Stratum Resource post, Supporting Digestive Health in Infants

The gastrointestinal tract of newborns is not fully developed at birth since nutrient intake and digestion are unnecessary in the womb.  Not only are there structural changes in the cells of the GI tract that take place after birth, but the gut prior to birth is a sterile environment, devoid of the trillions of microorganisms that will eventually take up residence. Vaginal birth along with breastfeeding can jump-start the colonization of an infant’s GI tract, but these optimal conditions are not always possible.  Therefore, meeting the nutritional needs of infants can be a challenge.

The gut microbiome is crucial for optimal digestion and absorption of nutrients as well as for immune system functioning and other metabolic activities, and it takes about 3 to 4 years to fully establish a mature gut microbiome after birth. As a result, young children are susceptible to various digestive tract difficulties that are often manifest as diarrhea. These issues are magnified in developing countries where there is less access to clean drinking water and basic sanitation.[i]

Rehydration therapies and antibiotics when appropriate have been the standard therapy to address these issues, and they are often necessary in cases of acute diarrhea where a known pathogen is the cause.  However, measures to support the development of healthy microbiota may be the best long-term solution for childhood diarrhea and other digestive problems.

Probiotic and prebiotic supplements have been around for several years and are beneficial in helping to establish the colonization of beneficial microorganisms.  Most probiotics formulated to support infant health contain species of Bifidobacterium which is the first genus of bacteria to typically inhabit an infant’s gut. These probiotics are frequently added to infant formula, sometimes in conjunction with a prebiotic, such as human milk oligosaccharides (HMOs). However, probiotics derived from sources that are indigenous to the human GI tract are living entities and present challenges related to their stability in the upper GI tract and their limited shelf life. In rare cases, some supplemented microorganisms can translocate into systemic circulation in immunocompromised individuals.[ii]

Within the last few years, postbiotics have risen to prominence within the dietary supplement industry; and in May 2021, the International Scientific Association of Probiotics and Prebiotics published a consensus statement on their definition and scope.[iii] The main criteria for classification as a postbiotic is the critical step of killing the source microorganism, usually by heat treatment.  Studies have shown that the resulting inanimate microbial cells and cell fragments can exert the same benefits as their living counterparts; and when combined with the culture media in which the source microbes were fermented, can provide many of the beneficial metabolites produced naturally in the human body. This has led to the introduction of several products identified as postbiotics. However, there is one postbiotic that has been around in a heat-treated form for over 100 years, and it has been studied extensively in pediatric populations.

Lactobacillus LB (LBiome™) has been marketed in France in its heat-treated form since around 1928 as an anti-diarrheal; it has been extensively studied in pediatric populations, establishing its safety even in younger, vulnerable individuals. Early studies established the optimal formula combining the heat-treated bacteria with its culture media at a dose of 170 mg (including 10 billion bacterial cells), administered twice daily.

One of the most recent studies demonstrated LBiome’s benefits in enhancing the anerobic growth of Bifidobacterial species and strains in a pure culture. In addition, this study showed the bifidogenic activity of Lactobacillus LB in an ex-vivo human fecal fermentation system.[iv]

Postbiotics such as LBiome with a long history of use demonstrating safety and efficacy in pediatric populations show great promise as viable alternatives to probiotics and prebiotics for supporting general digestive health and the establishment of a healthy microbiome, and they are worthy adjuncts to rehydration therapy for digestive distress.

References: 

[i] Walker, C.L.F., Perin, J., Aryee, M.J., Boschi-Pinto, C., & Black, R.E. (2012). Diarrhea incidence in low- and middle-income countries in 1990-2010: a systematic review. BMC Public Health, 12:220. Doi: 10.1186/1471-2458-12-220.

[ii] D’Agostin, M., Squillaci, D., Lazzerini, M., Barbi, E., Wijers, L., & Da Lozzo, P. (2021). Invasive infections associated with the use of probiotics in children: A systematic review. Children (Basel), 8(10):924.

[iii] Salminen, S., Collado M.C., Endo, A., Hill, C., Lebeer, S., Quigley, E.M.M., Sanders, M.E., Shamir, R., Swann, J.R., Szajewska, H., & Vinderola, G. (2021). The International Scientific Association of Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of postbiotics. Nature Reviews. Gastroenterology and Hepatology, 18(9), 649-667.

[iv] Warda, A.K., Clooney, A.G., Ryan, F., de Almeida Bettio, P.H., Di Benedetto, G., Ross, R.P., & Hill, C. (2021). A postbiotic consisting of heat-treated lactobacilli has a bifidogenic effect in pure culture and in human fermented faecal communities. Applied and Environmental Microbiology, 87(8), e02459-20.