Probiotics: As good as advertised?

“Take a few billion bacteria and call me in the morning.” With all the advertising attention paid to probiotics these days, it seems that this unlikely remedy might be the best prescription for many ailments. Are the results as good as advertised, and are these “good” bacteria really safe? Recent research sheds some light on the subject.

Claim: Probiotics may help treat antibiotic-related diarrhea.

Research Findings: True, according to a systematic review of 23 trials and a total of 4,213 participants that was published online May 31 in the Cochrane Database of Systematic Reviews. Researchers found that probiotic use was associated with a significant 64 percent reduction in risk.

My Experience: Based on my experience, probiotics do seem to be helpful in addressing the uncomfortable problem of diarrhea associated with taking antibiotics. By maintaining the presence of some of the normal bacteria of the colon or helping reestablish the bacteria eliminated by antibiotics, oral probiotics can assist in normal colonic function and prevent the onset of diarrhea caused by other diseases.

Claim: Probiotics help treat irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). IBS is characterized by abdominal pain, bloating and change in stool frequency/consistency in the absence of an organic cause. IBD is a group of disorders, such as ulcerative colitis and Crohn’s disease, characterized by chronic inflammation of the gastrointestinal tract of unknown cause.

Research Findings: Maybe. There is published literature and research indicating that probiotics can be effective in treating the diarrhea associated with these digestive disorders. However, a recent randomized placebo controlled 12-week study suggests that the same benefit can be achieved by consuming yogurt, regardless of whether it contains an added probiotic.

My Experience: For my patients with IBS or IBD, I typically introduce probiotics as an adjuvant therapy along with the prescribed course of treatment. By maintaining as much of the normal flora as possible in a manner which is acceptable to the patients dietary preferences and lifestyle, probiotics aid in a clinical and natural response to the prescribed therapy for the underlying disease process.

As to the safety of probiotics, I agree with information put forth by the Harvard Medical School: “An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. These microorganisms (or microflora) generally don’t make us sick; most are helpful. Gut-dwelling bacteria keep pathogens (harmful microorganisms) in check, aid digestion and nutrient absorption, and contribute to immune function.”

The medical school also adds an apt warning by reminding us that, “In the United States, most probiotics are sold as dietary supplements, which do not undergo the testing and approval process that drugs do. Manufacturers are responsible for making sure they’re safe before they’re marketed and that any claims made on the label are true. But there’s no guarantee that the types of bacteria listed on a label are effective for the condition for which you’re taking them. Health benefits are strain-specific, and not all strains are useful, so you may want to consult a practitioner familiar with probiotics to discuss your options. As always, let your primary care provider know what you’re doing.”

If you’re struggling with stomach issues, in particular diarrhea, it could well be that probiotics will help. Before you run to the store for a probiotic supplement, however, I recommend that you first see your GIA physician to be sure your symptoms are not indicative of a more serious ailment.