Specific probiotics in elite athlete injuries: indication for usage / Probiotics específicos em lesões de atletas elite: indicação de uso

Vanessa Teixeira Müller, José Raimundo Fernandes, Andre Malina, Ângela Celeste Barrteo de Azevedo, Ciro Jose Brito, Bianca Miarka


More severe effects of illness that require probiotic intervention and complete cessation of training activities might have a larger effect on competitive sport performance. In this review, we outline key principles of prevention for injury and illness in high level athletes using probiotic treatments, examine relevant scientific evidence on probiotics for reducing the risk of illness and injury, and summarize practical recommendations for high level athletes, coaches, and practitioners. Studies were obtained through manual and electronic journal searches, review articles, as well as personal correspondence, concerning the period 2000-2018. We used the following databases: PubMed, Web of Science, SCOPUS and Medline. Electronic databases were searched using keywords and/or MeSH terms such as [[[Athlete] or [Sport effects] or [Injuries] or [Disease] or [Allergy] or [Illness] or [Sickness] or [Desorder]] in combination with [[microbiota] or [microbiotas] or [Microbiome] or [microbiomes] or [Human Microbiome] or [Human microbiomes] or [microbiomes, Human] or [Microbiome, Human]] not [[disease]]], until February 18th, 2018. In this present review, we have outlined key points of injury and illness prevention for elite athletes using probiotic treatments, examining relevant scientific evidence on probiotics for reducing the risk of illness and injury, and summarized practical recommendations for high level athletes, coaches, and practitioners.


Microbiome, Microbiota, Injuries, Disease, Allergy, Prebiotics

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Alaranta, A., Alaranta, H., Heliövaara, M., Airaksinen, M., & Helenius, I. (2006). Ample Use of Physician-Prescribed Medications in Finnish Elite Athletes. International Journal of Sports Medicine, 27(11), 919–925. https://doi.org/10.1055/s-2006-923811

Anderson, S. D., & Daviskas, E. (2000). The mechanism of exercise-induced asthma is …. Journal of Allergy and Clinical Immunology, 106(3), 453–459. https://doi.org/10.1067/mai.2000.109822

Asthma. A summary of first-choice treatments. (2016). Prescrire International, 25(169), 73–76.

Bosenberg, A. T., Brock-Utne, J. G., Gaffin, S. L., Wells, M. T., & Blake, G. T. (1988). Strenuous exercise causes systemic endotoxemia. Journal of Applied Physiology, 65(1), 106–108.

Camus, G., Nys, M., Poortmans, J.-R., Venneman, I., Monfils, T., Deby-Dupont, G., … Duchateau, J. (1998). Endotoxaemia, production of tumour necrosis factor α and polymorphonuclear neutrophil activation following strenuous exercise in humans. European journal of applied physiology and occupational physiology, 79(1), 62–68.

Chakraborty, R., Savani, B. N., Litzow, M., Mohty, M., & Hashmi, S. (2015). A perspective on complementary/alternative medicine use among survivors of hematopoietic stem cell transplant: Benefits and uncertainties: Complementary and Alternative Medicine. Cancer, 121(14), 2303–2313. https://doi.org/10.1002/cncr.29382

Couto, M., & Moreira, A. (2016). The athlete “out of breath”. European Annals of Allergy and Clinical Immunology, 48(2), 36–45.

Del Giacco, S. R., Firinu, D., Bjermer, L., & Carlsen, K.-H. (2015). Exercise and asthma: an overview. European Clinical Respiratory Journal, 2(1), 27984. https://doi.org/10.3402/ecrj.v2.27984

Dokladny, K., Wharton, W., Lobb, R., Ma, T. Y., & Moseley, P. L. (2006). Induction of physiological thermotolerance in MDCK monolayers: contribution of heat shock protein 70. Cell Stress & Chaperones, 11(3), 268–275. https://doi.org/10.1379/CSC-194R.1

Fayock, K., Voltz, M., Sandella, B., Close, J., Lunser, M., & Okon, J. (2014). Antibiotic Precautions in Athletes. Sports Health: A Multidisciplinary Approach, 6(4), 321–325. https://doi.org/10.1177/1941738113506553

