Maintaining a healthy intestinal microbiota balance is something we should all strive for, especially because environmental factors such as pollution, smoking, stress and fast foods make it difficult for our bodies to stay in tip-top shape.
Some people may benefit more from taking probiotics than others. The list includes:
• People who have recently taken a course of antibiotics. Antibiotics are powerful aids in the fight against disease. But most antibiotics not only destroy the harmful bacteria that make us ill, they also knock out the good bacteria in our bodies. This may result in what’s known as antibiotic-associated diarrhoea (AAD).
Overall, there’s good evidence to support the use of Lactobacillus rhamnosus (L. rhamnosus) and Saccharomyces boulardii (S. boulardii) to prevent AAD in adults. In turn, Lactobacillus GG (LGG), Lactobacillus sporogens (L. sporogens) and S. boulardii can help prevent AAD in children.
• Adults or children who have had a bout of diarrhoea (for example, from food poisoning or a viral infection). The diarrhoea can directly deplete the healthy intestinal flora.
• Adults with acute diarrhoea. According to the World Gastroenterology Organisation’s Global Guidelines for Probiotics and Prebiotics, there’s reasonable evidence to suggest that the probiotic strain S. boulardii (109 CFU/capsule of 250mg twice daily) is effective in the treatment of acute diarrhoea in adults. Lactobacillus rhamnosus GG (LGG) has also been suggested to be of benefit.
Remember to start taking the probiotics within 24 hours of the onset of diarrhoea. During a bout of diarrhoea, probiotics should also always be taken with an oral rehydration solution. Mix 1 litre of boiling water with 8 tsp sugar and ½ tsp salt, and allow to cool down before drinking the solution.
• People who don’t follow a healthy, balanced diet rich in fibre-rich fruit, veggies, legumes and wholegrains. The good bacteria in our gastrointestinal systems need lots of fibre-rich foods to thrive on. Instead of just taking probiotics to remedy the problem, it’s best to improve your diet. Remember: fibre-rich foods are also important for your overall heart health, and these foods can assist in controlling blood-glucose levels after meals.
• People who have had radiotherapy or chemotherapy. These cancer treatments kill off many living cells in the body, including good bacteria. If you do decide to use a probiotic, make sure it’s in line with the treatment plan prescribed by your oncologist.
• People who are frequently treated for yeast infections such as Candida (thrush). This is common in women and can also be a side effect of HIV/AIDS. If you’re HIV-positive, it’s best to first check with your doctor before using a probiotic.
• Lactose-intolerant individuals. A good probiotic (including, for example, Streptococcus thermophilus or Lactobacillus bulgaricus) can ease the uncomfortable bloating, pain and diarrhoea associated with this common food intolerance.
• Adults with irritable bowel syndrome (IBS). This condition is thought to affect at least 8-23% of the world’s population. IBS symptoms may range from constipation to diarrhoea, and some people report bloating, heartburn, flatulence and abdominal pain.
Probiotics have been suggested as an adjunctive treatment that can help to “correct” the imbalance of bacteria in the gut (good bacteria vs. pathogenic bacteria). Based on current evidence, it seems that multi-strain probiotics, such as VSL#3, at a concentration of 10 billion CFU/day or less, offer the best chance of improving abdominal pain, global symptoms and quality of life.
• Adults with inflammatory bowel disease (IBD). Current evidence indicates there may be a place for the use of probiotics in the treatment of ulcerative colitis, an inflammatory bowel disease. It’s been found to be safe and effective when used as an adjunctive therapy (along with medicines prescribed by your doctor). For people with mild to moderate active ulcerative colitis, probiotics may even help to achieve remission.
Unfortunately, the evidence isn’t strong for the use of probiotics in the treatment of Crohn’s disease (another type of inflammatory bowel disease).
• Adults with pouchitis. Pouchitis is a condition in which the ileal pouch, which is surgically created in the small intestines of people who have undergone a colectomy, becomes inflamed. Ileal pouches, which take over the role of the rectum, are sometimes also created in people with severe ulcerative colitis, indeterminate colitis, or familial adenomatous polyposis. Growing evidence suggests that certain probiotic strains can help to prevent an initial flare-up of pouchitis as well as further relapse (after treatment with antibiotics).
• Adults with hepatic encephalopathy. This is a disorder of brain function that occurs as a result of liver failure. According to a recent Cochrane Systematic Review, there’s a lack of high-quality evidence, but probiotics do seem to improve recovery from this disease. The beneficial bacteria may also have a protective effect in terms of the development of overt hepatic encephalopathy. Probiotics may furthermore improve quality of life and plasma ammonia concentrations (which are toxic to the human body), but they don’t seem to affect mortality rates.
• Infants with atopic dermatitis (eczema). Numerous studies have shown that probiotics can potentially prevent atopic dermatitis in infants. The World Allergy Organisation has recommended the use of probiotics during pregnancy and breastfeeding, along with patient-specific recommendations on starting solids. Check with your allergy specialist if you or your child could potentially benefit from the use of probiotics.
• Pre-term neonates with necrotising enterocolitis (NEC). This is a condition in which the tissue in the small or large intestine of a preterm baby is injured or begins to die (a result of the digestive system not being fully developed yet). Meta-analyses of randomised controlled trials have shown a reduction in mortality rates in babies treated with probiotics. However, the evidence is still in its infancy and it isn’t yet known which probiotic supplement is most effective.
If a probiotic is used in treatment, it’s paramount that it’s done under the guidance of a specialist (a paediatrician or gastroenterologist). Providing the baby with expressed breast milk, which contains healthy bacteria from the mother, is most likely still the best recommendation.
Remember that dietary supplements aren’t regulated by the South African Department of Health and that probiotic strains vary greatly.
The probiotic strain in a particular supplement may not be specific for the condition you’re looking to treat. For this reason, you should always consult with a registered healthcare practitioner, like a GP or registered dietitian, who is familiar with the use of probiotics.
Reviewed by Kim Hofmann, registered dietitian, BSc Medical (Honours) Nutrition and Dietetics, BSc (Honours) Psychology. April 2018.