The Effect of Lactobacillus plantarum 299v on Iron Status and Physical Performance in Female Iron-Deficient Athletes: A Randomized Controlled Trial

Abstract

Iron is an essential micronutrient for oxygen transport and mitochondrial metabolism and is critical for physical performance. Compromised iron stores are more commonly found among athletes, and females are especially at risk. Iron deficiency is generally treated using oral iron supplements. However, only a small proportion of ingested iron is absorbed, necessitating higher intakes, which may result in adverse side effects, reduced compliance, and inefficient repletion of iron stores. The probiotic strain Lactobacillus plantarum 299v (Lp299v) significantly increases intestinal iron absorption in meal studies. The present study was conducted to explore the effects of 20 mg of iron with or without Lp299v on iron status, mood state, and physical performance. Fifty-three healthy non-anemic female athletes with low iron stores (ferritin < 30 μg/L) were randomized, and 39 completed the study. Intake of Lp299v with iron for four weeks increased ferritin levels more than iron alone (13.6 vs. 8.2 µg/L), but the difference between the groups was not significant (p = 0.056). The mean reticulocyte hemoglobin content increased after intake of Lp299v compared to control (1.5 vs. 0.82 pg) after 12 weeks, but the difference between the group was not significant (p = 0.083). The Profile of Mood States (POMS) questionnaire showed increased vigor with Lp299v vs. iron alone after 12 weeks (3.5 vs. 0.1, p = 0.015). No conclusive effects on physical performance were observed. In conclusion, Lp299v, together with 20 mg of iron, could result in a more substantial and rapid improvement in iron status and improved vigor compared to 20 mg of iron alone. A larger clinical trial is needed to further explore these findings as well as the impact of Lp299v on physical performance.

Probiotic Supplementation and Micronutrient Status in Healthy Subjects: A Systematic Review of Clinical Trials

“…All fourteen clinical trials were published in journals between the years 2000 and 2020. Studies were conducted in Austria [ 42 , 43 , 44 ], Indonesia [ 45 , 46 ], USA [ 47 ], India [ 48 ], Sweden [ 49 ], Italy [ 50 ], Egypt [ 51 ], Finland [ 16 ], Brazil [ 28 ], Serbia [ 52 ], and one was a multinational study [ 32 ]. Study design across the 14 included studies varied.…”

“…Study design across the 14 included studies varied. Four studies were randomized double-blind placebo-controlled trials [ 45 , 46 , 49 , 50 ], two others used a cross-over design [ 16 , 48 ], one was an open-label, randomized, multicenter study [ 32 ], and four randomized trials did not report blinding [ 43 , 44 , 47 , 51 ]. Three studies were nonrandomized trials [ 28 , 42 , 52 ].…”

“…Strains or species of bacteria also differed among studies. Seven studies used multi-strain probiotics or synbiotics [32,[42][43][44]47,48,50], three studies used L. plantarum [45,49,52], two used L. acidophilus [28,51], and one used L. helveticus [16]. In addition, one study used both L. rueteri and L. casei in two separate groups [46].…”

Recent advances in clinical probiotic research for sport

“…Increasing the absorption of iron could be a strategy for improving iron status and avoid the use of traditional high-dose iron supplements and thereby adverse side effects. In a recent double blind, 12 week randomized control trial in nonanemic female athletes with low-iron stores receiving a daily supplement of 20 mg of ferrous fumarate, L. plantarum 299v increased plasma ferritin (iron status), in those with ferritin levels above 20 μg/l at baseline compared with control [ 22 ▪ ]. Significantly, those with ferritin levels below 20 μg/l did not differ from each other in terms of the ferritin response (increase).…”

Sex differences and considerations for female specific nutritional strategies: a narrative review

“…Probiotics can even be helpful in treating recurring urinary tract infections (UTIs) in some women [ 162 ]. A recent study relevant to females, demonstrated an improvement in iron levels and absorption when 20 mg of iron (ferrous-fumarate) was combined with lactobaccilus plantarum 299v (LP299V, 10 10 CFU), suggesting this probiotic strain may help improve iron levels [ 163 ]. Probiotics should be chosen based on strain and desired outcome; strains may vary for women compared to men [ 164 , 165 ].…”