The Rationale for Probiotics in Female Urogenital Healthcare

Gregor Reid PhD MBA, BSc (Hons); Jeremy Burton PhD; Estelle Devillard PhD

Disclosures
In This Article

What Are Probiotics?

The concept of probiotics dates back more than 100 years. Most of the research has focused on intestinal benefits of lactic acid bacteria, resulting in narrow definitions for the term "probiotics." Recently, a much broader definition has been developed: "Live microorganisms, which when administered in adequate amounts, confer a health benefit on the host".[54] This recognizes the use of probiotics for urogenital diseases.

An argument has been made that patients should consume probiotics as part of their daily diet.[55] The essence of this argument is that the modern diet is designed to inhibit pathogens and is bereft of beneficial organisms. Increased exposure to antimicrobials and preservatives through the food chain that deplete the commensal flora, impaired or suboptimal immunity that reduces the ability to fight infection, and recognition of the important role that certain bacteria (lactobacilli, bifidobacteria, and others) play in health have resulted in this global trend in the interest in probiotic foods.

In this light, the new guidelines developed to define precisely what is expected of an organism or product designated to be probiotic are of great importance.[56] These guidelines were developed after requests from member nations of the Food and Agriculture Organization of the United Nations. The guidelines are critical because many so-called probiotic products currently on the market have never been proven, using acceptable methods, to have health benefits; indeed, many have been found to either contain dead organisms or species that are different from those stated on the label.[57,58,59,60] Furthermore, some less credible marketing companies make outlandish or subtly incorrect claims in their publicity material, including content placed on Web sites.[61] As a result, the concept of probiotics has lacked credibility in the medical community and many consumers have purchased and used unreliable products. But a broadening of education about probiotics spurred on by good science and rigorous clinical studies are changing perceptions in the medical community about probiotics. (For example, a recent Medscape Medical News CME program examined the safety and tolerability of probiotics added to infant formula.[62])

Following are probiotic strains that are both relatively easy to purchase in the United States and Europe and could be useful additions to the diet:

  • L casei DN_114001--Danone's Actimel fermented milk drinks; shown to control diarrhea[55]

  • L acidophilus NCFM--occurs in low numbers in many US probiotic yogurts but can alleviate lactose intolerance when administered in adequate amounts[63]

  • L reuteri SD2112--available in capsule form in the United States; shown to be useful in treating rotavirus diarrhea[64]

  • L plantarum 299V--similar to strain 299; shown to aid recuperation from surgery.[65]

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