Probiotics and Improving Skin Health



Probiotics and Improving Skin Health:A review on oral supplementation of Lactobacilli and the beneficial effects on the skin’s microbiomeNicole MeerwarthRussell Sage CollegeIntroduction:Probiotics are a relatively new field of research. In a short time, probiotics have been shown to improve skin health through their ability to improve the health of the human gut microbiome. The gut’s microbiome is a colony of bacteria that if maintained in a healthy, flourishing state, can have significant health benefits on the body. These beneficial effects include reducing overall body inflammation, helping general digestion problems and boosting the immune system (Berkeley Wellness, 2014). This paper will review the benefits of probiotic consumption as it beneficially modulates the microbiome of the gut, it also effects skin health, and helps to improve the skin’s own microbiome.Oral supplementation of probiotics through systemic effects in the body are effective at improving skin health by reducing the appearance of skin blemishes, such as acne or atopic dermatitis, and reducing skin inflammation. The extent of the effect or the quality of effect of the probiotic’s ability to improve skin health will depend on which strains are consumed, what source is consumed (such as in food or pill form), how long it is consumed for, and if it is being consumed simultaneously with any medications. The most common strains of probiotics that are used for skin health are variations of lactic acid bacteria, such as Lactobacillus paracasei which has been shown to reduce skin inflammation. The longer this probiotic, or any other, is consumed for the more effective it is, and the better the overall results are, i.e. reduction in skin inflammation. Lactobacillus probiotics are most often consumed in dairy products such as yogurt or kefir, which are lactic acid producing once the lactobacilli bacteria have been added, but can also be consumed as pills as CFU’s (colony forming units). If consumed simultaneously with some medications, such as an antibiotic for acne lesions, it has been shown that the probiotic and antibiotic can actually have synergistic effects (Jung et al., 2013). The recommended amount of probiotics for skin health should be determined by what the purpose is for taking the probiotics and in what form they are taken. The purpose of this paper is to review some of the current research on probiotics in relation to skin health on topics such as acne lesions, skin inflammation and atopic dermatitis. In addition, current research on other aspects of probiotics will be reviewed as well, such as duration of consumption and recommended dosage, so that consumers may reap the most and best possible benefits.Probiotics have a benefit on acne lesions, skin inflammation, and atopic dermatitis:Probiotics influences skin health. In particular, they have been shown to have many beneficial effects, such as reducing incidence of acne lesions. According to Nole et al. (2014) there has been up to 80% improvement in acne in small clinical trials which occurs due to the probiotic’s ability to reduce inflammation in the skin by regulating the release of inflammatory cytokines and the activation of regulatory T cells. In addition to Nole, Kim et al. (2010) also showed through a clinical study with a study sample of 36, “statistically significant improvement (p<0.05) by inflammatory lesion count by 38.6%, total lesion count by 23.1%, and clinical grade of acne by 20.3% after daily consumption of fermented milk with 200 mg of lactoferrin for 12 weeks compared to fermented milk (placebo) consumption”.Another example of the beneficial effects of probiotics is their ability to reduce skin inflammation, which according to Kober and Bowe (2015) is defined as the ability to induce an immune response to a true threat, while also inhibiting this immune response when no threat is present. Several lactobacillus strains, such as Lactobacillus reuteri, have been found to have anti-inflammatory effects. In a study by Hacini-Rachinel et al. (2009) a daily oral administration of 200 micrograms of Lactobacilllus casei demonstrated an alleviation of allergic inflammation. The alleviation of inflammation was measured by the effects of L. casei on DTH (delayed type hypersensitivity), which is a cell mediated immune response, in mice. Ear swelling on day 1 was reduced by 75% (p<0.001), and footpad swelling on day 3 was reduced by more than 80% (p<0.01). Later in a study by Gueniche, et al. (2010), “cultures of human skin were treated with L. paracasei NCC2461 and showed inhibition of substance-P-induced skin inflammation, as measured by reduction of vasodilation, edema, mast cell degranulation and tumor necrosis factor” although figures were not found to be significant at a P<0.05. In addition to these beneficial effects, probiotics also help to prevent atopic dermatitis. Atopic dermatitis is a chronic inflammatory skin disorder that normally appears in childhood and then persists into adulthood. Most treatments for atopic dermatitis only relieve symptoms but do not