PROBIOTICS: SHOULD YOU CONSIDER TAKING THEM?

Probiotics are foods or supplements that contain live microorganisms (bacteria, or germs) intended to maintain or improve the intestinal “good” bacteria (normal microflora) in the body. Prebiotics are foods (typically high-fiber foods) that act to promote these human microorganisms.

Probiotics are in foods such as yogurt, sauerkraut and others. Prebiotics are in foods such as whole grains, bananas, greens, onions, garlic, soybeans and artichokes. In addition, probiotics and prebiotics are added to some foods and are available as dietary supplements.

Research is ongoing into the relationship of the gut microflora to disease. The health benefits of currently available probiotics and prebiotics have not been conclusively proved, despite the fact that they are being touted for treatment of all sorts of maladies ranging from irritable bowel disorders, constipation, support of immunity, Crohn’s disease, and many others.

Inasmuch as side effects are rare, most healthy adults can safely add foods or supplements that contain prebiotics and probiotics to their diets, future research may lead to advanced probiotics with clear potential to improve health. However, the value of adding bacterial containing supplements to regular diets is quite suspect, in not downright bogus!

In newly issued—and surprising—guidelines, the American Gastroenterological Association (AGA) recommended against using supplemental probiotics for most digestive conditions.

The society said there was insufficient evidence to make recommendations on the use of probiotic supplements to treat Crohn’s disease, ulcerative colitis or irritable bowel syndrome, and they even question their use for Clostridioides difficile (“C. diff”) infections, If patients with any of these conditions are taking probiotics, the AGA suggested that they, with their physicians’ approval, consider stopping them due to associated costs and lack of evidence concerning potential harm. The AGA found that there is still a significant knowledge gap in the area of probiotics but believes it remains an important topic for research. A lack of consistent harms reporting and product manufacturing details limit understanding of probiotics, and future research will have to address these hurdles, according to the guidelines.

Contrary to these AGA recommendations, I believe that probiotics should be considered in adults and children taking broad spectrum antibiotics. In so doing, that may prevent reduction of the protective “good” bacteria in the intestine, which, in turn, may help tp avoid imbalance that can allow the toxic C. difficile infection to gain a foothold.

The AGA found that there is still a significant knowledge gap in the area of probiotics but believes it remains an important topic for research. A lack of consistent harms reporting and product manufacturing details limit understanding of probiotics, and future research will have to address these hurdles, according to the guidelines. Potential benefits of supplements should be weighed against undesirable consequences, including the risk for side effects and the cost of adherence to therapy.

My take on these disclosures

. Probiotics are used frequently in this country whether over the counter or recommended for an ailment. Many patients, possibly as many as 50%, take them actively at some point, often during management Crohn’s disease, ulcerative colitis, and others.

There are a lot of unmet needs causing people to turn to probiotics. Some are looking for treatments they think are safe to counter their ailments. The AGA guidelines are important because probiotics are overused and, while generally safe, it is good the AGA is taking an evidence-based approach. From a patient standpoint the guidelines may come as a surprise because so many people take probiotics or are considering taking them.

In those who are not taking antibiotic, if one wishes to take probiotics for general health, I would recommend regular consumption of yogurt. Also, kefir, kimchi, sauerkraut, tempeh, and others (see picture at top). In the case of yogurt, In order to distinguish brands that contain live cultures from those that don’t, the National Yogurt Association (NYA) has created a “live and active cultures.” label

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