Living microorganisms in foods and supplements may provide health benefits. The challenge is in discovering which ones to use.
The average person has several trillions of microorganisms which inhabit their body and particulalry the gut. Most of these microorganisms are bacteria but they also consist of other organisms such as yeast. This community of microorganisms is called the “human microbiome.” Probiotics are living microorganisms in food and dietary supplements which may promote our well-being.
Research is making it increasingly clear that the microbiome plays a significant role in our health. Studies also indicate that probiotics may provide benefits to the microbiome and, consequently, to an individual’s health.
“For instance, they improve the intestinal barrier function to make it resistant to harmful organisms and toxins. They also suppress the growth of other pathogenic bacteria in our gut,” says Premier gastroenterologist Dr. Farshad Elmi. “Probiotics also promote the production of cytokines—proteins secreted by immune cells that act on other cells to coordinate appropriate immune responses. There is data that indicates probiotics may modulate pain perception in our guts.”
“Although probiotics have been around for years in the form of active live cultures in yogurt for example, we have done systematic reasearch on them only over the past two decades,” Elmi says. “There is still not enough data for blanket medical approval of their use as a treatment for every illness. In fact, none of the probiotics are considered as a standard care or primary treatment for any gastrointestinal illnesses.”
Neverthless, probiotics have become big business. “We are having difficulty keeping pace with the probiotics industry’s rate of growth. It is outstripping the speed with which scientific research can verify the probiotic products and their benefits,” Elmi says. “Scientists are calling for more studies to help determine which probiotics are beneficial and which might be a waste of money.”
Research leads the way
There are some good studies showing that certain specific conditions, such as infectious diarrhea, warrant the use of probiotics. “It has also been proven that people on antibiotics who are at increased risk of getting Clostridium difficile (C. diff.)—a bacteria that can overgrow in the gut after using antibiotics leading to serious infection—or infectious diarrhea benefit from the administration of probiotics, as do children and infants who come down with viral gastroenteritis, or a rotovirus,” Elmi says.
Individuals who have had a total colectomy—removal of the entire large intestine—can experience inflammation of a surgically created pouch which is called “pouchitis.” “There is good data that probiotics work well to prevent this inflammatory condition,” Elmi says.
It is difficult to ascertain which over-the-counter (OTC) supplements or foods contain the most beneficial type and amount of probiotics for a given condition. “Consumers should be aware that although probiotics are available over the counter and considered a safe supplement,” Elmi says, “they are not always safe for individuals who have underlying immune deficiencies, as can be the case with the elderly or people who receive chemotherapy.”
Probiotics are dietary supplements and are not regulated by the FDA. The cost of these medications is not reimbursed by most medical insurances. Available data in support of probiotic use are mostly based on small studies, many of which have important methodologic limitations. Given these circustances, we will carefully consider a patient’s primary disease, available medical treatment options and the patient’s comorbidities before deciding to use probiotics. “Our medical knowledge about the benefits of probiotics is evolving and as more research comes out, we’ll have more data on the benefit and shortcoming of probiotics to share with our patients,” says Elmi. “We have a lot to look forward to from coming scientific studies.”