Probiotics

“Should I take some probiotics while I’m on antibiotics, doc?”

I get this question all the time. There’s seemingly endless information about probiotics and the microbiome (AKA the universe of microscopic life that dwells in the darkness of your intestines), and many people are recognizing the importance of keeping those symbiotic organisms  happy. 

We’ve written about kombucha before, the fermented drink containing the magical SCOBY, or “symbiotic culture of bacteria and yeast”. Even before the kombucha craze, yogurt, kimchi, and sauerkraut had already taken off in the popular conscience as a way to deliciously eat live bacteria.

However, a recent article in JAMA exposed many of the problems with probiotics and the misinformation around them.  Chiefly, that we don’t fully understand if / when probiotics can actually be harmful. The bottom line is that probiotics are poorly (if at all) regulated. They’re introduced to the marketplace without any burden to prove efficacy or to show a lack of harm. Similar to what we wrote on here previously about vitamins, the industry is rife with poorly regulated products that purport to do things that may or may not be true. And, at worst, could harm you.

Aren’t there benefits though?

With all of the talk about gut health, it seems that introducing “healthy” bacteria could help ward off the bad ones. I’m going to give you the punchline first. Yes, there has been some benefit shown.  But this was in a few studies, and the probiotic bacteria used were carefully selected and controlled. The researchers studied very specific organisms, which may or may not be in the product that you are chugging down with your Z-pack. As physicians, we still don’t have adequate evidence to say you should take a probiotic containing Saccharomyces or Lactobacillus, for this or that situation.

The situations where probiotics seemed to help were in decreasing diarrhea in children on antibiotics, preventing C. difficile associated diarrhea, and in children with acute infectious diarrhea. Outside of these conditions, there hasn’t been any evidence to suggest benefit of probiotics. But boy, have we tried to find some.

There have been trials looking at probiotics effectiveness for many medical issues.

That list includes Chron’s disease, common colds, allergies, eczema, vaginitis, diabetes and even preventing cavities. In each of these cases, the verdict came back the same – probiotics didn’t help. Ugh. We would love to think (and hope!) that these things help definitively. But the data just isn’t there.

Even in the case of diarrhea studies, the evidence is weak, and not relevant to consumer-available probiotic products since we can’t say for sure which probiotic is in them. And they could actually be the opposite of beneficial. One study recently showed how patients’ microbiomes reconstitute themselves after a course of antibiotics. One arm of the study took probiotics, and the other didn’t.  Here’s the kicker – The probiotics actually delayed the rebuilding of the gut microbiome. Also, if you have a compromised immune system, these foods can actually be harmful for you.

If you love kombucha, kimchi, and yogurt, go right ahead eating them. We agree that these foods are delicious! But eat them for that reason, and not for any hope that swallowing the bacteria in them is going to make you healthier. It seems like they should, but at this time, we just don’t know for sure.