Winter 2022 Newsletter
By Alicia S. Landry, PhD, RD, LDN, SNS
Department of Nutrition and Family Sciences
University of Central Arkansas
Dietary supplements can be casually grouped into a broad category of vitamins and minerals – multivitamins – that can be taken once daily to help meet the dietary recommendations of certain age groups. However, the dietary supplement industry has grown to include much more than traditional vitamin and mineral supplements and has expanded to include antioxidants, fiber, amino acids, probiotics, prebiotics, synbiotics, herbals, and protein or amino acids, among others. Dietary supplements are available in pills, capsules, liquids, gummies and can be found in energy drinks, snack bars, cookies, and other commonly available foods.
The Food and Drug Administration (FDA) regulates dietary supplement products and dietary ingredients, but under a different set of regulations than those standards for food and drug products (Nutrition, 2020). Dietary supplements are not pre-approved by the FDA for safety or effectiveness before marketing. Claims that supplement companies make and word-of-mouth may over-promise and under-deliver results for memory health, bowel movements, joint relief, and other ailments. Some dietary supplements can be very dangerous when paired with prescription drugs (i.e. St. John’s Wort and warfarin) while others may reduce efficacy (i.e. Black Cohosh and statins) and still, others may have no effect on pharmacokinetics whatsoever. There are few evidence-based research studies that ‘prove’ the effectiveness of dietary supplements. Conducting research on these items proves difficult, especially in senior adults, because the dose of active ingredients can vary across brands, ratios of fat and lean mass affect absorption, disease states and other medications interact with absorption, and as humans age the predictability and efficiency of gut functions are altered. Controlling these extraneous variables in conducting randomized-controlled research trials can seem impossible when gathering evidence to make general evidence-based recommendations about consuming dietary supplements.
While health professionals can advocate that no pill will replace nutrients in a balanced and moderate diet, sometimes supplementation is warranted (i.e. B12 deficiency). One such example of using dietary supplements to increase absorption and help positively influence gut function is probiotics. Probiotics are “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host” (Hill et al., 2014). Probiotics are usually bacterial components of the normal human intestinal flora that produce as end products of metabolism, lactate and short-chain fatty acids. Lactobacilli and bifidobacteria are examples and have well-defined benefits in human health (Ouwehand et al., 2002). Other similar terms that may be mentioned in probiotic literature are prebiotics and synbiotics. Prebiotics are defined as “a substrate that is selectively utilized by host microorganisms conferring a health benefit” (Gibson et al., 2017). Synbiotics are defined as “a mixture comprising live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host” (Swanson et al., 2020).
Common issues seen in aging adults that can affect nutritional status and dietary intake are inflammation-related and include constipation, undernutrition, neurodegenerative diseases, metabolic disorders, and reduced immune function (Ale & Binetti, 2021). While one’s overall health depends largely on the healthy functioning of the digestive system, the advantage of probiotic use among older adults is the prevention of antibiotic-associated diarrhea and Clostridium difficile colitis infection. Depending on the strain of probiotic taken, constipation and diarrhea (Björklund et al., 2012) as well as diverticulitis, mental conditions (Inoue et al., 2018; Kim et al., 2020), the immune system (Ibrahim et al., 2010), vitamin absorption, and metabolic disorders (Cicero et al., 2021) can all be positively affected.
In one study with elderly subjects, improved mental status and reduction of depression and anxiety were noted (Inoue et al., 2018). The probiotic treatment was paired with 12-weeks of physical activity classes including resistance training. The effect solely of the probiotics cannot be determined, but it is encouraging to consider the potential benefits of a combined program such as this one. In another study, probiotics were evaluated for their role in reducing inflammation, especially neuroinflammation seen in the early stages of Alzheimer’s disease (Leblhuber et al., 2018). All in all, there may be significant and promising results from the use of probiotics. However, probiotic effects can be attributed only to the strain or strains tested and not to the species or the whole group of lactic acid bacteria. Probiotics are defined by genus, species, and strain designation. The names sound complicated, but they are important for connecting the specific probiotic strain to the strain’s published scientific literature. Furthermore, products should contain the specific strain(s) of bacteria at the same levels used in published research. Common microorganisms are Lactobacillus and Bifidobacteria as well as Saccharomyces, Streptococcus, Enterococcus, Escherichia, and Bacillus.Probiotics must have live microorganisms in the product when they are placed on the shelf and throughout their shelf life, checking the brand reputation and evidence-based literature behind the brand and strains is very important in selecting quality supplements.
