About a year ago we posted on the potential of probiotics to facilitate weight-maintenance or weight-loss. In that post, we promised that we would tackle the role of probiotics in other aspects of health at a later date. We have finally found a spare moment, so here it is! As noted in the original post, probiotics are associated with many different aspects of health; however, one of the most common (and logical) is in maintaining and promoting gastrointestinal health.
We review the evidence (scarce though it may be, as the title suggests) regarding probiotics for the treatment of H. pylori, inflammatory bowel diseases, and diarrhea.
Prior to launching into the potential of probiotics to treat a few gastrointestinal disorders we would like to take a moment to consider the general risks and benefits of probiotics.
Benefits: Probiotics have several benefits over traditional treatments, especially antibiotics. Firstly, probiotics can, with very few exceptions, be taken as a preventative measure against various diseases or disorders; whereas antibiotics are typically restricted to treatment after the onset of disease. By Another advantage is the possible reduction in wide-spread antibiotic use and the associated negative effects, primarily the resistance of bacteria to antibiotic treatments (1). Hypothetically, reducing the use of antibiotics should help counteract the development of antibiotic-resistance strains.
Risks: Probiotics are typically viewed as safe for consumption; however, a few concerns have been identified. Firstly, it has been proposed that probiotics, being live organisms, could transfer antibiotic-resistance genes. There is also some concern regarding the use of probiotics in patients who do not have healthy immune systems (1). However, for the average, healthy adult they seem to pose little risk if taken properly.
Helicobacter pylori (H. pylori)
H. pylori is thought to cause peptic ulcers and is being increasingly diagnosed. Treatment of H. pylori is challenged by the increasing frequency of antibiotic-resistant strains and the side effects of the triple therapy (proton pump inhibitors and two antibiotics) used to eradicate it (2). Typically we think of bacteria living in the colon, which the majority do; however, there are some bacteria that can survive in the stomach. Human lactobacilli can live in the stomach and may prevent H. pylori from attaching to the cells lining the stomach (1). Probiotics may also be beneficial in decreasing the side effects of H. pylori treatment – namely antibiotic-associated diarrhea (ADD) – and increasing the success of the eradication (2). One study found that the concomitant use of S. boulardii and H. pylori-eradication therapy resulted in less ADD (3).
Inflammatory Bowel Diseases
Inflammatory bowel diseases, like Crohn’s disease and ulcerative colitis, may be linked to an abnormal response to the bacteria living in the gut. Based on this premise the effectiveness of probiotics in treating ulcerative colitis has been explored. According to a Cochrane review, the efficacy probiotic treatment did not differ from anti-inflammatory medication (mesalazine) in terms of relapse rates (4). With respect to Crohn’s disease, a Cochrane review did not suggest probiotics were effective in maintaining remission; however, they note a lack of large long-term trials (5). While there is limited research in this area, results are potentially promising – could probiotics be just as good as conventional medications?
Irritable bowel syndrome (IBS) is a spectrum of diseases for which the underlying causes are still unclear. There is a suggestion, however, that an abnormal relationship between the gut bacteria and the immune system is involved in the development of IBS. In this case, the effectiveness of probiotics is controversial; however, the data seems to be leaning towards slight improvements (6).
It’s that time of year when many Canadians “fly the coup” for somewhere warm and sunny! Unfortunately, for some that means gastrointestinal upset from contaminated water and food. It appears that probiotics can make the intestinal environment more acidic (killing harmful microorganisms), secrete substances which can kill bacteria, and prevent bacteria from sticking to the gut (1). As a prophylactic measure, it appears that probiotics can reduce the risk of traveler’s diarrhea – by 8% according to one study (7). Not a lot but for anyone who has suffered from traveler’s diarrhea, even an 8% reduction may be worth the cost! Probiotics may also be helpful in the prevention and treatment of antibiotic-associated diarrhea due to C. difficile (7).
No Baloney’s advice. The use of probiotics in promoting gastrointestinal health and the treatment of gastrointestinal diseases is still in its infancy and there is a significant amount of conflicting data! The results are also confused by the seemingly unlimited number of potential bacteria that can act as probiotics, not to mention the combinations. Individual variations in gut environment, health and diet, as well as the variety of probiotic doses available, used also muddy the waters.
While there is limited evidence to suggest benefits, probiotics are generally viewed as a safe option (although often not for your wallet!). As with any natural health product, it is often buyer beware with respect to the actual contents of what you are purchasing – look for an NPN on the label. Here’s a good breakdown of what to look for from Leslie Beck, RD at the Globe & Mail. If probiotics are being taken they need to be “pure” (uncontaminated), the amounts need to be sufficient, they need to be stored appropriately (usually in the fridge), and expiry dates should always be observed. Finally, you should always visit your physician and follow their advice in the event of an illness. It is not advisable to self-diagnose and/or self-medicate.
- Tanriover, MD et al (2012) Use of probiotics in various diseases: evidence and promises. Pol Arch Med Wewn 122 (Suppl. 1) 72-77.
- Du YQ et al (2012) Adjuvant probiotics improve the eradication effect of triple therapy for Helicobacter pylori infection. World J Gastroenterol. 18(43): 6302-6307.
- Duman DG et al. (2005) Efficacy and safety of Saccharomyces boulardii in prevention of antibiotic-associated diarrhea due to Helicobacter pylori eradication. Eur J Gastroenterol Hepatol 12:1357-1361.
- Naidoo K et al (2011) Probiotics for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev 7(12):CD007443.
- Rolfe Ve et al (2006) Probiotics for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev. 4:CD004826.
- Hoveyda N, et al (2009) A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome. BMC Gastroenterology 9:15.
- Sazawal S. (2006) Efficacy of probiotics in prevention of acute diarrhea: a meta-analysis of masked, randomized , placebo-controlled trials. Lancet Infect Dis 6(6):374-82.