• New guidelines
• Limited benefits
• Preventing disease
• Health fad?
What is already known on this topic
Probiotics are living microorganisms, including certain bacteria and yeasts, that are usually found in foods like yoghurt or in dietary supplements and that can confer a health benefit when administered in adequate amounts. However, because probiotics aren’t considered drugs in the United States or Europe, they aren’t regulated like a pharmaceutical product.What this research adds
After reviewing published research on probiotics use for digestive disorders, the American Gastroenterological Association (AGA) found insufficient evidence to recommend probiotics for treatment of Crohn’s disease, ulcerative colitis, irritable bowel syndrome, and C. difficile infection. However, the guidelines support the use of certain probiotic formulations for preventing C. difficile infection in people taking antibiotics, preventing certain gut diseases in preterm babies, and managing a complication of inflammatory bowel disease.Conclusion
The AGA report recommends that clinicians suggest probiotics to their patients only if there is clear health benefit.
Nearly four million of adults in the United States took some form of probiotics in 2015—four times that amount of people that took them in 2007—with many individuals looking to probiotics to improve their gut health. But a new report from the American Gastroenterological Association (AGA) doesn’t recommend using these so-called good microbes for most digestive conditions.
After reviewing published research on probiotics use for digestive disorders, the society found insufficient evidence to suggest probiotics for treatment of Crohn’s disease, ulcerative colitis, irritable bowel syndrome (IBS), and C. difficile infection. The guidelines are published in the AGA’s official journal Gastroenterology.
“Patients taking probiotics for Crohn’s, ulcerative colitis or IBS should consider stopping,” says Grace Su from the University of Michigan in Ann Arbor, who chaired the guideline panel. “The supplements can be costly and there isn’t enough evidence to prove a benefit or confirm lack of harm,” she says.
However, the guidelines support the use of certain probiotic formulations for preventing C. difficile infection in people taking antibiotics, preventing certain gut disorders in preterm babies, and managing a complication of inflammatory bowel disease.
New guidelines
Probiotics are living microorganisms, including certain bacteria and yeasts, that are usually found in foods like yoghurt or in dietary supplements. According to the World Health Organization, microorganisms can be considered probiotics if they confer a health benefit when administered in adequate amounts.
However, because probiotics aren’t considered drugs in the United States or Europe, they aren’t regulated like a pharmaceutical product. “This has led to widespread use of probiotics with confusing evidence for clinical efficacy,” the AGA report says.
To offer guidance about the appropriate use of probiotics to the public, the AGA evaluated available evidence on clinical efficacy of these products. After a technical review panel examined published research on probiotics use for digestive disorders, the guideline panel formulated recommendations based on quality of evidence as well as other factors, including patients’ preferences and cost. Then, the guidelines and technical review went through a 30-day public comment period.
Limited benefits
AGA makes no recommendations for the use of probiotics in the treatment of C. difficile infection. But they did suggest the use of certain strains of probiotics, such as Saccharomyces boulardii or a combination of Lactobacillus acidophilus CL1285 and L. casei LBC80R, in the prevention of C. difficile infection for adults and children taking antibiotics.
The society recommends using probiotics only in the context of a clinical trial for people with Crohn’s disease, irritable bowel syndrome, or ulcerative colitis. There’s growing interest in microbiota-based therapies for these conditions, the guideline panel says. “However, available evidence is limited because of heterogeneity in study design, patient populations, and the specific probiotics that have been studied,” the panel adds.
Preventing disease
The review did find that some probiotics can help in certain circumstances. For example, in people with a complication of inflammatory bowel disease called pouchitis, the AGA suggests the use of a combination of L. paracasei subsp. paracasei DSM 24733, L. plantarum DSM 24730, L. acidophilus DSM 24735, L. delbrueckii subsp. bulgaricus DSM 24734, Bifidobacterium longum subsp. longum DSM 24736, B. breve DSM 24732, B. longum subsp. infantis DSM 24737, and Streptococcus salivarius subsp. thermophilus DSM 24731 over other probiotics.
And a combination of Lactobacillus and Bifidobacterium species can help preterm babies born with a low birthweight to prevent gastrointestinal diseases such as necrotizing enterocolitis, which is characterized by the death of a portion of the bowel that leads to long-term gut conditions.
For these reasons, the AGA report recommends that clinicians suggest probiotics to their patients only if there is clear health benefit.
Health fad?
“While our guideline does highlight a few use cases for probiotics, it more importantly underscores that the public’s assumptions about the benefits of probiotics are not well-founded, and that there is also a major variation in results based on the formulation of the probiotic product,” Su says.
Others, however, say that probiotics shouldn’t be dismissed as a fad. “We agree with the AGA’s recommendation for patients to consult their doctors for advice regarding probiotic supplements, however the suggestion that patients consider stopping their probiotics is at odds with the evidence of benefit for a number of probiotics presented in their own technical review,” the International Probiotics Association said in a statement. “The logical approach would be to recommend probiotics that have good evidence of efficacy,” said the association, which includes manufacturers of live microorganisms and probiotics.
The AGA guidelines will undergo a review and will be updated within three to five years.