Probiotics, contained in “functional foods” (foods that provide physiological benefits or reduce the risk of chronic diseases, over and above their basic nutritional value), are available in several forms with the most common being yogurt. Some brands of yogurt specifically market patented live organisms while others contain microorganisms already present in the human gut microbiota. Fermented drinks, like buttermilk, kefir, or kombucha, and dehydrated bacteria in the form of powders are also available. As with all supplements, a healthcare provider should be consulted before use, and especially with probiotics, if the patient is immuno-compromised, probiotics should be used only under the supervision of a healthcare professional. Most probiotics are sold as dietary supplements or ingredients in foods and cannot legally claim to cure, treat, or prevent disease. Claims made on a product should be truthful and substantiated, but this may not always be the case.
Consider the following tips to help your patients or loved-ones as they explore dietary supplements: (1) recommend they visit with a registered dietitian nutritionist about their diet and lifestyle, (2) be wary of claims about curing multiple diseases, (3) fact check overly impressive-sounding terms, ancient secrets, miracle cures, and statements that suggest the product can treat or cure diseases or that it is quick and effective, (4) the term “natural” does not always mean safe, and (5) items that are extremely costly may not be warranted. As a reminder, healthy daily activities like consuming a balanced diet and being physically active remain incredibly important, our combined lifestyle factors affect our gut bacteria and gut health. The registered dietitian nutritionist is the expert on the healthcare team to ask about balanced diets and dietary supplements. Maintaining a healthy gut is about more than taking a probiotic supplement; keeping our guts functioning properly is essential to overall health and well-being.
Ale, E. C., & Binetti, A. G. (2021). Role of probiotics, prebiotics, and synbiotics in the elderly: Insights into their applications. Frontiers in Microbiology, 12, 631254. https://doi.org/10.3389/fmicb.2021.631254
Björklund, M., Ouwehand, A. C., Forssten, S. D., Nikkilä, J., Tiihonen, K., Rautonen, N., & Lahtinen, S. J. (2012). Gut microbiota of healthy elderly NSAID users is selectively modified with the administration of Lactobacillus acidophilus NCFM and lactitol. Age, 34(4), 987–999. https://doi.org/10.1007/s11357-011-9294-5
Cicero, A. F. G., Fogacci, F., Bove, M., Giovannini, M., & Borghi, C. (2021). Impact of a short-term synbiotic supplementation on metabolic syndrome and systemic inflammation in elderly patients: A randomized placebo-controlled clinical trial. European Journal of Nutrition, 60(2), 655–663. https://doi.org/10.1007/s00394-020-02271-8
Ibrahim, F., Ruvio, S., Granlund, L., Salminen, S., Viitanen, M., & Ouwehand, A. C. (2010). Probiotics and immunosenescence: Cheese as a carrier. FEMS Immunology and Medical Microbiology, 59(1), 53–59. https://doi.org/10.1111/j.1574-695X.2010.00658.x
Inoue, T., Kobayashi, Y., Mori, N., Sakagawa, M., Xiao, J.-Z., Moritani, T., Sakane, N., & Nagai, N. (2018). Effect of combined bifidobacteria supplementation and resistance training on cognitive function, body composition and bowel habits of healthy elderly subjects. Beneficial Microbes, 9(6), 843–853. https://doi.org/10.3920/BM2017.0193
Kim, C.-S., Cha, L., Sim, M., Jung, S., Chun, W. Y., Baik, H. W., & Shin, D.-M. (2020). Probiotic supplementation improves cognitive function and mood with changes in gut microbiota in community-dwelling older adults: A randomized, double-blind, placebo-controlled, multicenter trial. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 76(1), 32–40. https://doi.org/10.1093/gerona/glaa090
Leblhuber, F., Steiner, K., Schuetz, B., Fuchs, D., & Gostner, J. M. (2018). Probiotic supplementation in patients with Alzheimer’s Dementia—An explorative intervention study. Current Alzheimer Research, 15(12), 1106–1113. https://doi.org/10.2174/1389200219666180813144834
Nutrition, C. for F. S. and A. (2020, February 4). Dietary Supplements. FDA; FDA. https://www.fda.gov/food/dietary-supplements
Ouwehand, A. C., Salminen, S., & Isolauri, E. (2002). Probiotics: An overview of beneficial effects. Antonie Van Leeuwenhoek, 82(1–4), 279–289.