Skip to main content
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 2004 Aug;80(946):447–451. doi: 10.1136/pgmj.2003.015339

Probiotics and prebiotics in the elderly

J Hamilton-Miller
PMCID: PMC1743061  PMID: 15299153

Abstract

Probiotics (usually lactobacilli and bifidobacteria) and prebiotics (non-digestible oligosaccharides) have been shown to be useful in preventing certain disease conditions as well as possibly promoting specific aspects of health. In the present review, the evidence from clinical trials for benefits from probiotics and prebiotics to elderly populations is presented and discussed, specifically in respect of three common conditions found in the elderly. Both probiotics and prebiotics may be helpful in malnutrition, particularly in lactose intolerance and calcium absorption, and in constipation. Probiotics have been shown clearly to boost immunity in the elderly, but the clinical significance of this remains to be clarified. These results are encouraging, and further large scale studies seem justified to establish the place of probiotic and prebiotic supplements in elderly subjects.

Full Text

The Full Text of this article is available as a PDF (73.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aso Y., Akaza H., Kotake T., Tsukamoto T., Imai K., Naito S. Preventive effect of a Lactobacillus casei preparation on the recurrence of superficial bladder cancer in a double-blind trial. The BLP Study Group. Eur Urol. 1995;27(2):104–109. doi: 10.1159/000475138. [DOI] [PubMed] [Google Scholar]
  2. Aso Y., Akazan H. Prophylactic effect of a Lactobacillus casei preparation on the recurrence of superficial bladder cancer. BLP Study Group. Urol Int. 1992;49(3):125–129. doi: 10.1159/000282409. [DOI] [PubMed] [Google Scholar]
  3. Aspinall R., Andrew D. Immunosenescence: potential causes and strategies for reversal. Biochem Soc Trans. 2000 Feb;28(2):250–254. doi: 10.1042/bst0280250. [DOI] [PubMed] [Google Scholar]
  4. Blum Stephanie, Haller Dirk, Pfeifer Andrea, Schiffrin Eduardo J. Probiotics and immune response. Clin Rev Allergy Immunol. 2002 Jun;22(3):287–309. doi: 10.1007/s12016-002-0013-y. [DOI] [PubMed] [Google Scholar]
  5. Brumfitt W., Hamilton-Miller J. M. Cefaclor into the millennium. J Chemother. 1999 Jun;11(3):163–178. doi: 10.1179/joc.1999.11.3.163. [DOI] [PubMed] [Google Scholar]
  6. Bunout Daniel, Hirsch Sandra, Pía de la Maza María, Muñoz Carlos, Haschke Ferdinand, Steenhout Philippe, Klassen Petra, Barrera Gladys, Gattas Vivien, Petermann Margarita. Effects of prebiotics on the immune response to vaccination in the elderly. JPEN J Parenter Enteral Nutr. 2002 Nov-Dec;26(6):372–376. doi: 10.1177/0148607102026006372. [DOI] [PubMed] [Google Scholar]
  7. Cunningham-Rundles S., Ahrné S., Bengmark S., Johann-Liang R., Marshall F., Metakis L., Califano C., Dunn A. M., Grassey C., Hinds G. Probiotics and immune response. Am J Gastroenterol. 2000 Jan;95(1 Suppl):S22–S25. doi: 10.1016/s0002-9270(99)00813-8. [DOI] [PubMed] [Google Scholar]
  8. D'Souza Aloysius L., Rajkumar Chakravarthi, Cooke Jonathan, Bulpitt Christopher J. Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis. BMJ. 2002 Jun 8;324(7350):1361–1361. doi: 10.1136/bmj.324.7350.1361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gallagher-Allred C. R., Voss A. C., Finn S. C., McCamish M. A. Malnutrition and clinical outcomes: the case for medical nutrition therapy. J Am Diet Assoc. 1996 Apr;96(4):361-6, 369; quiz 367-8. doi: 10.1016/s0002-8223(96)00099-5. [DOI] [PubMed] [Google Scholar]
  10. Gibson G. R., Roberfroid M. B. Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr. 1995 Jun;125(6):1401–1412. doi: 10.1093/jn/125.6.1401. [DOI] [PubMed] [Google Scholar]
  11. Gill H. S., Rutherfurd K. J., Cross M. L. Dietary probiotic supplementation enhances natural killer cell activity in the elderly: an investigation of age-related immunological changes. J Clin Immunol. 2001 Jul;21(4):264–271. doi: 10.1023/a:1010979225018. [DOI] [PubMed] [Google Scholar]
