The Very Latest on Probiotics

Latest Australian study:

The latest study on probiotics was published yesterday (1st April 2014), but sadly it wasn’t an April Fools joke.  It appears to dash the hopes previously held for probiotics as a treatment for infant colic.  This Australian based study of 167 breast-fed and formula fed infants found that the group of colicky babies that received the probiotics actually cried MORE than the control group. 

Latest Italian study:

Interestingly these results are is in contrast with the very latest Italian study published on 1st March 2014, which was consistent with some other probiotics studies (see my previous blog about Probiotics for more information).  This study of 589 babies found that the babies who were proactively given probiotics for the first 3 months of their life had nearly half the crying duration at 3 months and had reduced regurgitation.

What the !??! I hear you say…. 

The same probiotic was used by both studies (Lactobacillus reuteri DSM 17938) and both studies were quite robustly designed from a scientific perspective, so how could the results be totally different?  That’s the question.

There is one key difference between the two trials: the Australian study focused on treating babies who had colic (after they were identified as having colic), whereas the Italian study treated a general group of babies proactively from shortly after birth for the first 3 months. 

So one possibility is that starting probiotics ASAP after birth makes all the difference, but another possibility is that it might have helped babies generally but didn’t assist babies with colic.

One Interesting Quirk About the Australian Study

The Australian study had one interesting quirk that’s worth mentioning.  It used a MODIFIED version of the traditional definition of colic to decide which babies would participate in the study.  The traditional definition is a baby who is otherwise healthy and has had his/her needs met, but is still crying for more than 3 hours a day, for more than 3 days in a week, for more than 3 weeks. 

The inclusion criteria for the Australian study modified this definition in 2 ways:

  1. In determining crying duration they included both full blown crying and also “fussing”, which was defined as “behaviour that is not quite crying but not awake and content either”; and
  2. They dropped the 3 weeks requirement and just used more than 3 hours of crying/fussing for 3 days or more over 7 days.

The reason this is interesting is that I believe there may be more than one underlying cause of colic.  Some babies may be crying for hours because they have a gastrointestinal issue and others because they are overstimulated and in need of advanced settling techniques. (You can read more about this in the book).

By softening the traditional definition and including babies who are “fussing”, it makes me wonder if its possible they included more cases that were NOT gastrointestinally caused colic.  Since probiotics are aiming to treat a gastrointestinal issue they wouldn’t have helped babies whose underlying problem was not gastrointestinal, and that makes me wonder if this could have skewed the results?

So Should Babies be Proactively Put on Probiotics from Birth?

Whilst the various Italian studies give some evidence in support of this, other doctors disagree.  Yesterday’s editorial by William Bennett in the British Medical Journal described preventative probiotics use as a “hammer looking for a nail”.

He says: “we know little about the acquisition and development of the microbiota in an infant’s gut. We are far from a sufficiently thorough understanding that would allow us to link changes in specific bacterial populations to changes in infant behaviour, given the enormous variation and complexity of both behaviour and microbiome composition between and among individuals. …This all points to our strikingly poor understanding of the normal intestinal milieu in infants, so we should hesitate to proclaim victory over colic just yet, or to aggressively alter the development of intestinal microbiota without a better understanding of normal intestinal development.”

In other words, Bennett means that we don’t know what the other impacts might be of proactively giving babies probiotics.

Jen’s View

Have to say that this latest Australian study is not encouraging…  And Bennett (and others) have valid concerns about the lack of knowledge about what the other impacts of probiotic use might be.

If I had another baby and if I was making a decision for my family alone, would I run that risk and give my next baby probiotics from around a week old as a preventative?  Well I’ve lived through the hell of our son’s colic, so based on current knowledge I probably would.  But that’s purely my personal choice (not a recommendation).

What do you think?  Would you give your baby (or your next one) probiotics?