Tummy Trouble? Probiotics May Provide Some Relief

A new research review validates the benefit of using probiotics to ease the discomfort of diarrhea caused by antibiotics or infection.

Typically taken in pill or liquid form, or by eating yogurt and other foods containing the live microorganisms, probiotics are “healthy” bacteria that may bring normal intestinal bacteria back into balance and help regulate the body’s immune system, among other healthy effects.

“Friendly bugs” foster intestinal balance

The review found that certain probiotics have been shown to help manage antibiotic-associated diarrhea and infectious diarrhea:

• One study found that the risk of developing diarrhea as an antibiotic side effect was reduced by 52% in people who took probiotics compared with people who did not. People who started the probiotics within 72 hours of beginning antibiotics benefited most.

• In another study, the risk of developing antibiotic-associated diarrhea was reduced from 28% to 12% in children who took probiotics compared with children who did not.

• A Cochrane review showed that the length of an episode of infectious diarrhea could be reduced by as much as 30 hours in people who took probiotics compared with people who did not.

• Emerging evidence also suggests that probiotics may ease abdominal pain and bloating in people with irritable bowel syndrome and may reduce the incidence of atopic dermatitis in children.

“A large number of organisms are being used in clinical practice for a variety of purposes,” said Benjamin Kligler, MD, MPH, lead author of the review and the research director of the Beth Israel Department of Integrative Medicine in New York City. “The most widely used and thoroughly researched organisms are Lactobacillus species, Bifidobacterium species, and Saccharomyces boulardii, a nonpathogenic yeast.”

Probiotics are generally considered safe with few side effects, which may include flatulence or mild abdominal discomfort. People who have a very weak immune system (such as people with AIDS or end-stage cancer), are severely ill, or who have a severely damaged intestinal tract, however, may be at risk for more serious side effects. Before taking probiotics for any condition, discuss the risks and benefits with a knowledgeable physician.

Tips when considering probiotics

Dr. Kligler offers the following advice when considering probiotic use:

• When to consider probiotics. A person should consider using probiotics when they need to take an antibiotic or when they have an episode of gastroenteritis that causes diarrhea. They might also be considered by people with irritable bowel syndrome.

• Dosage. Typical doses of probiotics vary depending on the product used, but the usual amount for adults is 10 billion or more colony-forming units per day and for children is 5 to 10 billion colony-forming units per day. Read product labels and discuss the appropriate intake with a knowledgeable physician.

• How long should I take probiotics? This depends on the condition, but for instance, a person taking probiotics for antibiotic-associated diarrhea should take the probiotics for at least several days after the antibiotic treatment is finished. Discuss the duration of use with a physician.

• Food sources of probiotics. Yogurt may not contain sufficient concentrations of probiotics to be effective, but several yogurt products on the market claim to contain 10 billion colony-forming units per serving. Further study is needed to determine the effectiveness of foods sources of probiotics.

(Am Fam Physician 2008;78:1073–8.)

Jane Hart, MD

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