Daniel Oberlin MD
Top urologist in minimally invasive surgery with expertise in oncology and stone disease in Berkeley, Oakland

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Are Probiotics better for your gut? What to tell your patients about the "good" bacteria health craze

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It seems that everywhere you look these days, we are confronted with the growing popularity of probiotics.  From enhanced Foods to kombucha, Probiotic foods and supplements continue to gain in popularity with a U.S. market worth $7 billion a year! let's explore the trend's myths and proven benefits.

The definitions to know:

  • Probiotics: live microorganisms which when administered in adequate amounts confer a health benefit on the host.
  • Prebiotics: To shift the microecological balance in the intestines in favor of probiotic bacteria, prebiotics such as dietary oligosaccharides (AKA carbs) are used as nutritional supplements. Prebiotic fiber is a non-digestible part of foods like bananas, onions and garlic, Jerusalem artichoke, the skin of apples, chicory root, beans, etc. Prebiotic fiber goes through the small intestine undigested and is fermented when it reaches the large colon. This fermentation process feeds beneficial bacteria colonies  and helps to increase the number of desirable bacteria in our digestive system
  • Symbiotics: Combination nutritional products comprised of probiotics and prebiotics
  • Functional foods: Foods that have a potentially positive effect on health beyond basic nutrition.  Example: oatmeal contains soluble fiber that can help lower cholesterol levels. Some foods are "functional" because they have been modified to have health benefits. An example is orange juice that's been fortified with calcium for bone health.
“probiotics are everywhere now: capsules and pills, fruit juices, cereals, sausages, cookies, candy, granola bars and pet food.”
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The controversy behind the craze:

The controversy about the regular use of probiotics is widespread.  Some specialists contend that the bacteria seem to help only those people suffering from a few specific intestinal disorders. “There is no evidence to suggest that people with normal gastrointestinal tracts can benefit from taking probiotics,” says Matthew Ciorba, a gastroenterologist at Washington University in St. Louis. “If you're not in any distress, I would not recommend them.” Emma Allen-Vercoe, a microbiologist at the University of Guelph in Ontario, agrees. For the most part, she says, “the claims that are made are enormously inflated.”2

Research on probiotic strains with regards to their microbiological features, their mode of action and their potential in medical practice has greatly expanded. In recent years, a strong emphasis was placed on the necessity of performing clinical trials to assess the tangible benefits of probiotics. 

Do the bacteria even make it past your stomach?

The acid in your stomach is very strong and it's likely that many strains of bacteria are destroyed before they make it to the small gut.  Even if some of the bacteria in a probiotic managed to survive and propagate in the intestine, its possible that too few of them are present to dramatically alter the overall composition of one's internal ecosystem. Whereas the human gut contains tens of trillions of bacteria, there are only between 100 million and a few hundred billion bacteria in a typical serving of yogurt or a microbe-filled pill. 

Proven benefits of Probiotics:

Despite growing evidence that probiotics do not offer benefit to healthy individuals, researchers have documented some benefits for people with certain conditions:

  1. Antibiotic use: Antibiotic use can reduce the colonies of naturally-occurring bacteria in your gut and can lead to overgrowth of harmful bacteria such as c-diff.  During times of antibiotic use, probiotics can promote "good" bacteria regrowth
  2. Vaginal conditions: conditions such as chronic bacterial vaginosis and yeast infections can benefit from administration of probiotics
  3. Hospitalized patients: Patients under stress of all ages--from neonates to octogenarians in the ICU--will benefit from probiotics while hospitalized.
  4. Bowel dysfunction: Conditions such as irritable bowel disease, ulcerative colitis have been proven to benefit
  5. Diarrhea: Several well-designed studies show acute and chronic diarrhea will improved with probiotics

Possible benefits of probiotics that need more studies:

  1. Recurrent UTIs 
  2. Some types of cancer2
  3. Improve Some Mental Health Conditions
  4. Certain Probiotic Strains may Help Keep Your Heart Healthy
  5. May Reduce the Severity of Certain Allergies and Eczema
  6.  Boost Your Immune System
  7. May Help You Lose Weight and Belly Fat

If you live in the East Bay of San Francisco including Oakland or Berkeley, schedule a visit with Dr. Oberlin to discuss the benefits probiotics may provide for you and create a personalized regimen of care. 

