Preventing & Treating Diarrhea with Probiotics

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Probiotics may help prevent antibiotic-associated diarrhea, and appear to speed recovery from acute gastroenteritis.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“Probiotics have moved from the field of alternative medicine into the mainstream, slowly but surely over the past decade.” The best evidence we have is for the prevention of antibiotic-associated diarrhea, and the treatment of gastroenteritis.

Antibiotics administration is followed in up to 40% of cases by the appearance of diarrhea, but, for example, you may be able to cut the risk in kids in half by administering probiotics along with the antibiotics. Which kinds, and how much? Lactobacillus rhamnosus and Saccharomyces boulardii appeared to be the most effective strains, and studies using more than five billion live organisms appeared to achieve better results than those using smaller doses.

The importance of correct dosing cannot, evidently, be overemphasized. For example, in adults, going to 100 billion organisms seemed to work nearly twice as well as 50 billion in preventing antibiotic-associated diarrhea.

The second well-established usage of probiotics is in the treatment of acute infectious diarrhea—shortening the duration of symptoms by about a day. But, we still don’t know what the best probiotic doses and strains are. Studies have used between 20 million organisms a day to three trillion, and there are thousands of different strains to choose from.

And, even if you wanted a particular strain, odds are the label is lying to you anyway. Less than a third of commercial probiotic products tested actually contained what the label claimed. About half had fewer viable organisms than stated, and half contained contaminant organisms—including potentially pathogenic ones, as well as mold.

Now, ideally, we’d repopulate our gut with the whole range of natural gut flora, not just one or two hand-picked strains. And, for serious infections, this has been attempted, starting back in 1958.

Why not give people a “fecal enema?” Take the full complement of gut bacteria from a healthy colon, and stuff it into an unhealthy colon. Or, you can go the other route, and administer the donor stool through the nose. Evidently, this route of administration saves time, is cheaper, less inconvenient for the patient.”

“Preferred stool donors (in order of preference) were…spouses or significant [others], family…members…,” and then, anyone else they could find, such as a medical staff member. What you do is first pick a nice “soft specimen,” whip it up in “a household blender” until “smooth”—a little Vitamix action. Put it through a “coffee filter,” and then just squirt the stool up their nose through a tube, and into their stomach. Don’t try this at home.

How receptive were the patients to this rather unusual smoothie recipe? “None of the patients in this series raised objections to the proposed stool transplantation procedure on the basis that it lacked aesthetic appeal. However, since production of fresh material on demand is not always practical,” researchers up in Minnesota “recently introduced frozen donor material as another treatment option.” All described in great detail in the latest review on the subject out of Yale entitled, “The Power of Poop.”

Please consider volunteering to help out on the site.

Images thanks to St. Murse via flickr and Eric Erbe via Wikimedia

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“Probiotics have moved from the field of alternative medicine into the mainstream, slowly but surely over the past decade.” The best evidence we have is for the prevention of antibiotic-associated diarrhea, and the treatment of gastroenteritis.

Antibiotics administration is followed in up to 40% of cases by the appearance of diarrhea, but, for example, you may be able to cut the risk in kids in half by administering probiotics along with the antibiotics. Which kinds, and how much? Lactobacillus rhamnosus and Saccharomyces boulardii appeared to be the most effective strains, and studies using more than five billion live organisms appeared to achieve better results than those using smaller doses.

The importance of correct dosing cannot, evidently, be overemphasized. For example, in adults, going to 100 billion organisms seemed to work nearly twice as well as 50 billion in preventing antibiotic-associated diarrhea.

The second well-established usage of probiotics is in the treatment of acute infectious diarrhea—shortening the duration of symptoms by about a day. But, we still don’t know what the best probiotic doses and strains are. Studies have used between 20 million organisms a day to three trillion, and there are thousands of different strains to choose from.

And, even if you wanted a particular strain, odds are the label is lying to you anyway. Less than a third of commercial probiotic products tested actually contained what the label claimed. About half had fewer viable organisms than stated, and half contained contaminant organisms—including potentially pathogenic ones, as well as mold.

Now, ideally, we’d repopulate our gut with the whole range of natural gut flora, not just one or two hand-picked strains. And, for serious infections, this has been attempted, starting back in 1958.

Why not give people a “fecal enema?” Take the full complement of gut bacteria from a healthy colon, and stuff it into an unhealthy colon. Or, you can go the other route, and administer the donor stool through the nose. Evidently, this route of administration saves time, is cheaper, less inconvenient for the patient.”

“Preferred stool donors (in order of preference) were…spouses or significant [others], family…members…,” and then, anyone else they could find, such as a medical staff member. What you do is first pick a nice “soft specimen,” whip it up in “a household blender” until “smooth”—a little Vitamix action. Put it through a “coffee filter,” and then just squirt the stool up their nose through a tube, and into their stomach. Don’t try this at home.

How receptive were the patients to this rather unusual smoothie recipe? “None of the patients in this series raised objections to the proposed stool transplantation procedure on the basis that it lacked aesthetic appeal. However, since production of fresh material on demand is not always practical,” researchers up in Minnesota “recently introduced frozen donor material as another treatment option.” All described in great detail in the latest review on the subject out of Yale entitled, “The Power of Poop.”

Please consider volunteering to help out on the site.

Images thanks to St. Murse via flickr and Eric Erbe via Wikimedia

Doctor's Note

This is the first of my four-part video series on the current state of probiotic science. Next up is Preventing the Common Cold with Probiotics?—in which their effect on immune function is explored.

Of course, the best way to avoid antibiotic-associated diarrhea is to prevent the need for antibiotics in the first place—by avoiding infection. See, for example:

You can also avoid consuming antibiotics in your diet; see Lowering Dietary Antibiotic Intake and More Antibiotics In White Meat or Dark Meat?

Another mention of frozen “poopsicles” can be found in Relieving Yourself of Excess Estrogen.

The mislabeling of probiotic supplements will come as no surprise to those who’ve been following my work. For example, see:

I also have many other videos on probiotics; for example, see Boosting Good Bacteria in the Colon without Probiotics. 

Update: In 2017, I released a new video on probiotics. See: Culture Shock – Questioning the Efficacy and Safety of Probiotics. 

For more context, check out my associated blog posts: Probiotics & Diarrhea; Probiotics During Cold Season?; How Should I Take Probiotics?; and How Probiotics Affect Mental Health.

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