“For the majority of the digestive diseases we have studied, there is currently insufficient evidence to recommend the use of probiotics,” said Dr. Geoffrey Preidis, pediatric gastroenterologist at Texas Medical Center and spokesperson. of the AGM.
Depending on where you live, probiotics are sold over the counter or by prescription – but supplements can be expensive and their formulation varies considerably.
“While our guideline highlights a few cases of probiotic use, it highlights more importantly that the public’s assumptions about the benefits of probiotics are unfounded,” said Dr. Grace L. Su, professor of medicine and chief of University of Michigan gastroenterology, Ann Arbor, in a press release. She was the chair of the panel that published the new guidelines.
Probiotics are tiny living organisms, including certain bacteria and yeasts, that are commonly found in foods like yogurt or supplements.
“Probiotics are living microorganisms that, when given at the right dose, provide health benefits to the host,” according to the World Health Organization.
One of the strengths of reviewing existing research and studies is that it has examined the effect of each formulation of single or multiple strains of probiotics independently, rather than grouping them into a single group, said Lynne McFarland , associate professor of medicinal chemistry at the University of Washington.
“Selecting an effective probiotic means matching the specific probiotic strain to the type of disease that requires treatment. Most of the time, the labels on probiotic products are not helpful, “said McFarland, who was not involved in the review.
Probiotics have become more popular as researchers learn more about the role of our gut bacteria, or microbiome, on our gastrointestinal health, with probiotics promising an effective way to modify the microbiome to our advantage.
The industry is largely unregulated and the marketing of products is often directed directly to consumers without providing direct and consistent evidence of effectiveness. This has led to widespread use of probiotics with confused evidence of clinical efficacy.
–American Gastroenterological Association new guidelines on probiotics
“Our hope would be that if we understand the microbiome better, we will be able to more effectively select probiotics that can be beneficial in certain circumstances,” said Dr. Su.
However, since probiotics are not considered drugs in the U.S. or Europe, they are not regulated as a pharmaceutical, which, according to Dr. Preidis, allowed consumers to receive misleading information and was a barrier to scientific research on how probiotics could help treat a disease.
“The industry is largely unregulated and the marketing of products is often directed directly to consumers without providing direct and consistent evidence of effectiveness,” according to the new guidelines. “This has led to widespread use of probiotics with confused evidence of clinical effectiveness,” he said.
The report estimates that 3.9 million American adults used some form of probiotics or prebiotics (nutrients that promote growth or beneficial functions of microbes) in 2015, four times more than in 2007. The industry is booming, with sales in the United States expected to exceed $ 6 billion this year, the report said.
“Patients regularly ask clinicians whether they should take probiotics – and if so, which products. These questions pose a dilemma, as none of the probiotic preparations being studied are currently manufactured as a medicine – for the purpose of treating, alleviating, or preventing disease. “, Said the technical review that accompanied the new guidelines.
Probiotics can be harmful in certain circumstances, especially in people with weakened immune systems, said Dr. Preidis, who urged anyone considering starting a probiotic diet to speak to their doctor.
“One of the most serious side effects is infection. As living microbes, probiotics can leave the intestines and enter the bloodstream, causing sepsis, “he said.
McFarland, however, said that probiotics should not be dismissed as a mode of health.
“Not all probiotics are created equal. Certain probiotic strains and mixtures are very effective for certain types of diseases and should not be overlooked due to studies that combine all probiotics into one, “she said.
The review found that probiotics can help under certain circumstances.
Specific probiotics can help premature babies born with low birth weight reduce the number of days they need to eat full meals and reduce the time spent in hospital.
Similarly, certain probiotics should be considered for the prevention of Clostridium difficile infections in adults and children taking antibiotics. C. difficile is a bacteria that causes diarrhea and inflammation of the colon.
The review also revealed that probiotics could be considered for the management of pochitis, a complication of ulcerative colitis that has been treated surgically.
However, the review found that there was insufficient evidence regarding the use of probiotics to treat C. difficile infection, Crohn’s disease, ulcerative colitis or IBS. In fact, the AGA suggested that people with these conditions consider stopping probiotics because of “the associated costs and insufficient evidence to suggest there is no harm.”
He also concluded that probiotics were not beneficial for children in North America with acute gastroenteritis and advised that children with diarrhea should not be routinely administered them in the emergency room.
However, McFarland said the review did not take into account research done outside the United States, which had shown that certain probiotics were effective in shortening the duration of acute diarrhea in children, particularly in developing countries.
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