A follow-up on Probiotics
1) Do Probiotics Really Work? Although certain bacteria help treat some gut disorders, they have no known benefits for healthy people. Scientific American, July 2017
“A closer look at the science underlying microbe-based treatments, however, shows that most of the health claims for probiotics are pure hype. The majority of studies to date have failed to reveal any benefits in individuals who are already healthy. The bacteria seem to help only those people suffering from a few specific intestinal disorders.”
https://www.scientificamerican.com/arti ... ally-work/2) What do Cochrane systematic reviews say about probiotics as preventive interventions?
Sao Paulo Medical Journal
On-line version ISSN 1806-9460
Sao Paulo Med. J. vol.135 no.6 São Paulo Nov./Dec. 2017
http://dx.doi.org/10.1590/1516-3180.2017.0310241017 ABSTRACT
BACKGROUND:
Probiotics have been used for a range of clinical situations and their use is strongly encouraged by the media worldwide. This study identified and summarized all Cochrane systematic reviews about the preventive effects of probiotics in clinical practice.
DESIGN AND SETTING:
Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp).
METHODS:
We included all Cochrane reviews on any probiotics when they were used as preventive interventions and compared with no intervention, placebo or any other pharmacological or non-pharmacological intervention.
RESULTS:
17 Cochrane systematic reviews fulfilled our inclusion criteria and were summarized in this report. None of the reviews included in the present study provided high-quality evidence for any outcome. The benefits from use of probiotics included decreased incidence of antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea; decreased incidence of upper respiratory tract infections and duration of episodes; decreased need for antibiotics and absences from school due to colds; and decreased incidence of ventilator-associated pneumonia. Probiotics seem to decrease the incidence of gestational diabetes mellitus, birthweight, risk of vaginal infection and incidence of eczema.
CONCLUSION:
Despite the marketing and the benefits associated with probiotics, there is little scientific evidence supporting the use of probiotics. None of the reviews provided any high-quality evidence for prevention of illnesses through use of probiotics. More trials are needed to gain better knowledge of probiotics and to confirm when their use is beneficial and cost-effective.
3) Harms Reporting in Randomized Controlled Trials of Interventions Aimed at Modifying Microbiota: A Systematic Review
Background: Probiotics, prebiotics, and synbiotics are used increasingly, although the safety and potential harms of these interventions are poorly understood.
Published: Ann Intern Med. 2018.
DOI: 10.7326/M18-0343
http://annals.org/aim/article-abstract/ ... ystematic#Conclusion:
Harms reporting in published reports of RCTs assessing probiotics, prebiotics, and synbiotics often is lacking or inadequate. We cannot broadly conclude that these interventions are safe without reporting safety data. Published: Ann Intern Med. 2018.
DOI: 10.7326/M18-0343
4) Probiotic use is a link between brain fogginess, severe bloating
Probiotic use can result in a significant accumulation of bacteria in the small intestine that can result in disorienting brain fogginess as well as rapid, significant belly bloating
https://www.sciencedaily.com/releases/2 ... 095213.htmJournal Reference:
Brain fogginess, gas and bloating: a link between SIBO, probiotics and metabolic acidosis.
Clinical and Translational Gastroenterology, 2018; 9 (6) Article number: 162 (2018)
DOI: 10.1038/s41424-018-0030-7
https://www.nature.com/articles/s41424-018-0030-7Abstract
Background
D-lactic acidosis is characterized by brain fogginess (BF) and elevated D-lactate and occurs in short bowel syndrome. Whether it occurs in patients with an intact gut and unexplained gas and bloating is unknown. We aimed to determine if BF, gas and bloating is associated with D-lactic acidosis and small intestinal bacterial overgrowth (SIBO).
Methods
Patients with gas, bloating, BF, intact gut, and negative endoscopic and radiological tests, and those without BF were evaluated. SIBO was assessed with glucose breath test (GBT) and duodenal aspiration/culture. Metabolic assessments included urinary D-lactic acid and blood L-lactic acid, and ammonia levels. Bowel symptoms, and gastrointestinal transit were assessed.
Results
Thirty patients with BF and 8 without BF were evaluated. Abdominal bloating, pain, distension and gas were the most severe symptoms and their prevalence was similar between groups. In BF group, all consumed probiotics. SIBO was more prevalent in BF than non-BF group (68 vs. 28%, p = 0.05). D-lactic acidosis was more prevalent in BF compared to non-BF group (77 vs. 25%, p = 0.006). BF was reproduced in 20/30 (66%) patients. Gastrointestinal transit was slow in 10/30 (33%) patients with BF and 2/8 (25%) without. Other metabolic tests were unremarkable. After discontinuation of probiotics and a course of antibiotics, BF resolved and gastrointestinal symptoms improved significantly (p = 0.005) in 23/30 (77%).
Conclusions
We describe a syndrome of BF, gas and bloating, possibly related to probiotic use, SIBO, and D-lactic acidosis in a cohort without short bowel. Patients with BF exhibited higher prevalence of SIBO and D-lactic acidosis. Symptoms improved with antibiotics and stopping probiotics. Clinicians should recognize and treat this condition.
In health
Jeff
PS some confusion exists became several years ago, in two newsletters Dr McDougall recommended probiotics and said there was no known harm. At the time, it was probably true. However, today we know differently and while very few things have changed at all in regard to the core McDougall Program, we do not recommend supplements, except for B12, and that includes Probiotics, unless they are medically indicated in some rare situations. Even then, there are so many strains out there and supplements have their own quality issues so one must always proceed with caution.