Patients frequently ask us whether they should use a probiotic. Probiotics are currently a multi-billion dollar industry, but their benefits aren’t supported by the best science. That being said, they are very safe and may help certain symptoms. Here I’ll answer some common questions:

What Are Probiotics?

Probiotics are living microscopic organisms that when ingested, might benefit your health. Our intestines are filled with trillions of organisms – including bacteria, yeast, and fungi – that may play a role in various diseases, symptoms, and our immune system.

Most Common Probiotics?

  • Lactobacillus: a healthy bacteria, found naturally in the human body. Multiple probiotics on the market contain lactobacillus (Culturelle, VSL#3)
  • Bifidobacterium: one of the major bacteria in our digestive tract. Products include:
  • Saccharomyces: a type of yeast. The main component of Florastor.
  • E. coli Nissle: a harmless form of E. coli bacteria. The main component of Mutaflor. What are the possible benefits of probiotics?

There are multiple purported benefits of probiotics. However, very few rigorous studies have examined these benefits. Here’s a brief summary:

  • Constipation: Small, randomized studies have shown a benefit of probiotics containing Lactobacilllus, Bifidobacterium, and E. coli Nissle.
  • Irritable bowel syndrome: Multiple studies have investigated the role of probiotics for IBS. These studies looked at improvement of abdominal pain, bloating, and diarrhea. Some show a benefit, some don’t. The strongest evidence is for Bifidobacterium (Align), but understand that there are major limitations to all of these studies. Overall, we know that approximately 50% of patients with IBS may benefit from probiotics.
  • Infectious diarrhea: Studies show that probiotics may help shorten the symptoms of an infectious diarrhea. Lactobacillus and saccharomyces have been studied the most.
  • Ulcerative colitis: The benefit is unproven, but there is some evidence that particular probiotics (E. coli Nissle) may help keep symptoms in control or possibly treat active colitis (VSL#3). However, probiotics should never be used for the treatment of ulcerative colitis or Crohn’s disease without first consulting your doctor.

Which Probiotic Should I Use?

This is largely a matter of preference and cost. None of the probiotic preparations are FDA approved, nor are they covered by insurance. Read the labels and try to stick with probiotics containing the microorganisms outlined above. Common probiotics that you will see are Align, Culturelle, DanActive, and Florastor, but that does not necessarily mean that one is better (or worse) than another.

Is Eating Yogurt The Same As Taking A Probiotic?

Yes and no. Yogurt does contain “live active cultures,” including lactobacillus. However, they are typically in a lower quantity and may be inactivated by the acidic yogurt environment. Pasteurization may also kill healthy bacteria in yogurt.

Are Probiotics Safe?

Probiotics are generally considered safe. They are normal microorganisms found in our body, and have a long history of use in dairy foods like milk and yogurt. However, it is not known if they are safe for people with severely impaired immune systems or in the elderly. You should always check with your doctor prior to starting a probiotic.

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