Increasing Work-place Healthiness with the Probiotic Lactobacillus reuteri: A Randomised, Double-blind Placebo-controlled Study

Increasing Work-place Healthiness with the Probiotic
Lactobacillus reuteri: A Randomised, Double-blind
Placebo-controlled Study

This section is compiled by Frank M. Painter, D.C.
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FROM:   Environ Health 2005 (Nov 7);   4:   25 ~ FULL TEXT

Tubelius P, Stan V, Zachrisson A

Tetra Pak Occupational Health and Safety AB,
Ruben Rausings Gata,
221 86 Lund, Sweden.

BACKGROUND:   Short term illnesses, usually caused by respiratory or gastrointestinal diseases are disruptive to productivity and there is relatively little focus on preventative measures. This study examined the effect of the probiotic Lactobacillus reuteri protectis (ATCC55730) on its ability to improve work-place healthiness by reducing short term sick-leave caused by respiratory or gastrointestinal infections.

METHODS:   262 employees at TetraPak in Sweden (day-workers and three-shift-workers) that were healthy at study start were randomised in a double-blind fashion to receive either a daily dose of 108 Colony Forming Units of L. reuteri or placebo for 80 days. The study products were administered with a drinking straw. 181 subjects complied with the study protocol, 94 were randomised to receive L. reuteri and 87 received placebo.

RESULTS:   In the placebo group 26.4% reported sick-leave for the defined causes during the study as compared with 10.6% in the L. reuteri group (p < 0.01). The frequency of sick-days was 0.9% in the placebo group and 0.4% in the L. reuteri group (p < 0.01). Among the 53 shift-workers, 33% in the placebo group reported sick during the study period as compared with none in the L. reuteri group(p < 0.005).

From the FULL TEXT Article:


The general well-being in work-places is receiving increased attention in Sweden. Not only is the well-being and healthiness important to the individual himself, but also important to fellow co-workers, family members and last but not least to the success of the company. During the last few decades increased focus have been on how to increase well-being by offering company-sponsored health care, memberships in fitness centres and similar programs aiming to prevent and cure disease and to increase physical activity and awareness on health issues.

Comparatively little attention has been on the diet and how a daily healthy diet impacts on general health with the exception of anti-obesity initiatives.

The cost due to short term sick-leave is in Sweden alone estimated to more than 2.2 billion [1] and a majority (5060%) of the episodes are caused by diseases in the respiratory tract (common cold) and gastrointestinal infections [2].

Of special interest is the well-being among shift-workers as this group is known to be at significantly higher risk to attract short-term illnesses such as the common cold and gastroenteritis [3].

Probiotics, i.e. naturally occurring bacteria with health benefits are gaining wider acceptance. These bacteria, commonly from the Lactobacillus family have been demonstrated to have numerous potentially important benefits in terms of gut health and immunity [4], but very few studies address how these effects translate into health benefits in normal populations.

Recently, it was demonstrated in a double blind study [5] that gastrointestinal illnesses and febrile episodes could be significantly reduced in babies attending day-care centers. This was achieved by adding the probiotic Lactobacillus reuteri to infant formula during a 12 week long study period.

This study aimed to evaluate if similar effects could be achieved in adults and if the addition of the probiotic L. reuteri as a daily dietary supplement can improve work-place healthiness.


The proportion of subjects that were withdrawn for reasons of non-compliance was fairly high, 31%. This can most probably be explained by the study design itself in combination with the fairly long study duration. When the study was designed it was decided that the study staff should meet the study subjects as little as possible in order to minimise any placebo effect as it was assumed that frequent contacts could increase the individual subject's awareness of health issues beyond the normal behaviour.

The outcome of the study demonstrates that daily intake of L. reuteri can reduce the proportion of subjects reporting sick from gastrointestinal or respiratory tract diseases by 60%. The effect was highly statistically significant and similar to the findings by Weizman et al [5], where small children in day-care centres had a 70% lower frequency of absence when given L. reuteri as compared with placebo.

As demonstrated elsewhere [6-8], L. reuteri is efficient both in preventing and treating acute diarrhoea and gastroenteritis in young children. In a study on healthy adults it was shown that L. reuteri was able to stimulate the immune system by recruiting CD4+-cells [9]. Such stimulation by L. reuteri has been observed in animal models and is associated with an improved response to pathogen infection [10]. Although the exact mechanism of action cannot be defined from our study it is likely that such an immune-stimulation lies behind the reduced morbidity in the subjects taking L. reuteri. This stimulation may also explain why the beneficial effect of L. reuteri in our study was specifically apparent among shift-workers. This subset consisted of 31% of the total study groups and therefore some caution is warranted when interpreting this result. Nevertheless, shift-workers are known to be at risk for having a weaker immuno-defence as compared to those working day-time shifts only [3]. Consequently it can be argued that shift-workers would benefit relatively more by the immuno-stimulating effect of L. reuteri.

In conclusion, the present study demonstrates that L. reuteri is effective to promote work-place healthiness. In the studied population sick-days caused by respiratory or gastrointestinal diseases could be reduced by 55% by the use of L. reuteri group as compared with the placebo group. Translated to the total Swedish work-force, this translates to a total of 4.3 million working days of improved productivity per year (3.9 million employed, 220 working days per year and 0,5% "saved" days). Our results indicate that the effect on shift-work productivity could probably be even more profound but this issue should be addressed in further studies.studies.


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