Multistrain probiotics may benefit functional constipation in the elderly: RCT

By Nicola Gordon-Seymour

- Last updated on GMT

© Syldavia / Getty Images
© Syldavia / Getty Images

Related tags Probiotics Constipation Gut health microbiome

Multistrain probiotics could be introduced as an add-on therapy to treat functional constipation in the elderly, says a new study from Croatia.

Using the branded PROBalans SENIOR drops product manufacturer by Croatian biotech PharmaS, researchers from the University of Zagreb reported that the supplement relieved symptoms within one week and cumulative stool numbers were significantly different by 10 weeks, compared with the placebo group.

The product is formulated with Lactobacillus acidophilus​ LA3, Bifidobacterium animalis​ subsp. lactis​ BLC1 and Lactobacillus casei BGP93​, and the study included a group of elderly subjects living in a nursing home and diagnosed with functional constipation.

The results of the study, which are published in the European Journal of Clinical Nutrition​, are consistent with other trials that support the “superior effects​” of multistrain probiotic supplements over single probiotics, said the authors.

“The trend of increasing the difference between the two groups, one week after the probiotic intervention indicated their prolonged effect,”​ and “could be attributed to synergistic interactions between distinct strains with varied activities​”, they added.

Increased vulnerability

Constipation is a common chronic condition in the elderly but is more prevalent in women as well as among nursing home residents. Studies suggest that about 50% of residents suffer from chronic constipation and 56-75% take laxatives to relieve symptoms. The high rate of polypharmacy in this age group is also a contributing factor.

Evidence supports the role of gut microbiota in the pathogenesis and treatment of functional constipation, which leads to decreased levels of bifidobacteria​ and lactobacilli​ and increased Bacteroidetes​ in constipated subjects, compared to healthy controls.

Reduced innate and acquired immune function and increased vitamin B12 deficiency are other characteristic features of old age that affect quality of life and life expectancy and are similarly associated with inadequate food intake and diet.

Probiotic bacteria are known to both reduce inflammation and promote vitamin B12 production, and especially the genera Lactobacillus​ and Bifidobacterium​.

“Therapeutic manipulation of intestinal bacteria by selectively altering the beneficial versus harmful microbial species could reverse the inflammatory responses and restore mucosal homoeostasis,” ​explained the authors.

Elevated levels of high-sensitivity C-reactive proteins (hsCRP) were found in serum samples for most subjects in the current study, indicating the presence of chronic low-grade inflammation.

The researchers aimed to evaluate the effect of selected multistrain probiotics without changes to lifestyle habits, including medication.

Study details

A total of 67 participants aged 65 years or over were selected for the double-blind controlled study and randomised to either the probiotic or placebo group.

Participants were administered nine drops of an oral liquid formulation once daily or placebo for 12 weeks. Subjects consumed a similar number of laxatives with Bisacodyl the main brand.

There was no significant difference between the two groups, but the cumulative number of stools in the probiotic group was consistently higher than the placebo and P values progressively decreased from week two to the end of the intervention period.

A total of 27 blood parameters were analysed to assess treatment differences for probiotic and placebo groups. No significant dependent and independent effect of treatment and time on blood parameter changes were observed, although there were significant within treatment changes in glucose and vitamin B12 levels in the probiotic group, and changes in cholesterol and LDL in the placebo.

Treatment was well tolerated and safe during in relation to haematological and biochemical profiles and adverse effects.

The authors assert the results suggest “long-term intake of these probiotics is needed to achieve a significant effect on constipation symptoms” ​but indicate their effectiveness may be reduced by the simultaneous use of laxative drugs.

Source: European Journal of Clinical Nutrition
Published online, August 4, 2022:
‘The effect of multistrain probiotics on functional constipation in the elderly: a randomised controlled trial’
Authors: K. Fehir Šola, et al.

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