Could Probiotics help against COVID-19?

Dr Aisling Dwyer MB BCh BAO (Medicine, Surgery and Obstetrics), MSc (Personalised Nutrition)​

 A newly published clinical study, currently being given worldwide press coverage, has established a link between the composition of the gut microbiome and symptom severity in COVID-19 infection1. This is not the first research article to call attention to the relationship between SARS-CoV-2, the virus strain implicated in COVID-19 and, the gut and its residing population of gut bacteria, known as the gut microbiome.

COVID-19 and the gut

Since the outbreak of the COVID-19 pandemic in early 2020, various clinical research studies have been published examining the relationship between SARS-CoV-2, gut health and the gut microbiome. Earlier in the course of the pandemic, in May 2020, researchers identified that SARS-CoV-2 can be transmitted via a faecal-oral route; infecting our gut cells2, and contributing to the gastrointestinal symptoms frequently present in acute infection3.

Several months later, further research emerged highlighting the presence of dysbiosis and a unique gut microbiome composition pattern in COVID-19 patients when compared with the microbiomes of healthy individuals4. Several bacterial species were identified as being most commonly associated with increased disease severity including Clostridium ramosum and Clostridium hathewayi, whereas others were associated with a reduction in severity such as Alistipes oderdonkii and Faecalibacterium prausnitzi. These findings suggest that the SARS-CoV-2 virus has the ability to influence the composition of the gut microbiome and that this could ultimately have an impact on the body’s immune response to the virus.

covid-19

Impact of Gut Bacteria on COVID Severity

A highly topical research article recently published in the British Medical Journal has found an association between the composition of the gut microbiome and the severity of symptoms in patients with COVID-19.

Our gut bacteria are known to influence our immune function5. This clinical study found that those with dysbiosis and low levels of known immunomodulatory commensal gut microbes have an exaggerated immune response to the SARS-CoV-2, when compared to those with a healthy gut microbiome1. This heightened immune response is recognised in the form of raised inflammatory markers and blood markers signifying tissue damage. Furthermore, this dysbiosis was suggested to be a contributing factor in the delayed resolution of symptoms after acute infection.

Can we deduce from the findings of this study that by addressing an imbalance within the gut microbiome, COVID-19 could be mitigated? Or, in other words, could probiotics help against COVID-19? Perhaps but the research is not quite there yet to confirm this claim.

Probiotics and COVID-19

In late 2020, research findings from the world’s largest ongoing study of COVID-196 were published in which probiotics were found to have ‘a small protective effect against testing positive for the virus’, as quoted by lead researcher Marica Meroni.

In this observational longitudinal study of 1.4 million users of the ZOE COVID Symptom Study App, a significant negative association was identified in women taking probiotic supplements, vitamin D, multi-vitamins and Omega-3 fatty acid supplements and the likelihood of testing positive for SARS-CoV-27. Of note, probiotics, of all health supplements assessed, were associated with the lowest risk of testing positive for SARS-CoV-2.

Vitamin D has been highly recognised for its role in the body’s immune response to SARS-CoV-2, with vitamin D deficiency being linked to increased COVID-19 symptoms severity8. As a result, vitamin D has garnered substantial interest in the medical community and with that, a surge in clinical research on this topic has arisen. Tens of journal articles examining the role of vitamin D in immunity related to COVID-19 have been published in 2021 already. Probiotics have not yet quite achieved this level of attention. However, there are several clinical trials in progress9 and with the release of research discussed in this article, further testing will be encouraged. We know that the properties of an individual probiotic strain are specific to that strain alone, as well documented and substantiated by clinical research10,11 . The effects of individual probiotics strains in COVID-19 infection have yet to be elucidated. High quality, well-designed clinical trials are required to ascertain which probiotic strains may be beneficial in preventing the development or reducing symptom severity of COVID-19. 

This research paper is not yet peer-reviewed and several limitations of the study have already been pointed out12. These limitations include the lack of baseline nutritional status information of the population studied; the fact that self-measured data collected is subject to bias; and the lack of representation across the general population. However, as highlighted by Marica Meroni the lead researcher of this study, the findings are worth considering as only some supplements were determined to be helpful. ‘Healthy bias’, where people who use the app are more likely to engage in health-conscious behaviours, does not account for the fact that only certain supplements were found to be protective against COVID-19. It would be expected that if it was ‘healthy bias’ alone at play, the association would be the same across all supplements; when in fact, vitamin C, zinc and garlic supplements demonstrated no protective effects against COVID-19.

Although the findings of this study are promising, it demands further investigation. Therefore, currently, there is not enough evidence to unequivocally support taking probiotics to help against COVID-19; however, this may change as our knowledge of this field continues to expand.