actually cure the disorder. Probiotics help by modulating T helper cytokine activation and upregulating regulatory T cells as well as accelerating barrier function recovery (Nole et al., 2014). In a meta-analysis by Cao, L, et al. (2015), it is explained that administration of probiotics during pregnancy and during the early years of the child’s life can significantly reduce the risk of developing atopic dermatitis by 14%. In a clinical trial, Wickens et al. (2013) confirmed Cao’s study further by determining that “Lactobacillus rhamnosus during prenatal and postnatal periods provided persistent protection by halving the prevalence in the development of pediatric atopic dermatitis and atopic sensitization at 4 and 6 years of age”. Effect of the Gut Microflora on Skin Health:By oral supplementation, a probiotic is first absorbed and digested in the gut. As the health of the gut is increased, the ability of the gut to aid in digestion, absorb nutrients and contribute to the immune system is also improved. This boost in beneficial effects then is also able to spread to other parts of the body. The cosmetic effects of probiotics on the skin is an outward sign of overall host health (Levkovich et al., 2012). In a study by Matsumoto et al. (2007) “reported significant (P<0.05) improvements that ingested yogurt (110g/day/individual) had on subjective symptoms (itching and burning) and the intestinal environment in patients with atopic dermatitis. Compared to the control group, the yogurt group had significant improvement in itching and burning sensations”. Later in another study by Levkovich et al. (2012), it was shown that mice who were fed probiotic yogurt for 20-24 weeks had significant differences (P<0.0001) in fur luster, dermal thickness, and had more follicular sebocytes than the mice who did not eat probiotic yogurt. Follicular sebocytes are responsible for the production of sebum for hair follicles, and the sebum is essential for maintenance of the epidermis. Proper functioning of the follicular sebocytes reduces the development of acne lesions. (Shamban, et al., 2009)Strain Dependency of Probiotic Effects:The most common strains of probiotics supplemented are lactic acid bacteria, such as Lactobacillus delbrueckii and Lactobacillus plantarum, which play specific roles in the body. “Recent studies have shown that lactic acid bacteria and their extracts have beneficial effects on maintenance and improvement of skin health. Oral administration of Lactobacillus delbrueckii inhibits the development of atopic disease, and Lactobacillus plantarum has anti-photoaging (the skin’s reaction to exposure to ultraviolet lights) effects on human skin cells by regulating the expression matrix meralloprotionase-1 (MMP-1) expression”. (Jeong, et al., 2015)Probiotic StrainAssociated ActionsLactobacillus acidolphilusClinical Improvement of acneLactobacillus bulgaricusClinical Improvement of acneLactobacillus caseiAlleviation of skin inflammationLactobacillus delbreuckiiInhibition of atopic dermatitis developmentLactobacillus paracaseiTherapy for atopic dermatitisLactobacillus reuteriTherapy for atopic dermatitisLactobacillus salivariusTherapy for atopic dermatitisLactobacillus plantarumAnti-photoaging effectsLactobacillus rhamnosusPrevention of atopic dermatitisJeong, et al. (2015). All of the probiotic strains found in the table are lactic acid bacteria and can easily be found in fermented dairy products. Although consumption of any fermented dairy product may help improve skin health due to its probiotic content, knowing which strains have which associated actions can help with a more specific treatment and a faster improvement.Supplement Dependency of Probiotic Effects:Probiotics can be supplemented in food or pill (extract) form of the active live probiotic cultures. Some of the most common probiotic foods are those found in dairy products. The probiotic bacteria found in these products are generally termed as lactic acid bacteria. Yogurt is one of the most commonly eaten probiotic foods. Other foods include kefir (an Eastern European fermented milk), kimchi (a Korean specialty of pickled vegetables), sauerkraut, as well as fermented soybean products, such as tempeh. The bio-availability of live cultures may depend on how old the food product is, and whether or not the bacteria are still alive. Food labels should provide the use by date, before which there should be the highest concentration of live bacteria, as well as include information on the specific strains of bacteria that can be found in that product. Organic products are also preferred due to the bacteria killing action of pasteurization (Getz, 2011). Unpasteurized yogurt is not sold commercially. Commercial yogurt is made from milk that has been pasteurized and then the cultures are added. Overall, food products tend to be a more viable option for the average consumer due to their easy availability, convenience and cost effectiveness. (Govender et al., 2013)Probiotics can also be taken in pill form. The formulations of this type of supplementation vary in their reliability, but are considered to