Probiotic Supplementation and Weight Loss

Research Paper:

Probiotic Supplementation and Weight Loss

Introduction

Probiotics, present in supplements, fermented foods and beverages, have been consumed for their beneficial effects on gut microbiota. The prevalence of obesity has drawn attention to the use of probiotics for improving digestion, reducing inflammation, and possibly aiding in weight loss. Research evaluating the consumption of probiotics in supplement and dietary intake form has found,however, both significant and insignificant results in aiding weight loss. Common strains of probiotics consumed for their benefits in weight loss, metabolic syndrome, reduced visceral fat, glucose tolerance, are Lactobacillus and Bifidobacterium, which can be found in fermented products such as yoghurt, sour milk and cheese (Cani et al., 2008; F.S.Teixeira et al., 2013). Today, individuals can also consume probiotics in the form of a supplement along with their meal.

This paper aims to provide supporting and non-supporting research literature investigating the relationship between probiotic supplementation and weight loss. I hypothesize that the supplementation of probiotics in the forms of food, beverages or supplementation will aid in weight loss. Current research shows that the use of probiotic supplements in decreasing inflammation related illnesses, such as atopic dermatitis (Kalliomäki et al.) and Myasthenia gravis (Chae et al.) The improved digestion and decrease of inflammation in patients using supplements show evidence for this hypothesis.

Evidence

Probiotic supplementation and weight loss has been a topic of research interest due to its possible weight loss effects and improved gut flora balance. As a result, probiotic supplementation has been encouraged for weight loss enhancement and management of digestive tract. Roux-en-Y gastric bypass (RNYGB) is a form of surgery performed to encourage weight loss by reducing the size of the stomach in patients. RNYGB has been noted to damage the gastrointestinal (GI) flora balance, the imbalance of flora could possibly lead to the overgrowth of bacteria and therefore promote dysmotility. Woodard et al.‘s (2009) study used a parallel- Random Control Trial (RCT) over 44 subjects to see if daily use of probiotics would improve GI outcomes after RNYGB. Participants were given supplements containing 2.4 billion colonies of Lactobacillus probiotic strains. The control group received a placebo supplement. The study assessed levels of bacterial overgrowth, GI-related quality of life, and weight loss at 3 and 6 months post-operatively. The study found that at 6 months, a statistically significant reduction in the overgrowth of gut bacterial from before to after the intervention of -32.13 parts per million. The probiotic group achieved a significantly greater percent excess weight loss than the control group at (controls = 25.5%, probiotic = 29.9%) and 3 months (38.55%, 47.68%).

This study introduced another new interest of probiotic supplementation relating to B12 absorption. Further research on B12 availability and probiotic supplementation may be of future research interest. A limitation of this study is that probiotic supplementation was administered daily instead of at every meal. Probiotics in naturally fermented foods are consumed at every meal in some cultures, and therefore aid in the digestion of each meal.

Probiotics are of interest in balancing the gut flora for not only weight loss but also weight management. Sanchez et al. (2013)’s evaluated the effect of Lactobacillus Rhamnosus (LPR) supplementation on weight loss and maintenance in obese men and women over 24 weeks. The study used a blind, placebo-controlled, randomized control trial where each subject ingested two capsules a day of a placebo or a LPR formula of CFU in a capsule form combined with oligofructose and inulin. Each group consumed a moderate calorie restricted diet for the first 12 weeks and then weight maintenance in the additional 12 weeks. Women in the LPR group lost significantly more body weight and fat mass during the weight-maintenance period, but women in the placebo group gained weight during the weight maintenance period. Changes in body weight and fat mass were similar for both the LPR and placebo groups. Women in the LPR group reported to have significant reductions in fat mass along with increased circulating leptin concentrations and Lachnospiraceae family in faeces. In obesity, a decreased sensitivity to leptin, can cause a lack of satiety feeling despite a feeling of fullness. Therefore, optimal leptin functioning is of importance for weight management in overweight individuals. The study is unique in its ability to show that women may benefit in supplementing with probiotic, Lactobacillus rhamnosus, and its possible increase in the Leptin hormone. This study has a limitation in that the control group and the probiotic receiving group did not only differ in their ingestion of probiotic strains, but also in their ingestion of the two other ingredients in the capsules, oligofructose and inulin. Inulin is an insoluble fiber, and is beneficial for helping aid digestion and therefore gastric motility. Therefore, the probiotic receiving group has an additional cofactor in helping their digestion and therefore gut flora activity.

