. Do probiotics act more efficiently in foods than in supplements? Nutrition 2012;28:733–6. [20] Homayouni Rad A, Akbarzadeh F, Vaghef Mehrabany E. Which are more important: Prebiotics or probiotics? Nutrition 2012;28:1196–7.
Aziz Homayouni Rad, Ph.D. Department of Food Science and Technology, Faculty of Nutrition Tabriz University of Medical Sciences Tabriz, Iran E-mail address: [email protected] (A. Homayouni Rad) Reza Torab, M.D. Faculty of Medicine, Tabriz University of Medical Sciences Tabriz, Iran Amir Mohammad Mortazavian, Ph.D. Department of Food Science and Technology, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Elnaz Vaghef Mehrabany, M.Sc. Department of Nutrition, Faculty of Nutrition Tabriz University of Medical Sciences Tabriz, Iran E-mail address: [email protected] (E. V. Mehrabany) Leila Vaghef Mehrabany, M.Sc. Department of Nutrition, Faculty of Nutrition and Diet Therapy Tehran University of Medical Sciences, Tehran, Iran
Contents lists available at ScienceDirect
Nutrition journal homepage: www.nutritionjrnl.com
Editorial
Can probiotics prevent or improve common cold and influenza? The common cold, influenza, and probiotics The common cold and influenza are two of the most common respiratory tract infections that, because of loss in productivity and high medical costs, impose a considerable economic burden on governments [1]. Though the causative factor in these two distinct cases is viral, they are often treated with antibiotics. Antibiotic resistance, which is in large part attributed to antibiotic overuse, has encouraged investigators to seek for alternative methods for either preventing or treating the common cold and influenza [2]. During the last decade, much attention has been paid to probiotics in this regard. Probiotics are defined as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host” by the Food and Agriculture Organization/World Health Organization [3]. Immune system regulation is among the most recognized benefits of probiotics [4]. The intestine, its microbiota, and the associated immune system have been the principle targets for consumed probiotics; thus, investigations and clinical studies of nonintestinal infections are rather limited. However, new applications for probiotics outside of the intestine have been taken into consideration recently. Common viral infections, such as the common cold and influenza, are among the fairly new targets for probiotics [5]. The respiratory tract is a suitable area for probiotic immune stimulation, because its mucosal surfaces are functionally linked to other mucosal surfaces of the common mucosal-associated lymphoid tissues [6]. There is some evidence that consumption of probiotics by infants may be protective against common respiratory tract infections [7–9]. Vaccination against influenza has become increasingly popular among aged people because of the high prevalence of the disease in the elderly; probiotics have been shown to increase antibody response to vaccination in a substantial number of trials conducted in this respect [10–14]. Effect of probiotics on influenza prevention in adults The number of clinical trials investigating the effects of probiotics on the prevention of cold and influenza episodes in adults is rather limited. Two major outcomes that have been measured in these clinical trials are the number of cold or influenza episodes in the ensuing weeks after probiotic supplementation, as well as how efficiently the symptoms are alleviated once the disease develops. In a randomized clinical trial, de Vrese, et al. [15] supplemented 479 adults with a 5 107 colony forming unit (CFU) (Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, and Bifidobacterium 0899-9007/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.nut.2012.10.009
bifidum MF 20/5, spray dried with vitamins and minerals) and evaluated cellular immune parameters as well as symptom score, duration of common cold episodes, and days of fever during an episode. Patients having received at least 3 months of probiotic supplements had shorter cold episodes by 2 d and experienced less severe symptoms. When administered orally at a dose of 2 109 CFU/d for 30 d, Bacillus coagulans GBI-30 (GanedenBC30) increased TNF-a production on exposure to a strain of influenza A, which was an advantage to the patients. No assessments were made on the influenza episodes and severity of the symptoms in patients affected by influenza. This may be due to the short period of supplementation [16]. Twelve wk of a probiotic product consumption containing 109 CFU Lactobacillus plantarum HEAL and Lactobacillus paracasei was shown to reduce the risk of developing common cold infections. Furthermore, the proliferation of Blymphocytes was greater in the probiotic group than the control group [17]. Conclusion It may be too soon to judge the role that probiotics may play in the prevention of the common cold and influenza because there are many strains of probiotics with established immune modulatory effects yet to be tried with the particular goal of seeking their effects on these two common respiratory infections. However, on the basis of the available evidence, it appears that probiotics (at least those investigated thus far in clinical trials), when administered at a dose between 107 and 109 CFU/ d for at least 30 d, can decrease the incidence and the duration of the common cold and influenza, as well as decrease the severity of the symptoms. The underlying mechanism for such effect is, without a doubt, associated with the impact that probiotics have on different arms of the immune system [18]. It is also noteworthy that probiotic foods have been claimed to be of more significance when public health promotion is targeted [19]. Thus, it may be reasonable to take this into account in future trials. Furthermore, prebiotics tend to be better fields to invest in, due to some particular reasons [20]; this could be a potentially important point to consider as well, when studies with the aim of improving public health are planned. References [1] Heikkinen T, J€ arvinen A. The common cold. Lancet 2003;361:51–9. [2] Vouloumanou EK, Makris GC, Karageorgopoulos DE, Falagas ME. Probiotics for the prevention of respiratory tract infections: A systematic review. Int J Antimicrob Agents 2009;34:197.e1–197.e10.
806
Editorial / Nutrition 29 (2013) 805–806
[3] Homayouni A. Letter to the editor. Food Chemistry 2009;114:1073. [4] Ejtahed HS, Mohtadi-Nia J, Homayouni-Rad A, Niafar M, Asghari-Jafarabadi M, Mofid V. Probiotic yogurt improves antioxidant status in type 2 diabetic patients. Nutrition 2012;28:539–43. [5] de Vrese M, Schrezenmeir J. Probiotics and non-intestinal infectious conditions. Br J Nutr 2002;88:S59–66. [6] Hatakka K, Saxelin M. Probiotics in intestinal and non-intestinal infectious diseasesdClinical evidence. Curr Pharm Des 2008;14:1351–67. [7] Rautava S, Salminen S, Isolauri E. Specific probiotics in reducing the risk of acute infections in infancydA randomised, double-blind, placebo-controlled study. Br J Nutr 2009;101:1722–6. [8] Leyer GL, Li S, Mubasher ME, Reifer C, Ouwehand AC. Probiotic effects on cold and influenza-like symptom incidence and duration in children. Pediatrics 2009;124:e172–9. [9] Kukkonen K, Savilahti E, Haahtela T, Juntunen-Backman K, Korpela R, Poussa T, et al. Long-term safety and impact on infection rates of postnatal probiotic and prebiotic (synbiotic) treatment: Randomized, double-blind, placebo-controlled trial. Pediatrics 2008;122:8–12. [10] Aubin J, Remigy M, Verseil L, Bourdet-Sicard R, Vaudaine S, van der Werf S, et al. A probiotic fermented dairy product improves immune response to influenza vaccination in the elderly. Proceedings of the Nutrition Society 2008;67: 205–20. migy M, Vaudaine S, Tanguy J, Bourdet-Sicardc R, van der Werf S. [11] Boge T, Re A probiotic fermented dairy drink improves antibody response to influenza vaccination in the elderly in two randomised controlled trials. Vaccine 2009;27:5677–84. ndez M, Pe rez M, Farran M, Fuentes MC, Cun ~e J. Lactoba[12] Bosch M, Me cillus plantarum CECT7315 and CECT7316 stimulate immunoglobulin production after influenza vaccination in elderly. Nutr Hosp 2012;27: 504–9. [13] Davidson LE, Fiorino AM, Snydman DR, Hibberd PL. Lactobacillus GG as an immune adjuvant for live-attenuated influenza vaccine in healthy adults: A randomized double-blind placebo-controlled trial. Eur J Clin Nut 2011;65: 501–7. [14] Namba K, Hatano M, Yaeshima T, Takase M, Suzuki K. Effects of bifidobacterium longum BB536 administration on influenza infection, influenza vaccine antibody titer, and cell-mediated immunity in the elderly. Biosci Biotechnol Biochem 2010;74:939–45. [15] de Vrese M, Winkler P, Rautenberg P, Harder T, Noah C, Laue C, et al. Effect of Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, B. bifidum MF 20/5 on common cold episodes: A double blind, randomized, controlled trial. Clin Nutr 2005;24:481–91. [16] Baron M. A patented strain of Bacillus coagulans increased immune response to viral challenge. Postgrad Med 2009;121:114–8.
€ n I, Larsson N, Onning [17] Berggren A, Lazou Ahre G. Randomised, doubleblind and placebo-controlled study using new probiotic lactobacilli for strengthening the body immune defence against viral infections. Eur J Nutr 2011;50:203–10. [18] Delcenserie V, Martel D, Lamoureux M, Amiot J, Boutin Y, Roy D. Immunomodulatory effects of probiotics in the intestinal tract. Curr Issues Mol Biol 2008;10:37–54. [19] Homayouni Rad A, Vaghef Mehrabany E, Alipoor B, Vaghef Mehrabany L, Javadi M. Do probiotics act more efficiently in foods than in supplements? Nutrition 2012;28:733–6. [20] Homayouni Rad A, Akbarzadeh F, Vaghef Mehrabany E. Which are more important: Prebiotics or probiotics? Nutrition 2012;28:1196–7.
Aziz Homayouni Rad, Ph.D. Department of Food Science and Technology, Faculty of Nutrition Tabriz University of Medical Sciences Tabriz, Iran E-mail address: [email protected] (A. Homayouni Rad) Reza Torab, M.D. Faculty of Medicine, Tabriz University of Medical Sciences Tabriz, Iran Amir Mohammad Mortazavian, Ph.D. Department of Food Science and Technology, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Elnaz Vaghef Mehrabany, M.Sc. Department of Nutrition, Faculty of Nutrition Tabriz University of Medical Sciences Tabriz, Iran E-mail address: [email protected] (E. V. Mehrabany) Leila Vaghef Mehrabany, M.Sc. Department of Nutrition, Faculty of Nutrition and Diet Therapy Tehran University of Medical Sciences, Tehran, Iran