Let thy food be thy Medicine, and thy medicine be thy food - Hippocrates

25 June 2014

Probiotic supplements (“Good bacteria”) are everywhere now, and some producers claim they are the new Snake oil. No such thing as a cure for everything exists of course, but they come pretty close to being good for a lot of things, and are nearly always safe. They exist in certain foods like yoghurt, banana, tomato, green beans, sauerkraut, but you can also buy them as supplements in many forms. Some of those foods also contain prebiotics – the fibre that the good bacteria eat.

An summary of current literature:

Indication

Type        

Dose

Good evidence

Acute gastro in children

LGG = Lactobacillus rhamnosus GG
Lactobacillus Reuteri

1010-1011 2x/day 2-5 days
1010-1011 daily up to 5 days

Antibiotic associated diarrhoea
Take 2 hours before / after abs

Saccharomyces boulardii
LGG
Lactobacillus acidophilus & bulgaricus
L acidophilus & Bifidobacterium longum
L acidophilus & Bifidobacterium lactis

4×109–2×1010 CFU daily for 1–4 wk
6×109–4×1010 CFU daily for 1–2 wk
2×109 CFU daily for 5–10 day
5×109 CFU daily for 7 days
1×1011 CFU daily for 21 days

Clostridium Difficile

S Boulardii +  specific antibiotics

2×1010 CFU (1 g) daily for 4 wk

Traveller’s diarrhoea

LGG
S boulardii

2×109 daily - 2 days before - end of trip
5×109–2×1010 daily 5d before-end of trip

Allergic eczema prevention

LGG – pregnant women
LGG – infants

1010 daily for 2–4 wk before
6 months

Some evidence, not entirely convincing yet

IBS
(Irritable Bowel Syndrome)

VSL#3b
Bifidobacterium infantis 35624
LGG & others

9 × 1011 CFU daily for 8 wk
106–1010 CFU daily for 4 wk
8–9 × 109 CFU daily for 6 mo

Lactose intolerance

Lactic acid bacteria &Strep salivarius subsp thermophilus

 

Active UC
(Ulcerative colitis, a form of IBD – Inflammatory bowel disease)

E coli Nissle 1917

S boulardii
VSL#3b

5 × 1010 2x/day max12 wk, then 5 × 1010
  bacteria daily for max 12m
250 mg 3x/day 4 wk & mesalamine
1.8 × 1012 (=2x3g sachets) 2x/day 6wk
 + conventional therapy

Inactive UC

E coli Nissle 1917

5 × 1010 bacteria daily 12w

Crohn’s (IBD)

S boulardii

1 g daily for 6 mo plus mesalamine

Thrush (vulvovaginal candidiasis)

LGG
L. rhamnosus GR-1 & Lactobacillus fermentum RC14

109  suppository 2x/day 7 days
> 109 in skim milk 2x/day 2w

Cow’s milk allergy

LGG& B. lactis BB-12

 

Bacterial vaginosis

L. rhamnosus GR-1 & L. fermentum RC14
L crispatus CTV05 (after Metronidazole)

Weekly vaginal insertion
Vaginal

UTIs in women

L rhamnosus GR

 

Weight loss -obese women

L. rhamnosus CGMCC1.3724

2x 1.6 × 108 with oligofructose &inulin

Possible future uses, being researched

Rheumatoid arthritis

L casei L1

(Colorectal) cancer prevention

Synbiotics = Probiotics + prebiotics :
Lactobacillus& bifidobacteria strains & oligosaccharides (GOS, FOS and inulin)

Dental caries

Lactic acid bacteria

Nasal pathogens

Lactic acid bacteria

(childhood) resp illness

L. johnsonii

LDL/cholesterol drop

L. reuteri

Wound Staph after surgery

L. fermentum RC-14

           

With regards to safety: critically ill people or people with a reduced immune system (eg chemotherapy) are at risk of infection by the probiotics, but in most people they are quite safe.

 

If you have any doubt, speak to your pharmacist or doctor about them.