THERE IS A DARK SIDE TO PROBIOTICS, including problematic research studies, incomplete reporting, and under-reported safety. I have written about the promise of probiotics, but I want to highlight some of the perils: Are your antibiotics safe?
First, what are probiotics? They are live bacteria and yeasts that are touted to be good for us, especially the digestive system. While we know germs can cause diseases, our bodies are full of bacteria with both “good” and “bad” properties regarding gut health.
Some of the proposed ways that probiotic supplements may help you keep healthy include the following:
- When we lose “good” bacteria (for example, after antibiotics), probiotics can help to replace them.
- Probiotics may help balance “good” and “bad” bacteria to optimize our body’s function.
You can find probiotics in supplements and some foods, including yogurt. Today there is a shift in the scientific world to focus on the human microbiome.
Probiotic microbe types and benefits
Many types of bacteria are probiotics. While they have various touted benefits, most come from two groups:
- Lactobacillus. Lactobacillus is the most common probiotic. You can find it in yogurt and other fermented foods. Lactobacillus may help with diarrhea and lactose intolerance.
- Bifidobacterium. This bacteria form is in some dairy products and may help with problems such as irritable bowel syndrome.
Saccharomyces boulardii is a yeast found in probiotics. This fungus may help to fight diarrhea and other intestinal problems.
Alleged probiotic benefits
Probiotics aim to help maintain a healthy balance in your body. With illness, bad bacteria enter your body and increase in number, throwing your body off balance. So-called good bacteria can help to fight off bad bacteria and restore your body’s balance.
The “good” bacteria may support your immune function and control inflammation. Some bacteria types may also help you to digest food, create vitamins, keep bad bacteria from getting out of control, and break down and absorb medicines. Finally, probiotics help support the cells lining your gut, preventing bad bacteria from entering your blood.
Do we need probiotics? Some argue that our bodies are naturally in balance. However, eating a well-balanced diet rich in fiber daily may help you keep your good bacteria at appropriate levels.
Probiotics may have value for some common conditions, including:
- Infectious diarrhea
- Antibiotic-induced diarrhea
- Inflammatory bowel disease
- Irritable bowel syndrome
- Constipation
- Gum disease
Some find value in using probiotics for urinary and vaginal health, preventing colds and allergies, oral health, and skin conditions such as eczema.
Probiotic sources
Do you want to increase the number and variety of good microbes in your body? Breakfast sources include sourdough bread, buttermilk, and yogurt. For lunch, consider kombucha (fermented tea), tempeh, or cottage cheese. Need a snack? Reach for some fermented pickles.
Finally, dinner sources include kimchi, miso soup, and fermented sauerkraut. Kefir (a fermented dairy drink) is another potential source of probiotics.
Probiotic risks – Are Your Probiotics Safe?
First, the United States Food and Drug Administration regulates probiotics like foods, not medications. As a result, probiotic supplement manufacturers don’t need to demonstrate safety or effectiveness.
Microbes have a remarkable arsenal of negative factors that can suppress or destroy human host mechanisms. Probiotic bacteria ingestion can create a survival struggle with well-established gut microbiome members.
Are your probiotics safe? Potential virulent pathways may be executed by probiotics, affecting our health. Aaron Lerner, Yehuda Shoenfeld, and Torsten Matthias note several such avenues:
- Horizontal Gene Transfer (HGT). HGT is the lateral movement of mobile gene elements between organisms. The human gastrointestinal tract serves as an ideal environment for Horizontal Gene Transfer. With the extensive use of probiotics in processed and fermented products (and as over-the-counter supplements), can probiotics deliver hostile genetic elements to our gut microbiome?
- Bacteriophages of Probiotics Transfer Mobile Virulent Genes. These are bacterially infectious small viruses that lyse (the disintegration of a cell by rupture of the cell wall or membrane) microbes. The probiotic bacteriophages are potential carriers of hostile genes that can spread genetic material into our cells.
- D-lactate, Metabolic Acidosis, and Brain Fogginess. Probiotic consumption is associated with d-lactic acidosis in infants on probiotic-containing formula and adults. D-lactic acidosis appears to be associated with neurocognitive impairments and chronic fatigue syndrome, including brain fogginess.
- Intestinal Bacterial Overgrowth, Gas, and Bloating. Probiotic fermented carbohydrates in the proximal small bowel induce intestinal bacterial overgrowth, resulting in d-lactic acid production, with resultant increased gas output, abdominal bloating, and fatigue.
- Additional problems with probiotics. Individuals with congenital or acquired immune debilitating conditions, heart anomalies, on chemotherapy or radiotherapy, with a surgical abdomen, HIV-infected, critically ill, post-organ transplantation, post-operation, central venous catheters, autoimmune disease on immune suppression, pregnancy, neutropenia, critically ill patients, including antibiotic-associated diarrhea, active ulcerative colitis, and potential for translocation of probiotic across bowel wall should generally avoid probiotics. This article gives more details:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490230/?report=reader
On the other hand, some studies demonstrate the safe use of probiotics in solid organ transplant recipients, and other immunocompromised hosts, without developing a systemic infection.
Two small studies (pooled to increase statistical power) showed probiotics reduced complications from a systemic infection (sepsis), surgical intervention, and infected skin death (necrosis) in patients with pancreas inflammation given a probiotic with lactic acid and fiber.
Two other studies of critically ill adults and children hinted at possibly higher infection-related complications in patients given probiotics.
Are your probiotics safe? My take
Many healthcare providers encourage probiotic consumption. I suspect that the substances have value for those on antibiotics, I but hope we get more studies looking at effectiveness and safety.
I no longer reflexively think of probiotics as simple “good microbes or bacteria,” but I believe that we must take manufacture’s claims of health promotion with a bit of skepticism.
Two Israeli studies showed that using probiotics may impair gut microbiome reconstruction. Other studies show improvement. We have work to do, including in the regulatory realm. Are probiotics food? Drugs? Dietary supplements?
Before taking probiotics, ask a knowledgeable healthcare provider if taking probiotics is a good idea for you. Probiotic foods and supplements may be safe for many, but those with compromised immune systems should not consume them.
Mild side effects include an upset stomach, gas, diarrhea, and bloating (especially for the dirt couple of days). Probiotics occasionally trigger an allergic reaction. Unlikely risks include infection and antibiotic resistance.\
If you have problems, stop taking them and talk to your healthcare provider. Thank you for joining me in this look at the question, “Are you sure your probiotics are safe?” A conversation is always worth the time when it concerns your health.
Thank you for joining me in this look at the question, “Are your antibiotics safe?” If you want to learn more about the microbiome, here’s a piece I previously wrote:
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