WeeklySA_AdminEFFICACY: The most important message is to pay attention to which probiotics you take, says medical expert.
By Own Correspondent
There’s convincing evidence that probiotics can be helpful in maintaining gastrointestinal health in certain select situations.
But, cautions Dr Joel Mason of United States’ Tufts University, like many natural approaches to maintaining health, there’s been a tendency toward generalising the benefits, so probiotics are frequently touted as a panacea for all types of health problems.
“Many advertisements and internet postings say probiotics are effective for the treatment of asthma, dermatitis, and a wide diversity of other conditions” says Mason. “At best, there is marginal evidence that probiotics are helpful for many of these conditions”.
The medico says there had been a lot of work that’s been done on probiotics in the management of irritable bowel syndrome (IBS), which is important since it’s such a common condition: it’s estimated that upwards of 15% of the US adult population has an irritable bowel.
“I would say that the summary of all the studies is that there are certain probiotics that seem to help a little bit with IBS, but quite frankly, the magnitude of the benefit tends to be very small, and it was probably not adequate as management of irritable bowel by itself,” says Mayson.
It was estimated that around 8% of the South African population (approximately 4.6 million South Africans) suffer from IBS, defined as recurrent abdominal pain, stomach cramps and intermittent diarrhoea, on average, at least 1 day/week in the last 3 months. It is important to note that IBS is not a disease, but rather a functional disorder, meaning an abnormal function of the bowels, resulting in a number of symptoms, according to the Viome medical journal.
Where probiotics have been convincingly shown to be beneficial is in the treatment or prevention of certain kinds of diarrhoea. Rotavirus is a common cause of infectious diarrhoea in infants and children. Once a child has the ‘gastrointestinal flu’, there is strong evidence to show that probiotics reduce the duration and severity of the illness. There was less convincing evidence that suggests probiotics can be used to prevent it.
“Let’s say your child’s school sends home a note that says 30% of the class is out with gastrointestinal flu,” says Mason. “You could give your child the appropriate probiotic with the hope that it might prevent them from developing it. But if they get sick and you administer it to them, it’ll probably shorten the duration of the disease”.
“The probiotic most consistently shown to be effective in this situation is Lactobacillus GG, which was developed at Tufts University by Sherwood Gorbach and Barry Goldin of the medical school,” he says. “You can buy it at drugstores under the name Culturelle. A yeast called Saccharomyces boulardii, sold in stores under the name Florastor, also seems to be effective in managing childhood infectious diarrhoea”.
A second instance where probiotics can be useful was with antibiotic-associated diarrhoea. When people go on antibiotics—whatever kind that may be—they frequently develop diarrhoea. There had been a number of trials in which people were administered certain probiotics, along with the antibiotics used to treat an infection, and that helped prevent diarrhoea.
Two probiotics had been shown to be effective for this problem: Lactobacillus GG and Saccharomyces boulardii.
For people who often go on antibiotics—say, a woman who gets a lot of bladder infections and then gets diarrhoea from the antibiotic—it would make sense to take one of these products, along with the antibiotic and extend for a few days after the antibiotic stops. Data suggested that to be effective in the prevention of antibiotic-associated diarrhoea, the probiotic should be taken for upwards of a week after stopping to take the antibiotic.
In some cases of antibiotic-associated diarrhoea, a very nasty bug called Clostridium difficile takes over because the antibiotics have knocked out the good bacteria in your gut and this bug fills the void. C. diff, as it is known, can cause dysentery, bloody diarrhoea and fever, and can even be life-threatening. The only organism that has been shown to convincingly prevent C. difficile is Saccharomyces boulardii.
A major addition to the list of things that probiotics seemed to be effective for was traveller’s diarrhoea. There was now pretty convincing data that these same two probiotics, Lactobacillus GG and Saccharomyces boulardii, were each effective in reducing the risk of traveller’s diarrhoea.
“For people who want to avoid developing this kind of traveller’s diarrhoea, taking one of these two probiotics seems to sizably reduce the risk. You also can take Pepto Bismol tablets, two tablets four times a day.
This has been shown to also be effective. So, there are a couple ways that people can try to protect themselves from developing traveler’s diarrhea aside from being careful about what they eat and drink,” says Mason.
Many people ate yogurt or kefir because it contained probiotic organisms, but studies looking at the potential usefulness of probiotics in a rigorous scientific manner have generally used pure preparations in tablets or capsules, not yogurt. And in many brands, the organisms used to make the yogurt or kefir aren’t necessarily the ones that have been shown to be effective in clinical trials. I can’t say that fermented dairy products aren’t effective. But whether the helpful bacteria you get by eating yogurt are really as effective as pure probiotics is up for debate right now.
“People taking probiotics should also be aware that they were not totally innocuous for all individuals. A lot of people say, ‘This is natural; it might help, and it won’t hurt, so I may as well take it.’ Remember that when you’re taking a probiotic, you’re swallowing billions of bacterial spores, and there are rare situations in which those spores can set up a serious infection in your body.
Lest I create too much anxiety: this complication seems to occur only in people whose immune systems are suppressed by drugs or other diseases, or who are critically ill”.
The most important message was to pay attention to which probiotics one took. There was a myth that all probiotics were the same, but because they were not viewed as drugs, they are not regulated by the Food and Drug Administration, so there could be problems with quality control. When one took a probiotic, one assumed they were ingesting billions of bacterial spores that would hatch and result in live bacteria in the gut.
“But there are probiotics you can buy in which 99 percent of the spores are dead—you may as well throw your money away. Moreover, if you’re going to approach this scientifically, you have to pay attention to the particular species of bacteria or yeast that you’re ingesting.
When I put patients on probiotics, I’m very specific about what products to take”.
Mason is a physician and senior scientist at the Jean Mayer USDA Human Nutrition Research Centre on Aging and a faculty member at Tufts University School of Medicine and the Friedman School of Nutrition Science and Policy at Tufts University.
