It’s not as simple as a yes or a no answer. Yes, I have prescribed probiotics to treat diarrhea and yes I have seen them work wonders in the right situations; even outside its use for traditional diarrhea for example in pouchitis; but the evidence for the use of probiotics in all diarrhea per se is mixed. So, no I would not use it in all circumstances.
While there is convincing evidence of its benefits in acute diarrhea in the pediatric patient group; the strongest with rotaviral illness, it is more mixed in preventing traveler’s diarrhoea in adults. The idea of probiotic use is in its benefit at restoring the disrupted gut bacteria balance, but even so, recent evidence has suggested probiotics can also delay gut bacteria colonization and restoration adding to the confusion of the yes or no for probiotics in diarrhoea. Probiotics are basically bacteria and humans normally have over 600 different species and trillions in the gut.
Most probiotics drinks have between 6 to 20 strains of bacteria in them and although they tend to have the strains with the most evidence for its claimed benefits, it is uncertain if you are in fact deficient in said strain or will benefit from the addition this strain. This then follows with the question of how much is actually needed for such benefits as doses often don’t match up to the published work.
Simply adding to what you already have just does not make sense either. At best you will be wasting money, at worse you have introduced a pathogen. I don’t recommend otherwise healthy individuals using probiotics without at least having a discussion with their doctor. This is more so if you have a suppressed immune system where there is evidence of actual harm being done with probiotic use.
What would you prescribe instead?
Causes of diarrhoea are many including viruses, bacteria, inflammatory bowel disease, cancers, and the list goes on. A good history, examination and relevant investigation are vital here as to the cause and the following management strategy. For example, viral diarrhoea does not require antibiotics but more focused on symptomatic management e.g. fluids and hydrating salts while in inflammatory bowel disease, it is immunosuppressive agents. If there is a good enough temporal relationship to poorly prepared food, then bacterial and virus will top the list and here, oral hydrating salts and medications such as hidrasec or Smecta can certainly help. Maybe also consider an antibiotic or 2 if bacteria is the likely cause. To put it simply, we want these pathogens out without compromising the patient by way of dehydration and electrolyte imbalances. This is also why I tend not to favour agents that cause constipation as the first line. If unable to tolerate being at home or balances not being met, and more so in those with chronic disease, brief hospital admission is often required for safety.
Should healthy people take probiotics as a supplement?
I don’t think so. Side effects in this group being rare tends to favour its use but a normal healthy varied diet and healthy lifestyle should technically suffice. There are many foods that have probiotic properties e.g. yogurts and kefir and they also are much cheaper. There will be cases where individuals do get added benefits while of probiotics but often these individuals have actually also made other changes to their lifestyle which in truth will be difficult to know what the game changer was.
