Probiotics And Gi Health
Found in yogurts with live bacterial cultures, as well as in other foods and dietary supplements , “probiotic” products continue to multiply on the shelves of grocery stores and vitamin and supplement retailers.
Global sales of probiotic foods and supplements reached $21 billion in 2010 and were projected to reach $31 billion by 2015, according to one market analysis.
But which probiotics are best and in what quantities?
Sydne J. Newberry, PhD, of RAND’s Southern California Evidence-based Practice Center, says this is not yet clear.
What Is Diarrhea And How Does It Manifest
Diarrhea is more common than you might think in our environment and is defined as a decrease in the consistency of your stools and/or an increase in their frequency .
As a general rule, diarrhea lasts less than 14 days and usually resolves within 7 days. If diarrhea lasts longer than 4 weeks, the physician has to find out whether it is caused by another disease or by drug treatment.
Antibiotics are the first medications that have surely come to mind as the reason for diarrhea. However, in addition to antibiotics, many other drugs can cause chronic diarrhea, such as antihypertensives, cholesterol, and triglyceride-lowering drugs, antiarrhythmics, antacids, stomach protectors, laxatives, antidepressants, nonsteroidal anti-inflammatory drugs, and sugar-lowering drugs, among others.
Diarrhea is sometimes accompanied by vomiting, fever, and abdominal pain of abrupt onset. If the microorganism responsible for the diarrhea is a virus the stool will be watery, while if the microorganism has invaded your intestinal mucosa the stool will have blood and mucus and will be accompanied by high fever and severe abdominal pain.
In addition to infectious causes and drugs, sometimes diarrhea is the first sign of chronic disease. For example, the onset of diarrhea may be behind the first outbreak of inflammatory bowel disease, a food allergy, or the onset of irritable bowel syndrome, celiac disease, or an autoimmune disease.
Risk Of Bias In Included Studies
The risk of bias is categorized into three categories: high risk of bias, low risk of bias, and unclear. The individual studies results of the risk of bias assessment are shown in .
Risk of bias summary.
The quality of reporting was low 11 trials lacked adequate information to assess one or more of the parameters, thus making the risk of bias unclear. This was the case particularly regarding allocation concealment and blinding methods. For the blinding of participants, nearly half of the studies were evaluated as having a high risk of bias because the participants in the control group did not receive any kind of placebo matching the probiotic given to the intervention group.
Loss to follow-up was substantial in three trials . 11 studies did not perform an intention-to-treat analysis.
Visual inspection of the funnel plot for the primary outcome identified minor asymmetries for the smaller studies, but the relationship between the risk ratio and standard error did not appear substantially skewed, in turn suggesting that a possible publication bias is not likely to markedly affect the results.
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Increased Risk Of Infection
review from 2017 suggest that children and adults with severe illnesses or compromised immune systems should avoid using probiotics. Some people with these conditions have experienced bacterial or fungal infections as a result of probiotic use.
If a person has a condition that affects their immune system, they should speak with their doctor before taking probiotics.
Also, anyone using antifungal medication should wait until the infection has cleared up before taking probiotics.
Factors Confounding The Use Of Probiotics In Aad
Several confusing factors hinder our understanding of probiotics and flaw the studies aiming to detect their beneficial effects. Perhaps the most complex one is the type and composition of various probiotics used. Should we use single or multiple strains in our prevention? Are certain strains more beneficial than others are? Johnston et al addressed this issue in their review and found that trials using multiple species showed a larger effect than those using a single strain in preventing CDAD. The test for interaction suggested a low likelihood that chance alone explains such a difference . They commented that the hypothesis is sufficiently credible to warrant further assessment through serious future studies.
It is very difficult to draw conclusions from the available data and meta-analysis regarding the duration of treatment. The extent of heterogeneity between different studies precludes any reasonable analysis. This is also similar for the follow up period, as most publications do not precisely dwell on this issue.
