That gut feeling on probiotics

Even before the microbiome craze — the hope that the bacteria in your gut holds the key to good health — people were ingesting cultures of living microorganisms to treat a host of conditions. These probiotics have become so popular that they are being marketed in foods, capsules and even beauty products. Probiotics have the potential to improve health, including by displacing potentially harmful bugs. The trouble is that the proven benefits involve a very small number of conditions and probiotics are regulated less tightly than drugs. In a recent article in JAMA Internal Medicine , Pieter Cohen, an Associate Professor of medicine at Harvard Medical School, urges us to consider the harms as well as the benefits. Among immune-compromised individuals, for instance, probiotics can lead to infections. The most obvious use of probiotics would be in the treatment of gastrointestinal disorders, given that they are focused on gut health. There have been many studies in this domain, so many that early this year the journal Nutrition published a systematic review of systematic reviews on the subject. The takeaway: certain strains were found useful in preventing diarrhoea among children being prescribed antibiotics. A 2013 review showed that after antibiotic use, probiotics help prevent Clostridium difficile-associated diarrhoea. A review focused on acute infectious diarrhoea found a benefit, again for certain strains of bacteria at controlled doses. There is also evidence that they may help prevent necrotizing enterocolitis (a serious gastrointestinal condition) and death in preterm infants. Those somewhat promising results — for very specific uses of very specific strains of bacteria in very specific instances — are just about all the “positive” results you can find. Lack of evidence However, probiotics did not show a significant benefit for chronic diarrhoea. Three reviews looked at how probiotics might improve Crohn’s disease and none could find sufficient evidence to recommend their use. Four more reviews looked at ulcerative colitis and similarly declared that we do not have the data to show that they work. The same was true for the treatment of liver disease. Reviews show that there is insufficient evidence to recommend their use to treat or prevent eczema, preterm labor, gestational diabetes, bacterial vaginosis, allergic diseases or urinary tract infections. Reviews looking at the treatment or prevention of vulvovaginal candidiasis in women, pneumonia in patients hooked up to respirators, and colds in otherwise healthy people show some positive results. But the authors note that the studies are almost all of low quality, small in size, and often funded by companies with significant conflicts of interest.

Source : https://www.thehindu.com/todays-paper/tp-life/that-gut-feeling-on-probiotics/article25291832.ece

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