Kang, Yun & Park (2010) evidenced rats incurring weight loss through the administration of probiotics. The probiotic strain, Lactobacillus Gasseri BNR17, was administered to rats in order to investigate its effect on adipose tissue mass. Lactobacillus Gasseri is a probiotic naturally occurring in gut flora, but the probiotics’ effect on losing weight has not been yet researched. In order to administer Lactobacillus Gasseri, the probiotic strain was isolated from human breast milk from lactating females within two weeks of parturition. The rats were kept at normal cyclical sleeping patterns, temperature and humidity control. The rats were given a high carbohydrate diet and water was ad libitum. The control group consisted of the same diet without Lactobacillus Gasseri. There were 10 rats receiving Lactobacillus Gasseri and 10 rats in the control group. The study found that there were no significant differences in food intake between the control and Lactobacillus Gasseri receiving rats, showing that they consumed nearly identical diets. However, the Lactobacillus Gasseri receiving rats significantly lowered blood glucose levels than did that the control rats. The percent increase in the body weight (P<0.0331) and fat pad mass (P<0.01) mass of the control group was higher in the control group. There was an abnormal increase in liver weight in the control group in comparison. This outcome may be explained by how obesity causes hepatomegaly and encourages the development of a fatty liver. This research therefore may show a prominent new point that the administration of Lactobacillus Gasseri could prevent the accumulation of excess fat in the liver, in addition to preventing fat pad mass accumulation. A limitation of this study is that the Lactobacillus Gasseri used in this study was retrieved from human female subjects, and was used for male rats. An improvement for this study could be to use the Lactobacillus Gasseri found in lactating female rats and administer this to female and male rats. In addition, we are not aware if the components of breast milk themselves are what is uniquely responsible in giving the study’s results or if it is the probiotic strains, Lactobacillus Gasseri , isolated effects. A future clinical trial utilizing this bacterial strain would be encouraged to further cement the finding of possible prevention of fatty liver and fat mass accumulation through the administer of Lactobacillus Gasseri.

Probiotics and their relation to immune cell functioning in the human body is of interest in the current literature. Probiotics are believed to have effects on gene expression through different cytokines and transcription factors. Zarrati et al. (2013) performed a double-blinded, randomized controlled clinical trial with 75 people with BMI ranging from 25 to 35. Individuals were assigned to one of the three groups, with 25 people in each group. Group 1 consumed regular yogurt with a low calorie diet (LCD) named as (RLCD), Group 2 consumed probiotic yogurt with a LCD (PLCD), and Group 3 ate probiotic yogurt without a LCD (PWLCD) for 8 weeks. Before and after specific gene expressions of the participants were assessed. In all three groups gene expression for ROR-γt was reduced, and for FOXP3 was increased, whereas the expression of TNFα, TGFβ, and GATA3 genes were not affected. However, the T-bet gene expression was significantly less in PLCD and PWLCD groups (P < 0.001), showing that probiotics have a connection to weight loss. A decreased T-bet gene expression is seen in obese individuals. Limitations of this study was that the duration of the study, 8 weeks, could be considered too short to see significant results.

