It seems that there has been a lot of hoopla about a class of foods and supplements called probiotics. The name probiotics is especially confusing as they exist as liquids, pills, beverages, powders and milk foods. Probiotics are not “prebiotics” which are another class of supplements that work to fuel the normal bacteria that live in our guts. A probiotic can be called a probiotic if it contains viable live bacteria and/or yeasts that confer a health benefit. There is a variance from brand to brand as to the type of bacteria or yeasts as well as the amount that they contain. The variation is large: 2.5 million to 900 billion cells depending on the product type.
Probiotics work on enhancing and protecting the normal bacteria (flora) that live inside of our intestines by producing natural inhibitory substances that battle bad, opportunistic infections. A common bacteria that takes advantage of us when we are down is Clostridium dificile. This troublesome bacteria accounts for hospital acquired diarrhea and can be hard to remedy.
It was thought that probiotics originally re-populated decimated bowel flora, but we now know that is not the case.
The reasons to take probiotics are several. Some people with irritable bowel syndrome take probiotics. Studies using the brand probiotic, Align, improved bloating and gas but did nothing to improve stool frequency. In people with the diagnosis of irritable bowel syndrome some have more diarrhea and some have more constipation. None of the studies in patients with the diarrhea associated irritable bowel syndrome were helped (aside from bloating and gas) but the patients with the constipation form. It is not clear what type of probiotic is best only that amount of the probiotic seemed to improve symptoms. The higher concentrated forms of the probiotic were better in relieving irritable bowel symptoms. Needless to say, more research on probiotics needs to be completed on patients with irritable bowel syndrome before any definitive advice can be given.
For patients with diverticular disease who wish to prevent diverticulosis may benefit from a Lactobaccillus probiotic. A small study of 210 patients with diverticular disease benefited from this treatment.
Most research on probiotics is the prevention of antibiotic associated diarrhea. In 2002 a study using the brand probiotic, Florastor, helped reduce the cause of diarrhea. It appears that probiotic formulations with high concentrations and multiple types of bacteria and yeast had the best effect in this population. There was a 75% risk reduction with the multiple varieties of probiotic blend versus a 50% risk reduction in the single species probiotic.
It is important to give the probiotic in this situation a couple of hours after the antibiotic and to take it for at least a week after the antibiotic has been stopped. Look for the higher dose version of probiotic (10-billion or more cells) that has more than one type of beneficial bacteria.
For other medical conditions including vaginal bacterial infections, prostate infections, throat infections, and cold prevention there is not enough data to support the use of probiotics to either prevent or treat these conditions.
A great alternative to probiotic capsules or powders is Kefir. Kefir is a cultured milk that you can buy at your local supermarket (I just saw it in the dairy case at QFC). Kefir contains very high amounts of probiotics; 150-950 Billion live cells per cup. A gastroenterologist in the midwest successfully prevented and treated antibiotic associated diarrhea using 2 cups of Kefir per day while antibiotics are being used.
A final word is to also be careful if you are milk allergic (lactose intolerance is OK): some probiotic formulations contain milk.
Source of information for this article: Consumer Labs 2016
–James Bowers MD FACP
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