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Safety Of Probiotic Use
Examining available data for adverse events of probiotics is not an easy task it is mostly under-reported in the literature. In their trial, Allen et al found a statistically significant difference in flatus in the probiotic group. Almost 20% of participants had serious adverse events, but the frequency was similar in both groups. The most common were respiratory, mediastinal and thoracic disorders . In the 2012 review performed by Johnston et al, 17 RCTs reporting on side effects were assessed. Four reported no adverse events at all and three reported serious ones. However, the frequency of events was higher in the control group . The most commonly reported symptoms were abdominal cramping, nausea, fever, soft stools and flatulence. When Pattani et al performed their meta-analysis they found no life threatening adverse effects in the 16 RCTs studied. Furthermore, one of the largest meta-analyses to-date assessing probiotics is the one performed by Hempel et al in 2012 it included 84 RCTs, of which 59 did not report on probiotic-specific adverse events. The rest did not mention any serious side effects. More importantly, three recent systematic reviews have addressed the safety of probiotics. The most comprehensive of them searched 12 electronic databases they included 208 RCTs. For short-term probiotic use compared with the control group there was no statistically significant difference in the overall number of adverse events including serious ones .
Does Taking Probiotics Routinely With Antibiotics Prevent Antibiotic Associated Diarrhoea
- Accepted 27 October 2011
Diarrhoea develops in association with antibiotic treatment in 1% to 44%12 of cases, and ranges from mild episodes that resolve when antibiotics are stopped to serious complications such as toxic megacolon, bowel perforation, and death. Risk is increased with extremes of age, co-morbidity, oral broad spectrum antibiotics , prolonged antibiotic duration, previous antibiotic associated diarrhoea, and hospitalisation. Probioticslive microorganisms that, when administered in adequate amounts, confer a health benefit on the hostare present in products available in shops as foodstuffs, and in formulations used for specific therapeutic purposes. Probiotics are thought to combat antibiotic associated diarrhoea through restoring resistance to colonisation by pathogenic bacteria after the normal colonic microflora have been damaged by antibiotics, by breaking down non-absorbable compounds into absorbable products, by interfering with pathogenic toxins, and by enhancing immunity. Effects of probiotics vary by strain owing to differing resistance to gastric acid and bile, ability to colonise mucosa, and susceptibility to antibiotics.3
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Prevention Of Infectious Diarrhea In Healthy Children And Adults
In large part, studies demonstrating positive effects on the prevention and alleviation of infectious diarrhea in healthy human populations have been performed in infants and children. Young children may be particularly responsive to probiotics because of the immaturity of their immune system and the greater simplicity of their intestinal microflora compared with that of adults. Malnourished children or children attending child-care centers are exposed to a higher risk of gastrointestinal and respiratory tract infections , which may be reduced by the consumption of probiotic milk products or milk formulas supplemented with probiotic bacteria.
Administration of L. rhamnosus GG or a placebo to 204 malnourished children in Peru was associated with a significantly lower incidence of diarrhea in the treated compared with the placebo group .
In a prospective, randomized, controlled French study, 287 children in day-care nurseries were administered daily either unfermented jellied milk, conventional yogurt, or a probiotic yogurt product containing 108 cfu/mL L. casei spec. Each product was given over 1 mo, each month being followed by 1 mo without supplementation. The conventional yogurt brought the mean duration of diarrhea from 8.0 d down to 5 d, and the probiotic product brought it down to 4.3 d the incidence of diarrhea was not different between groups .
Study Selection And Inclusion Criteria
In this review we chose to only include studies that had a clear definition of antibiotic-associated diarrhea, to be able to compare their results in a systematic way. However, studies lacking a precise definition of diarrhea may still provide valuable information, and it could be a subject for future discussions how to interpret them and whether to take them into account when formulating recommendations. Furthermore, the strict definition of diarrhea used in some studies means that the protective effect of probiotics against AAD may have been underestimated . Given the scope of the review, we searched for clinical trials involving the use of antibiotics, but we didnt apply strict inclusion criteria regarding the kind of antibiotic used. We didnt look for studies using specific treatments, nor did we exclude studies that did not indicate which antibiotics they used, since diarrhea can be a side-effect of many. Five of the studies that we included did not specify which antibiotic was administered to the patients during the clinical trial. Of the remaining 27 studies, 21 enrolled patients taking different antibiotics, including antibiotic such as broad-spectrum penicillins and cephalosporins associated with a high-risk of AAD.
