Probiotics for Constipation in Parkinson Patients

by | Sep 22, 2016 | 2016, Parkinson's, Probiotics

Written by Joyce Smith, BS. A fermented milk supplementation with added probiotics and prebiotic fiber significantly improved constipation in participating subjects with Parkinson disease compared to control.

shutterstock_295871813The hallmark of Parkinson’s disease is Lewy bodies which are deposits of abnormal protein in the brain that disrupt the healthy functioning of brain cells. Lewy bodies have recently been found in other areas of the body as well, such as the mucosa of the sigmoid colon. 1 These Lewy bodies disrupt the intestinal barrier integrity and increase intestinal permeability (leaky gut). 2 Imbalances in the gut bacteria and changes in the composition of fecal bacteria are common occurrences. 3 which, together, suggest that constipation may originate in the nervous system. 2 Improper functioning of the autonomic nervous system, which regulates smooth muscle activity including digestive processes, may be a contributing factor. Constipation can occur when the digestive tract slows down. Today, eighty to ninety percent of patients with Parkinson disease (PD) suffer from chronic constipation. 4-6

Some studies have shown that probiotics can improve functional constipation in patients; 7 however, very few studies have explored treatment options for constipation in patients with PD. 8 The objective of this single-center, randomized, parallel-group, placebo-controlled, double-blind trial was to determine whether probiotics and prebiotic fiber treatment would improve constipation in PD patients.

Prospective study participants were initially screened to confirm a diagnosis of constipation. They were required to complete a 2 -week pretreatment stool diary to assess daily and weekly symptoms of constipation. From this screening, 120 patients with confirmed constipation were selected and randomly assigned to either a 2:1 ratio of fermented milk containing multiple probiotic strains and prebiotic fiber or placebo, to be taken once daily for 4 weeks. The probiotic strains included Streptococcus salivarius subsp thermophilus, Enterococcus faecium, Lactobacillus rhamnosus GG, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus paracasei, Lactobacillus delbrueckii subsp bulgaricus, and Bifidobacterium (breve and animalis subsp lactis) (CFU 250×109 ) Also included was 7.8 grams of fiber of which 2.4 grams were prebiotics called Fructooligosaccharides. Placebo consisted of 125 grams of pasteurized fermented milk that contained only 0.26 grams of fiber.

A standard nutritional and neurological assessment was done on all patients. Physical activity was also recorded. Patients were asked to reduce laxative use and maintain or increase their daily fiber intake to at least 15-20 grams and daily fluids to 1.5 L. They were to maintain a daily diary of their bowel movements and constipation symptoms.

The primary goal was to increase the number of complete bowel movements (CBM’s) per week. Secondary goals were 3 or more CBM’s and an increase of one or more CBM’s per week during weeks 3 and 4.

Results were as follows:

  • Patients who had fermented milk containing probiotics and prebiotics had a mean increase of 1.2 CBM’s compared to 0.1 in the control group. (P<0.002)
  • 54 % patients in the probiotic – prebiotic group reported 1 or more CBMs during weeks 3 and 4 compared to 25 % in the control group (P=0.004)
  • 59% of patients in the probiotic – prebiotic group reported 3 or more CBMs during weeks 3 and 4 compared to 36 % in the control group (P=0.030)

Researchers conclude that fermented milk with added probiotics and prebiotic fiber was significantly superior to placebo in improving constipation in PD patients and can be recommended as an effective additional treatment option for constipation. However, confirmation studies are necessary.

Limitations of this study:

  • Medications such as anticholinergics and dopamine agonists may contribute to constipation in PD patients 5
  • Assessments consisted of self-reported symptoms which brings subjectivity into the equation because bowel habits are subject to individual sensitivity.
  • Patients were asked to reduce their intake of laxatives as much as possible rather than forbidding laxative use.

Source: Barichella, Michela, Claudio Pacchetti, Carlotta Bolliri, Erica Cassani, Laura Iorio, Chiara Pusani, Giovanna Pinelli et al. “Probiotics and prebiotic fiber for constipation associated with Parkinson disease An RCT.” Neurology 87, no. 12 (2016): 1274-1280.

© 2016 American Academy of Neurology

Posted September 22, 2016.

References:

  1. Cersosimo MG. Gastrointestinal Biopsies for the Diagnosis of Alpha-Synuclein Pathology in Parkinson’s Disease. Gastroenterology research and practice. 2015;2015.
  2. Forsyth CB, Shannon KM, Kordower JH, et al. Increased intestinal permeability correlates with sigmoid mucosa alpha-synuclein staining and endotoxin exposure markers in early Parkinson’s disease. PloS one. 2011;6(12):e28032.
  3. Keshavarzian A, Green SJ, Engen PA, et al. Colonic bacterial composition in Parkinson’s disease. Movement Disorders. 2015;30(10):1351-1360.
  4. Barichella M, Cereda E, Pezzoli G. Major nutritional issues in the management of Parkinson’s disease. Movement disorders. 2009;24(13):1881-1892.
  5. Fasano A, Visanji NP, Liu LW, Lang AE, Pfeiffer RF. Gastrointestinal dysfunction in Parkinson’s disease. The Lancet Neurology. 2015;14(6):625-639.
  6. Berg D, Postuma RB, Adler CH, et al. MDS research criteria for prodromal Parkinson’s disease. Movement Disorders. 2015;30(12):1600-1611.
  7. Dimidi E, Christodoulides S, Fragkos KC, Scott SM, Whelan K. The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. The American journal of clinical nutrition. 2014;100(4):1075-1084.
  8. Zangaglia R, Martignoni E, Glorioso M, et al. Macrogol for the treatment of constipation in Parkinson’s disease. A randomized placebo‐controlled study. Movement disorders. 2007;22(9):1239-1244.