Probiotics are “good” microorganisms or bacteria, found naturally in foods or concentrated and dried in a pill form for a health benefit.  Food sources include dairy products such as yogurt, gouda and goat’s milk cheese, and Kefir.  Other food sources include unpasteurized sauerkraut, dark chocolate, pickles, honey, oatmeal, and red wine.  When looking at food sources, the label needs to say “live” cultures.  The bacterium needs to be alive in sufficient amounts to exert a health benefit.  For adults, a dose greater than 10 billion CFU (colony forming unit) or greater than 5 billion CFU for children is suggested as a daily dose. With probiotics, the live bacteria needs to persist until end of shelf life.  Therefore, the expiration dates of probiotic products are important.  Expired products will not have the correct level of live bacteria to effect health.

There are more than 1,000 bacterium that are considered normal on the skin, in the vaginal area, or in the gastrointestinal (GI) tract.  As long as the bacterium stays in the specific area, this is considered “normal flora”.  If the normal flora is altered, the good bacterium may be overtaken by the bad bacterium and cause symptoms or illness. Probiotics help to maintain or restore the normal flora. Normal bacterium in the GI tract helps with digestion, vitamin synthesis, activation of the immune response, and fight against foreign substances.  The lower GI tract is where most of the “good” bacteria reside.

Probiotics consist of 3 broad categories, or genus, of live bacteria: Lactobacillus (L.), Bifidobacterium (B.), and Saccharomyces (S.).  Each of these broad categories is broken down into more specific species or sub categories.  For example, in the lactobacillus group, there is acidophilus, rhamnosus, reuteri, casei, and bulgaricus.  When reading food product labels, look for L. rhamnosus, L . reuteri, L. casei, or L. bulgaricus.  Health benefit desires are dependent on the specific bacteria.

Most of the health benefits of probiotics are related to the GI tract.  Other health benefits include relief for vaginosis, common infectious disease, allergies, and regulation of the immune response.  According to Agency for Healthcare Research and Quality (AHRQ), probiotic products are generally safe in the short term, but there is limited evidence for long term benefits.   Most of the health benefits have been in the area of prevention rather than treatment.

Probiotics with S. boulardi, L. acidophilus, B. lacytis and B. bifidum have been effective for prevention of traveler’s diarrhea.  When taking an antibiotic, the “bad” and “good” bacteria are killed and this upsets the normal flora in the GI tract, causing diarrhea.  Taking a probiotic before starting, or along with an antibiotic, will boost the “good” bacteria and prevent diarrhea.  If a probiotic is taken after the onset of diarrhea, studies suggest that the probiotic may decrease the length and frequency of diarrhea.  For traveler’s diarrhea, the recommendation is to start a probiotic 5 days prior to travel for prevention.  Probiotics have helped people with irritable bowel syndrome (IBS), especially IBS with diarrhea. Probiotic with B. infantis decreased the pain and distention of IBS.

Women that are prone to yeast infections may benefit from a probiotic with L. rhamnosus or B. longum, especially in prevention of antibiotic induced yeast infection.  To be most beneficial, the probiotic should be taken 2 hours after the prescription antibiotic.

Probiotics show promising health benefits in immune response and regulation.  Over half of our immune cells are found in the lining of the intestines.  Probiotics are thought to inhibit the immune or inflammatory process to foreign agents.  In upper respiratory infections, probiotic L. reuteri, L. casei, or L. rhamosous have shown decrease length of symptoms and need for antibiotics.  Some studies have shown that 3 weeks of probiotics result in decreased nasal congestion and episodes of ear infections from upper respiratory infections.  Other clinical trials have suggested that probiotics may be effective in recurrent atopic eczema by altering the immune response.

In summary, probiotics are bacteria, found naturally in foods or concentrated and dried in a pill form that reach the intestines alive and have a health benefit, especially in prevention of diarrhea and vaginal yeast infections.  Promising benefits are decreasing symptoms from upper respiratory infections and allergies.  Probiotics aid in normal digestion, making of  B vitamins and regulation of the bowels by maintaining the normal balance of good and bad bacteria in the GI tract.

If you have a question about the benefits of probiotics or where they can be found, Madison Health Primary care can help.

Beverly Clensey is a certified nurse practitioner at Madison Health Primary Care in West Jefferson and is currently accepting new patients.  To make an appointment, call 614-879-8141.