Probiotics and colic 

Up to 25% of infants suffer with colic, which may be caused by intestinal dysbiosis. Bifidobacterium, BB-12^® (hereafter referred to by use of the trademark BB-12^®) has been associated with regulating microbial imbalances and alleviating colic symptoms.

Colic symptoms add to parental pressures

Infant colic is defined as fussing and excessive, constant crying for extended periods.² It is a major source of anxiety and distress, negatively impacting quality of life.³ Colic is common, with up to 20% of all infants under three months of age visiting the doctor's office due to colic symptoms.^{4, 5}

Colic and the gut health of infants

Occurring in otherwise healthy infants, with no apparent cause or signs of failure to thrive,⁴ colic was previously defined as idiopathic, but recent clinical studies suggest that colic is related to an imbalance in the gut microbiome.^{3, 6}  

Infants with colic symptoms during the first two weeks of life showed a distinct microbial pattern with less bacterial diversity and stability in the gut microbiota.³ Intestinal dysbiosis affects the microbial concentrations, with a lower number of good (or beneficial) bacteria, particularly bifidobacteria, and increased concentrations of undesirable, and potential pathogenic bacteria.⁶ 

Help restore gut microbiome balance

Bifidobacteria are found in breast milk,⁷ and Bifidobacterium, BB-12^® has demonstrated a positive impact on infant gastrointestinal issues.⁸ Therefore, BB-12^® may help address colic symptoms.

Though the mechanism is not entirely elucidated, one mode of action by which BB-12^® may regulate intestinal dysbiosis is competitive exclusion.^8,9 By utilizing the high adherence properties of BB-12^®,⁸ the probiotic bacteria adheres to the mucosa layer in the gastrointestinal tract, occupying the potential adhesion sites of pathogenic bacteria, and thus displacing them.⁸ Additionally, BB-12^® might regulate the microbiota by producing antimicrobial substances such as lactic acid and acetic acid; modifying the intestinal environment, making it hostile to pathogenic bacteria.¹⁰ 

In a randomized trial, BB-12^® probiotic supplementation has been associated with improvements of colic symptoms, and of the infant gut microbiota.¹

Clinical trial

• A randomized, double-blind, placebo-controlled trial investigated the impact of 1 billion CFU/day (colony forming units) of BB-12^® probiotic supplementation or placebo for 28 days on 80 breast fed infants (≤ 7 weeks) diagnosed with colic.¹ The primary endpoint was the proportion of infants with a reduction of ≥ 50% in the mean duration of daily crying. Number and duration of crying episodes, stool consistency, and number of bowel movements were reported daily by parents, using a validated diary (Barr).¹ 
• At the end of the trial period, 80% of BB-12^® treated infants had ≥ 50% reduction in duration of crying, compared to 33% of placebo group (p<0.0001).¹ Further, mean daily stool frequency decreased significantly more in the BB-12^® group. 
• Baseline vs. end-of-treatment microbiota analyses demonstrated that in those infants who responded to BB-12^® supplementation, there was a significant increase in the abundance of bifidobacteria.¹ The BB-12^® group demonstrated a significant increase in butyrate production, and in immunity biomarkers, which may have beneficial effects at intestinal and extra-intestinal levels, and the gut microbiota structure, respectively.¹

Studies suggest that BB-12^® may address colic symptoms by modifying the microbiota in infants with intestinal dysbiosis. This may be achieved through producing antimicrobial substances and competing with the harmful bacteria for adhesion sites in the intestine.¹

BB-12® is a registered trademark of Chr. Hansen A/S.

The article is provided for informational purposes regarding probiotics and is not meant to suggest that any substance referenced in the article is intended to diagnose, cure, mitigate, treat, or prevent any disease.

Reference list

1.  Nocerino R, et al. The therapeutic efficacy of Bifidobacterium animalis subsp. lactis BB-12((R)) in infant colic: A randomised, double blind, placebo-controlled trial. Aliment Pharmacol Ther. 2019. (PubMed)

2. Wolke D, et al. Systematic Review and Meta-Analysis: Fussing and Crying Durations and Prevalence of Colic in Infants. J Pediatr. 2017;185:55-61.e4. (PubMed)
3. Zeevenhooven J, et al. Infant colic: mechanisms and management. Nat Rev Gastroenterol Hepatol. 2018;15(8):479-96. (PubMed)
4. Kheir AEM. Infantile colic, facts and fiction. Ital J Pediatr. 2012;38:34. (PubMed)
5. Alvarez M, St James-Roberts I. Infant fussing and crying patterns in the first year in an urban community in Denmark. Acta Paediatr. 1996;85(4):463-6. (PubMed)
6. Mayer EA, et al. Gut/brain axis and the microbiota. J Clin Invest. 2015;125(3):926-38. (PubMed)
7. Fernandez L, et al. The microbiota of human milk in healthy women. Cell Mol Biol. 2013;59(1):31-42. (PubMed)
8. Jungersen M, et al. The Science behind the Probiotic Strain Bifidobacterium animalis subsp. lactis BB-12((R)). Microorganisms. 2014;2(2):92-110. (PubMed)
9. Collado MC, et al. Role of commercial probiotic strains against human pathogen adhesion to intestinal mucus. Lett Appl Microbiol. 2007;45(4):454-60.  (PubMed)
10. Martins FS, et al. Comparative study of Bifidobacterium animalis, Escherichia coli, Lactobacillus casei and Saccharomyces boulardii probiotic properties. Arch Microbiol. 2009;191(8):623-30.  (PubMed)