Should you take probiotics?

Probiotics, a Latin term meaning "for life", are living bacteria that may be formulated into a tablet or capsule as a dietary supplement or added to foods such as yogurt. Unlike bacteria that cause strep throat or gastroenteritis, probiotics are thought to benefit the body by taking up residence in you intestines, where they prevent invasion by undesirable or harmful bacteria. They may improve functioning of the digestive tract by acting as a laxative, increasing immune defenses and aiding in the digestion of lactose. More than 400 species of bacteria live in your digestive tract, and researchers believe that at least some of these bugs thwart invading organisms by using resources the bad bugs need or by producing chemicals that kill them.

People from Finland, Sweden and many other European countries have been taking probiotics for decades to ward off digestive ills like diarrhea, food allergies and constipation. Epidemiological studies of these populations indicate that the supplements may live up to some of these health claims, and they don’t appear to cause any side effects. A recent study found that a specific probiotic containing Lactobacillus GG was effective in preventing atopic disease in children at high risk.

American clinical trials of probiotics have been few and far between. Frequently, these studies have yielded mixed results, with some finding a benefit and others finding no benefit. "The evidence to date points toward the concept that probiotics are beneficial, but this concept is awaiting definitive proof, in my mind. The field is in its infancy in terms of research," says a professor of Medicine, Microbiology and Immunology at the University of North Carolina School of Medicine in Chapel Hill.

A lack of clear scientific data, however, hasn’t stopped many Americans from jumping on the probiotics bandwagon. Many are buying products at health food stores or over the Internet without their doctor’s knowledge. In fact, an Internet search of "probiotics health product" yielded 4,740 sites offering products containing beneficial bacteria. Health claims made by the manufacturer range from the markedly questionable to the theoretically sound.

Another product, however, is purported to "strengthen the immune system, promote better overall health, reduce the symptoms of IBS, improve intestinal functioning, increase energy and reverse the effects of infections, antibiotics, alcohol, stress and poor diet" according to the website of its Manufacturer. This manufacturer may actually be breaking federal law, which forbids supplement manufacturer from claiming that their products cure diseases. This is according to Head of gastroenterology at Cooper Health System and professor of Medicine at the Robert Wood Johnson Medical School in Camden, N.J.

Pharmaceuticals must undergo a rigorous approval process by the Food and Drug Administration (FDA) before their label can state that they can cure or alleviate the symptoms of a medical condition. "Small supplement manufacturers may try to get away with making therapeutic claims, but a major drug company is too high profile," according to the said professor at Robert Johnson Medical School. Thus, a larger company that makes other popular medications wouldn’t want to risk attracting the FDA’s attention by over-reaching on the claims they make for a supplement.

Even if these beneficial bacterial live up to their promise, you might not be getting enough live ones in every capsule to reap the benefits. After recently analyzing 55 products labeled "probiotic" Belgian biologists found that only 13 percent of the products contained all the bacteria types listed on the label. More than a third of the powdered products contained no living bacteria whatsoever, according to the study, which was presented at the American Society for Microbiology’s General Meeting.

"These products have a limited shelf life. The longer a product sits around, the lower the live bacteria count. You have no way of knowing whether the product you buy contains what is stated on the labeled," says by the said professor from North Carolina Schools of Medicine. This lack of consumer protection is due to the fact that probiotics are considered dietary supplements. According to the 1994 Dietary Supplement and Health Education Act passed by Congress, supplement manufacturers – unlike pharmaceutical manufacturers are not required to standardize their products to verify that they contain what is stated on the label, nor are they required to test their products for safety or efficacy before they put them on the market.

Fortunately, probiotics appear to cause no side effects. Researchers have found little evidence that probiotics can break face of the gut and enter the bloodstream causing a bacterial infection. Nor have they found that probiotics can cause an overgrowth of good bacteria in the gut. "In general, it is the bad bacteria that multiply too rapidly – not the good bacteria". Added by the professor. He recommends buying only products that are marked with expiration dates and looking for products that have been studied in clinical trials.