Sharafutdinov et al. (2013) investigated whether gut lactobacilli affects the metabolic functions of healthy humans. A 1500 kcal/day diet was supplemented with cheese with the probiotic Lactobacillus plantarum to reduce metabolic syndromes present in adults with obesity and hypertension. In the 3 week, randomized, double-blind, placebo-controlled parallel pilot study, 25 subjects ate probiotic cheese and 15 the control cheese. The cheese was 175 kcal for the 50 grams served. Blood pressure, anthropometric measurements, liver and kidney functioning, metabolic and urine measurements were taken. In addition, fecal amounts of lactobacilli and L. plantarum were measured. The results of the study showed that the probiotic L.plantarum was present in 16/25 of the subjects. The BMI was significantly reduced in the probiotic cheese group. In addition, there was a decrease in morning systolic blood pressure for patients receiving probiotic supplementation. The study concluded that a hypocaloric diet supplemented with probiotic cheese can help to reduce BMI and arterial BP values. A limitation of this study is that the study was performed for only 3 weeks, and changes in BMI and blood pressure may take longer to take effect.

Kadoka et al. (2013) performed a multi-center, double blind, parallel randomized control trial with 210 healthy Japanese adults with visceral areas circumference between 80.2-187.8 cm². The adults were randomly assigned to three groups who consumed 200 g of fermented milk with either 1 million, 10 million, or just normal yogurt probiotics CFU strains (control group) per gram for 12 weeks. The study investigated the effect of LG2055, a probiotic lactic acid bacterium which originally exists in the human intestine, would become observable by increase or possibly, decrease in size as an effect of probiotic supplementation. The study found that in the 1 million and 10 million doses there was a statistically significant reduction in visceral fat with probiotic supplementation. 33 men and 36 women receiving 1 million, and 36 men and 35 women receiving 10 million CFU/g/day had a significant reduction in visceral fat. The amount of LG2055 did not have a significantly different effect in reducing visceral fat; therefore, consuming 100 g or 1 kg of yogurt did not affect the participants differently. Looking at the study, we see an 8% reduction in visceral fat; therefore, the reduction in waist size is statistically significant. This study is significant in being one of the first studies using a human trial examining the effect of different dosages of probiotics on adipose tissue in the abdomen. However, a limitation of the study is that it uses overweight individuals. It may be that the probiotics are combating inflammation in the body, and aiming to return the individual’s body to a healthy weight. However, if the study could perform identical measures on a group of healthy weight individuals, then by comparing the normal and overweight individuals weight loss, the study could draw a conclusion to probiotics and visceral fat loss.

In connection with Kadooka et al.’s study, Tripolt et al. (2013) investigate inflammation and probiotic supplementation. Probiotic intake has also been linked to improve insulin sensitivity by reducing endotoxemia and inflammation. The objective of the study was to monitor the effect of supplementing subjects with metabolic syndrome with the probiotic strain Lactobacillus Casei Shirota (LcS). 30 subjects with metabolic syndrome received Lactobacillus Casei Shirota 3 times daily for 12 weeks or received a control therapy.Results showed that the insulin sensitivity improved after the 3 months of probiotic supplementation; however, this change was not significant. There were no improvements in β-cell function reported. The probiotic supplementation resulted in a significant reduction in soluble vascular cell adhesion molecules (a biomarker for inflammatory responses). There were no significant changes in the low-grade inflammation parameters or measurements of endothelial functioning. The intake of probiotic supplementation did not change significantly change insulin sensitivity, β-cell function, endothelial function, or inflammation markers for this study. This study draws important attention to changes in soluble vascular cell adhesion molecules.

Probiotics have been researched in their improvement of the gut lining through administration in a clinical trial. Radiotherapy is a type of cancer therapy which can cause intestinal injury. The mucosal activity of normal bacteria in the intestine provide for the healthy digestion, absorption and immune responses of the individual. The damage of this mucosal activity through radiation affects the health of the individual. In Demirer et al.’s (2006) study, the probiotic strain found in dairy yogurt, Lactobacillus bulgaricus, was isolated and given to rats treated with radiation. As a result, the rats’ intestinal segments had improved mucosal functioning. The improved mucosal functioning can help as a protective barrier against future intestinal damaging and possibly repair what radiation may incur. The study suggests that the probiotic administration of Lactobacillus bulgaricus, may improve intestinal mucosal activity. The study proposes that probiotics added via oral or enteral route to patients in nutrition therapy may be a vital way to improve the gastrointestinal lining of radiotherapy patients. The study also suggests that the enteritis which causes malnutrition in the radiotherapy patients may also be prevented. Limitations of this study can be that instead of a clinical trial, a trial with rats was used. However, the study encourages a new research area of using probiotic supplements as a form of nutrition therapy for patients undergoing or have undergone radiation.