Fitch, K. D. (1986). The use of anti-asthmatic drugs. Do they affect sports performance? Sports Medicine (Auckland, N.Z.), 3(2), 136–150. https://doi.org/10.2165/00007256-198603020-00004

Giel, K. E., Hermann-Werner, A., Mayer, J., Diehl, K., Schneider, S., Thiel, A., … for the GOAL study group. (2016). Eating disorder pathology in elite adolescent athletes: Eating Disorder Pathology in Young Elite Athletes. International Journal of Eating Disorders, 49(6), 553–562. https://doi.org/10.1002/eat.22511

Gill, S. K., Teixeira, A., Rama, L., Prestes, J., Rosado, F., Hankey, J., … Costa, R. J. S. (2015). Circulatory endotoxin concentration and cytokine profile in response to exertional-heat stress during a multi-stage ultra-marathon competition. Exercise Immunology Review, 21, 114–128.

Gleeson, M., & Pyne, D. B. (2016). Respiratory inflammation and infections in high-performance athletes. Immunology and Cell Biology, 94(2), 124–131. https://doi.org/10.1038/icb.2015.100

Gotoh, M., Sashihara, T., Ikegami, S., Yamaji, T., Kino, K., Orii, N., … Okubo, K. (2009). Efficacy of oral administration of a heat-killed Lactobacillus gasseri OLL2809 on patients of Japanese cedar pollinosis with high Japanese-cedar pollen-specific IgE. Bioscience, Biotechnology, and Biochemistry, 73(9), 1971–1977. https://doi.org/10.1271/bbb.90144

Gouttebarge, V., Tol, J. L., & Kerkhoffs, G. M. M. J. (2016). Epidemiology of symptoms of common mental disorders among elite Gaelic athletes: a prospective cohort study. The Physician and Sportsmedicine, 44(3), 283–289. https://doi.org/10.1080/00913847.2016.1185385

Hallstrand, T. S. (2012). New insights into pathogenesis of exercise-induced bronchoconstriction: Current Opinion in Allergy and Clinical Immunology, 12(1), 42–48. https://doi.org/10.1097/ACI.0b013e32834ecc67

Hallstrand, T. S., & Henderson, W. R. (2009). Role of leukotrienes in exercise-induced bronchoconstriction. Current Allergy and Asthma Reports, 9(1), 18–25.

Hallstrand, T. S., Moody, M. W., Wurfel, M. M., Schwartz, L. B., Henderson, W. R., & Aitken, M. L. (2005). Inflammatory basis of exercise-induced bronchoconstriction. American Journal of Respiratory and Critical Care Medicine, 172(6), 679–686. https://doi.org/10.1164/rccm.200412-1667OC

Hart, G. R., Anderson, R. J., Crumpler, C. P., Shulkin, A., Reed, G., & Knochel, J. P. (1982). Epidemic classical heat stroke: clinical characteristics and course of 28 patients. Medicine, 61(3), 189–197.

Hasegawa, T., Hirakawa, K., Matsumoto, T., Toki, S., Maeyama, Y., & Morimatsu, F. (2009). Efficacy of Lactobacillus plantarum strain HSK201 in relief from Japanese cedar pollinosis. Bioscience, Biotechnology, and Biochemistry, 73(12), 2626–2631. https://doi.org/10.1271/bbb.90465

Henz, B. M., Maurer, M., Lippert, U., Worm, M., & Babina, M. (2001). Mast cells as initiators of immunity and host defense. Experimental Dermatology, 10(1), 1–10.

Hughes, L., & Leavey, G. (2012). Setting the bar: athletes and vulnerability to mental illness. British Journal of Psychiatry, 200(02), 95–96. https://doi.org/10.1192/bjp.bp.111.095976

Ikari, K., Kuwahara, M., Nakamura, T., Momohara, S., Hara, M., Yamanaka, H., … Kamatani, N. (2005). Association between PADI4 and rheumatoid arthritis: A replication study. Arthritis & Rheumatism, 52(10), 3054–3057. https://doi.org/10.1002/art.21309

Ishida, Y., Nakamura, F., Kanzato, H., Sawada, D., Hirata, H., Nishimura, A., … Fujiwara, S. (2005). Clinical effects of Lactobacillus acidophilus strain L-92 on perennial allergic rhinitis: a double-blind, placebo-controlled study. Journal of Dairy Science, 88(2), 527–533. https://doi.org/10.3168/jds.S0022-0302(05)72714-4

Ishida, Yu, Nakamura, F., Kanzato, H., Sawada, D., Yamamoto, N., Kagata, H., … Fujiwara, S. (2005). Effect of milk fermented with Lactobacillus acidophilus strain L-92 on symptoms of Japanese cedar pollen allergy: a randomized placebo-controlled trial. Bioscience, Biotechnology, and Biochemistry, 69(9), 1652–1660.

