Abstract
Gastrointestinal (GI) dysfunction in older adults may be associated with gut microbiota activity or composition changes. Lactiplantibacillus plantarum strains KABP031 and KABP032 have been shown to beneficially influence the frequency of bowel movements (BMs) and nutritional status in older adults. This study investigated the efficacy of this probiotic blend on defecation/stool consistency, GI symptoms, nutrient uptake, and mental well-being in older adults with occasional constipation. Subjects 50–85 years of age with infrequent BMs, straining during defecation and hard stool consistency, were randomized to either the Probiotic or Placebo group for 84 days. Changes in bowel function, GI symptoms, and stress were assessed by the daily bowel habits diary, Gastrointestinal Symptoms Rating Scale (GSRS) and the Perceived Stress Scale (PSS), respectively. Improvements in bowel movement frequency (p = 0.027, 95% CI: 0.22–2.39) and stool consistency (p = 0.002; 95% CI: 0.32–1.30) with the Probiotic were significantly greater compared to Placebo after 42 days. There was also significant decrease in the percentage of weekly BMs with a Bristol Stool Scale score of ≤2 with Probiotic vs. Placebo (-28.6% vs. −3.2%, p < 0.001). A significantly lower proportion of participants in the Probiotic group reported moderate stress following 84 days of supplementation compared to the Placebo group (9.4% vs. 37.9%, p = 0.013). Further, within-group significant improvements in stool consistency and BM frequency from baseline at days 42 and 84 were observed with the Probiotic (p < 0.001), but not the Placebo. The findings suggest the probiotic blend alleviated constipation symptoms and improved the mental well-being in older adults with occasional constipation.
Introduction
Digestive health disorders including altered bowel functions and nutrient malabsorption are commonly observed in older adults and may develop due to age-associated changes in metabolic and physiological processes. Altered bowel function characterized by difficult and infrequent bowel movements (BMs), straining, abdominal pain, and bloating can negatively impact quality of life (QoL), and result in major social and healthcare burden (Nag et al. Citation2020). Current treatment options to relieve gastrointestinal (GI) symptoms and improve BMs include over-the-counter (OTC) remedies such as laxatives and fiber supplements (Johanson and Kralstein Citation2007). However, most consumers are dissatisfied with traditional treatment options due to a lack of predictability, ineffective relief of constipation, bloating, and other symptoms (Johanson and Kralstein Citation2007). These limitations have prompted interest in other effective therapeutic strategies. Further, nutrition is essential for regulation of physiological functions. However the ability of the GI tract to absorb nutrients may be impaired in older adults, which may lead to malnutrition (Amarya et al. Citation2015). The alterations in nutrient absorption and GI health observed in older adults may be associated with changes in gut microbiota activity or composition (He et al. Citation2003; Blaut et al. Citation2006). Therefore, probiotics have emerged as an attractive and safe alternative that may be useful in improving nutrient absorption (Judkins et al. Citation2020) as well as improving GI symptoms and altered bowel habits in the older adult population (Miller and Ouwehand Citation2013; Martínez-Martínez et al. Citation2017; Takeda et al. Citation2023).
Probiotics are defined as ‘live microorganisms which when administered in adequate amounts confer a health benefit on the host’ (Hill et al. Citation2014). Furthermore, probiotic effects are strain-specific and there is general consensus that recommendations, especially in clinical settings, should be based on human studies showing the claimed benefits (Hill et al. Citation2014; McFarland et al. Citation2018; Guarner et al. Citation2024). The effect of probiotics, primarily bifidobacteria and lactobacilli, in the management of constipation has been investigated in several randomized controlled trials, systematic reviews, and meta-analyses (Dimidi et al. Citation2014; Martínez-Martínez et al. Citation2017; Ding et al. Citation2024). However, the majority of studies have been conducted in individuals with functional or chronic constipation with a limited number in healthy populations (Del Piano et al. Citation2010).
A pre-clinical investigation of two Lactiplantibacillus plantarum (L. plantarum) strains, KABP031 and KABP032, reported their functional probiotic properties including high tolerance to GI tract conditions and antimicrobial activity against pathogens (Bosch et al. Citation2012). Therefore, it is important to investigate the effect of this probiotic blend on human health. A previous study by Bosch et al. conducted in an elderly cohort in Spain demonstrated that consumption of low dose L. plantarum KABP031 and KABP032 significantly improved intestinal transit and nutritional status (Bosch Gallego et al. Citation2011). The ability of these L. plantarum strains to improve nutritional status in older adults may be attributed to the beneficial effect of probiotics on digestive health (Markowiak and Śliżewska Citation2017). Further, a growing body of evidence suggests that stress may lead to alterations in gut microbiota composition further contributing to bowel dysfunction characterized by decreased gut motility, inflammation, and increased permeability (Chang et al. Citation2014). Supplementation with specific probiotic strains has shown to have beneficial effects on mental health (Messaoudi et al. Citation2011) via the gut-brain axis. There is evidence demonstrating the link between probiotic-induced changes in gut microbiota and reduction of anxiety in stressed adults (Ma et al. Citation2021). Therefore, investigating the effect of L. plantarum strains KABP031 and KABP032 on mental health is warranted. The objective of this study was to examine the effects of a probiotic blend containing L. plantarum KABP031 and KABP032 strains on bowel function and GI symptoms, nutrient absorption, as well as emotional and general well-being in older adults with occasional constipation.
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Singh, R. G., Aoki, F., Rodriguez-Palmero Seuma, M., Aguilo, M., Washida, M., Espadaler-Mazo, J., … Lewis, E. D. (2025). Efficacy of Probiotic Supplementation with Lactiplantibacillus plantarum Strains on Gastrointestinal Tract Function – A Randomized Controlled Trial. Journal of Dietary Supplements, 1–22. https://doi.org/10.1080/19390211.2025.2507610
