Probiotics won’t help most people’s guts stay healthy — and may harm them, report finds
Millions of Americans are taking probiotics in an effort to digest food more easily, fight harmful gut bacteria and regulate their immune system.
But now, the American Gastroenterological Association (AGA) says you might be wasting your time and money.
The group released new clinical guidelines Tuesday after reviewing available literature, concluding that there is not enough evidence to prove probiotics are entirely safe or helpful for most digestive conditions.
It’s the first set of guidelines to analyze the effects of probiotics across multiple gastrointestinal diseases while also studying individual and combinations of strains, which can have varying biological consequences.
The report is to be published in the journal Gastroenterology.
“The supplements can be costly and there isn’t enough evidence to prove a benefit or confirm lack of harm. Talk with your doctor,” guideline panel chair Grace Su, a professor of medicine and chief of gastroenterology at the University of Michigan, Ann Arbor, said in a news release.
“Given widespread use and often biased sources of information, it is essential that the public have objective guidance about the appropriate use of and indications for probiotics,” the news release said.
Probiotics were found to be helpful for preventing Clostridioides difficile infection — a germ that causes diarrhea and inflammation in the colon — in adults and children taking antibiotics.
Research has shown that taking probiotics with antibiotics, depending on the disease being treated, might make one less likely to get diarrhea caused by the medication, according to a 2019 letter posted by Harvard Medical School.
Probiotics are also helpful for the prevention of necrotizing enterocolitis — a disease that causes harmful bacteria to invade the intestine — in preterm, low-weight infants, as well as for “the management of pouchitis, a complication of inflammatory bowel disease,” the report said.
On the other hand, the guidelines say there isn’t enough evidence to support the use of probiotics for the treatment of Crohn’s disease, ulcerative colitis, irritable bowel syndrome and C. difficile infection.
Patients currently taking probiotics for these conditions should consider stopping, the AGA said.
The group also recommends against the use of probiotics for children who have acute gastroenteritis, or those who visit the emergency room for diarrhea.
Regulation of probiotics is complicated
Probiotics are microscopic organisms, often called “good” bacteria or yeast, found in foods, some beauty products and dietary supplements.
The last 20 years have seen an uptick in interest in the gut microbiome and its role in gastrointestinal health, leading to a “multi-billion dollar industry worldwide,” the report said.
But people don’t need probiotics because they already have healthy gut bacteria, experts say. However, sometimes imbalances occur that can lead to health problems.
Scientists agree more research is needed to better understand how probiotics can help relieve certain diseases, but most of them are not considered drugs in the U.S. or Europe, according to the AGA report.
“The industry is largely unregulated and marketing of products is often geared directly at consumers without providing direct and consistent proof of effectiveness,” the report said. “This has led to widespread use of probiotics with confusing evidence for clinical efficacy.”
But depending on the intended use, the U.S. Food and Drug Administration might regulate a probiotic as a dietary supplement, food ingredient or a drug, according to the U.S. Department of Health and Human Services.
If sold as a dietary supplement, which most of them are, the FDA does not require approval before they’re marketed, meaning labels cannot make health claims without the FDA’s consent.
If the probiotic is intended to be a drug for treatment of disease, “it has to meet stricter requirements,” and proven safe through clinical trials before it can be sold, the Department of Health and Human Services said.
The AGA said more “well-designed” clinical trials will be needed to refine their recommendations so the pros and cons of probiotics can be better understood.
This story was originally published June 9, 2020 at 11:53 AM with the headline "Probiotics won’t help most people’s guts stay healthy — and may harm them, report finds."