Jeukendrup, A. E., & Jentjens, R. (2000). Oxidation of carbohydrate feedings during prolonged exercise. Sports Medicine, 29(6), 407–424.

Kaliszewski, P., Kończak, D., Chołbiński, P., Wicka, M., Michalak, D., Kwiatkowska, D., … Pokrywka, A. (2016). BUDESONIDE TREATMENT OF PROFESSIONAL ATHLETES AND ANTI-DOPING TESTING--CASE STUDIES. Acta Poloniae Pharmaceutica, 73(1), 229–237.

Kalsen, A., Hostrup, M., Bangsbo, J., & Backer, V. (2014). Combined inhalation of beta 2 -agonists improves swim ergometer sprint performance but not high-intensity swim performance: Ergogenic effects of inhaled beta 2 -agonists. Scandinavian Journal of Medicine & Science in Sports, 24(5), 814–822. https://doi.org/10.1111/sms.12096

Kenney, W. L., & Ho, C. W. (1995). Age alters regional distribution of blood flow during moderate-intensity exercise. Journal of Applied Physiology, 79(4), 1112–1119.

Komaroff, A. L. (2017). Inflammation correlates with symptoms in chronic fatigue syndrome. Proceedings of the National Academy of Sciences of the United States of America, 114(34), 8914–8916. https://doi.org/10.1073/pnas.1712475114

Lambert, D. M., Knemeyer, A. M., & Gardner, J. T. (2004). Supply Chain Partnerships: Model Validation and Implementation. Journal of Business Logistics, 25(2), 21–42. https://doi.org/10.1002/j.2158-1592.2004.tb00180.x

Lambert, G. P. (2008). Intestinal Barrier Dysfunction, Endotoxemia, and Gastrointestinal Symptoms: The ‘Canary in the Coal Mine’ during Exercise-Heat Stress? In F. E. Marino (Org.), Medicine and Sport Science (Vol. 53, p. 61–73). Basel: KARGER. https://doi.org/10.1159/000151550

Laval, L., Martin, R., Natividad, J. N., Chain, F., Miquel, S., De Maredsous, C. D., … van Hylckama Vlieg, J. E. T. (2015). Lactobacillus rhamnosus CNCM I-3690 and the commensal bacterium Faecalibacterium prausnitzii A2-165 exhibit similar protective effects to induced barrier hyper-permeability in mice. Gut microbes, 6(1), 1–9.

Lim, B.-O., Lee, Y. S., Kim, J. G., An, K. O., Yoo, J., & Kwon, Y. H. (2009). Effects of sports injury prevention training on the biomechanical risk factors of anterior cruciate ligament injury in high school female basketball players. The American Journal of Sports Medicine, 37(9), 1728–1734. https://doi.org/10.1177/0363546509334220

Lim, C. L., & Mackinnon, L. T. (2006). The roles of exercise-induced immune system disturbances in the pathology of heat stroke : the dual pathway model of heat stroke. Sports Medicine (Auckland, N.Z.), 36(1), 39–64. https://doi.org/10.2165/00007256-200636010-00004

Liu, H., & Hall, S. G. (2001). Creating high-frequency national accounts with state-space modelling: a Monte Carlo experiment. Journal of Forecasting, 20(6), 441–449. https://doi.org/10.1002/for.810

Lloyd, R., & Oliver, J. (2012). The Youth Physical Development Model. Strength and Conditioning Journal, 34, 61–72. https://doi.org/10.1519/SSC.0b013e31825760ea

Malaviya, R., Ikeda, T., Ross, E., & Abraham, S. N. (1996). Mast cell modulation of neutrophil influx and bacterial clearance at sites of infection through TNF-alpha. Nature, 381(6577), 77–80. https://doi.org/10.1038/381077a0