Probiotics have also been utilised in a different manner to help against COVID-19 – to make a vaccine. Lactobacillus acidophilus has been increasingly recognised for its potential as a vaccine vector. Biomedical research carried out by a team of scientists at the Department of Microbiology, Immunology and Pathology in Colorado State University, assessed the use of genetically modified Lactobacillus acidophilus13 as a vaccine vector to target the coronavirus. Extensive clinical testing was required before it could be proven to be efficacious as a vaccine against SARS-CoV-2. In the meantime, other vaccines have been approved and disseminated.

Probiotics and Gut Bacteria

Although it remains to be confirmed that probiotics can help against COVID-19, it can be acknowledged that maintaining a healthy gut microbiome plays an important role in normal immune function. Replenishing our gut microbiome, whether through diet or by other means, is therefore worth considering. Earlier this month, the epidemiologist Professor Tim Spector from ZOE, the COVID symptom study app, released a video update including advice on how to support our health against COVID-19. He discussed how our gut microbiome is negatively impacted by the virus and by “keeping it in good shape, you can do something to ameliorate the disease”. He recommended supporting the health of our gut microbiome by eating plenty of fresh fruit and vegetables, by including fermented foods in our diet, for example sauerkraut or kefir, and polyphenol-rich foods such as peanuts and berries. Along with Professor Spector’s suggestions, it is worth noting probiotic supplements are also an option for replenishing the gut microbiome with beneficial bacteria. Learn more about the microbiome over on the Probiotics Learning Lab.

Key Points covered in this article

  • SARS-CoV-2 can affect gut health by infecting gut cells and by causing gastrointestinal symptoms. It also can influence the composition of the gut microbiome.
  • There is currently not enough clinical research published to support the use of probiotics in protecting against COVID-19. Although results thus far have been promising, further investigation is required.  
  • The gut microbiome plays an important role in normal immune function.

If you enjoyed this article, you may also like to read:

All about the Microbiome

Gut Health – All you need to know

References

  1. Yeoh YK, Zuo T, Lui GC-Y, et al. Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. Gut. 2021:1-9. doi:10.1136/gutjnl-2020-323020
  2. Lamers MM, Beumer J, van der Vaart J, et al. SARS-CoV-2 productively infects human gut enterocytes. Science (80- ). May 2020:eabc1669. doi:10.1126/science.abc1669
  3. Cholankeril G, Podboy A, Aivaliotis VI, et al. High Prevalence of Concurrent Gastrointestinal Manifestations in Patients with SARS-CoV-2: Early Experience from California. Gastroenterology. 2020. doi:10.1053/j.gastro.2020.04.008
  4. Zuo T, Zhang F, Lui GCY, et al. Alterations in Gut Microbiota of Patients With COVID-19 During Time of Hospitalization. Gastroenterology. 2020;159(January):944-955.
  5. Zheng D, Liwinski T, Elinav E. Interaction between microbiota and immunity in health and disease. Cell Res. 2020;30(6):492-506. doi:10.1038/s41422-020-0332-7
  6. COVID Symptom Study - About this Research. https://covid.joinzoe.com/about. Accessed January 20, 2021.
  7. Louca P, Murray B, Klaser K, et al. Dietary supplements during the COVID-19 pandemic: insights from 1.4M users of the COVID Symptom Study app - a longitudinal app-based community survey. medRxiv. 2020:0. https://doi.org/10.1101/2020.11.27.20239087.
  8. Griffin G, Hewison M, Hopkin J, et al. Vitamin D and COVID-19: evidence and recommendations for supplementation. R Soc Open Sci. 2020;7(12):201912. doi:10.1098/rsos.201912
  9. Effect of Lactobacillus on the Microbiome of Household Contacts Exposed to COVID-19 - Full Text View - ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT04399252. Accessed January 21, 2021.
  10. Bubnov R V, Babenko LP, Lazarenko LM, et al. Specific properties of probiotic strains: relevance and benefits for the host. EPMA J. 2018;9:205-223. doi:10.1007/s13167-018-0132-z
  11. McFarland L V., Evans CT, Goldstein EJC. Strain-specificity and disease-specificity of probiotic efficacy: A systematic review and meta-analysis. Front Med. 2018;5(MAY). doi:10.3389/fmed.2018.00124
  12. Expert reaction to preprint from the ZOE COVID Symptom Study app looking at vitamin supplements and likelihood of reporting a positive COVID-19 test | Science Media Centre. https://www.sciencemediacentre.org/expert-reaction-to-preprint-from-the-zoe-covid-symptom-study-app-looking-at-vitamin-supplements-and-likelihood-of-reporting-a-positive-covid-19-test/?cli_action=1611145450.453. Accessed January 20, 2021.
  13. Coronavirus ‘spike’ protein just mapped, leading way to vaccine | Live Science. https://www.livescience.com/coronavirus-spike-protein-structure.html. Accessed April 14, 2020.
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