Understanding Probiotics: Why Multistrain rules over Monostrain
In recent years, the intestinal microbiota has been found to significantly influence multiple biological processes relevant for human health and longevity. This is critical as aberrations in microbial composition are known in response to external factors, like an unbalanced diet, lack of physical activity, smoking, etc. Probiotics are a key factor in maintaining the optimal composition of the intestinal microbiota. (1) Multistrain probiotics have certain unique characteristics, which may potentially lead to specific advantages. The rationale and evidence are examined here through a scientific spectacle.
Interactive Mechanisms with Multistrain Probiotics - Successful colonization & Health effects
Successful colonization with multi-strain probiotics: Different strains of probiotics with different characteristics have an enhanced opportunity of colonization due to greater divergence of strong traits; increased chances of survival of at least one or several strains and creation of a probiotic niche; thus leading to a greater likelihood of successful colonization of the other strains, through mechanisms like reduction of antagonistic activity of the endogenous microflora against other sensitive probiotic strains, induction of an optimal pH range, creation of an anaerobic niche, enhanced adhesion, etc. (2)
Health effects exerted by multistrain probiotic preparation: The probiotic effect may be augmented due to a combination of strain-specific properties through the additive effect of specific strain properties such as the colonization of different niches, synergistic effects of different strains with unique properties; the aggregate probiotic effect may be more than the sum of individual health-promoting properties. Also, positive interactions between strains which enhance their biological activity may be established through a symbiosis between different strains, e.g. due to the exchange of different metabolites. (2)
The rationale for Development and Use of Multistrain Probiotics
The physiology through which multi-strain probiotics exert their effects includes cell-cell communications, interactions with the host tissues, and modulation of the immune systems. Multi-strain probiotics' applications include alleviation of disease conditions, inhibition of pathogens, and restoration of the gastrointestinal microbiome. Some multi-strain probiotics have reported enhanced benefits due to the constituent strains' synergy and additive effects resulting in high adhesion to the gastrointestinal mucosa and pathogen inhibition within the digestive tract. (3) Many scientific studies have claimed that probiotic mixtures have beneficial effects against a wide range of diseases affecting the host, thus suggesting that a combination of different probiotic microorganisms in the same product could likely provide greater protection against several intestinal pathogens as compared to mono-strain products. (4)
Multistrain Probiotics More Effective than Mono-Strain Probiotics – Specific Advantage for Lactobacillus containing Probiotic Mixtures
A study published by Chapman et al, in the European Journal of Nutrition, aimed to examine the evidence of whether probiotic mixtures are beneficial across a spectrum of health-related outcomes and if mixtures are more or less effective than their component strains administered separately. More than thirty-five studies were examined across different indications in pre-clinical and human studies. The results of this analysis pointed out that mixtures comprising of multistrain probiotics had beneficial effects on the endpoints pertaining to multiple clinical indications - irritable bowel syndrome and gut function, diarrhea, atopic disease, immune function and respiratory tract infections, gut microbiota modulation, inflammatory bowel disease and treatment of Helicobacter pylori infection. Of the sixteen studies which compared the effect of probiotic mixtures with that of its component strains separately, in twelve studies (75%), the mixture was more effective. It is noteworthy that of the twelve studies showing greater effectiveness of probiotic mixtures, eight used a Lactobacillus sp. as well as another non-bifidobacterial strain, while only six used a Bifidobacterium sp. along with a Lactobacillus. This suggests greater efficacy of Lactobacilli within a mixture. It was thus concluded that multi-strain probiotics appear to show greater efficacy than single strains, including strains that are components of the mixtures themselves. (5)
