Probiotics are substances that contain microorganisms that are similar to the beneficial bacteria normally found in the human gut. Probiotics work by restoring the balance of the GI flora that has been altered by lifestyle, diet, toxin exposure or prolonged antibiotic use. Since the gastrointestinal ©system and the immune system are closely tied together, restoring balance within the gut has beneficial effects on our body’s ability to defend itself from inflammation and infection.
Use and Regulation
The use of probiotics to treat gastrointestinal conditions has long been regarded as a safe and effective alternative to conventional medicine. It has been shown to be effective in treating diarrhea, both infectious and antibiotic-associated types, ulcerative colitis, and irritable bowel syndrome. However, despite much evidence of its effectiveness, there is still a lack of clear guidelines physicians can follow in using them on patients largely due to its relative newness and overlaps in regulating agencies.
When probiotics are used as dietary supplements, they are regulated by the US Food and Drug Administration’s Center for Food Safety and Applied Nutrition. When used as drugs with therapeutic intent, the jurisdiction falls under the US FDA using Current Good Manufacturing Practices and Investigational New Drug approval processes.
Conditions treated with Probiotics
Acute bacterial infectious diarrhea has been found to be susceptible to probiotic treatment. In a review conducted by Cochrane of over 63 randomized controlled trials, researchers found that the use of probiotics reduced the duration of diarrhea by about 25 hours without any negative side effects. It was also determined that probiotics can also decrease the risk of developing traveler’s diarrhea by as much as 15 percent if probiotic treatment is started two days before travel and continued for the duration of the trip. It is important to note that probiotics seem to exert its effect only on bacterial diarrhea and does not improve the outcome of diarrhea caused by viral infections like the ones associated with rotavirus. Another study of over 3,938 participants found that children who are given probiotics experience a reduction in the risk of developing antibiotic-associated diarrhea by at least 11 percent.
Probiotics can also be used as a supportive treatment for cases of ulcerative colitis. In a meta-analysis of 23 randomized controlled trials with 1,763 adult participants, it was shown to increase the rate of remission by a rate of 12 percent. In another Cochrane review, it was found that probiotics were able to match the effect mesalamine, a standard drug for ulcerative colitis, with no significant difference.
Constipation can be effectively treated with probiotics specifically those containing the probiotic Bifidobacterium. A randomized controlled trial involving 165 adults was able to determine that yogurt containing the Bifidobacterium probiotic was able to alleviate the symptoms of constipation.
Necrotizing enterocolitis is a serious condition in which the intestinal tissue becomes damaged and begins to die. This condition commonly affects infants who are born prematurely. Compared to a control group, the group treated with probiotics experienced a reduction in the risk of severe necrotizing enterocolitis by as much as 0.43 and was able to decrease the mortality rate by 0.65.
Although probiotics are generally considered safe, it is prudent to exercise caution when using it in immunologically vulnerable populations. The findings from Agency for Healthcare Research and Quality states that in over a total of 24,615 participants, they did not show a significant increase in the reporting of side effects or adverse effects versus the control group. However, it is important to note that the studies only covered the short-term use of probiotics, and the long-term effects are still largely unknown. Populations cautioned with the overuse of probiotics include those with impaired immune conditions like those suffering from cancer. In a systematic review of 17 studies involving 1,530 cancer patients, five cases of probiotic associated bacteremia were confirmed via blood culture.
Like any other treatment, the risk must be weighed against the benefits, and as for the current evidence, it would seem like the use of probiotics has a positive future in the treatment of gastrointestinal diseases.
Probiotics for treating acute infectious diarrhea
Probiotics for Gastrointestinal Conditions: A Summary of the Evidence.Diarrhea, Probiotics, Ulcerative Colitis