  12. Gill H. S., Rutherfurd K. J., Cross M. L., Gopal P. K. Enhancement of immunity in the elderly by dietary supplementation with the probiotic Bifidobacterium lactis HN019. Am J Clin Nutr. 2001 Dec;74(6):833–839. doi: 10.1093/ajcn/74.6.833. [DOI] [PubMed] [Google Scholar]
  13. Hirayama K., Rafter J. The role of probiotic bacteria in cancer prevention. Microbes Infect. 2000 May;2(6):681–686. doi: 10.1016/s1286-4579(00)00357-9. [DOI] [PubMed] [Google Scholar]
  14. Hopkins M. J., Sharp R., Macfarlane G. T. Age and disease related changes in intestinal bacterial populations assessed by cell culture, 16S rRNA abundance, and community cellular fatty acid profiles. Gut. 2001 Feb;48(2):198–205. doi: 10.1136/gut.48.2.198. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kelly C. P., Pothoulakis C., LaMont J. T. Clostridium difficile colitis. N Engl J Med. 1994 Jan 27;330(4):257–262. doi: 10.1056/NEJM199401273300406. [DOI] [PubMed] [Google Scholar]
  16. Kleessen B., Sykura B., Zunft H. J., Blaut M. Effects of inulin and lactose on fecal microflora, microbial activity, and bowel habit in elderly constipated persons. Am J Clin Nutr. 1997 May;65(5):1397–1402. doi: 10.1093/ajcn/65.5.1397. [DOI] [PubMed] [Google Scholar]
  17. Kot T. V., Pettit-Young N. A. Lactulose in the management of constipation: a current review. Ann Pharmacother. 1992 Oct;26(10):1277–1282. doi: 10.1177/106002809202601017. [DOI] [PubMed] [Google Scholar]
  18. Lewis S. J., Potts L. F., Barry R. E. The lack of therapeutic effect of Saccharomyces boulardii in the prevention of antibiotic-related diarrhoea in elderly patients. J Infect. 1998 Mar;36(2):171–174. doi: 10.1016/s0163-4453(98)80008-x. [DOI] [PubMed] [Google Scholar]
  19. Marteau Philippe R. Probiotics in clinical conditions. Clin Rev Allergy Immunol. 2002 Jun;22(3):255–273. doi: 10.1007/s12016-002-0011-0. [DOI] [PubMed] [Google Scholar]
  20. McWhirter J. P., Pennington C. R. Incidence and recognition of malnutrition in hospital. BMJ. 1994 Apr 9;308(6934):945–948. doi: 10.1136/bmj.308.6934.945. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Meydani S. N., Ha W. K. Immunologic effects of yogurt. Am J Clin Nutr. 2000 Apr;71(4):861–872. doi: 10.1093/ajcn/71.4.861. [DOI] [PubMed] [Google Scholar]
  22. Mitsuoka T. Intestinal flora and aging. Nutr Rev. 1992 Dec;50(12):438–446. doi: 10.1111/j.1753-4887.1992.tb02499.x. [DOI] [PubMed] [Google Scholar]
  23. Murray F. E., Bliss C. M. Geriatric constipation: brief update on a common problem. Geriatrics. 1991 Mar;46(3):64–68. [PubMed] [Google Scholar]
  24. Nopchinda Supujchara, Varavithya Wandee, Phuapradit Pornpimol, Sangchai Rawiwan, Suthutvoravut Umaporn, Chantraruksa Vinita, Haschke Ferdinand. Effect of bifidobacterium Bb12 with or without Streptococcus thermophilus supplemented formula on nutritional status. J Med Assoc Thai. 2002 Nov;85 (Suppl 4):S1225–S1231. [PubMed] [Google Scholar]
  25. Ouwehand Arthur C., Lagström Hanna, Suomalainen Tarja, Salminen Seppo. Effect of probiotics on constipation, fecal azoreductase activity and fecal mucin content in the elderly. Ann Nutr Metab. 2002;46(3-4):159–162. doi: 10.1159/000063075. [DOI] [PubMed] [Google Scholar]
  26. Ouwehand Arthur C., Salminen Seppo, Isolauri Erika. Probiotics: an overview of beneficial effects. Antonie Van Leeuwenhoek. 2002 Aug;82(1-4):279–289. [PubMed] [Google Scholar]
  27. Rajala S. A., Salminen S. J., Seppänen J. H., Vapaatalo H. Treatment of chronic constipation with lactitol sweetened yoghurt supplemented with guar gum and wheat bran in elderly hospital in-patients. Compr Gerontol A. 1988 Jun;2(2):83–86. [PubMed] [Google Scholar]
  28. Reid Gregor, Sanders M. E., Gaskins H. Rex, Gibson Glenn R., Mercenier Annick, Rastall Robert, Roberfroid Marcel, Rowland Ian, Cherbut Christine, Klaenhammer Todd R. New scientific paradigms for probiotics and prebiotics. J Clin Gastroenterol. 2003 Aug;37(2):105–118. doi: 10.1097/00004836-200308000-00004. [DOI] [PubMed] [Google Scholar]