Marchbank, T., Davison, G., Oakes, J. R., Ghatei, M. A., Patterson, M., Moyer, M. P., & Playford, R. J. (2011). The nutriceutical bovine colostrum truncates the increase in gut permeability caused by heavy exercise in athletes. American Journal of Physiology. Gastrointestinal and Liver Physiology, 300(3), G477-484. https://doi.org/10.1152/ajpgi.00281.2010

Montoya, J. G., Holmes, T. H., Anderson, J. N., Maecker, H. T., Rosenberg-Hasson, Y., Valencia, I. J., … Davis, M. M. (2017). Cytokine signature associated with disease severity in chronic fatigue syndrome patients. Proceedings of the National Academy of Sciences of the United States of America, 114(34), E7150–E7158. https://doi.org/10.1073/pnas.1710519114

Moreira, A., Delgado, L., & Carlsen, K.-H. (2011). Exercise-induced asthma: why is it so frequent in Olympic athletes? Expert Review of Respiratory Medicine, 5(1), 1–3. https://doi.org/10.1586/ers.10.88

Morelli, L., & Capurso, L. (2012). FAO/WHO Guidelines on Probiotics: 10 Years Later. Journal of Clinical Gastroenterology, 46, S1–S2. https://doi.org/10.1097/MCG.0b013e318269fdd5

Morris, G., Berk, M., Galecki, P., & Maes, M. (2014). The Emerging Role of Autoimmunity in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/cfs). Molecular Neurobiology, 49(2), 741–756. https://doi.org/10.1007/s12035-013-8553-0

Mountjoy, M., Junge, A., Benjamen, S., Boyd, K., Diop, M., Gerrard, D., … Verhagen, E. (2015). Competing with injuries: injuries prior to and during the 15th FINA World Championships 2013 (aquatics). British Journal of Sports Medicine, 49(1), 37–43. https://doi.org/10.1136/bjsports-2014-093991

Munakata, S., Arakawa, C., Kohira, R., Fujita, Y., Fuchigami, T., & Mugishima, H. (2010). A case of D-lactic acid encephalopathy associated with use of probiotics. Brain and Development, 32(8), 691–694. https://doi.org/10.1016/j.braindev.2009.09.024

Olle, B. (2013). Medicines from microbiota. Nature Biotechnology, 31(4), 309–315. https://doi.org/10.1038/nbt.2548

Pals, K. L., Chang, R.-T., Ryan, A. J., & Gisolfi, C. V. (1997). Effect of running intensity on intestinal permeability. Journal of Applied Physiology, 82(2), 571–576. https://doi.org/10.1152/jappl.1997.82.2.571

Patel, R. M., Myers, L. S., Kurundkar, A. R., Maheshwari, A., Nusrat, A., & Lin, P. W. (2012). Probiotic bacteria induce maturation of intestinal claudin 3 expression and barrier function. The American journal of pathology, 180(2), 626–635.

Petito, A., Altamura, M., Iuso, S., Padalino, F. A., Sessa, F., D’Andrea, G., … Bellomo, A. (2016). The Relationship between Personality Traits, the 5HTT Polymorphisms, and the Occurrence of Anxiety and Depressive Symptoms in Elite Athletes. PLOS ONE, 11(6), e0156601. https://doi.org/10.1371/journal.pone.0156601

Pillard, F., Lavit, M., Cances, V. L., Rami, J., Houin, G., Didier, A., & Rivière, D. (2015). Medical and pharmacological approach to adjust the salbutamol anti-doping policy in athletes. Respiratory Research, 16(1). https://doi.org/10.1186/s12931-015-0315-2

Pyne, D. B., Guy, J. H., & Edwards, A. M. (2014). Managing Heat and Immune Stress in Athletes with Evidence-Based Strategies. International Journal of Sports Physiology and Performance, 9(5), 744–750. https://doi.org/10.1123/ijspp.2014-0232

Pyne, D. B., West, N. P., Cox, A. J., & Cripps, A. W. (2015). Probiotics supplementation for athletes – Clinical and physiological effects. European Journal of Sport Science, 15(1), 63–72. https://doi.org/10.1080/17461391.2014.971879

Rice, S. M., Purcell, R., De Silva, S., Mawren, D., McGorry, P. D., & Parker, A. G. (2016). The Mental Health of Elite Athletes: A Narrative Systematic Review. Sports Medicine, 46(9), 1333–1353. https://doi.org/10.1007/s40279-016-0492-2

