Probiotic Warnings – A Licensed Pharmacist Shares His Thoughts

Author: Dr. Brian Straub, Pharm.D.
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Probiotics Overview

Over the past decade there has been a very clear trend towards the use of probiotics.

Bacteria live in our gut in a natural balance and directly affect the functioning of the human body.

The theory of probiotic use relates to the idea that a triggering event – antibiotic use, poor diet, infection – can knock this gut flora out of balance and putting the proper healthy bacteria into our bodies can restore that balance.

Probiotics Studies

There is mounting research to back all of this up.

Studies have shown that probiotics are effective in treating the following:

  1. Probiotics may reduce the incidence of antibiotic-related diarrhea.
  2. Probiotics may reduce the duration and severity of all-cause infectious diarrhea.
  3. Probiotics may reduce the severity of pain and bloating in patients with irritable bowel syndrome.
  4. Probiotics may reduce the incidence of atopic dermatitis in at-risk infants.

    There is preliminary support for treatment of symptoms.

In addition to these, certain gut bacteria species and levels have been correlated with mental and brain health, body weight, mental clarity, and on and on.

There is no doubt that the use of probiotics can be highly beneficial and we will continue to see abundant research in this area.

Potential Downsides To Probiotics

Now for the current drawbacks with probiotic therapy. The research is still very young.

There are thousands of strains of bacteria living inside of us and the numbers are in the billions and billions.

We have been able to correlate different strains with different disease processes, but we still have a long way to go.

Because we don’t know the specific balance and there is significant difference from person to person, it is unknown whether the same strains and amounts are the best for everyone.

Another challenge is that many of the claims are anecdotal and haven’t been tested in appropriate double blind studies.

Probiotics have the potential to be very beneficial, but they aren’t a panacea or a cure all.

Many people have very health guts, good diets and eat plenty of food with live cultures and have absolutely no need to add probiotics to their regimen.

There are thousands of probiotics that are hitting the market.

If I were to select a probiotic I would stick with a larger brand name and specifically one that has been clinically tested.

Probiotics Precautions and Contraindications:

By and large, probiotics have very few side effects.

The most common would be flatulence or mild abdominal discomfort.

If a quality probiotic, from a reputable manufacture is selected the chance of a pathological infection is extremely rare.

That being said, there are people at higher risks for more serious adverse effects (see below) and probiotics should be avoided.

Do not take this medication if you have:

  • Weakened Immune System
  • Short Bowel Syndrome
  • Ulcerative Colitis
  • Damaged Heart Valves
  • Severely Ill
  • Immunocompromised

Administration:

Taking antibiotics along with probiotic can reduce the effectiveness of the probiotic.

To avoid this interaction, take probiotic products at least 2 hours before or after antibiotics

Can I take Probiotics if I am pregnant, planning to become pregnant or breastfeeding?

  • Probiotics are listed as POSSIBLY SAFE when taken by mouth appropriately while pregnant and breastfeeding.

    Probiotics have been used safely in pregnant and breast-feeding women, but not all strains have been tested.

Moderate Interactions

  • Auto-Immune Medications (immunosuppressants for transplant, rheumatoid arthritis, psoriasis, etc.)
    • azathioprine (Imuran)
    • cyclosporine (Neoral, Sandimmune)
    • mycophenolate (CellCept)
    • tacrolimus (Prograf)
    • sirolimus (Rapamune)
    • prednisone (Deltasone, Orasone)
    • corticosteroids (prednisone, etc)
    • and others

References:

  1. https://www.webmd.com/vitamins/ai/ingredientmono-790/lactobacillus
  2. https://www.aafp.org/afp/2008/1101/p1073.html
  3. https://www.medscape.com/viewarticle/719654_14
  4. https://www.sciencedirect.com/science/article/pii/S2213453015000300


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Author: Dr. Brian Straub, Pharm.D.

Brian Straub is a medical science liaison and licensed clinical pharmacist. He graduated from the University of Pittsburgh School of Pharmacy in 2011, and is also a registered yoga instructor.