Recent research has shown the presence of gut dysbiosis related to a shift in short-chain fatty acids in patients with Parkinson’s disease (PD). Besides this, constipation is a major nonmotor feature of PD and little is known about whether probiotics and prebiotics could improve constipation in patients with PD.
A recent randomized, double-blind, placebo-controlled trial, led by Dr. Emanuele Cereda from the Nutrition and Dietetics Service at Fondazione IRCCS Policlinico San Matteo in Pavia (Italy), has found that a fermented milk containing multiple probiotic strains and a prebiotic fibre may help manage constipation in patients with PD.
The researchers performed a tertiary setting, single-centre, randomized, parallel-group, double blind, placebo-controlled trial in patients with PD with Rome III-confirmed constipation based on 2-week stool diary data and weekly assessments of symptoms at baseline. Thereafter, patients (n = 120) were randomly assigned (2:1) to a group that received either a fermented milk (n = 80) containing 250 x 109 colony-forming units of the following probiotic strains: Streptococcus salivarius subsp thermophilus, Enterococcus faecium, Lactobacillus rhamnosus GG, L. acidophilus, L. plantarum, L. paracasei, L. delbrueckii subsp bulgaricus, and Bifidobacterium (breve and animalis subsp lactis) plus a prebiotic fibre consisting of 2.4 g of fructooligosaccharides, or a placebo group (n = 40) that received a pasteurized fermented fibre-free milk, once daily for 4 weeks.
The mean increase in the number of complete bowel movements during the last 2 weeks of intervention compared to the baseline was considered the primary efficacy endpoint. According to the authors, a complete bowel movement is defined as “a movement after which a feeling of complete evacuation is reported, including a movement associated with the use of laxatives in the last 24 hours”. Besides this, three or more complete bowel movements and an increase by one or more complete bowel movements per week during weeks 3 and 4 were secondary endpoints.
The consumption of the fermented milk containing multiple probiotic strains and a prebiotic fibre led to a higher increase in the number of complete bowel movements (mean 1.2) when compared to placebo (mean 0.1). Regarding secondary endpoints, 58.8% of patients in the experimental group reported 3 or more complete bowel movements and 53.8% reported an increase by one or more complete bowel movements during weeks 3 and 4. In both cases, the results in the probiotics-prebiotic group were significantly higher than placebo (37.5% and 25.0%, respectively).
To sum up, a fermented milk containing multiple probiotic strains and a prebiotic fibre was superior to placebo for improving constipation in patients with PD. Further human studies are needed in order to determine whether probiotics and prebiotics may be considered an effective adjuvant therapy option for constipation in PD.
Barichella M, Pacchetti C, Bolliri C, et al. Probiotics and prebiotic fiber for constipation associated with Parkinson disease: An RCT. Neurology. 2016; 87(12):1274-80. doi: 10.1212/WNL.0000000000003127.