Probiotics Recommended Against Digestive Conditions
Written By: Paphapin Pairojtanachai
June 17, 2020
According to recent news from the American Gastroenterological Association (AGA), probiotics shouldn’t be used to treat most gastrointestinal (GI) conditions due to the lack of supporting evidence that probiotics are beneficial. After Dr. Alexander Khoruts of the University of Minnesota and his colleagues have reviewed various aspects of the use of probiotics reported in Gastroenterology (AGA's official journal) with an AGA Clinical Practice Guideline (CPG), they found that probiotics are effective only when used in premature newborns.
“Early studies in animals showed that probiotics modulate the immune system, provide resistance to invasion by pathogens, improve intestinal barrier function, lower the pH of the gut and modulate intestinal motility and pain perception,” Dr. Khoruts indicated. However, there is not enough evidence that ensures that probiotics can be used safely in humans, even though many claim that probiotics can relieve symptoms of anything, “from autism to osteoporosis”. One of the difficulties with this issue is that there is a failure to understand that the functions of bacteria are specific to the bacterial strains, not the species. For instance, while Nissle 1917, an E. coli strain, is acknowledged as a valid probiotic, other strains of E. coli aren’t.
The probiotics that do ease symptoms are not suitable for existing in the intestinal tract, and therefore the popular belief that probiotics “help balance the intestinal microbial composition is almost certainly wrong.” In fact, one of the reasons why certain probiotics are regarded as harmless is because they do not survive in the intestines. Even if they do survive, their power would still be impacted by that of the various microbiomes living in the human intestinal tract.
Today, probiotics are found mainly in dietary supplements. Due to this, the name of the strain and the number of live microbes are not required to be printed on the product labels. Additionally, an expensive and time-consuming procedure is mandatory for companies who want to confirm that their probiotics “can be used to diagnose, treat, mitigate, cure, or prevent disease.” Since their products have to undergo clinical testing in humans, no manufactured probiotics have been certified by the US Food and Drug Administration (FDA) as treatments for diseases, says Dr. Khoruts.
The new clinical guidelines released by the AGA “focus on probiotics across multiple GI diseases while also considering the effect of each single-strain or multi-strain formulation of probiotics independently instead of grouping them all under the single umbrella of ‘probiotics’.” Based on the CPG, probiotics can be used in three situations:
Probiotics containing numerous strains of Lactobacillus and Bifidobacterium can prevent necrotizing enterocolitis, a serious GI disease in preterm newborns with low birth weights.
Probiotics can prevent Clostridioides difficile infection in those who take antibiotics.
Probiotics can be used to manage pouchitis, which is a complication of the inflammatory bowel disease.
Nonetheless, the AGA does not support the use of probiotics in children with acute infectious gastroenteritis, and there is still inadequate evidence to determine whether probiotics are beneficial for Crohn's disease, ulcerative colitis, and irritable bowel syndrome.
While new technology will facilitate further research on probiotic selection, the AGA strongly recommends gastroenterologists to prescribe probiotics to their patients only if there is a clear benefit from taking the probiotics.
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