A gastroenterologist guide to probiotics

In recent years, scientists have introduced us to a paradigm shift in the microscopic world. We've moved from thinking about all bacteria as bad guys to be wiped out with antibiotics and hand sanitizer to recognizing that some microbes are helpers, good bacteria that live in our GI tract (and all over our bodies) that keep us healthy.

Even obsessive germ-a-phobes have been given pause, realizing that taking a Z-Pack at the first sign of a cold may not be the best idea.

Christine Hachem, M.D., assistant professor of internal medicine at Saint Louis University and a SLUCare Physician Group gastroenterologist, reports that her patients are on board with the concept, even if old habits die hard when it comes to antibiotics.

"Patients seem to be embracing probiotics!" Hachem said. "They are surprisingly excited about bacteria as good guys. On the other hand, antibiotic usage is still increasing and over-utilized.

"The health of our microbiota is a good reason to avoid unnecessary antibiotics as they definitely change our gut flora. Patients should realize that there are clear GI consequences to the use of antibiotics and should make sure that they really need antibiotics before they take them."

While laboratories are brimming with microbiome research, exploring the potential for new cures in virtually every area of health, gastroenterology is one area of medicine that has already been able to put the science into practice in the clinic. Some of the best successes have been in treating gastroenterology's "I" diseases, Hachem says: inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and hard-to-treat infections.

"We have shown some great success with probiotics in managing diseases that have been traditionally quite difficult to treat with traditional antibiotics, like refractory c.dificile and pouchitis (IBD)."

But many people are interested in probiotics' potential beyond treating these specific illnesses, and this leads to questions about the safety and effectiveness of probiotics for general good health and disease prevention.

The first thing to know, Hachem says, is that probiotics are considered supplements and not prescription medicine, and as such, are not regulated by the FDA. The probiotics with the most data for GI health are lactobacillus, sacharomyces and bifidobacterium.

If you are generally healthy, there probably is not a huge downside to taking probiotics, other than cost. People who are immunosuppressed, like transplant recipients, however, may be at increased risks of infections from probiotic use.

Next to probiotics on the health food store shelf, you may see prebiotics. Prebiotics are nondigestable food products that stimulate beneficial bacteria. They are often nondigestable carbohydrates found in food sources such as fiber.

"There are a lot of advertisements for different prebiotics and probiotics but the advertising seems to far outpace the actual data supporting their efficacy, at least when it comes to the specific products that are currently on the market," Hachem says. "Overall, though, there is some data for prebiotics and probiotics making its way through the research and there definitely is interest in their therapeutic and preventative options, especially from patients."

But, should you take probiotics as a supplement for general health?

"Their benefit definitely seems to go beyond just GI health and disease but I think there are not enough studies, there are too many strains, and nothing is FDA regulated at this time, to endorse it for everyone," Hachem said.

"I do think, though, that gut health is important. If you want to take care of your gut, a good place to start is ensuring you get plenty of fiber.

"What you eat and ingest, in the form of medications and foods, really matters because it will affect a colony of gut bacteria armed with the potential for both good and bad."

Take Aways:

*It is important to only take antibiotics when necessary, so that you don't wipe out healthy bacteria and needlessly upset your body's microbiota balance.

*People with immunosuppression should use caution and consult a physician before using probiotics.

*For some GI issues, probiotics have already shown great success in the clinic, helping doctors treat formerly difficult to manage illnesses.

*Much of the science work is yet to be done in figuring out how best to balance and support our microbiome. Stay tuned!