To get a probiotic product that actually contains the amount of bacteria stated on the level, it is recommended to purchase a product that is manufactured by a large, well-known pharmaceutical firm or food company. These companies are already familiar with the standardization process and high-quality processing technique, so they are more likely to follow these standards when making probiotic products. The jury is still out over most of the health claims associated with probiotics, and researchers still are not sure whether you need to ingest a specific type of bacteria to prevent specific problems.

Gastroenteritis in children • What the research shows: Rotavirus, the most common cause of severe diarrhea in children, maybe prevented with probiotics according to several well designed studies. After the FDA recently pulled a new rotavirus vaccine from the market because of safey concerns, probiotics may be an appealing option for parents looking to ward off the stomach flu in their children. Over the past decade, at least seven different studies conducted abroad found that the probiotic Lactobicillus GG (LGG) significantly shortens the duration of rotarvirus diarrhea in people who take the supplement before contracting the infection. This is good to know if your child is in a high-risk environment where an outbreak occurs in other children.

In a recent study published in the Journal of Pediatrics, hospitalized infants at high risk of acquiring intestinal microbes such as rotavirus were given a formula containing LGG daily, while the others were given formula without the probiotic. One-third of the children receiving the placebo formula developed diarrhea compared to only seven percent of the children who received the probiotic formula. This translates into an 80 percent reduction in risk.

Expert’s take: "If I had a child in a day care, I would probably put him or her on probiotic to help prevent viral gastroenteritis, which is often spread in these centers," says the director of Pediatric Gastroenterology at the University of Nebraska in Omaha, who conducted the study mentioned above. You can mix a powdered probiotic into your child’s formula, juice or baby food. You do, however, need to give your child a dose regularly to prevent infection. Probiotics are not particularly effective at combating diarrhea once an infection sets in.

Diarrhea Associated with Antibiotic use • What the research shows: Whenever you take a course of antibiotics, you have a 20 percent chance of developing diarrhea. This side effect occurs because some antibiotics wipe out all the bacteria that live in your intestines, including the good bacteria that prevent the overgrowth of years and harmful bacteria. New harmful bacteria can enter the gut when antibiotics destroy your defenses and can colonize rapidly, causing diarrhea.

Several studies have found a modest reduction in antibiotic-associated diarrhea in those who take a probiotic along with their antibiotic-reducing risk, on average, from 20 percent to about 10 percent. In a 1999 study, probiotic LGG was randomly assigned to 188 children under age 11 who needed antibiotics and found that those who took the probiotic had an eight percent incidence of diarrhea compared to a 26 percent incidence in those who took a placebo. A September 2001 study from the Mayo Clinic in Rochester, Minn., however, found that LGG offered no protection against antibiotic-associated diarrhea in a study involving 302 adults. Diarrhea developed in 29.3 percent of the patients who were randomly treated with LGG compared to 29.9 percent of patients who received a placebo.

Expert’s take: Probiotics may be useful in preventing or treating antibiotic-associated diarrhea in adults and children, but they should not be relied on. Once C.Difficile-related diarrhea is documented, standard antibiotic treatment with metronidazole or vancomycin is advised. It is recommended to give your child a probiotic along with any antibiotic because of the strong benefit researchers seen in these studies. You need to see your doctor immediately if you have severe or bloody diarrhea associated with antibiotic use. "Antibiotics can sometimes enable a type of harmful bacteria to gain a foothold, causing inflammation or colitis. This condition can be quite serious and needs to be treated with a second antibiotic," one of the researchers says.

