By Andrew Heiner, MD and May Marschner, PA-C
As the interest in probiotics has greatly increased nationwide, it is important to know that there is very limited data supporting when to use probiotics, which strains are most effective, and what benefits they actually provide.
Recent studies to determine the effectiveness and benefits (or negative effects) of probiotics on the system are somewhat inconclusive. There are not only multiple forms, strains and qualities of probiotics, there are also many types of people. Some individuals are naturally resistant to the bacteria in probiotics, while others may see successful colonization of microbes when probiotics are introduced. The mechanisms of action of probiotics in various disease states are not fully understood, nor is the question of contamination.
Recent research tested a group of patients taking a course of antibiotics. The group of patients was divided and treated in one of three ways:
– No intervention at all, leaving the patient to regain normal status on their own,
– Took probiotics after antibiotic therapy,
– Reinstated with original microbiomes to the gut. These microbiomes were taken from their own gut before they took antibiotics and reintroduced by Autologous Fecal Microbiome Transplant (aFTM).
Although the group taking probiotics saw rapid recolonization, the probiotic’s quick takeover prevented the participants’ normal bacteria from repopulating – delaying the return to normal for months. The aFMT group was returned to normality within days.
Another study has determined that probiotic use can result in an inappropriate accumulation of bacteria in the small intestine that can result in brain fogginess and rapid, significant belly bloating. Researchers found high levels of D-lactic acid being produced by the bacteria lactobacillus’ fermentation of sugars in food. D-lactic acid interferes with cognition and sense of time. Some patients using probiotics had two to three times the normal amount of D-lactic acid in their system, impacting their cognitive abilities. Probiotic-containing foods such as yogurt, fermented foods and dark chocolate provide normal amounts of bacteria rather than the significant blast of microbes that probiotic supplements offer.
Probiotics do offer therapeutic benefits to patients suffering with certain medical issues, but assuming they are harmless and a benefit to everyone may be a false assumption and requires further research. Patients who are immunocompromised, hospitalized, or post-op should not take probiotics without speaking with a healthcare professional.
Some Good News
In patients with pouchitis, studies have found that probiotics are an effective treatment for mild ileal inflammation and help prevent further inflammatory damage. Probiotics have also been well-studied in infectious diarrhea in pediatric patients — with the main benefit being a shorter duration of diarrhea-type symptoms. Recent studies have shown that probiotics reduce the risk of c. difficile associated diarrhea by 50% in hospitalized patients when started within two days of the first dose of antibiotics. The research on IBS is more limited, but controlled trials in patients with IBS-D have shown that B infantis 35624 at a dose of 1×108 CFU per day for four weeks can reduce bloating, abdominal pain, bowel dysfunction, incomplete evacuation, straining, and passage of gas. Other strains of bacteria (such as B bifidum MIMBb75) have been shown to not only improve IBS symptoms but also patient quality of life.
The above research sounds promising and there are many studies currently underway which should provide more insight into the risks and benefits of probiotics in the future. It is important to remember that probiotics should not be used as a substitute for scientifically proven treatments.
Consult your healthcare provider before taking probiotics, particularly if you have medical issues, as they have proven to cause some adverse effects in people with certain illnesses. As more research becomes available, we hope to gain more knowledge about the possible uses, and risks, associated with probiotics in order to provide the best possible treatment options for patients.