Probiotics

What are probiotics?

Products sold as probiotics include foods (such as yogurt), dietary supplements, and products that aren't used orally, such as skin creams. Some insurance plans will cover a few probiotics.

Although people often think of bacteria and other microorganisms as harmful "germs," many microorganisms help our bodies function properly.

• Bacteria that are normally present in our intestines to help digest food, destroy disease-causing microorganisms, and produce vitamins. Large numbers of microorganisms live on and in our bodies. In fact, microorganisms in the human body outnumber human cells by 10 to 1.

Many of the microorganisms in probiotic products are the same as or similar to microorganisms that naturally live in our bodies.

Will insurance pay for probiotic treatment?

Traditionally, insurance companies have been reluctant to pay for them. That is gradually changing. More and more plans are paying for some if they are not taken for general health improvement but rather for the treatment of a specific medical condition.

It may not be an easy process to get one covered. Your doctor will need to actually prescribe the probiotic and in a form or concentration not available over-the-counter. Most doctors are aware they will need to demonstrate the medical necessity for their treatment plan.

Do not be afraid to ask your doctor for help. Don’t be discourage if your request for coverage is denied. You have the option to file an appeal.

The history of probiotics

The concept behind probiotics was introduced in the early 20th century, when Nobel laureate Elie Metchnikoff, known as the "father of probiotics," proposed that consuming beneficial microorganisms could improve people’s health.

Researchers continued to investigate this idea, and the term probiotics meaning "for life" eventually came into use.

Probiotics may contain a variety of microorganisms. The most common are bacteria that belong to groups called Lactobacillus and Bifidobacterium. Each of these two broad groups includes many types of bacteria. Other bacteria may also be used, and so may yeasts such as Saccharomyces boulardii.

Probiotics, Prebiotics, and Synbiotics

Prebiotics are not the same as probiotics. The term "prebiotics" refers to dietary substances that favor the growth of beneficial bacteria over harmful ones.

• Prebiotics are basically food for probiotics. Taking prebiotics can help probiotics work better and more efficiently. Not all prebiotics are digestible by humans, but they can encourage the growth of beneficial bacteria.

Prebiotics can be found in many foods we eat every day like fruits, vegetables, and whole grains.

The term "synbiotics" refers to products that contain both probiotics and prebiotics.

• Live yogurt or yogurt with added probiotics would fall under this term. Numerous supplements are sold online that contain probiotic material plus various fiber materials to serve as the prebiotic component.

How popular are probiotics?

About 4 million U.S. adults have used probiotics or prebiotics in the past 30 days. Among adults, probiotics or prebiotics were the third most commonly used dietary supplement other than vitamins and minerals. The use of probiotics quadrupled between 2007 and 2012.

• An NIH survey in 2023 found that the majority (52%) of the parents were familiar with the term ‘probiotics’ and 86.3% were including probiotics in their children’s diet at the time of the survey.

The main source was probiotic food (36.3%), of which yoghurt was the most commonly consumed (87.2%).

Are probiotics effective?

Researchers have studied them to find out whether they might help prevent or treat a variety of health problems, including:

• Digestive disorders such as diarrhea caused by infections, antibiotic-associated diarrhea, irritable bowel syndrome, and inflammatory bowel disease

• Allergic disorders such as atopic dermatitis (eczema) and allergic rhinitis (hay fever)

• Tooth decay, periodontal disease, and other oral health problems

• Colic in infants

• Liver disease

• The common cold

• Prevention of necrotizing enterocolitis in very low birth weight infants.

There’s preliminary evidence that some are helpful in preventing diarrhea caused by infections and antibiotics and in improving symptoms of irritable bowel syndrome, but more needs to be learned.

♦ It is not clear which ones are helpful and which are not. It is also not well understood how much you would have to take to experience any benefits.

Probiotics are not all alike.

• If a specific kind of Lactobacillus helps prevent an illness, that doesn’t necessarily mean that another kind of Lactobacillus would have the same effect or that any of the Bifidobacterium probiotics would do the same thing.

Some have shown promise in research studies but there is not enough evidence to support uses for most health conditions.

♦ The U.S. Food and Drug Administration (FDA) has not approved any probiotics for preventing or treating any health problem.

♦ The American Gastroenterological Association (AGA) does NOT recommend the use of probiotics for most digestive conditions. Evidence to support the use of probiotics to treat digestive diseases is greatly lacking.

Some experts have cautioned that the rapid growth in marketing and use of probiotics may have outpaced scientific research.

How do probiotics work?

They may have a variety of effects in the body, and different ones may act in different ways.

Probiotics might:

• Help to maintain a desirable community of microorganisms

• Stabilize the digestive tract’s barriers against undesirable microorganisms or produce substances that inhibit their growth

• Help the community of microorganisms in the digestive tract return to normal after being disturbed (for example, by an antibiotic or a disease)

• Out compete undesirable microorganisms

• Stimulate the immune response.

Government regulation of probiotics

Government regulation in the United States is complex. Depending on a product’s intended use, the FDA might regulate it as a dietary supplement, a food ingredient, or a drug.

♦ Many are sold as dietary supplements, which do not require FDA approval before they are marketed.

• Dietary supplement labels may make claims about how the product affects the body without FDA approval, but they cannot make health claims (claims that the product reduces the risk of a disease) without the FDA’s consent.

If a probiotic is marketed as a drug for specific treatment of a disease or disorder in the future, it will be required to meet more stringent requirements. It must be proven safe and effective for its intended use through clinical trials before it can be approved by the FDA.

Safety and side effects of probiotics

Whether they are likely to be safe for you depends on the state of your health.

• In people who are generally healthy, probiotics have a good safety record. Side effects, if they occur at all, usually consist only of mild digestive symptoms such as gas.

• On the other hand, there have been reports linking probiotics to severe side effects, such as dangerous infections.

♦ This is usually in people with serious underlying medical problems. The people who are most at risk of severe side effects include critically ill patients, those who have had surgery, very sick infants, and people with weakened immune systems

Even for healthy people, there are uncertainties about the safety of probiotics. Because many research studies haven’t looked closely at safety, there isn’t enough information right now to answer some safety questions.

Most of our knowledge about safety comes from studies of Lactobacillus and Bifidobacterium; less is known about other probiotics. Information on the long-term safety of probiotics is limited, and safety may differ from one type of probiotic to another.

More Safety Considerations

• Don’t replace scientifically proven treatments with unproven products and practices. Don’t use a complementary health product, such as probiotics, as a reason to postpone seeing your health care provider about any health problem.

• If you’re considering a probiotic dietary supplement, consult your health care provider first. This is especially important if you have health problems. Anyone with a serious underlying health condition should be monitored closely while taking them.

• If you’re pregnant or nursing a child, or if you’re considering giving a child a dietary supplement, it’s especially important to consult your (or your child’s) health care provider.

• Tell all your health care providers about any non-prescription approaches you use. This will help ensure coordinated and safe care.

Quality concerns about probiotic products

Some probiotic products have been found to contain smaller numbers of live microorganisms than expected. In addition, some products have been found to contain bacterial strains other than those listed on the label.

Source: NIH, FDA