Additional research on inflammation, investigated the effects of probiotic supplementation and weight loss as a result of reduced inflammatory responses (Gobel et al. 2012.) Gut microbiota, energy expenditure and inflammation are currently of research interests as they have been related to obesity related disorders. Inflammation is a physical condition in which the body becomes inflamed to protect itself from injury or infection.. The study aimed to investigate the effect of the probiotic strain Lactobacillus salivarius Ls-33 on inflammation and metabolic syndrome is a risk factor from insulin resistance, high adipose tissue deposition and malfunction. Metabolic syndrome is linked to inflammation, and increases an individual’s risk factors for coronary heart disease, diabetes, fatty liver and several cancers. Symptoms of metabolic syndrome can be hypertension, hyperglycemia, hypertriglyceridemia and abdominal obesity. The study used a double-blind placebo study with 50 adolescents with recorded obesity, that were randomly administered to Ls-33 or a placebo daily for 12 weeks. The study found that there was no difference in biomarkers for inflammation and metabolic syndrome. The limitations of this study are the isolated supplementation of Lactobacillus salivarius. This probiotic group of strains occurs in the human gut to balance the pathogenic bacteria and is not found isolated in nature. Research on Lactobacillus salivarius demonstrated that the probiotic strains works best in conjunction with other Probiotic strains present as it would occur in fermented foods, which can have usually 1 to 4 strains of probiotics (Neville & O’Toole, 2010). Therefore, the administration of Lactobacillus salivarius in a fermented food form present with other probiotics, and prebiotics may be of future research interest.

Interest in probiotic supplementation and its related cardiovascular health benefits grew after the initial findings of a 2000 study by Agerholm-Larsen et al. findings of improvements in cardiovascular health. An 8 week, randomized, double-blind, placebo and parallel study investigated the effect of probiotic milk with the culture Causido and two alternative products on risk factors for cardiovascular disease in overweight and obese people. Four groups of subjects consumed 450 mL fermented milk products (yoghurt) daily. Group 1 consumed a yogurt with Streptococcus Thermophilus and two strains of Lactobacillus Acidophilus (StLa). The second group of subjects consumed a placebo fermented yoghurt beverage with delta-acid-lactone (PY). The third group consumed a yogurt with two strains of Streptococcus thermophilus and one strain of Lactobacillus rhamnosus (StLr). Group 4 consumed a yogurt with one strain of Enterococcus faecium and two strains of Streptococcus thermophilus (CAUSIDO (R) culture), GAIO(R) (G). The yoghurts given to the four groups were otherwise similar in composition. The fifth group was given two placebo pills (PP) once a day. The study found that after adjustments for small changes in weight, there was a 8.4% decrease in LDL cholesterol and increase in fibrinogen in the G-group. The group consuming chemically fermented yogurt (PY) and placebo pills had significantly less different changes in LDL cholesterol and fibrinogen increase. After 8 weeks, systolic blood pressure was significantly reduced in the StLa and G-group compared to StLr. This study shows that although the study did not statistically significant decreases in weight loss, the study showed a decreased LDL cholesterol and increased fibrinogen levels (to prevent excessive bleeding) are effects that can improve an individual's overall health. The study proposed that the effect of probiotic supplementation and LDL cholesterol decrease and fibrinogen increase could be explained by the effect of a stimulating the immune system of participants through probiotic supplementat. A limitation of this study is that the subjects were instructed to be weight stable and not lose or gain more than a maximum of 2 kg body weight.

