Probiotics: What's the Scoop?

The idea that probiotics may provide health benefits has been explored for over 100 years; however, the concept of taking a probiotic as a daily dietary supplement has gained momentum only recently. Data show that as many as 4 million adults take a probiotic in the United States, making probiotics some of the most widely used supplements. The most commonly found bacteria in daily probiotics are currently Bifidobacteria, lactobacilli, and bacilli coagulans, with saccharomyces boulardii as the most common yeast.

Probiotics have been used primarily to promote healthy digestion and help curb bothersome digestive symptoms that can accompany chronic conditions such as Crohn’s disease, ulcerative colitis, constipation, diarrhea, and generalized intestinal or stomach inflammation and ulceration.1 The bacteria and yeast found in probiotic supplements naturally exist in the human body and are therefore usually considered safe.

In some cases, though, patients may experience nausea, diarrhea, constipation, flatulence, or allergic symptoms due to ingesting priobiotics.2 These experiences tend to be mild to moderate in nature and occur as the body acclimates to a new balance of bacteria or yeast cultures in the body, and patients often begin to tolerate the supplements shortly after starting to take them. Initiating a probiotic supplement can be a concern if a patient has a known intolerance or allergy to some component of the supplement, a history of pancreatitis or other serious intestinal or bowel inflammatory disease, or chronic decreased functioning of the immune system. It is recommended that patients talk to their physicians before starting a probiotic if they list any of the above in their history.2,1

Choosing the Right Probiotic
Probiotics are used widely to promote digestive health, but based upon the specific digestive condition, the recommendation for which strains should be included varies. For instance:

  • Probiotics with lactobacilli strains are shown as effective treatments for acute-onset infectious diarrhea. Patients’ symptoms and duration of diarrhea were shortened by a whole day with the taking of a daily probiotic.3
  • Lactobacillus rhamnosus GG and saccharomyces boulardii have proven to reduce cases of antibiotic-associated diarrhea in both pediatric and adult patients. Unlike bacterial acute-onset diarrhea, it is only recommended to take a probiotic to prevent diarrhea caused by antibiotics, and not to treat it after the fact.3
  • Research has shown some evidence for reduction of bothersome symptoms caused by irritable bowel syndrome (IBS), particularly with strains of bifidobacteria, but results have not been clear enough for the American College of Gastroenterology to support a professional recommendation of a probiotic to help manage IBS.3
  • Trials that have experimented with probiotics to help manage Crohn’s disease have been inconsistent as far as trial type and type of probiotic used. These factors may have contributed to inconclusive results, along with some results suggesting probiotic use is not superior to placebo in Crohn’s disease patients.
  • Patients suffering from ulcerative colitis, however, have experienced remarkable induction and maintenance of a remissive state when using probiotics. One probiotic in particular, VSL #3, has provided these benefits to patients.3

Recommendations
Based upon the continuous positive evidence for use of a probiotic to help manage digestive diseases in patients, pharmacists are in a great position to recommend a daily probiotic to patients they know could benefit from one. Pharmacists should always recommend that patients consult a doctor and alert them to their desire to a start a probiotic before starting one.1 For patients who are immunocompromised, who had recent surgery, have suffered acute abdominal or digestive distress or trauma, or currently suffer from severe uncontrolled disease, starting a probiotic may not be a good idea.

Counseling
When talking with patients about incorporating probiotics into their health regime, its essential to get a complete list of all their medications, including any over-the-counter medications or supplements. This list should be shared with any other health provider they consult with as well.

Side effects from probiotics tend to be mild but talk to patients who have a known intolerance to lactose about choosing a probiotic that is dairy-free. Most probiotics can now be taken by those with an intolerance, but some marketed as “complete” or “milk-sourced” may contain lactose, often in the fillers and binders.

For those patients concerned about the safety of probiotics, recommend a probiotic supplement containing strains of lactobacilli and bifidobacteria, as these are groups of bacteria that have been widely researched and incorporated into most probiotic supplements.2

Conclusion
Probiotics are known to help alleviate bothersome digestive and intestinal symptoms with different strains recommended for the patient’s specific condition. Patients, in collaboration with their physicians and pharmacists, can learn more about health maintenance with probiotics to determine which one is an appropriate addition to their wellness routine.

References

  1. National Center for Complementary and Integrative Health. Probiotics: In depth. https://nccih.nih.gov/health/probiotics/introduction.htm#hed4. Updated July 31, 2018. Accessed January 9, 2019. 
  2. Mayo Foundation for Medical Education and Research. What are probiotics? https://www.mayoclinic.org/what-are-probiotics/art-20232589. Updated 2019. Accessed January 9, 2019. 
  3. Ciorba M. A gastroenterologist’s guide to probiotics. Clin Gastroenterol Hepatol. 2012 Sep; 10(9): 960-968.

 

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