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Food Sources For Probiotics
Even if there aren’t recommendations on specific products, there are food sources for probiotics:
- Yogurt that contains live bacteria: Not all yogurts have these. Make sure the label says “live culture,” “live bacteria,” or “probiotic.” Buttermilk and acidophilus milk.
- Cheese with live bacteria cultures: Aged cheeses such as cheddar and blue cheese are a good source, but don’t cook them. Heat kills the bacteria cultures.
- Kefir: a yogurt-based drink found in most major food outlets.
- Miso and Tempeh: different forms of fermented soy. Miso is a paste used for seasoning and tempeh is a fermented version of soy often used as a meat substitute.
- Fermented cabbage: Sauerkraut is the German version Kimchi is the Korean style. But heavily processed products packaged in cans or jars probably don’t have live bacteria. Check the label.
Do Probiotics Help With Diarrhea In Dogs
Yes, probiotics can help dogs with diarrhea. Studies show that probiotics can be used to manage diarrhea decrease its duration and intensity. Other studies demonstrate that preventive use of probiotics before a stressful event can decrease diarrhea incidence.
Plus, a study evaluating the safety of probiotics in growing puppies concluded that the supplementation is well tolerated with no safety concerns.
In simple words, when it comes to managing canine diarrhea, probiotics are both efficient and safe. Plus, they will contribute with a few other health benefits.
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Probiotic Foods To Start Eating
Pills arent the only . You can get your dose of healthy intestinal bacteria through everyday foods. The process of fermentation encourages the growth of different bacterial species, like those commonly used in probiotics.
Anything pickled, such as sauerkraut and kimchi, is a great option for probiotic foods. If pickled food isnt your favorite choice, there are still plenty of other options. Theres a reason miso, tempeh and kombucha are found in the health food section of the grocery store, and thats because of the critical fauna these items have stored up for you.
Yogurt is a widely popular food that contains considerable probiotics and is also enjoyed by many different cultures as part of their regional cuisines. If you have an aversion to vinegar, yogurt might be the better choice for you.
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Consider Some Otc Help
You might also ask your physician about taking the over-the-counter anti-diarrhea medication loperamide , which works by decreasing fluids that flow into your colon and slowing down the movement of your gut, prompting fewer poops, according to the U.S. National Library of Medicine. If you have certain underlying health conditions, your doctor might advise against this type of medicine Dr. Kistler says, so always check with them first.
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The Best Time To Take Probiotics: During And After Treatment
Bedford recommends that you start taking probiotics the same day as an antibiotic treatment.
While you’re on antibiotics, take those first before the probiotics. Don’t take them at the exact same time because the antibiotics could destroy the bacteria from the probiotic and cancel out any beneficial effects, Bedford says.
“You don’t want the probiotic on board until a couple of hours after the antibiotic itself is taken,” says Bedford.
Moreover, Bedford highly recommends that you continue to take probiotics for two weeks after you’ve completed your antibiotic dose to get your gut microbiome back to normal.
The Power Of Probiotics
It may seem strange: Youre taking antibiotics, so wouldnt probiotics undo the good your treatment is doing?
However, probiotics add helpful bacteria to your digestive system not the bacteria that cause infections. They dont have any effect on the antibiotic treatment. They only treat the side effects.
The thing that has really been shown to help the most with preventing diarrhea is taking probiotics when taking antibiotics, Dr. Rabovsky says. He notes that reviews of studies suggest probiotics are effective both for regular antibiotic-associated diarrhea and for diarrhea related to C. diff. They also seem to help with side effects such as cramping and gas.
