Probiotics and our gut - what you should know

Probiotics and our gut - what you should know

By Karlee J. Ausk, MD

Did you know that the bacteria that live in our intestines account for over two pounds of our body weight? And that there are 10 times the number of bacterial cells in our body than human cells? Some bacteria play a beneficial role in a normal gastrointestinal (GI) tract and are known as probiotics.

Probiotics have a variety of functions in the GI tract including aiding the intestinal immune system and the intestinal nervous system, breaking our food into nutrients, blocking the bad bacteria, and promoting a healthy intestinal lining. With so many important tasks, it is no surprise that probiotics can be used to treat some common GI conditions. Though studies of probiotics are small with considerable variability, there is evidence supporting probiotic use for prevention of diarrhea caused by antibiotic use and treatment of infectious diarrhea, ulcerative colitis, clostridium difficile, and irritable bowel syndrome.

What you should know:

The U.S. FDA considers probiotics as dietary supplements, so their production is not tightly regulated and quality can vary widely. In addition, insurance companies do not cover probiotics, and the cost adds up quickly.

Should I eat more yogurt?

People often believe that eating yogurt gives them the benefit of probiotic therapy (just ask Jamie Lee Curtis). However, not all yogurts are created equal. Reading the label of your favorite yogurt should give you the quantity and type of probiotic it contains.

Will any probiotic work for my symptoms?

In the store, you will find many bottles of probiotics. One key point in using probiotic therapy is the understanding that each probiotic is different. There are a wide variety of bacterial and yeast strains available, and trials evaluate many different combinations. To achieve the best chance of probiotics being helpful, I recommend choosing the type and dose of probiotic that has been best studied for your individual symptoms. I have included some of the probiotics that I commonly recommend, but this list is not all-inclusive.

Antibiotic-associated diarrhea Culturelle LGG 10 billion count/day
  Danactive L casei 10 billion count/day
  Florastor Saccharomyces bouldardii 250 mg twice daily
Infectious diarrhea Culturelle LGG 10 billion count/day
  Florastor Saccharomyces boulardii 250 mg twice daily
Irritable bowel syndrome Align B infantis 1 billion count/day
  Culturelle LGG 10 billion count/day
  VSL#3 Multiple 1 sachet/day
Ulcerative colitis VSL#3 Multiple Up to 8 sachet/day


Are there times that I should avoid probiotics?

Even if clinical trials do not prove probiotics to be helpful for your condition, there is usually little harm. However, there are case reports of patients with suppressed immune systems becoming ill from probiotic therapy, so if you are on immune suppressing drugs you should talk with your doctor before starting anything.

Finally, probiotic therapy most often works in conjunction with, but does not replace conventional therapy. Please tell your healthcare team about anything that you are putting into your body.

Karlee Ausk, MD
This is a good question about small intestinal bacterial overgrowth (SIBO) and probably one that we don't yet know enough about. Because of conflicting data in clinical trials, probiotics are not currently recommended for patients with SIBO.
3/4/2013 3:19:58 PM
What about those with SIBO? Is adding more bacteria to an already bacteria overloaded small intestine beneficial or counter productive? If it will help, which strand of bacteria or brand?

Many of those with IBS seem to have SIBO as well.
1/27/2013 9:57:01 PM
Melinda Thompson
Very impressive article with useful information! A+
10/24/2012 3:55:27 PM
Great article! I've never seen the probiotics layed out like that before!
10/24/2012 11:56:02 AM
Great report! This Dr. Ausk should replace Dr. Oz, am I right?
10/24/2012 11:32:01 AM
Thanks for this post! It is extremely helpful information that you can't find anywhere.
10/24/2012 8:43:55 AM
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