The Truth about Probiotics: Constipation Version

Families are often surprised to learn my opinion about probiotics.  The “truth” about probiotics is that they are poorly regulated/lack rigorous production standards and are mostly ineffective for many of the conditions for which they have been promoted.  Even in conditions in which there is some effectiveness (eg. antibiotic-associated diarrhea), the number of persons needed to treat for one person to benefit is fairly high.

In addition, when someone says that they are taking a probiotic, many families do not understand the idea of “strain” specific effects.  I tell families that if they see a “dog in yard” sign that they do not know if that is a poodle of a pit bull.  With probiotics, similarly you often do not know if you are getting a pit bull or a poodle.

As a consequence, I think negative studies like a recent report (K Wojtyniak et al. J Pediatr 2017; 184: 101-05) are helpful. In this study, the authors examined the effectiveness of Lactobacillus casei rhamnosus Lcr35 (Lcr35) in the management of constipation.

This randomized, double-blind, placebo-controlled trial was conducted in 94 children <5 years of age. Dose: 8 x10 to the 8th CFU twice daily x 4 weeks.

Key findings:

  • “Lcr35 as a sole treatment was not more effective than placebo in the management of functional constipation.” In fact, the placebo group had a greater increase in bowel movement frequency than the treatment group.
  • Both groups had improvement -more than half in each group (total 52 of 81 who completed study) had reached endpoint of 3 or more BMs/week without soiling.

My take: Probiotics often are ineffective.  This study showed that Lcr35 was NOT helpful for pediatric constipation.

Related blog posts:

Claude Monet, La Rue Montorgueil

 

 

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3 thoughts on “The Truth about Probiotics: Constipation Version

  1. Can you please send me your email so I can send you data. I looked but can’t find it anywhere.A pt of mine just sent me your blog and wanted to know if she should stop her daughter’s probiotic based on I guess one negative study. Imagine if someone wrote a blog like this after one of the negative diabetic trials, would they even think about doing that? Much of what you say about probiotics is true, ie strain data needed, clearly only indicated for certain indications, etc. But your overall take is dangerous and just wrong. The NNT for probiotics for the following are, Colic=4, NEC to prevent death=41, AAD=9, CDI=28, mild to moderate UC=4. Most of these reviews are from Cochrane. Anyway, it is likely malpractice if one of your mild to mod. UC pts isn’t taking VSL#3, so best to follow the data. Happy to send it to you so you can better inform your followers.

    • Dan,

      If you follow my blog, you will note that I have published many positive comments/posts about probiotics for certain problems (like NEC) and these can be found readily by searching. At the same time, most people are taking probiotics for situations in which there is very low likelihood of benefit. I am happy to post a detailed counter post. Feel free to send me your opinion and data to my email: jjhochman@gmail.com

  2. Pingback: Another Shady Pharmaceutical Business Practice: Citizen’s Pathway to Delay Competition | gutsandgrowth

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