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      Evaluation of Probiotics for Warfighter Health and Performance

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          Abstract

          The probiotic industry continues to grow in both usage and the diversity of products available. Scientific evidence supports clinical use of some probiotic strains for certain gastrointestinal indications. Although much less is known about the impact of probiotics in healthy populations, there is increasing consumer and scientific interest in using probiotics to promote physical and psychological health and performance. Military men and women are a unique healthy population that must maintain physical and psychological health in order to ensure mission success. In this narrative review, we examine the evidence regarding probiotics and candidate probiotics for physical and/or cognitive benefits in healthy adults within the context of potential applications for military personnel. The reviewed evidence suggests potential for certain strains to induce biophysiological changes that may offer physical and/or cognitive health and performance benefits in military populations. However, many knowledge gaps exist, effects on health and performance are generally not widespread among the strains examined, and beneficial findings are generally limited to single studies with small sample sizes. Multiple studies with the same strains and using similar endpoints are needed before definitive recommendations for use can be made. We conclude that, at present, there is not compelling scientific evidence to support the use of any particular probiotic(s) to promote physical or psychological performance in healthy military personnel. However, plausibility for physical and psychological health and performance benefits remains, and additional research is warranted. In particular, research in military cohorts would aid in assessing the value of probiotics for supporting physical and psychological health and performance under the unique demands required of these populations.

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          Most cited references109

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          Wound Healing: A Cellular Perspective

          Wound healing is one of the most complex processes in the human body. It involves the spatial and temporal synchronization of a variety of cell types with distinct roles in the phases of hemostasis, inflammation, growth, re-epithelialization, and remodeling. With the evolution of single cell technologies, it has been possible to uncover phenotypic and functional heterogeneity within several of these cell types. There have also been discoveries of rare, stem cell subsets within the skin, which are unipotent in the uninjured state, but become multipotent following skin injury. Unraveling the roles of each of these cell types and their interactions with each other is important in understanding the mechanisms of normal wound closure. Changes in the microenvironment including alterations in mechanical forces, oxygen levels, chemokines, extracellular matrix and growth factor synthesis directly impact cellular recruitment and activation, leading to impaired states of wound healing. Single cell technologies can be used to decipher these cellular alterations in diseased states such as in chronic wounds and hypertrophic scarring so that effective therapeutic solutions for healing wounds can be developed.
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            The effects of acute exercise on cognitive performance: a meta-analysis.

            There is a substantial body of literature related to the effects of a single session of exercise on cognitive performance. The premise underlying this research is that physiological changes in response to exercise have implications for cognitive function. This literature has been reviewed both narratively and meta-analytically and, although the research findings are mixed, researchers have generally concluded that there is a small positive effect. The purpose of this meta-analysis was to provide an updated comprehensive analysis of the extant literature on acute exercise and cognitive performance and to explore the effects of moderators that have implications for mechanisms of the effects. Searches of electronic databases and examinations of reference lists from relevant studies resulted in 79 studies meeting inclusion criteria. Consistent with past findings, analyses indicated that the overall effect was positive and small (g=0.097 n=1034). Positive and small effects were also found in all three acute exercise paradigms: during exercise (g=0.101; 95% confidence interval [CI]; 0.041-0.160), immediately following exercise (g=0.108; 95% CI; 0.069-0.147), and after a delay (g=0.103; 95% CI; 0.035-0.170). Examination of potential moderators indicated that exercise duration, exercise intensity, type of cognitive performance assessed, and participant fitness were significant moderators. In conclusion, the effects of acute exercise on cognitive performance are generally small; however, larger effects are possible for particular cognitive outcomes and when specific exercise parameters are used. Copyright © 2012 Elsevier B.V. All rights reserved.
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              Muscle damage and inflammation during recovery from exercise.

              Unaccustomed exercise consisting of eccentric (i.e., lengthening) muscle contractions often results in muscle damage characterized by ultrastructural alterations in muscle tissue, clinical signs, and symptoms (e.g., reduced muscle strength and range of motion, increased muscle soreness and swelling, efflux of myocellular proteins). The time course of recovery following exercise-induced muscle damage depends on the extent of initial muscle damage, which in turn is influenced by the intensity and duration of exercise, joint angle/muscle length, and muscle groups used during exercise. The effects of these factors on muscle strength, soreness, and swelling are well characterized. By contrast, much less is known about how they affect intramuscular inflammation and molecular aspects of muscle adaptation/remodeling. Although inflammation has historically been viewed as detrimental for recovery from exercise, it is now generally accepted that inflammatory responses, if tightly regulated, are integral to muscle repair and regeneration. Animal studies have revealed that various cell types, including neutrophils, macrophages, mast cells, eosinophils, CD8 and T-regulatory lymphocytes, fibro-adipogenic progenitors, and pericytes help to facilitate muscle tissue regeneration. However, more research is required to determine whether these cells respond to exercise-induced muscle damage. A large body of research has investigated the efficacy of physicotherapeutic, pharmacological, and nutritional interventions for reducing the signs and symptoms of exercise-induced muscle damage, with mixed results. More research is needed to examine if/how these treatments influence inflammation and muscle remodeling during recovery from exercise.
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                Author and article information

                Contributors
                Journal
                Front Nutr
                Front Nutr
                Front. Nutr.
                Frontiers in Nutrition
                Frontiers Media S.A.
                2296-861X
                09 June 2020
                2020
                : 7
                : 70
                Affiliations
                [1] 1Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, MD, United States
                [2] 2Naval Medical Research Unit Dayton, Environmental Health Effects Laboratory , Dayton, OH, United States
                [3] 3Soldier Performance Optimization Directorate, U.S. Army Combat Capabilities Development Command - Soldier Center , Natick, MA, United States
                [4] 4Air Force Research Laboratory, 711th Human Performance Wing, Wright Patterson Air Force Base , Dayton, OH, United States
                [5] 5Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine , Natick, MA, United States
                [6] 6Oak Ridge Institute for Science and Education, Wright Patterson Air Force Base , Oak Ridge, TN, United States
                Author notes

                Edited by: Jennie Cecile Brand-Miller, University of Sydney, Australia

                Reviewed by: Mary Ellen Sanders, Dairy & Food Culture Technologies, United States; Emilia Vassilopoulou, International Hellenic University, Greece

                *Correspondence: Jason W. Soares Jason.w.soares.civ@ 123456mail.mil

                This article was submitted to Nutrition and Metabolism, a section of the journal Frontiers in Nutrition

                Article
                10.3389/fnut.2020.00070
                7296105
                32582752
                400dc7a4-c954-42a8-8391-e4e586558a3a
                Copyright © 2020 Agans, Giles, Goodson, Karl, Leyh, Mumy, Racicot and Soares.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 13 March 2020
                : 24 April 2020
                Page count
                Figures: 2, Tables: 10, Equations: 0, References: 150, Pages: 23, Words: 17475
                Categories
                Nutrition
                Review

                microbiota,probiotics,performance,cognition,warfighter,microbiome,physical,nutrition

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