Which probiotics are best for teenagers?

Kathy Wheddon Nutritional Therapist DipION

Parents of teenagers will know only too well that the transitional years between childhood and adulthood, can be full of turmoil and highs and lows. These years are often difficult for everyone in the household, as tension increases and tempers fray. In this article we will look at both the physical changes that occur during adolescence, and lifestyle factors that have a knock on effect on the physical wellbeing of our young people. We’ll also discuss the surprising role that the microbiome can play in common ‘teen’ symptoms, and how probiotics can help. 

This blog forms part 5 in the 'Microbiome series' and is aimed for children 13+. For children 12 and below please see 'Child's microbiome, Dr Kate's guide'.

Physical changes during adolescence:

There are two main areas of physical change during adolescence that have far reaching effects in the body. The first, and most obvious, is the onset of hormonal changes, and the second (less obvious) area of change is in the brain. Brain development is often over-looked when trying to understand and navigate the ‘choppy waters’ of teenage emotions! Let’s take a closer look at these areas.

female teenager questioning gesture with hands

Sex hormones

Sex hormones are present in tiny quantities from birth, however they surge during puberty. The main hormones in question are oestrogen (responsible for anatomical changes, and the onset of menstruation in girls) and testosterone (responsible for the development of facial hair, and a drop in voice pitch etc in boys).

In addition to transforming a child’s body into that of a young adult, the sudden surge in sex hormones can also lead to behavioural changes. As a result of wildly fluctuating hormones, teenagers can experience intense emotions, and may swing from one emotional state to another. An emerging interest in romantic relationships can be confusing for many, and bring about new emotional challenges.

The sex hormones also affect circadian rhythms, meaning that teenagers may be inclined to stay up later at night. A lack of quality sleep adds to any difficulties being experienced on an emotional level, and also affects the physical body in many ways, including: lowering immunity1, impairing healing2, affecting cognition3 and causing blood sugar swings4.

Lastly, the sex hormones also cause an increase in sebum production, which often leads to blocked pores and acne. At a time when appearance becomes increasingly important, skin health issues can be a constant source of upset and low self-esteem for teenagers.

Whilst hormones play a part in the process, acne is an inflammatory condition, with sufferers having higher levels of inflammatory cytokines (markers) in the blood. Inflammation often stems from the gut, as toxins produced by pathogenic (harmful) strains of bacteria and yeast cause inflammation of the gut lining.

Taking a well-researched multi-strain probiotic can be helpful for healing the gut, rebalancing microbial communities and reducing systemic inflammation. Additionally, Streptococcus salivarius 10 strains have been shown in-vitro to reduce Propiobacterium acnes colonisation. P. acnes is a pathogenic species of bacteria often implicated in acne. The relationship between the gut and skin, known as the gut-skin axis is exciting research scientists and offering a whole new avenue for skin care.

Brain development

You might be surprised to know that the human brain is not considered fully developed until we reach our mid to late 20’s! So whilst a teenager goes through anatomical changes that make them start to look like an adult from the outside, cognitively they are still quite far from reaching maturity.

The prefrontal regions of the brain, including the frontal lobe, are the last to fully develop, not reaching full maturity until our late twenties. The frontal lobe is responsible for many complex thought processes, including: rational thinking, predicting consequences for our actions, and supressing socially unacceptable behaviour. This region plays a big role in our choice between what would be a good, or bad action to take in a situation. With this brain region still in an immature state teenagers can often make, what adults would consider to be, poor or ‘risky’ choices.   

So, whilst ‘hormones’ generally take the blame for teenage moodiness, in reality brain development, or rather the lack of it, should also be implicated.

lifestyle impacts on gut health in teenagers

Lifestyle changes in adolescence

Along with physical changes, most teenagers also see huge changes to their lifestyle in these transitional years. It should not be over-looked just how much these lifestyle factors can impact on both their health and their mood.

Many symptoms experienced during the teenage years include: acne, weight gain, fatigue, anxiety, self-esteem issues and moodiness. These may all be helped with improved lifestyle choices. Interestingly, most of these symptoms also respond to improvements to the gut microbiome.

Typically the teenage years, are when children start to take a little more control over their own lives. Having previously been dependent on parental guidance, they may now start to have more influence over factors such as: what they eat, when they eat and how much sleep they get. Additionally, external pressures increase with teenagers facing exam stress, and also pressure from their peers to maybe have the latest trend items, and even to look a certain way.

Teenage Diet and Gut Health

As soon as they leave the front door our teens are bombarded with advertising and temptation to buy lots of unhealthy types of food. Eating ‘on the go’ and eating at irregular times of the day are also not conducive to optimum digestion, as the body digests better when it is at rest, and in synch with circadian rhythms. Many adolescents fall prey to the rush of a quick sugar high, but probably don’t realise that sugar damages our health on many levels.

Firstly, a high sugar diet creates havoc in the gut, feeding bad bacteria and yeasts. An overgrowth of pathogenic microbes can lead to symptoms such as bloating, constipation or diarrhoea and abdominal pain. On a wider level it can also be a factor in systemic symptoms, such as obesity, acne, inflammation and of course hormonal fluctuations. At a time when hormones are already surging, and when looking good is a focus, these are all symptoms that could be done without. Read more about ‘probiotics for acne’. Helping your teenagers to understand the links between what they eat and how they feel and look could help to make their adolescence easier.