Explore the available literature here:

  1. http://www.editiontruth.com/trends-probiotics-market-will-reflect-significant-growth-prospects-2018-2026/
  2. https://www.scientificamerican.com/article/do-probiotics-really-work/
  3. Sanders ME. Probiotics. International Scientific Association for Probiotics and Prebiotics. https://isappscience.org/probiotics/ Accessed September 25, 2017.
  4. Wilkins T, Sequoia J. Probiotics for gastrointestinal conditions: a summary of the evidence. Am Fam Physician. 2017;96:170-178.
  5. The scoop on probiotics. Consum Rep Health. 2015;27:9.
  6. Guerra PV, Lima LN, Souza TC, et al. Pediatric functional constipation treatment with Bifidobacterium-containing yogurt: a crossover, double-blind, controlled trial. World J Gastroenterol. 2011;17:3916-3921.
  7. Macchi C, Botta M, Bosisio R, et al. Efficacy and safety of a nutraceutical with probiotic and red yeast rice extract in patients with moderate hypercholesterolemia: a randomized, double-blind, placebo-controlled study. Program and abstracts of the European Atherosclerosis Society Annual Congress; April 25, 2017; Prague, Czech Republic. Abstract 78448.
  8. Barengolts E. Gut microbiota, prebiotics, probiotics, and synbiotics in management of obesity and prediabetes: review of randomized controlled trials. Endocr Pract. 2016;22:1224-1234.
  9. Goldenberg JZ, Lytvyn L, Steurich J, Parkin P, Mahant S, Johnston BC. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev. 2015;22:CD004827.
  10. Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA. 2012;307:1959-1969.
  11. Goldenberg JZ, Ma SS, Saxton JD, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev. 2013;5:CD006095.
  12. Johnston BC, Ma SS, Goldenberg JZ, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. Ann Intern Med. 2012;157:878-888.
  13. Spinler JK, Auchtung J, Brown A, et al. Next-generation probiotics targeting Clostridium difficile through precursor-directed antimicrobial biosynthesis. Infect Immun. 2017;85.
  14. Shen J, Zuo ZX, Mao AP. Effect of probiotics on inducing remission and maintaining therapy in ulcerative colitis, Crohn's disease, and pouchitis: meta-analysis of randomized controlled trials. Inflamm Bowel Dis. 2014;20:21-35.
  15. Derwa Y, Gracie DJ, Hamlin PJ, Ford AC. Systematic review with meta-analysis: the efficacy of probiotics in inflammatory bowel disease. Aliment Pharmacol Ther. 2017;46:389-400.
  16. Ford AC, Moayyedi P, Lacy BE, et al; Task Force on the Management of Functional Bowel Disorders. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109 Suppl 1:S2-S26.
  17. Zhang Y, Li L, Guo C, et al. Effects of probiotic type, dose and treatment duration on irritable bowel syndrome diagnosed by Rome III criteria: a meta-analysis. BMC Gastroenterol. 2016;16:62.
  18. Korterink JJ, Ockeloen L, Benninga MA, Tabbers MM, Hilbink M, Deckers-Kocken JM. Probiotics for childhood functional gastrointestinal disorders: a systematic review and meta-analysis. Acta Paediatr. 2014;103:365-372.
  19. Butterworth AD, Thomas AG, Akobeng AK. Probiotics for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2008;3:CD006634.
  20. Rolfe VE, Fortun PJ, Hawkey CJ, Bath-Hextall F. Probiotics for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2006;4:CD004826.
  21. Doherty G, Bennett G, Patil S, Cheifetz A, Moss AC. Interventions for prevention of post-operative recurrence of Crohn's disease. Cochrane Database Syst Rev. 2009;4:CD006873.
  22. Gou S, Yang Z, Liu T, Wu H, Wang C. Use of probiotics in the treatment of severe acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2014;18:R57.
  23. Saab S, Suraweera D, Au J, Saab EG, Alper TS, Tong MJ. Probiotics are helpful in hepatic encephalopathy: a meta-analysis of randomized trials. Liver Int. 2016;36:986-993.
  24. AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev. 2014;CD005496.
