Over the last few years, I’ve heard the refrain that my health – oddly – starts in my gut. So whenever I got sick, someone would advise me to take probiotics. Even within the past few months, my best friend mailed me 2 bottles of probiotics after I came down with a cold. But in a press release from early June, the American Gastroenterological Association (AGA) recommended that people with digestive disorders like ulcerative colitis or Crohn’s disease should not be using probiotics.
You can check out a few of their guidelines on probiotic usage below. Additionally, you can find the full set of clinical guidelines published in Gastroenterology.
So what are probiotics? According to the AGA, probiotics are:
bacteria or other living organisms, like yeasts, that are usually found in foods or dietary supplements.
These live microorganisms mostly live in your gut and help enhance your gut’s microbiome. Your gut flora contains up to 1,000 different microorganisms! Normally, these help with metabolism, vitamin consumption, and immune support. But when your gut flora becomes unbalanced, you can get sick. Probiotics are supposed help restore that balance. An estimated 3.9 million Americans have tried probiotics.
Recently, the AGA released clinical guidelines states that (in most cases) there is not enough evidence to show that probiotics can support or benefit patients with digestive disorders.
First, they state that there are 3 situations in which usage is supported or recommended:
- Managing pouchitis. When a patient with IBD undergoes surgery to remove the rectum and large intestine, doctors create a pouch to store and get rid of stool. Pouchitis occurs when the pouch becomes irritated and swollen, causing pain, gastrointestinal problems, and bloating. Around 50% of patients who get this surgery for ulcerative colitis will get pouchitis at some point, while 40% of all patients who get this surgery develop pouchitis once per year.
- Preventing C. difficile infection in patients on antibiotics. Clostridioides difficile (C. difficile or C. diff) is a bacteria which causes colon inflammation and diarrhea. About 16% of patients with C. diff will develop it again within 8 weeks. Taking antibiotics is the biggest risk factor, but old age, a weakened immune system, and hospitalizations are other risk factors.
- Stopping VLBWB (very low birth weight babies) from developing necrotizing enterocolitis. Necrotizing enterocolitis (NEC) is an inflammatory condition which causes intestinal inflammation in infants, particularly premature infants. The inflammation causes intestinal holes, allowing bacteria into the abdomen and causing pain, infection, and poor growth.
- Probiotics can be used for premature babies under 5.5 pounds. Using specific strains can improve quality of life, prevent NEC and early death, promote full feeds, and decrease hospitalization length.
In these situations, probiotics are considered adequate, well-tolerated, and effective treatments.
However, there are many situations in which the AGA recommends against probiotic use. Some recommendations include:
- Patients with ulcerative colitis, irritable bowel syndrome (IBS), or Crohn’s disease should consider stopping probiotic usage. The AGA notes that probiotic supplements can be expensive and there is not enough research or evidence to prove that they are helpful for this group.
- Pediatric patients with acute infectious gastroenteritis should not use probiotics. So, pediatric patients who come to the emergency room with severe diarrhea should avoid this potential treatment.
- Researchers need to perform clinical trials to affirm and refine these recommendations.