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What’s the lowdown on probiotics? I hear and read about 'em a LOT, but is it really necessary to supplement the average diet with them?
Why or why not?
Or is this just another marketing fad?
I recently had a terrible bout of gastroenteritis and it was suggested (not by an M.D.) that I repopulate my gut with – probiotics.
So… ?
When started within three days of beginning a course of antibiotics, probiotics seem to decrease the risk of antibiotic associated diarrhea.
I also recently had a bout of the stomach flu, followed by a sinus infection. Went to the Minute Clinic and got antibiotics and the nurse practitioner (also not an MD but close enough!) reminded me to get probiotics, which is something I always do now when I get antibiotics. I am prone to getting yeast infections when on antibiotics and the probiotics help me avoid it (it worked).
ANYWAY she also mentioned that the probiotics will help with the recovery from the stomach flu. It’s hard to tell exactly what they may have done for my stomach because I was also taking ANTI-biotics (which will mess with your stomach as well as your vaginal flora) but at least now we have an anecdote of a medical professional suggesting probiotics after a stomach flu.
If nothing else, they’re cheap!
What kind do you get? I’ve seen so many, and I don’t know enough to know which are the best. Or are they all the same?
Welp, the last 2 times I bought it I was at CVS (the minute clinic - for antibiotics for a sinus infection) and they only have two kinds. One says “PROBIOTIC” and one says “PROBIOTIC ACIDOPHILUS.”
I know that in the past I had taken acidophilus on the recommendation of a gynecologist for yeast infections, so that’s what I got. It also says on the bottle “Friendly bacteria for the digestive system.” (IIRC so did the “PROBIOTIC” bottle, though)
Acidophilus is not the probiotic in Activia yogurt, though. That has Bifidobacterium lactis. That is added to the yogurt - the stuff that is “naturally” found in yogurt is Lactobacillus bulgaricus (it’s what is used to make yogurt).
Here’s a decent article that goes over the different strains of probiotic for different situations. I see it is in line with the “acidophilus for yeast infections” advice I got. Looks like yogurt/lactobacillus is more useful for stomach flu.
Short version: solid evidence for prevention of antibiotic associated diarrhea and lot else which is possible but unproven; the way most people use them is both faddish and of little rational sense.
Slightly longer version: think of your body as an ecosystem. Lake Erie was not “dead” in the 1960s because of a lack of new fish coming in but because it was an ecosystem out of whack without that which a variety of fish needed to survive let alone thrive. Putting a few thousand extra of one or two species of fish in there each month would not have helped until the ecosystem was such that they could thrive. But that is what many are doing with “probiotics”; they are ignoring the overall ecosystem and throwing a relatively very few random “good” species in hoping that such will cure all.
No question by now that the gut microbiota has far reaching impact on appetite, metabolism, inflammation including that associated with heart disease, autoimmune and allergic diseases. Hardly any understanding of the specifics, just scratching the surface. And how to impact it? In what way should we want to impact it? Speculations only at this point although no shortage of those who claim to “know.” For now the best bet is to feed the ecosystem with a variety of real food fiber sources and avoid antibiotics unless really really needed (including advocating for less antibiotics in the food supply and from there into the shared environment). And if any of you are parents that being very stingy with antibiotics especially applies to your babies … make sure your kid’s doc knows that you are of course willing to use antibiotics if needed but that you’d prefer not to if not absolutely indicated … ear infections, for example, can often be managed with “watchful waiting” and courses of antibiotics often avoided. Early antibiotic use impacts the trajectory of the microbiota’s evolution in a lasting way … worth it if the med is needed but make sure it is is all.
Should be added - even for the solid evidence bit - antibiotic associated diarrhea - the effect is fairly modest. Of every seven patients who would develop diarrhea as a result of antibiotic use, one of them would be prevented with probiotic use and six would still get it. It’s real but not dramatic.
My Dad nearly died last week because he picked up C. Diff from being in the hospital on antibiotics the week before. I think if he’d been taking probiotics he might not have been so sick. I wonder why the doctors don’t routinely prescribe or recommend probiotics along with antibiotics.
Well… because a lot of doctors weren’t introduced to the concept in medical school and there has not been sufficient scientific evidence since them for a major medical association or similar body to come out and recommend them?
Actually, I do have an anecdote (with the usual caveats about anecdotes and data) of a gastroenterologist who, when I was having difficulty recovering from a bout of norovirus, explicitly recommended probiotics for me. I will note, however, this was also with recommendations of other dietary changes and part of a several months recovery.
Probiotics probably helped my recovery, but they weren’t a magic bullet, they did not cure my allergies, make me prettier, or a bunch of other woo stuff. The doc I went to did not recommend them as a daily supplement forever, he recommended a healthy diet for long-term health.
So they have some use but are often over-hyped by either the credulous or those seeking to make money.
So, that’s the other reason docs probably don’t recommend them a lot - they’re useful, but not magic. They’re also not terribly cheap, either. If someone has budgetary concerns and can tolerate antibiotics without needing probiotics they’re an unnecessary expense. Some of the conditions they’re promoted for could be better served by eating more fiber in real food. They’re an option, not a mandate.
Gut flora and the microbiome is a hot topic now, with some top minds in Infectious Disease investing a lot of effort and money into it.
Gut fauna and the macrobiome is being looked into also. (Obligatory xkcd link)
All I know is that once I started eating yogurt for breakfast regularly, the volume and stench of my… emissions has gone way down, without any other change in diet or behavior.
So I don’t doubt that they do something, even if that something is to make you fart less, and less dog-like when you do.
Can’t say much about the adult side and C diff … how effective it actually is and what the number needed to treat would be to prevent a case. I’d suspect that certain antibiotics used or patient populations at greater C diff risk would warrant it. Searching I find different meta-analyses that come to different conclusions though about what the current evidence actually supports.
I do know that in premies (under 34 weeks gestational age, under 1500 grams) routine probiotic use during a NICU stay is indicated.
The link to the whole comic xkcd: Gut Fauna is good too. The mouseover text is often the best part of xkcd and a direct link to the jpg leaves that off.
Why eat probiotics when you can get a poop transplant?
You probably can’t get a poop transplant. Not until you’ve tried other treatments first, like antibiotics and…probiotics. at least, not if you want your insurance to pay for it and a doctor to administer it. There are people doing DIY fecal transplants, but they’re idiots.
I’ve been doing daily probiotics for about 6 months, and they’ve been fantastic. Last week, I ran out and decided to go without, figuring that surely by now I’ve reestablished the correct gut flora. I’ve now had a week of gas, cramps and diarrhea. So not happy. (Luckily today is payday and I can get more probiotics.)
Studies are mixed, so this is one area where you’ve got to learn from your own body at this point.
Because maybe some people have gotten fat from getting a poop transplant from an obese donor.
One lady. A fascinating case study, to be sure, but “some” is overstating it, unless more have been uncovered that I’m unaware of.
Need a donor?
That’s why I said “maybe some”.
A bit more to it than one case study. A 2013 Science article about it (not sure if behind paywall or not).
I want to highlight one part of that: “good” microbiota alone is insufficient; they are not the ecosystem in isolation of giving them the feedstock they need, a suitable host diet.
