Blog | Thursday, February 23, 2017

Probiotics promote digestive health--is there a germ of truth

Several times each week, I am asked about the value of probiotics. Many of my patients are already on them, based on a personal recommendation or an advertisement. As a gastroenterologist, I routinely treat patients with all varieties of diarrhea conditions, such as irritable bowel disease, ulcerative colitis, Crohn's disease, lactose intolerance, celiac disease, and the highly feared gluten sensitivity. Many of them arrive in the office with a probiotic in hand waiting for me to pass judgment. These patients look to me as a Digestive Supreme Court Justice as they sit on the edge of their chairs waiting for my ruling in the case of Probiotics vs. Disease.

First, let's all be clear on what a probiotic is. Probiotics are bacteria that provide health benefits when consumed. Stop a moment and consider how bizarre this concept is. Physicians have been fighting germs since the days of Louis Pasteur. We have taught the public for generations how important personal hygiene is. We are counseled not to eat under-cooked food from fear of contracting a food borne illness. Every hospital in the country is stressing hand washing to all personnel to protect patients from infection. Many of us won't leave the house without a hand sanitizer bottle.

In other words, germs are bad, unless they are probiotics! In the latter case, billions of germs are deliberately ingested in order to relieve symptoms and treat diseases, an ironic shift in classic germ-fighting medical practice.

Hardly. Our intestines are filled with zillions of bacteria. Miraculously, during health these germs are not able to penetrate through the walls of intestines to reach internal organs which would cause a severe infection. These strains of bacteria within the bowel all live together in balance providing health benefits to us. They aid in digestion and immunity. Some of these germs create vitamin K, which we use to maintain a healthy clotting system.

When this bacterial neighborhood, which is called the intestinal biome, is disrupted, then disease can set in. For example, when we take antibiotics to attack “bad germs,” such as for a pneumonia or a urinary tract infection, the antibiotic also upsets the “good bacteria” within our intestines. In addition, many digestive diseases have an intestinal biome that is out of balance. When the biome isn't balanced, then the whole body is under a strain.

Here's the theory in simplified form. When the community of beneficial germs within our bowels is disrupted from antibiotics or disease, probiotics can get the biome back into balance. Scientists are not entirely sure how this happens, but probiotic research is in high gear to understand how they work and who should receive them. The theory is that bringing the biome back to its normal state restores health and relieves symptoms.

What do I tell my patients with digestive conditions regarding probiotics? I tell them the truth. The supportive science is rather thin, but many of my patients feel better on a probiotic program. We don't know precisely which probiotic works best for a specific patient or disease, or how often to dose them. Importantly, we believe that they are safe, but I would be very reluctant to recommend them to someone with compromised immunity.

If you have digestive symptoms and are contemplating a probiotic, here are 3 steps to consider:
• Open the jar.
• Open your mouth.
• Open your mind to the belief that these germs can heal you.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.