  29. Reuter G. The Lactobacillus and Bifidobacterium microflora of the human intestine: composition and succession. Curr Issues Intest Microbiol. 2001 Sep;2(2):43–53. [PubMed] [Google Scholar]
  30. Roberfroid M. Dietary fiber, inulin, and oligofructose: a review comparing their physiological effects. Crit Rev Food Sci Nutr. 1993;33(2):103–148. doi: 10.1080/10408399309527616. [DOI] [PubMed] [Google Scholar]
  31. Salminen S., Salminen E. Lactulose, lactic acid bacteria, intestinal microecology and mucosal protection. Scand J Gastroenterol Suppl. 1997;222:45–48. doi: 10.1080/00365521.1997.11720717. [DOI] [PubMed] [Google Scholar]
  32. Saltzman J. R., Russell R. M., Golner B., Barakat S., Dallal G. E., Goldin B. R. A randomized trial of Lactobacillus acidophilus BG2FO4 to treat lactose intolerance. Am J Clin Nutr. 1999 Jan;69(1):140–146. doi: 10.1093/ajcn/69.1.140. [DOI] [PubMed] [Google Scholar]
  33. Saran Shailee, Gopalan Sarath, Krishna T. Prasanna. Use of fermented foods to combat stunting and failure to thrive. Nutrition. 2002 May;18(5):393–396. doi: 10.1016/s0899-9007(01)00790-0. [DOI] [PubMed] [Google Scholar]
  34. Scheppach W. Effects of short chain fatty acids on gut morphology and function. Gut. 1994 Jan;35(1 Suppl):S35–S38. doi: 10.1136/gut.35.1_suppl.s35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Sheih Y. H., Chiang B. L., Wang L. H., Liao C. K., Gill H. S. Systemic immunity-enhancing effects in healthy subjects following dietary consumption of the lactic acid bacterium Lactobacillus rhamnosus HN001. J Am Coll Nutr. 2001 Apr;20(2 Suppl):149–156. doi: 10.1080/07315724.2001.10719027. [DOI] [PubMed] [Google Scholar]
  36. Solis B., Samartín S., Gómez S., Nova E., de la Rosa B., Marcos A. Probiotics as a help in children suffering from malnutrition and diarrhoea. Eur J Clin Nutr. 2002 Aug;56 (Suppl 3):S57–S59. doi: 10.1038/sj.ejcn.1601488. [DOI] [PubMed] [Google Scholar]
  37. Stanton C., Gardiner G., Meehan H., Collins K., Fitzgerald G., Lynch P. B., Ross R. P. Market potential for probiotics. Am J Clin Nutr. 2001 Feb;73(2 Suppl):476S–483S. doi: 10.1093/ajcn/73.2.476s. [DOI] [PubMed] [Google Scholar]
  38. Szilagyi A. Review article: lactose--a potential prebiotic. Aliment Pharmacol Ther. 2002 Sep;16(9):1591–1602. doi: 10.1046/j.1365-2036.2002.01321.x. [DOI] [PubMed] [Google Scholar]
  39. Tamime A. Y. Fermented milks: a historical food with modern applications--a review. Eur J Clin Nutr. 2002 Dec;56 (Suppl 4):S2–S15. doi: 10.1038/sj.ejcn.1601657. [DOI] [PubMed] [Google Scholar]
  40. Tanaka R., Shimosaka K. [Investigation of the stool frequency in elderly who are bed ridden and its improvements by ingesting bifidus yogurt]. Nihon Ronen Igakkai Zasshi. 1982 Nov;19(6):577–582. [PubMed] [Google Scholar]
  41. Teitelbaum Jonathan E., Walker W. Allan. Nutritional impact of pre- and probiotics as protective gastrointestinal organisms. Annu Rev Nutr. 2002 Jan 4;22:107–138. doi: 10.1146/annurev.nutr.22.110901.145412. [DOI] [PubMed] [Google Scholar]
  42. Teuri U., Korpela R. Galacto-oligosaccharides relieve constipation in elderly people. Ann Nutr Metab. 1998;42(6):319–327. doi: 10.1159/000012751. [DOI] [PubMed] [Google Scholar]
  43. Van de Water J., Keen C. L., Gershwin M. E. The influence of chronic yogurt consumption on immunity. J Nutr. 1999 Jul;129(7 Suppl):1492S–1495S. doi: 10.1093/jn/129.7.1492S. [DOI] [PubMed] [Google Scholar]
  44. van den Heuvel E. G., Schoterman M. H., Muijs T. Transgalactooligosaccharides stimulate calcium absorption in postmenopausal women. J Nutr. 2000 Dec;130(12):2938–2942. doi: 10.1093/jn/130.12.2938. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

[Conflict of Interest Satement]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES