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When you hear the word ‘probiotics’, the first thing you’re likely to think of is your gut. That’s what probiotics are all about, right? So, it’s a safe assumption that probiotic supplements could help support symptoms of stomach bugs. However, a recent study1 conducted in America may provide evidence to the contrary, though we're not totally convinced by its findings. We're interested in the facts though, and so we've looked past the negative headlines to see what the real story is...

The Study

The study looked at 971 children (943 having completed the study), aged between three months and four years, who were admitted to the emergency room presenting symptoms of gastroenteritis. Such symptoms include diarrhoea, vomiting, and stomach cramps. The researchers randomly assigned the children to one of two five-day treatment conditions: a supplementation of the probiotic strain Lactobacillus rhamnosus LGG®, or a placebo.

L. rhamnosus
is a very well-researched probiotic, and the particular strain used in the study has been found in the past to help with diarrhoea2, 3, 4, specifically in children, and building immunity5. Following the treatment period, the children were monitored and their symptoms tracked for two weeks, and the researchers found that the instances of vomiting and diarrhoea reduced at the same rate in both those children taking the placebo and those taking the probiotics. Therefore, the probiotics didn’t improve recovery time or symptoms. A similar study6 conducted on 827 subjects in Canada also reported insignificant results.

The researchers dismissed the idea that friendly bacteria could help to fight pathogens based on their findings, but could there be more to the story?

In a recent study, probiotics were found to be ineffective at alleviating symptoms of gastroenteritis in children

What does this mean for probiotics?

Although the studies make it seems as though probiotics exert no real benefits, it's not quite that simple. It's fair to say that the two studies certainly had their merits. Both boasted large sample sizes, and they were well-designed; being double blind, placebo-controlled, and randomised. Furthermore, the probiotics supplements used all contained high numbers of live cultures (although you can read more here about why quantity does not necessarily equal quality!).

Despite these successes though, it’s important to note the drawbacks as no clinical trials are ever infallible:

  • The intervention only lasted for five days. Probiotic supplementation is usually recommended on a long-term basis. The Canadian paper even stated that “[their] findings cannot be extrapolated to longer-term use of probiotics or other outcomes...”.
  • Probiotics shouldn't be used as a 'treatment'. It’s not advisable to use probiotics to ‘treat’ an acute set of symptoms such as you might find in stomach viruses like gastroenteritis. Probiotic strains are usually researched for specific health conditions; for example, there is a wealth of support for the strain Saccharomyces boulardii in supporting health in those with diarrhoea7, 8.
  • Parents provided researchers with observations. The symptoms of stomach flu were also collected on a self-report basis from parents, as opposed to direct observation by the researchers, so it’s possible that misinterpretations could have been made.
As with any acute infections or serious conditions affecting your child's stomach, including gastroenteritis, professional medical advice should be sought first. Probiotics are ideally used as part of a prevention protocol or symptom-management plan, not a direct 'cure'.

Overall, both studies were well-designed and thorough investigations. However, there are many proven benefits of probiotics to help support children's immunity, as shown when used for their intended purpose. In addition to the research behind L. rhamnosus LGG® (used in the American study), and Saccharomyces boulardii (mentioned above), strains such as Lactobacillus reuteri Protectis® have been shown to provide support with a myriad of digestive problems in infants9, 10, 11. Moreover, the results of the studies were not negative – they didn’t find any detriment to taking probiotics, and there were absolutely no issues with safety.

So if your child does develop a tummy bug, don’t disregard probiotics entirely – whilst they may not be a ‘miracle cure’ for acute gastroenteritis, they still have a lot to offer to holistic health for your child.

You may also be interested in the following articles:
Healthcare practitioners can read more about the strains mentioned in this blog over in Probiotic Professionals, on the Probiotics Database.

Healthcare practitioners might also be interested in our FAQ: Do probiotics help an upset stomach? (and if so, which ones?)

1. David Schnadower, M.D., et al. (2018), 'Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children'. The New England Journal of Medicine, 379:2002-2014.
2. Vanderhoof J.A. et al., (1999), ‘Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children’. Journal of Pediatrics, 135(5):564-568.
3. Basu S., et al., (2007a), ‘Effect of Lactobacillus rhamnosus GG in persistent diarrhoea in Indian children: a randomized controlled trial’. Journal of Clinical Gastroenterology, 41(8):756-60.
4. Basu S., et al., (2009b) ‘Efficacy of High-dose Lactobacillus rhamnosus GG in Controlling Acute Watery Diarrhea in Indian Children: A Randomized Controlled Trial’. Journal of Clinical Gastroenterology, 43:208-13.
5. Schultz M., et al., (2003), ‘Immunomodulatory consequences of oral administration of Lactobacillus rhamnosus strain GG in healthy volunteers’. Journal of Dairy Research, 70(2):165.
6. Freedman S. B., et al. (2018),'Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis'. The New England Journal of Medicine, 379:2015-2026.
7. McFarland L.V., (2010), ‘Systematic review and meta-analysis of Saccharomyces boulardii in adult patients’. World Journal of Gastroenterology, 16(18):2202–2222.
8. Cetina-Sauri, G. & Basto, S., (1994), ‘Therapeutic evaluation of Saccharomyces boulardii in children with acute diarrhea’. Annales de Pediatrie, 41(6):397-400.
9. Savino F. et al., (2015), ‘Preventive effects of oral probiotic on infantile colic: a prospective, randomised, blinded, controlled trial using Lactobacillus reuteri DSM 17938’. Benef. Microbes, 6(3):245-251, ePub 8 Dec. 2014.
10. Weizman Z. et al., (2016), ‘Lactobacillus reuteri DSM 17938 for the management of functional abdominal pain in childhood: a randomized, double-blind, placebo-controlled trial’. J Pediatr. 174:160-164.
11. Gutierrez-Castrellon P. et al., (2014), ‘Diarrhea in preschool children and Lactobacillus reuteri: a randomized controlled trial’. Pediatrics, 133:e904-e909.

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