Probiotics come in several varieties. The most commonly studied for antibiotic-associated diarrhea are Lactobacillus rhamnosus-based and Saccharomyces boulardii-based probiotics. Probiotics come in capsules, tablets, powders and even liquid form.
With so many options, be sure to ask your doctor for advice before taking any probiotics, as you should for any type of supplement. Probiotics could possibly be harmful for people with immune deficiencies or those who are severely debilitated.
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What Did They Find
- Probiotics reduced the risk of CDAD, by 64%. 2% of the probiotic group got CDAD compared with 5.5% of the control group. This suggests that 29 people need to be treated to prevent one case of CDAD
- Probiotics did not reduce the incidence of C.difficile infection
- Probiotics reduced the risk of side effects by 20%. In both groups side effects included stomach cramps, feeling sick and taste disturbance
- Limited data from three RCTs found no difference in length of time in hospital
Can Probiotics Worsen Diarrhea
Digestive symptoms When first using probiotics, some people experience gas, bloating, or diarrhea. Changes in the gut microbiota can result in bacteria producing more gas than usual, which can lead to bloating. However, these side effects usually clear up within a few days or weeks of taking the probiotics.
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How Good Is The Evidence
Overall, the evidence was judged to be of moderate quality. The low risk of bias studies suggested a stronger protective effect of probiotics than the high risk of bias studies. Looking at the data in various ways, to explore the possible effect of missing data for example, did not weaken the results and the reviewers judge that the evidence warrants modest confidence in the findings that taking probiotics significantly reduces your risk of CDAD but doesnt lower the risk of infection. There was a lot of variation in descriptions of side effects again the reviewers judged that overall the data on side effects is of moderate quality.
So what does this change?
In a press release, lead researcher Bradley Johnston of The Hospital for Sick Children Research Institute in Toronto, Canada said that giving probiotics to people on antibiotics could have an immediate impact on patient outcomes, especially in outbreak settings. He cautioned we still need to establish the probiotic strains and doses that provide the best results, and determine the safety of probiotics in immunocompromised patients.
Further, the review suggests that probiotics prevent symptoms of infection or limit the infection, rather than preventing the infection itself and this is something that future research could explore, possibly throwing some light on how probiotics prevent CDAD too.
When To Talk To Your Doctor
To reduce the risk of unnecessary problems ahead of time and ask your doctor if your antibiotic prescription is even necessary, as 28 percent of antibiotic prescriptions are unnecessary, according to the Centers for Disease Control and Prevention.
Know that antibiotics won’t help if you have a cold or flu, as antibiotics don’t heal viral illnesses.In addition to communicating with a health professional before you take a medication to treat antibiotic-associated diarrhea, you should contact them if you notice any blood in your diarrhea, if you develop fever, find a rash anywhere or experience significant abdominal pain beyond a little cramping, Dr. Kistler says. Here’s to better times ahead.
Probiotics Reduce Antibiotic Diarrhea
May 8, 2012 — Diarrhea is a common side effect of antibiotic use, occurring in almost 1 in 3 people who take the drugs. But new research suggests that probiotics may help lower the risk of that unwanted side effect.
By affecting good bacteria, as well as bad, antibiotics can disrupt the delicate microbial balance in the intestines, but the live microorganisms marketed as probiotics can help restore this balance to reduce diarrhea risk, a new review of the research suggests.
Supported by a federal grant, researchers from the nonprofit research and analysis group RAND Corporation pooled the best available research on probiotics and antibiotic-associated diarrhea, including the most recent studies.
They found that in people taking antibiotics, those who used probiotics were 42% less likely to develop diarrhea.
The review appears this week in the Journal of the American Medical Association.
Even with the latest research, the science showing that probiotic foods and supplements promote digestive health has not yet caught up to the hype, and many questions remain about their benefits, experts tell WebMD.
“The good news is that a lot of extremely high-quality research is going on now,” says gastrointestinal disease researcher Eamonn Quigley, MD, of Ireland’s University College Cork, who was not involved in the review.
“Up until now, most of the noise about probiotics has been generated by marketing, but it may soon be generated by the science.”