Traveler’s Diarrhea • What the research shows: If you take a trip to a third-world country, you have about 50-50 chance of developing diarrhea from pathogens found in the water supply and on raw foods. Research on probiotics to prevent traveler’s diarrhea has had mixed results, with some finding no effect and others finding a modest to large reduction in the incidence of symptoms. Those studies that found the largest reduction used a combination of beneficial bacteria. For instance, a Danish study found that travelers to Egypt who took the probiotic VSL#3, a combination of Lacidophilus, L. bulgarius, bifid bacteria and streptococci, had a 43 percent chance of experiencing diarrhea compared to a 71 percent chance in those who took no probiotics.

Expert’s take: Probiotics aren’t particularly effective against foreign bacteria that may infect your GI tract when you travel abroad, but probiotic can be useful to prevent traveler’s diarrhea. "In my experience, I’ve found Lactobacillus GG good for preventing or reducing the severity of viral diarrhea. These kinds of viral infections are commonly acquired from food or water in many foreign countries especially in Mexico and in countries in Central America, Africa and Asia," said by the director of Gastroenterology at the University of Nebraska. He recommends taking a probiotic supplement before traveling to these countries.

Inflamatory Bowel Disease • What the research shows: Three recent studies using the probiotic E. Coli nissle have found that the supplement may prevent a relapse in patients with inflammatory bowel disease (IBD), a serious condition that causes ulcers and irritation in the GI tract. In one study, the probiotic was as effective as a 2.4-gram dose of mesalamine, a standard drug used to prevent IBD relapses. Another study found that Crohn’s patients who were given E.Coli-nissle along with prednisone therapy had fewer relapses that those given prednisone alone. A third study published in the August 2000 issue of Gastroenterology examined the use of the combination probiotic VSL#3 to prevent pouchitis, an inflammation of the small intestine that commonly occurs after surgery for IBD. Only 15 percent of the 20 patients who were given VSL#3 for nine months following surgery developed pouchitis compared to 100 percent of the 20 patients who were given a placebo.

Expert’s take: Both researchers believe that probiotics show promise or preventing the relapses associated by IBD. "The pouchitis study is clearly the most convincing probiotic data that I’ve seen so far." Commented by the said Researcher & Director from University of Nebraska. The other researcher called the results "Impressive". Both of them also thinks that it is a good idea to take probiotics following surgery for IBD but advise patients to take a supplement under their doctor’s supervision.

Irritable Bowel Syndrome • What the research shows: At this point, no solid research has seen able to establish a benefit for taking probiotics to relieve the symptoms of irritable bowel syndrome (IBS). One randomized controlled trial involving 34 patients found that the probiotic Saccharomyces Boulardii decreased diarrhea but didn’t relieve other IBS symptoms such as abdominal pain and constipation. Two separate studies on IBS using various probiotics were conducted by them and found that none worked to relieve symptoms.

Expert’s take: "Most studies have come up empty-handed. At this point no positive effect from taking probiotics," say by the researcher.

Vaginal Yeast Infections • Scant clinical evidence exists to back up the claim that probiotics can prevent vaginal yeast infections. One study did find significant benefits for taking probiotics. Several consultants at Long Island Jewish Hospital gave 13 women with recurrent yeast infections one daily eight-ounce yogurt containing L.acidophilus for six months and then told them to abstain from eating yogurt for six months. During the time they ate yogurt, the women experienced an average of less than one infection (0.38) compared to an average of 2.5 infections when they didn’t eat yogurt daily. Other researchers haven’t been able to replicate these results. In one recent review study, researchers expressed concern that many of the aeidophilus products sold in health-food stores don’t have quality control and may not contain enough live bacteria to be effective.

Expert’s take: "I don’t think there’s enough evidence at this point to say that probiotics work to prevent yeast infections," the researcher says.

On the cutting edge of probiotics research are the studies examining claims that probiotics can prevent cancer or boost the immune system. Other research is evaluating whether probiotics can alleviate food sensitivities like lactose intolerance. Only time will tell if the supplements will indeed live up to their health claims. "The whole field is provocative and theoretically interesting. But all these theories remain to be proven," they says.