Conclusion

Probiotic supplementation seems to have mixed findings in its benefits towards weight loss. Research discussed above demonstrates how probiotic supplementation has benefited humans and rats for weight loss purposes. Simultaneously, probiotics have been shown to help reduce cardiovascular risk, reduce inflammation and help restore healthy gut flora balance, which can aid for proper digestion and nutrient balances, another concern for overweight individuals. Inflammation can commonly occur in overweight individuals as a response to excess adipose tissue deposition. Chronic or systemic inflammatory responses have been thought to originate from the gut, and therefore improving gut microbiota flora balance can be a possible way to improve one’s risk for fighting inflammation. This paper demonstrates how scientific literature exists to demonstrate the beneficial effects of probiotic supplementation and weight loss. Several studies have been included in this paper showing insignificant weight loss after probiotic supplementation, which have been included to give contrary evidence to my hypothesis.

Some of my personal limitations could be the lack of consistent, large and long-term studies including probiotic supplementations with every meal for human studies, solely focusing on weight loss. Much research focuses on investigating weight loss along with other variables and does not include probiotics as a live food which is offered at every meal. Therefore, usually one instead of multiple strains of probiotics are administered to individuals. In order to include factors relating to weight loss, cardiovascular health and gut lining health has been evaluated. During my research, I also discovered factors such as improved sexual functioning and feelings of well being with probiotic supplementation.

References

Agerholm-Larsen, L., Raben, A., Haulrik, N., Hansen, A., Manders, M., & Astrup, A. (2000). Effect of 8 week intake of probiotic milk products on risk factors for cardiovascular diseases. European Journal Of Clinical Nutrition, 54(4), 288-297. http://dx.doi.org/10.1038/sj.ejcn.1600937

Ao, X., Zhang, X., Zhang, X., Shi, L., Zhao, K., & Yu, J. et al. (2012). Identification of lactic acid bacteria in traditional fermented yak milk and evaluation of their application in fermented milk products. Journal Of Dairy Science, 95(3), 1073-1084. http://dx.doi.org/10.3168/jds.2011-4224

Cani, P., Bibiloni, R., Knauf, C., Waget, A., Neyrinck, A., Delzenne, N., & Burcelin, R. (2008). Changes in Gut Microbiota Control Metabolic Endotoxemia-Induced Inflammation in High-Fat Diet-Induced Obesity and Diabetes in Mice. Diabetes, 57(6), 1470-1481. http://dx.doi.org/10.2337/db07-1403

Gøbel, R., Larsen, N., Jakobsen, M., Mølgaard, C., & Michaelsen, K. (2012). Probiotics to Adolescents With Obesity. Journal Of Pediatric Gastroenterology And Nutrition, 55(6), 673-678. http://dx.doi.org/10.1097/mpg.0b013e318263066c

Grover, S., Mallappa, R., Rokana, N., Duary, R., Panwar, H., & Batish, V. (2012). Management of metabolic syndrome through probiotic and prebiotic interventions. Indian Journal Of Endocrinology And Metabolism, 16(1), 20. http://dx.doi.org/10.4103/2230-8210.91178

Demirer, S., Aydıntug, S., Aslım, B., Kepenekci, I., Sengül, N., & Evirgen, O. et al. (2006). Effects of probiotics on radiation-induced intestinal injury in rats. Nutrition, 22(2), 179-186. http://dx.doi.org/10.1016/j.nut.2005.08.003

Dogra, S., Sakwinska, O., Soh, S., Ngom-Bru, C., Brück, W., & Berger, B. et al. (2015). Dynamics of Infant Gut Microbiota Are Influenced by Delivery Mode and Gestational Duration and Are Associated with Subsequent Adiposity. Mbio, 6(1), e02419-14. http://dx.doi.org/10.1128/mbio.02419-14

F.S.Teixeira, T., Grześkowiak, Ł., Salminen, S., Laitinen, K., Bressan, J., & Gouveia Peluzio, M. (2013). Faecal levels of Bifidobacterium and Clostridium coccoides but not plasma lipopolysaccharide are inversely related to insulin and HOMA index in women. Clinical Nutrition,32(6), 1017-1022. http://dx.doi.org/10.1016/j.clnu.2013.02.008