Having good gut health is vital to maintaining hormone balance. If constipation is present ‘spent’ hormones are able to be reabsorbed, rather than excreted, from the bowel. By recycling ‘old’ hormones in this way, constipation is known to exacerbate existing hormonal issues11 In order to improve bowel regularity, teenagers should ensure that they are eating a fibre rich diet, with plenty of fresh fruit and veg. It is also important to maintain adequate hydration levels, and to ensure regular exercise is taken, as regularity is improved by activity. Encouraging teenagers to join school sports or activity clubs, or planning family trips doing something active at the weekend are two good ways to incorporate more activity in to their lives.

Additionally, certain strains of probiotic have been shown to improve bowel transit time. The strain Bifidobacterium lactis BB-12® has been extensively researched for constipation, and can be taken in supplement form to improve bowel regularity. Health Professionals can learn more about Bifidobacterium lactis BB-12® over at the Probiotics Database.

Lack of sleep

Sex hormones affect our circadian rhythms, which means that teenagers often feel energised in the evening, and are resistant to the idea of going to bed. This coupled with the desire to be plugged in to their devices and social media accounts until the small hours, can mean that teenagers are just not getting the amount of quality sleep that they need. Not only does a lack of sleep lower our immunity, affect our mood, and reduce cognition, but research also suggests that it affects our microbiome. A small Swedish study 9 showed that after just two nights sleep deprivation the study participant’s microbiome was significantly altered. Click here to read more: ‘Does lack of sleep affect gut bacteria?’

teenage girl sleeping

Fatigue

Teenagers often feel fatigued. Whilst a lack of sleep and poor diet makes this worse, another key factor is that their bodies are undergoing a period of rapid growth. Demands on their energy are high, which is why they often feel hungry all the time too. Ensuring that nutrients are being absorbed effectively from their food is vital. Probiotics can help in the process of digestion and absorption, as they produce digestive enzymes which help with food break down. They also improve the health of the gut lining, which allows for greater absorption of nutrients. You can learn more about this in Dr. Kate’s blog: ‘What are probiotics?’.

All metabolic processes rely on adequate supply of micronutrients, and the B family of vitamins in particular are used in energy production. Probiotic bacteria can be helpful here too, as they actually produce certain B-vitamins for us, whilst also helping us absorb key vitamins and minerals from the digestive tract. Any good, well-researched probiotic that has been shown to have good survivability and adherence properties would help here. Read how we ensure the survivability of our probiotic strains in the following blog: ‘Do probiotics survive to reach the gut alive.’

Stress

Teenage years can be difficult years to navigate through. There may be worries about all sorts of things: body changes, fitting in with peers, sexual relationships, exam stress etc. As emotional intelligence is still developing, dealing with new situations may lead to anxiety and depression, both of which can affect so many areas of health and wellbeing.

Sadly, mental health problems are on the rise. This is a trend seen amongst all age groups, however teens fare particularly badly, with as many as 1 in 55 adolescents affected. This figure is slightly higher in girls, with 1 in 46 said to be affected by the age of 14.

In response to stress the body increases production of stress hormones, namely cortisol and adrenaline. These hormones affect our blood sugar levels, and can lead to blood sugar ‘crashes’ and a craving for high energy foods. An over-reliance on these types of foods makes teenage hormonal swings even worse, and can also lead to weight gain.

Additionally, stress hormones have been shown to negatively impact the gut microbiome. In a trial7 involving 47 pre-term infants (born at between 24-37 weeks), regular stool samples were taken during their stay in NICU, and analysed for microbial composition. Babies in a neo-natal unit were purposefully selected for this trial, as according to the study authors:

'The environment (NICU) places preterm infants under a great deal of stress as infants are exposed to pro‐longed separation from parents, chronic and extreme stressors, and painful lifesaving medical procedures. Furthermore, preterm infants are unable to articulate to caregivers their burden of stress. The cumulative and multifaceted experiences of high‐level stress, coupled with the preverbal stage of development and inability to self‐advocate, potentially lead to toxic stress exposure.’

Study findings showed that whilst the process of infant gut microbial colonisation is affected by many factors, stress appears to be a significant one. The authors concluded that:

‘For vulnerable preterm infants who experience high NICU stress exposure, our data suggest these infants also experience increased microbial abundances of Proteus and Veillonella. As a species of Gamma-proteobacteria, dominance of Proteus may pose an in‐creased risk for immunocompromised preterm infants.

As well as stress affecting the microbiome, clinical trials in humans have found the opposite to be true as well. Taking probiotics can support our mental wellbeing thanks to our gut brain axis. Supplementing with certain strains of probiotics, including Lactobacillus acidophilus Rosell-52 and Bifidobacterium longum Rosell-175 may improve our mental health8.