  25. Olsen R, Greisen G, Schrøder M, Brok J. Prophylactic probiotics for preterm infants: a systematic review and meta-analysis of observational studies. Neonatology. 2016;109:105-112.
  26. Sarkar A, Lehto SM, Harty S, Dinan TG, Cryan JF, Burnet PW. Psychobiotics and the manipulation of bacteria-gut-brain signals. Trends Neurosci. 2016;39:763-781.
  27. Marin IA, Goertz JE, Ren T, et al. Microbiota alteration is associated with the development of stress-induced despair behavior. Sci Rep. 2017;7:43859.
  28. Pinto-Sanchez MI, Hall GB, Ghajar K, et al. Probiotic Bifidobacterium longum NCC3001 reduces depression scores and alters brain activity: a pilot study in patients with irritable bowel syndrome. Gastroenterology. 2017;153:448-459.
  29. Steenbergen L, Sellaro R, van Hemert S, Bosch JA, Colzato LS. A randomized controlled trial to test the effect of multispecies probiotics on cognitive reactivity to sad mood. Brain Behav Immun. 2015;48:258-264.
  30. Yang H, Zhao X, Tang S, et al. Probiotics reduce psychological stress in patients before laryngeal cancer surgery. Asia Pac J Clin Oncol. 2016;12:e92-e96.
  31. Allen AP, Hutch W, Borre Y, et al. Towards psychobiotics for stress & cognition: Bifidobacterium longumblocks stress-induced behavioural and physiology changes and modulates brain activity and neurocognitive performance in healthy human subjects. Program and abstracts of the Society for Neuroscience 2015 Annual Meeting; October 17-21, 2015; Chicago, Illinois. Abstract 162.04.
  32. Beilharz JE, Kaakoush NO, Maniam J, Morris MJ. Cafeteria diet and probiotic therapy: cross talk among memory, neuroplasticity, serotonin receptors and gut microbiota in the rat. Mol Psychiatry. 2017 Mar 14. [Epub ahead of print]
  33. Sawas T, Al Halabi S, Hernaez R, Carey WD, Cho WK. Patients receiving prebiotics and probiotics before liver transplantation develop fewer infections than controls: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2015;13:1567-1574.
  34. Manzanares W, Lemieux M, Langlois PL, Wischmeyer PE. Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis. Crit Care. 2016;19:262.
  35. Rao SC, Athalye-Jape GK, Deshpande GC, Simmer KN, Patole SK. Probiotic supplementation and late-onset sepsis in preterm infants: a meta-analysis. Pediatrics. 2016;137:e20153684.
  36. Panigrahi P, Parida S, Nanda NC, et al. A randomized synbiotic trial to prevent sepsis among infants in rural India. Nature. 2017;548:407-412.
  37. Becattini S, Littmann ER, Carter RA, et al. Commensal microbes provide first line defense against Listeria monocytogenes infection. J Exp Med. 2017;214:1973-1989.
  38. Smith TD, Watt H, Gunn L, Car J, Boyle RJ. Recommending oral probiotics to reduce winter antibiotic prescriptions in people with asthma: a pragmatic randomized controlled trial. Ann Fam Med. 2016;14:422-430.
  39. Hao Q, Lu Z, Dong BR, Huang CQ, Wu T. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev. 2011;006895.
  40. Laursen RP, Larnkjær A, Ritz C, Hauger H, Michaelsen KF, Mølgaard C. Probiotics and child care absence due to infections: a randomized controlled trial. Pediatrics. 2017;140:e20170735.
  41. Hsiao KC, Ponsonby AL, Axelrad C, Pitkin S, Tang ML. Long-term clinical and immunological effects of probiotic and peanut oral immunotherapy after treatment cessation: 4-year follow-up of a randomised, double-blind, placebo-controlled trial. Lancet Child & Adolescent Health. 2017;1:97-105.
  42. NUS News. NUS researchers create novel probiotic beer that boosts immunity and improves gut health. June 28, 2017. http://news.nus.edu.sg/press-releases/novel-probiotic-beer-boosts-immunity Accessed September 28, 2017.
  43. American Chemical Society. No guts no glory: harvesting the microbiome of athletes. August 20. 2017. https://www.acs.org/content/acs/en/pressroom/newsreleases/2017/august/no-guts-no-glory-harvesting-the-microbiome-of-athletes.html Accessed September 28, 2017.
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