International Society of Sports Nutrition Position Stand: Probiotics

Ralf Jäger, Alex E Mohr, Katie C Carpenter, Chad M Kerksick, Martin Purpura, Adel Moussa, Jeremy R Townsend, Manfred Lamprecht, Nicholas P West, Katherine Black, Michael Gleeson, David B Pyne, Shawn D Wells, Shawn M Arent, Abbie E Smith-Ryan, Richard B Kreider, Bill I Campbell, Laurent Bannock, Jonathan Scheiman, Craig J Wissent, Marco Pane, Douglas S Kalman, Jamie N Pugh, Jessica A Ter Haar, Jose Antonio, Ralf Jäger, Alex E Mohr, Katie C Carpenter, Chad M Kerksick, Martin Purpura, Adel Moussa, Jeremy R Townsend, Manfred Lamprecht, Nicholas P West, Katherine Black, Michael Gleeson, David B Pyne, Shawn D Wells, Shawn M Arent, Abbie E Smith-Ryan, Richard B Kreider, Bill I Campbell, Laurent Bannock, Jonathan Scheiman, Craig J Wissent, Marco Pane, Douglas S Kalman, Jamie N Pugh, Jessica A Ter Haar, Jose Antonio

Abstract

Position statement: The International Society of Sports Nutrition (ISSN) provides an objective and critical review of the mechanisms and use of probiotic supplementation to optimize the health, performance, and recovery of athletes. Based on the current available literature, the conclusions of the ISSN are as follows: 1)Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host (FAO/WHO).2)Probiotic administration has been linked to a multitude of health benefits, with gut and immune health being the most researched applications.3)Despite the existence of shared, core mechanisms for probiotic function, health benefits of probiotics are strain- and dose-dependent.4)Athletes have varying gut microbiota compositions that appear to reflect the activity level of the host in comparison to sedentary people, with the differences linked primarily to the volume of exercise and amount of protein consumption. Whether differences in gut microbiota composition affect probiotic efficacy is unknown.5)The main function of the gut is to digest food and absorb nutrients. In athletic populations, certain probiotics strains can increase absorption of key nutrients such as amino acids from protein, and affect the pharmacology and physiological properties of multiple food components.6)Immune depression in athletes worsens with excessive training load, psychological stress, disturbed sleep, and environmental extremes, all of which can contribute to an increased risk of respiratory tract infections. In certain situations, including exposure to crowds, foreign travel and poor hygiene at home, and training or competition venues, athletes' exposure to pathogens may be elevated leading to increased rates of infections. Approximately 70% of the immune system is located in the gut and probiotic supplementation has been shown to promote a healthy immune response. In an athletic population, specific probiotic strains can reduce the number of episodes, severity and duration of upper respiratory tract infections.7)Intense, prolonged exercise, especially in the heat, has been shown to increase gut permeability which potentially can result in systemic toxemia. Specific probiotic strains can improve the integrity of the gut-barrier function in athletes.8)Administration of selected anti-inflammatory probiotic strains have been linked to improved recovery from muscle-damaging exercise.9)The minimal effective dose and method of administration (potency per serving, single vs. split dose, delivery form) of a specific probiotic strain depends on validation studies for this particular strain. Products that contain probiotics must include the genus, species, and strain of each live microorganism on its label as well as the total estimated quantity of each probiotic strain at the end of the product's shelf life, as measured by colony forming units (CFU) or live cells.10)Preclinical and early human research has shown potential probiotic benefits relevant to an athletic population that include improved body composition and lean body mass, normalizing age-related declines in testosterone levels, reductions in cortisol levels indicating improved responses to a physical or mental stressor, reduction of exercise-induced lactate, and increased neurotransmitter synthesis, cognition and mood. However, these potential benefits require validation in more rigorous human studies and in an athletic population.

Keywords: Gut-muscle-Axis; Microbiome; Microbiota; Muscle; Sport performance.

Conflict of interest statement

AM, ASR, KB, LB, and SDW declare no competing interests. RJ has received grants to evaluate the efficacy and safety of probiotics, serves on scientific advisory boards, and has served as an expert witness, legal and scientific consultant. AEM and KCC are employed by Isagenix, a company selling branded probiotics products. CMK has previously received external funding to conduct research studies involving nutritional supplements and is currently conducting studies involving prebiotics and probiotics. MP has received grants to evaluate the efficacy and safety of probiotics, and has served as a scientific consultant. JRT reports no conflicts of interest regarding the material or paper presented. JRT has previously received grants to evaluate the efficacy of various nutritional supplements including probiotics. ML conducts industry sponsored studies and serves as a scientific consultant to the Juice Plus+ Company. MG reports no conflicts of interest regarding the material or paper presented. MG has previously received external funding to conduct research studies involving nutritional supplements including probiotics. DBP reports no conflicts of interest regarding the material or paper presented, and has received grants to evaluate the effectiveness of probiotic supplementation in athletes. BIC serves on the scientific advisory board of Dymatize (Post Holdings). SMA reports no conflicts of interest related to the material presented in this paper. He has conducted industry sponsored studies at the universities he has been affiliated with and has occasionally served as an expert witness and scientific consultant. RBK reports no conflicts of interest related to the material presented in this paper. He has conducted industry sponsored studies at the universities he has been affiliated with and occasionally serves as a scientific and legal consultant related to exercise and nutrition intervention studies. CJW is employed by Jamieson Labs, a company selling branded probiotics products. MPa is employed by Biolab research Srl, performing research & development activities for Probiotical SpA, a leading probiotic supplier. DSK works for a Contract Research Organization (Nutrasource) that has received funding from the probiotic industry for clinical trials and serves on the Scientific Advisory Board for Dymatize (Post Holdings). JS is a co-founder of FitBiomics, a company identifying, researching and commercializing new probiotic strains. JAT is employed by the International Probiotic Association and further consults within the probiotic and microbiome industries. JA is the CEO of the International Society of Sports Nutrition.

Figures

Fig. 1
Fig. 1
Probiotic benefits are strain specific and probiotics must be described as genus, species and strain, as genetic variation between the same genus and species can be as significant as the difference between a human and a lemur (illustration by Stephen Somers, Milwaukee, WI, USA)
Fig. 2
Fig. 2
Early research indicates that gut bacteria reflect the activity level of its host. An athlete’s gut microbiota is different from a sedentary individual: increased diversity and greater abundance of health promoting bacterial species linked to exercise and increased protein intake (illustration by Stephen Somers, Milwaukee, WI, USA)

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