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To restore intestinal balance they’re sure they don’t have, some people are turning to probiotics.
But what exactly are probiotics? They work? How do you know if you need it? We posed these questions and more to Columbia gastroenterologist Daniel Freedberg, MD, who studies probiotics and their effectiveness.
What are Probiotics?
Probiotics are “good” bacteria taken in hopes of improving health.
What are probiotics for?
Probiotics change the bacteria that live in your gut, called the gut microbiome. The hope is that probiotics will lead to more beneficial and less harmful bacteria in the gut and better digestive or general health.
Why does everyone think they need a probiotic?
We surveyed over 500 people who were arriving for a routine colonoscopy and asked them about probiotics. About a quarter of them had used probiotics recently. Of these, 45% said they take probiotics to improve overall health and longevity. An overlapping 45% thought probiotics specifically improved gut health.
Does the microbiome affect health?
The microorganisms in the human gut contribute to nutrition and protect us from disease and illness. A healthy gut has a balanced mix of different bacterial species which promotes immunity.
Compared to healthy volunteers, differences in gut microbiota are seen in people with conditions such as inflammatory bowel disease (e.g. Crohn’s disease or ulcerative colitis); irritable bowel syndrome (IBS); intestinal infections, such as Clostridioides difficile infection; diabetes; metabolic syndrome; multiple sclerosis; non-alcoholic fatty liver disease; urinary tract infections; and psychiatric disorders, such as depression.
While these problems have been associated with an altered gut microbiota, we don’t really know if a “bad” gut microbiota causes them. For many conditions, “bad” microbiota appears to be more likely a consequence rather than a cause of the condition.
We also know that microbiomes vary widely in healthy people. In the Human Microbiota project, stool samples from thousands of healthy people (those with no abdominal pain, diarrhea, constipation, or other known intestinal problems) were examined. There was a wide range of gut bacteria, meaning two people might have completely different gut bacteria, but both people are perfectly healthy.
What does scientific research say about probiotics?
There is scientific evidence that probiotics help with some health problems. But not all probiotics are suitable for all diseases and illnesses. Some probiotic manufacturers make big claims that aren’t backed up by any evidence. The degree to which a probiotic can correct any problem is likely limited.
When should someone take probiotics?
The American Gastroenterological Association recommends the use of probiotics in three specific situations: (1) to prevent intestinal infections while taking antibiotics, (2) in preterm infants, and (3) in people with inflammatory bowel disease who have a condition called pouchitis.
Most people who take probiotics do not fall into any of these three categories.
I try to steer my patients away from probiotics for the purpose of improving overall health and towards a high fiber diet. Fiber acts as a “prebiotic,” so it also changes the bacteria that live in your gut.
What is the best probiotic, if I need it?
The organisms recommended by the American Gastroenterological Association are S. boulardii (a yeast), Lactobacillus species, and Bifidobacterium species. Again, these are only recommended in some specific situations and not for general health. Also, probiotics have different effects in different people.
Remember that probiotics are regulated like food, not drugs. Probiotic manufacturers are not obligated to prove any health benefits of their products.
Could taking probiotics be dangerous, whether someone needs them or not?
Probably not. The bacteria that go into probiotics varies, but they are always nonpathogenic bacterial species, which means you cannot get a bloodstream infection or any other infection from this type of bacteria.
Stomach pain is a sign that your gut microbiota is out of balance and can it be corrected with a probiotic?
No. The medical term for stomach pain is “abdominal pain.” The most common cause of abdominal pain is gas/wind in the colon. No studies have ever shown that probiotics reduce abdominal pain.
When it comes to probiotics, what’s the one thing you wish everyone knew?
At the office, I encourage people to think about a healthy, high-fiber diet instead of probiotics. Dietary fiber is a prebiotic that modifies the bacteria present in the intestines. Fiber is inexpensive and natural, and changing your dietary fiber intake changes your gut bacteria.
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