Beat those stomach troubles with probiotics
View(s):Probiotics are currently defined by the World Health Organisation as “live microorganisms which when administered in adequate amounts confer health benefits on the host.” There are trillions of bacteria which live in our digestive tracts. More than 400 different species have been identified. Most of these are healthy bacteria while others have the potential to cause damage to our intestinal systems. The good bacteria keep the bad bacteria in check by limiting the unhealthy bacteria’s ability to increase in numbers.
Probiotics are found in products such as yoghurt. Pic by Nilan Maligaspe
The good bacteria can also secrete chemicals which break down toxins produced by the bad bacteria, and activate the immune system to help fight the bad bacteria. At times, an imbalance between the good and bad bacteria can lead to uncomfortable symptoms or illnesses.Simply put, probiotics are bacteria or yeast which may alleviate these common medical symptoms and illnesses. They are found in many commercial products including yoghurt, juices, soy products, fermented milk and other dietary supplements. They also come in capsule, tablet or powder formulations.
n How do Probiotics work?
Probiotic supplements are specifically formulated to assure that the bacteria are able to survive the acid environment of the stomach, attach to the cells of, and colonise the small intestine and/or colon. While the specific effects of each probiotic species likely differs, in general, these organisms have been shown to confer health benefits through a variety of mechanisms.
Some have the ability to populate or modify the surrounding environment so that bad bacteria are unable to colonise or survive in the intestines. Many species release chemicals which break down the damaging toxins produced by unhealthy bacteria causing illnesses such as diarrhoea. Some increase the number of infection-fighting cells in the gastrointestinal tract, while others have the ability to stop bad bacteria or their byproducts from leaving the gastrointestinal tract and entering the rest of the body. A few have been shown to modify pain perceptions.
Are all Probiotic preparations basically the same?
No. In fact it is important to note that most probiotics differ both in their bacterial composition and quantity. There are more than 100 commercially available probiotic supplements. Many of these are single species preparations while others contain either multiple strains of a single species, multiple species, or both. Furthermore, the concentration of bacteria in each preparation varies. Some contain hundreds of colonies while others billions. There is no evidence to support the claim that either preparations with multiple species/strains or higher concentrations of bacteria leads to improved symptom resolution.
How do I know which Probiotic to take for my particular gastrointestinal illness?
The best way to identify an appropriate supplement is to consult with your primary care doctor or gastroenterologist. It is difficult for individuals to identify appropriate products for their symptoms or illnesses. Many trials have been performed assessing the benefits of probiotics for treating gastrointestinal illnesses. Some have identified beneficial preparations for treating individual disorders, while others have yielded conflicting results. Overall, there is general agreement that the data from these studies has to be interpreted in the context of each individual disorder. The following are disorders with studies suggesting potential benefits for probiotics:
Irritable Bowel Syndrome (IBS): IBS has been one of the most extensively studied disorders with multiple Bifidobacterium and Lactobacillus species tested both individually and in combination. A number of clinical trials have been completed and the use of single strain probiotic Bifidobacterium infantis appears beneficial for treating IBS.
Antibiotic Associated Diarrhoea (AAD): Clinical trials have suggested that the risk of AAD can be reduced by 50-60% if probiotics are co-administered with antibiotics. The individual probiotic strains found to be most effective include Saccharomyces boulardii (S. boulardii), a yeast, and Lactobacillus rhamnosus.
Clostridium difficile Associated Diarrhoea (CDAD): Data for the use of probiotics for the treatment of CDAD is limited, but they have been tested for both treatment and prevention. The strongest evidence suggests that adding the yeast S. boulardii to standard antimicrobial treatment may increase the likelihood of cure and reduce the rate of recurrence in patients experiencing mild repetitive CDAD infections.
Inflammatory Bowel Disease (IBD): There is growing data suggesting that probiotics may be of some benefit in the treatment of two of three different IBD-related disorders: Ulcerative Colitis, and Pouchitis. The data for Crohn’s Disease is less convincing. Pouchitis: Many patients need to undergo removal of their colon as a curative treatment for their UC. In these instances, the last part of the small intestine is sometimes used to create a reservoir, or pouch, where stool is collected before it is expelled from the body. Pouchitis is a condition where the pouch becomes inflamed resulting in multiple symptoms including the passage of blood or mucus or an increase in frequency or urge to go to the bathroom.
Within the first year after surgery, pouchitis is identified in approximately 20% of patients and by five years, 50% of patients have developed this condition. Studies have shown that the bacteria in these pouches differ from those seen in the normal colon and it is surmised that these lead to the development of inflammation. This disorder is commonly treated with antibiotics, but the recurrence rate is high. Therefore, it makes sense that repopulating these pouches with healthy bacteria may alleviate symptoms.
How long should one continue taking a probiotic if it is effective?
We do not know. Most patients have not been monitored for long enough periods of time subsequent to their participation in clinical trials. While there is nothing wrong with stopping probiotics and monitoring for symptom recurrence, some people choose to continue their supplements indefinitely.
n Are probiotics safe?
In general, probiotics are considered safe and many have been used for more than 100 years. Overall, complications from probiotics are rare, but appear to occur more frequently in immune-compromised patients, or in patients with indwelling intravenous catheters, suffering from infections of the gastrointestinal tract, or who are sick enough to require hospitalization in an intensive care unit. Their use should generally be avoided in these situations. This includes patients with certain bowel disorders like ulcerative colitis, being treated with immune suppression. Discussion with your doctor about any supplements that you are considering is very important
Are Probiotics the same as Prebiotics?
No. Prebiotics are non-digestible dietary compounds which promote the health of the beneficial bacteria. The majority are carbohydrates such as soluble fibres or oligosaccharides found in onions, bananas, tomatoes, soy beans and other plants. It has been suggested that these products make their way through the digestive tract and stimulate the growth or activity of healthy bacteria naturally residing in the colon. In some instances prebiotics are added to probiotic supplements and these products are known as synbiotics.
(The writer is a Consultant Physician, Sri Lanka Police
Hospital Colombo)