be just as effective as the food forms. However, the pills are also still susceptible to lyophilization, which reduces the stability of the probiotic bacteria, and affects the ability of the dosage to deliver the correct amount of bacteria. They are also are susceptible to the very acidic environment of the stomach where up to 60% of the bacteria can die before reaching the intestines, this is true for food supplements as well (Govender et al., 2013). In addition to this, probiotic pills are also not regulated by the FDA, but are instead, only notified of the new supplement. The manufacturer is responsible for making sure their product is safe and actually contains what they claim it does. (Venugopalan, et al., 2010)Synergy between Probiotics and Medications:Probiotic consumption can actually increase the beneficial effects of the medication pharmacodynamics. This was later confirmed by a study to reduce acne lesions by Jung et al. (2013) that demonstrated the synergistic effects of taking both an antibiotic for acne and supplementation of a probiotic (strain type was not given). The trial consisted of 45 subjects with one group taking both a minocycline and a probiotic supplement simultaneously, one taking only the minocycline and the last taking only the probiotic supplement. Only the group who took both the minocycline and the probiotic supplement simultaneously had a significant (p<0.001) decrease in acne lesions. However, this effect may differ depending on the medication being taken.Consumption Interval Dependency of Probiotic Effect:Benefits of probiotics also depend on the length of consumption. Probiotics survive in the gut and have an impact on the gut’s microbiome. However, most of the healthy bacteria do not colonize and any benefits received from probiotics are only sustained during the length of consumption (Ciorba, 2012). The duration of the consumption of probiotics also depends on the reason the consumer is taking them. Most studies on probiotics that are conducted have subjects consuming the probiotic for several weeks before measuring results. In a study mentioned previously by Levkovich et al. (2013), mice were fed the probiotic supplement for 20-24 weeks (5-6 months) before measuring results for shinier fur, increased dermal thickness and increased follicular sebocytes. In another study mentioned earlier, Jung et al. (2013) had groups of patients that were supplemented for 12 weeks, showing a substantial decrease in acne lesions at only 4 weeks. Depending on what the overall goal of the probiotic consumption is, the duration can be increased or decreased accordingly. For general health, probiotics may be taken daily, especially in food form, and the consumption is only effective for the duration it is taken for. For digestive difficulties, probiotic consumption may be a shorter (or longer) treatment depending on the intensity of the symptoms. However, data remains rather inconclusive on the recommended duration of consumption of probiotics (Verna & Lucak, 2010).Recommended Dosage of Probiotics:By eating a dose of a probiotic supplement on a daily basis and maintaining great gut health, the rest of the body, including the skin, will experience beneficial side effects. The size of the dose depends on the supplement being taken and why it is being taken. Julianne Schaeffer from Today’s Dietitian (2014) quotes Sherry Collins (MS, RDN, LD) recommendation of 6-8 ounces of plain yogurt or 4 ounces of kefir to maintain good digestion. If taking a probiotic pill, the size of the supplement will vary depending on the brand, and the reason for the supplement. Ultimate Flora for Vaginal Support by Renew Life recommends one capsule daily, each capsule containing 50 billion bacteria and 10 different probiotic strains. U.T. Biotic by Vibrant Health recommends one capsule per day containing only 25 billion probiotics and 7 different strains. In addition to this probiotics have also been found to be effective at varying strengths. “Scientific studies have determined health benefits from 50 million to more than 1 trillion CFUs per day. A probiotic with higher CFUs doesn't necessarily equal better quality or effectiveness” (Collins, 2015) Overall, how much a patient or client should consume really depends on why they are taking the supplement and in what form.Conclusion:Based on this research, there was sufficient evidence to suggest that oral consumption of probiotics in both food and pill form are effective at improving skin health by reducing acne blemishes, reducing skin inflammation and preventing atopic dermatitis. This is important as ingested probiotic supplements are able to spread their beneficial effects systemically to the body’s tissues, and the skin is considerably affected. Acne lesions, inflammation and atopic dermatitis were all significantly (p<0.05) improved, ranging from substantial reduction of appearances to total prevention. Acne total lesion count was reduced by 23.1%, inflammatory lesion count was reduced by 38.6% and clinical grade of acne was reduced by 20.3%, skin inflammation was alleviated, and atopic dermatitis