Robson, P. (2003). Elucidating the unexplained underperformance syndrome in endurance athletes : the interleukin-6 hypothesis. Sports Medicine (Auckland, N.Z.), 33(10), 771–781. https://doi.org/10.2165/00007256-200333100-00004

Robson-Ansley, P., Howatson, G., Tallent, J., Mitcheson, K., Walshe, I., Toms, C., … Ansley, L. (2012). Prevalence of Allergy and Upper Respiratory Tract Symptoms in Runners of the London Marathon: Medicine & Science in Sports & Exercise, 44(6), 999–1004. https://doi.org/10.1249/MSS.0b013e318243253d

Selkirk, G. A., McLellan, T. M., Wright, H. E., & Rhind, S. G. (2008). Mild endotoxemia, NF-κB translocation, and cytokine increase during exertional heat stress in trained and untrained individuals. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 295(2), R611–R623.

Sidiropoulou, M. P., Kokaridas, D. G., Giagazoglou, P. F., Karadonas, M. I., & Fotiadou, E. G. (2012). Incidence of Exercise-Induced Asthma in Adolescent Athletes under Different Training and Environmental Conditions: Journal of Strength and Conditioning Research, 26(6), 1644–1650. https://doi.org/10.1519/JSC.0b013e318234eb0c

Stang, J., Stensrud, T., Mowinckel, P., & Carlsen, K.-H. (2016). Parasympathetic Activity and Bronchial Hyperresponsiveness in Athletes: Medicine & Science in Sports & Exercise, 48(11), 2100–2107. https://doi.org/10.1249/MSS.0000000000001008

Swann, C., Moran, A., & Piggott, D. (2015). Defining elite athletes: Issues in the study of expert performance in sport psychology. Psychology of Sport and Exercise, 16, 3–14. https://doi.org/10.1016/j.psychsport.2014.07.004

Van Wijck, K., Lenaerts, K., Van Bijnen, A. A., Boonen, B., Van Loon, L. J. C., Dejong, C. H. C., & Buurman, W. A. (2012). Aggravation of Exercise-Induced Intestinal Injury by Ibuprofen in Athletes: Medicine & Science in Sports & Exercise, 44(12), 2257–2262. https://doi.org/10.1249/MSS.0b013e318265dd3d

van Wijck, K., Lenaerts, K., van Loon, L. J. C., Peters, W. H. M., Buurman, W. A., & Dejong, C. H. C. (2011). Exercise-induced splanchnic hypoperfusion results in gut dysfunction in healthy men. PloS One, 6(7), e22366. https://doi.org/10.1371/journal.pone.0022366

Verratti, V. (2009). Neuroimmune biology of physical exercise. Journal of Biological Regulators and Homeostatic Agents, 23(3), 203–206.

WADA publishes 2016 Prohibited List (29 September 2015). (2015, setembro 29). Recuperado 26 de dezembro de 2018, de https://www.wada-ama.org/en/media/news/2015-09/wada-publishes-2016-prohibited-list

West, C. E., D’Vaz, N., & Prescott, S. L. (2011). Dietary Immunomodulatory Factors in the Development of Immune Tolerance. Current Allergy and Asthma Reports, 11(4), 325–333. https://doi.org/10.1007/s11882-011-0200-0

West, N., Pyne, D., Peake, J., & Cripps, A. (2009). Probiotics, immunity and exercise: A review (Vol. 15).

Xiao, J.-Z., Kondo, S., Yanagisawa, N., Takahashi, N., Odamaki, T., Iwabuchi, N., … Enomoto, T. (2006). Probiotics in the treatment of Japanese cedar pollinosis: a double-blind placebo-controlled trial. Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology, 36(11), 1425–1435. https://doi.org/10.1111/j.1365-2222.2006.02575.x

Xu, B., Jahic, M., Blomsten, G., & Enfors, S.-O. (1999). Glucose overflow metabolism and mixed-acid fermentation in aerobic large-scale fed-batch processes with Escherichia coli. Applied Microbiology and Biotechnology, 51(5), 564–571. https://doi.org/10.1007/s002530051433

DOI: https://doi.org/10.34119/bjhrv3n1-079


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