Multistrain Probiotics Possess Benefits Beyond the GI System
A meta-analysis published by Kelly A. Tiderencel et al included nine studies assessing the effect of probiotics in the management of Type 2 Diabetes. The average participant age was 55 years across the studies analyzed. It was demonstrated that multi-strain probiotics contain seven million to 100 billion CFU of Lactobacillus acidophilus, Streptococcus thermophilus, Lactobacillus bulgaricus, and/or Bifidobacterium lactis administered for 6 to 12 weeks may be efficacious in improving glycaemic control among adult T2DM patients. (6)
Multistrain Lactobacillus Probiotics – Improves Vaginal Flora and Clinical Symptoms in Bacterial Vaginosis
Alberti D et al published a study to assess the effect of oral multi-strain Lactobacillus probiotics including L. acidophilus La-14 and L. rhamnosus HN001 on vaginal flora among healthy women. The study demonstrated that treatment with oral Lactobacillus-based multi-strain probiotics led to detectable changes in vaginal microbial flora. (7) Rosario Russo et al, reported a clinical trial indicating that two-week treatment with multi-strain Lactobacillus probiotics containing L. acidophilus La-14, L. rhamnosus HN001 among women suffering from bacterial vaginosis led to the restoration of normal vaginal flora, indicated by changes in Nugent scores and improved clinical symptoms like itching, fishy odor, and abnormal vaginal discharge. (8)
In Summary
Probiotics have been demonstrated to be effective in a variety of conditions including travelers' diarrhea, antibiotic-associated diarrhea, upper respiratory tract infections, atopic eczema, and certain inflammatory conditions. (5) Multistrain probiotics may have specific physiological advantages (2) and clinical benefits over single strain probiotics across various clinical indications, and there seems a distinct advantage with the use of Lactobacillus containing multistrain probiotic formulation. (5)
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References:
1. Trush EA, Poluektova EA, Beniashvilli AG, Shifrin OS, Poluektov YM, Ivashkin VT. The Evolution of Human Probiotics: Challenges and Prospects. Probiotics Antimicrob Proteins. 2020 Dec;12(4):1291-1299. doi: 10.1007/s12602-019-09628-4. PMID: 31907861.
2. Timmerman HM, Koning CJ, Mulder L, Rombouts FM, Beynen AC. Monostrain, multistrain and multispecies probiotics--A comparison of functionality and efficacy. Int J Food Microbiol. 2004 Nov 15;96(3):219-33. doi: 10.1016/j.ijfoodmicro.2004.05.012. PMID: 15454313.
3. Kwoji ID, Aiyegoro OA, Okpeku M, Adeleke MA. Multi-Strain Probiotics: Synergy among Isolates Enhances Biological Activities. Biology (Basel). 2021 Apr 13;10(4):322. doi: 10.3390/biology10040322. PMID: 33924344; PMCID: PMC8070017.
4.Toscano Marco, De Grandi Roberta, Pastorelli Luca, Vecchi Maurizio, Drago Lorenzo.A Consumer's Guide for Probiotics: 10 Golden Rules for a Correct Use.Digestive and Liver Disease, http://dx.doi.org/10.1016/j.dld.2017.07.011.
5. Chapman CM, Gibson GR, Rowland I. Health benefits of probiotics: are mixtures more effective than single strains? Eur J Nutr. 2011 Feb;50(1):1-17. doi: 10.1007/s00394-010-0166-z. Epub 2011 Jan 13. PMID: 21229254.
6. Tiderencel KA, Hutcheon DA, Ziegler J. Probiotics for the treatment of type 2 diabetes: A review of randomized controlled trials. Diabetes Metab Res Rev. 2020 Jan;36(1):e3213. doi: 10.1002/dmrr.3213. Epub 2019 Sep 12. PMID: 31465625.
7. De Alberti D, Russo R, Terruzzi F, Nobile V, Ouwehand AC. Lactobacilli vaginal colonisation after oral consumption of Respecta(®) complex: a randomised controlled pilot study. Arch Gynecol Obstet. 2015 Oct;292(4):861-7. doi: 10.1007/s00404-015-3711-4. Epub 2015 Apr 9. PMID: 25855055.
8. Russo R, Edu A, De Seta F. Study on the effects of an oral lactobacilli and lactoferrin complex in women with intermediate vaginal microbiota. Arch Gynecol Obstet. 2018 Jul;298(1):139-145. doi: 10.1007/s00404-018-4771-z. Epub 2018 Apr 10. PMID: 29637269.