had a significant 14% reduction in development if there was consumption during pregnancy.Food forms of probiotics are more convenient and cost efficient than pills, but the effectiveness of the probiotics in both forms were found to be equally effective. Yogurt is the most commonly known and consumed probiotic food. These are a key points as the average consumer is able to afford and consume a dose of probiotics daily with no harm to their budget. Depending on the timing of supplementation, probiotics have the ability to have synergistic effects with certain drugs when taken simultaneously, such as when taking a minocycline. This is an important aspect of probiotics being able to work synergistically with medications, and further studies should be conducted to research probiotics effects with other drugs, in addition to minocycline. The dosage recommendation depends on the reason for the supplementation and in what form it is taken, food or pill, however further research should be done in order to make more specific recommendations to consumers, including both dose size and duration. Duration of probiotic supplementation can affect the consumer’s ability to benefit from the probiotic, although more research needs to be done to as most data remains inconclusive. Current research does support the consumption of probiotics to improve skin health as being both worthwhile and beneficial. Probiotics are a very exciting and growing area of research, however, there is still a great need for further research to be done.Reference Page:Berkeley Wellness (2014). Probiotics Pros and Cons. Retrieved from: on 11/30/15Cao, L. & Wang, L. & Yang, L. & Tao, S. & Xia, R. & Fan, W. (2015). Long-term effect of early life supplementation with probiotics on preventing atopic dermatitis: a meta-analysis. Journal of Dermatology Treatment, DOI: 10.3109/09546634.2015.1027168Ciorba, M. (2012). A gastroenterologist’s guide to probiotics. Clin Gastroenterol Hepatol, 10(9) 960-968Collins, S. (2015). Probiotics: improve gut health with probiotic supplements. Today’s Dietitian 17(3) 14Getz, L. (2011). A healthful dose of bacteria-yogurt is the best probiotic source, but do clients have other options. Today’s Dietitian, 13(10) 46Govender, M. & Choonara, Y. & Kumar, P. & Toit, L. & Vuuren, V. & Pillay, V. (2014). A review of the advancements in probiotic delivery: conventional vs. non-conventional formulations for intestinal flora supplementation. AAPS PharmSciTech 15(1), 29-43Gueniche, A. & Bastien, P. & Ovigne, JM. & Kermici, M. & Courchay, G. & Chevalier, V. et al. (2010). Lactobacillus paracasei CNCM I-2166 (ST11) inhibits substance P-induced skin inflammation and accelerates skin barrier function recovery in vitro. European Journal of Dermatology, 20(6), 731-7Hacini-Rachinel, F. & Gheit, H. & Le Leduec, J. & Dif, F. & Nancey, S. & Kaiserlian, D. (2009) Oral probiotic control skin inflammation by acting on both effector and regulatory t-cells. PlosOne 4(3): e4903. Doi:10.1371/journal.pone.0004903Jeong, J. & Lee, C. & Chung, D. (2015). Probiotic lactic acid bacteria and skin health. Critical Reviews in Food Science and Nutrition, DOI: 10.1080/10408398.2013.834874Jung, GW. & Tse, JE. & Guiha, I. & Rao, J. (2013). Prospective randomized open label trial comparing the safety, efficacy and tolerability of an acne treatment regimen with and without a probiotic supplement in subjects with mild to moderate acne. J Cutan Med Surg, 17(2), 114-22Kim, J. & Ko, Y. & Park, YK. & Kim NI. & Ha, WK. & Cho, Y. (2012). Dietary effect of lactoferrin-enriched fermented milk on skin surface lipid and clinical improvement of acne vulgaris. Nutrition, 26, 902-9Levokovich, T. & Poutahidis, T. & Smillie, C. & Varian, B. & Ibrahim, Y. & Lakritz, J. & Alm, E. & Erdman, S. (2013). Probiotic bacteria induce a ‘glow of health’. PlosONE 8(1): e53867. DOI: 10.1371/journal.pone.0053867 Matsumoto M. & Aranami A. & Ishige, A. (2007). LKM512 yogurt consumption improves the intestinal environment and induces the T-helper type 1 cytokine in adult patients with intractable atopic dermatitis. Clin Exp Allergy, 37, 358-370Nole, K. & Yim, E. & Keri, J. (2014). Probiotics and prebiotics in dermatology. American Academy of Dermatology, 71(4) 814-821Schaeffer, J. (2014) Dairy’s probiotic power- a review of the benefits of probiotics, the top sources, and what’s new in the dairy case. Today’s Dietitian 16(8) 32Shamban, A. & Narurkar, V. (2009). Multimodal treatment of acne, acne scars and pigmentation. Dermatol Clin 27, 459-471Venugopalan, V. & Shriner, K. & Wong-Beringer, A. (2010). Regulatory oversight and safety of probiotic use. Emerg Infect Dis, 16(11) 1661-1665Verna, E. & Lucak, S. (2010). Use of probiotics in gastrointestinal disorders: what to recommend? Therap Adv Gastroenerol 3(5) 307-319Wickens, K. & Stanley, TV. & Mitchell, EA. & Barthow, C. & Fitzharris, P. & Purdie, G. (2013). Early supplementation with Lactobacillus rhamnosus HN001 reduces eczema prevelance to 6 years: does it also reduce atopic sensitization? Clin Exp Allergy, 43, 1048-57 ................
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