Kadooka, Y., Sato, M., Ogawa, A., Miyoshi, M., Uenishi, H., & Ogawa, H. et al. (2013). Effect of Lactobacillus gasseri SBT2055 in fermented milk on abdominal adiposity in adults in a randomised controlled trial. British Journal Of Nutrition, 110(09), 1696-1703. http://dx.doi.org/10.1017/s0007114513001037

Kang, J., Yun, S., & Park, H. (2010). Effects of Lactobacillus gasseri BNR17 on body weight and adipose tissue mass in diet-induced overweight rats. The Journal Of Microbiology, 48(5), 712-714. http://dx.doi.org/10.1007/s12275-010-0363-8

Keshani, Sharma, P., Sharma, K., & Kanwar, S. (2015). Molecular and functional diversity of Saccharomyces cerevisiae strains of traditional fermented foods of the North-Western Himalayas.Ann Microbiol. http://dx.doi.org/10.1007/s13213-015-1068-3

Kotzampassi, K. (2013). Bacteria and Obesity: The Proportion Makes the Difference.Surgery: Current Research, 03(05). http://dx.doi.org/10.4172/2161-1076.1000152

Morelli, L., & Capurso, L. (2012). FAO/WHO Guidelines on Probiotics. Journal Of Clinical Gastroenterology, 46, S1-S2. http://dx.doi.org/10.1097/mcg.0b013e318269fdd5

Neville, B., & O’Toole, P. (2010). Probiotic properties of Lactobacillus salivarius and closely related Lactobacillus species. Future Microbiology, 5(5), 759-774. http://dx.doi.org/10.2217/fmb.10.35

Sanchez, M., Darimont, C., Drapeau, V., Emady-Azar, S., Philippe, L., & Ammon-Zuffrey, C. et al. (2013). Effect of Lactobacillus Rhamnosus CGMCC1.3724 Supplementation on Weight loss and Maintenance in Obese Men and Women. Canadian Journal Of Diabetes, 37, S269. http://dx.doi.org/10.1016/j.jcjd.2013.03.270

Sharafedtinov, K., Plotnikova, O., Alexeeva, R., Sentsova, T., Songisepp, E., & Stsepetova, J. et al. (2013). Hypocaloric diet supplemented with probiotic cheese improves body mass index and blood pressure indices of obese hypertensive patients - a randomized double-blind placebo-controlled pilot study. Nutrition Journal, 12(1), 138. http://dx.doi.org/10.1186/1475-2891-12-138

Tripolt, N., Leber, B., Blattl, D., Eder, M., Wonisch, W., & Scharnagl, H. et al. (2013). Short communication: Effect of supplementation with Lactobacillus casei Shirota on insulin sensitivity, β-cell function, and markers of endothelial function and inflammation in subjects with metabolic syndrome—A pilot study. Journal Of Dairy Science, 96(1), 89-95. http://dx.doi.org/10.3168/jds.2012-5863

Woodard, G., Encarnacion, B., Downey, J., Peraza, J., Chong, K., Hernandez-Boussard, T., & Morton, J. (2009). Probiotics Improve Outcomes After Roux-en-Y Gastric Bypass Surgery: A Prospective Randomized Trial. Journal Of Gastrointestinal Surgery, 13(7), 1198-1204. http://dx.doi.org/10.1007/s11605-009-0891-x

Zarrati, M., Shidfar, F., Nourijelyani, K., Mofid, V., Hossein zadeh-Attar, M., & Bidad, K. et al. (2013). Lactobacillus acidophilus La5, Bifidobacterium BB12, and Lactobacillus casei DN001 modulate gene expression of subset specific transcription factors and cytokines in peripheral blood mononuclear cells of obese and overweight people.Biofactors, 39(6), 633-643. http://dx.doi.org/10.1002/biof.1128