Are Probiotics Helpful for People Living with CF?
Probiotics are live microorganisms, such as bacteria, which are found naturally in the gut. Probiotic supplements, if taken in adequate amounts, have been shown to provide health benefits in the general population. They are available as a dietary supplement and also found in foods such as yoghurt and fermented dairy products.
A balanced gut contains a wide variety of microorganisms which are essential to staying healthy. People with CF are known to have decreased gut microbial diversity which may contribute to poor growth in children and more respiratory exacerbations. Probiotics may help improve the number of microorganisms in the gut and also improve health outcomes.
In a recent Cochrane Systematic Review of twelve randomised controlled trials (eleven completed, with one trial planned but terminated early) with 464 people living with CF, the evidence for the use of probiotics in those with CF was investigated. Eight of the trials used a probiotic with one type of bacteria and four of the trials used probiotics consisting of two or more types of bacteria.
The review results found that probiotics may reduce the number of respiratory exacerbations (increase in respiratory symptoms such as cough, sputum production and drop in lung function) however, this was not confirmed. The review also indicated that probiotics reduced the amount of faecal calprotectin, a protein released indicating inflammation in the gastrointestinal tract however, the benefit of this finding is not yet known.
There were no differences seen in the trials between probiotics and placebo for height, weight or body mass index and probiotics did not show any effects on lung function, abdominal symptoms, or the need for hospital admission. Adverse reactions occurred in 2% of people and included vomiting, diarrhoea, and allergic reaction.
Quality of life was measured in one small trial where the children reported no difference between probiotics and placebo however, the parent’s questionnaire responses favoured probiotics.
In summary, the review concluded that:
- Probiotics may have health benefits for children and adults with CF, however they are linked with a small number of adverse events.
- Probiotics significantly lowered faecal calprotectin (marker for gastrointestinal inflammation) however, the clinical significance of this needs further research.
- Future multicentre randomised controlled trials, over a timeframe of at least twelve months, are needed for children and adults living with CF to assess the safety and health benefits of the many probiotics available, given the variability in composition and dosage.
Article from RED Magazine, Edition 1, 2021.
MJ Coffey, N Homaira, A Jaffe, CY Ooi. Cochrane (21 January 2020)