L. acidophilus Rosell-52 and B. longum Rosell-175 have been shown in a gold standard human clinical trial to significantly reduce depression, anger hostility and psychological distress, as well as have positive effects on anxiety. The study also improved problem solving skills and self blame scores which could be of interest to teenagers going through exam seasons.  

Supporting teenagers through any particularly stressful times with a probiotic researched for mental health can be very helpful. Taking prebiotics can also help, as prebiotics encourage the proliferation of friendly strains of bacteria in the intestine.

You can read more on the relationship between the gut and our emotional health in the following articles:

The gut-brain axis.

Probiotics and emotional health.

Can high fibre diets improve brain health?

Intimate health

As hormones surge in the body, teenagers naturally start to explore their sexuality. The topic of sexual education is broached at a young age at school, so our youngsters are hopefully fully aware of the risks of STIs and pregnancy. However, for girls, the onset of menstruation caused by the surge in oestrogen and progesterone, can sometimes signal the arrival of unwanted vaginal infections. Infections, such as thrush and bacterial vaginosis are rare in pre-menstrual girls, but common after the onset of menses.

Our vaginal flora is sensitive to fluctuations in hormones, which can predispose women to recurrent infection. Read Bev’s blog ‘All about your vaginal flora’ to find out more. Only certain strains of probiotics have been proven to have a beneficial effect on vaginal health.

In order to improve the vaginal flora, probiotic bacteria need to survive transit through the entire length of the GI tract, and then successfully colonise the vaginal tract. Once colonised they need to produce anti-microbial substances to inhibit the growth of pathogenic bacteria and yeasts that cause common vaginal infections. Probiotic strains that have been trialled in humans and are known to be beneficial include: Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14®. A combination of these two strains has been shown to reduce the risk and help alleviate symptoms of thrush, cystitis and bacterial vaginosis. Health Professionals can read about Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14® over at the Probiotics Database.

Probiotics can help:

Probiotics can offer support to your whole family, including your teenager. There is good evidence to suggest that many of the physical and emotional health issues bought about by either surging hormones or changes in lifestyle as a teenager, can be helped by probiotic supplementation. Where possible, it is recommended to select a product based on research in to the health concern in question. Where this research is yet to be done, it may still be worthwhile to seek broad-spectrum support from a quality probiotic formulation. By helping to mediate stress, balance hormones, produce B-vitamins (for energy) and reduce inflammation in the body, probiotics can help with many physical and emotional aspects of adolescence.

Many teens may even wish to continue with their probiotic into adulthood to support their health and wellbeing as they face new challenges such as the workforce, parenthood and other stresses that may develop.

To summarise, we can support our teens by:

  • Encouraging them to eat a varied balanced diet and limit sugar levels
  • Ensuring they get plenty of exercise, even if its walking the dog or signing them to an outdoor activity centre
  • Think about an evening “9pm” phone/laptop ban to encourage better sleep and limit fatigue
  • Encourage your teen to open up to you, a family member, school teacher they trust or even a therapist to discuss any issues that might be weighing down on their mental health. Offer them all the support you can give.
  • Consider giving your teen a probiotic that can target specific health conditions or offer all round support. Looking after their guts can bring surprising all round support and give that extra boost they may need.

References:

  1. Bryant PA et al. 2004. Sick and tired: does sleep have a vital role in the immune system? Nature Reviews Immunology volume 4, pages 457–467
  2. Shilo L (MD) et al. 1999. Patients in the Intensive Care Unit Suffer from Severe Lack of Sleep Associated with Loss of Normal Melatonin Secretion Pattern. The American Journal of the Medical Sciences. Volume 317, Issue 5, Pages 278-281.
  3. Killgore WDS. 2010. Effects of sleep deprivation on cognition. Neuroimaging Center, McLean Hospital, Harvard Medical School, Belmont, MA, USA. Progress in Brain Research. Volume 185, Pages 105-129.
  4. Chaput JP. July 2014. Sleep patterns, diet quality and energy balance. Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada. Physiology & Behavior. Volume 134, July 2014, Pages 86-91
  5. https://www.mentalhealth.org.uk/statistics/mental-health-statistics-children-and-young-people
  6. https://www.nhs.uk/news/mental-health/many-teenagers-reporting-symptoms-depression/
  7. D’Agata AL et al. Dec. 2018. Effects of early life NICU stress on the developing gut microbiome. College of Nursing, University of Rhode Island, Kingston, Rhode Island, USA. Wiley Developmental Psychobiology. DOI: 10.1002/dev.21826.
  8. Messaoudi M. et al., (2011), ‘Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects’. British Journal of Nutrition, 105(5):755.
  9. Benedict. C et al. 2016. Gut Microbiota and Glucometabolic Alterations in Response to Recurrent Partial Sleep Deprivation in Normal-weight Young Individuals. J. Molecular Metabolism.
  10. Bowe WP et al., (2006). Inhibition of Propionibacterium acnes by bacteriocin-like inhibitory substances (BLIS) produced by Streptococcus salivarius. J Drugs Dermatol. 5 (9): 868
  11. Lewis S.J et al. 1997. Lower serum oestrogen concentrations associated with faster intestinal transit. Br J Cancer. 76(3): 395-400.