Preventing & Treating Diarrhea with Probiotics

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 & DiarrheaProbiotics During Cold Season?How Should I Take Probiotics?; and How Probiotics Affect Mental Health.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

64 responses to “Preventing & Treating Diarrhea with Probiotics

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  1. Fecal enema? Donor stool through the nose? Preferred stool donors were spouses (that must be love!)

    I prefer diarrhea and the can…..

  2. OK, I’m seriously grossed out.

    After the shock and disgust has died down a bit, I have to say that the important part of this video, and the reason I am so glad I listened, is in the middle where Dr. Greger told us how often the probiotics sold in stores do not actually contain what they say. And often even contain harmful contaminants. I long suspected such might be the case, but am still saddened to hear that it’s true. Since so many people are buying those probiotics, I wish this information was widely disseminated to the public.

  3. I also wanted to share another concern/question I have: I’m a big, big fan of the recipes in the book, Artisan Vegan Cheeses. SO yummy!

    But those recipes start out with me essentially making my own probiotic. It is called rejuvalac, and I have been making it with quinoa (which works relatively fast). I have been making some delicious cashew-based cheeses, but I have no way of knowing if or when the little guys in the rejuvalac turn evil. I presume that the bacteria that develop in my rejuvalac come from a) anything that is on the (organic) quinoa itself and b) anything that is in my air and water.

    I haven’t keeled over yet. But I wonder, how healthy is it? Is there some way to tell when the bad organisms outweigh the good.

    On a different, but similar line of questioning: One of the key steps in the cheese making is where the rejuvalac-cashew mixture is left out to ferment. The word “ferment” is actually used in the book. I presume this includes the backeria in the rejuvalac having lots of time to breed. Is that what fermentation is? What I’m thinking of, is Dr. Greger’s previous videos on effects of drinking wine on our health. I wonder, do those effects apply to eating cheese too? Since it is fermented? Just wondering.

    1. Great post. I haven’t tried it yet, but learned of this method from Green Smoothie Girl. She didn’t show making the cheeses that I could see. Just drank it, which is ok too. Rejuvilac comes from the Ann Wigmore Institute. I’m looking forward to trying this. It appeals to me more in the form of a “cheese.” I do like to limit my use of nuts, so will see how it all works. Thanks for the update and the book title. Lynn

      1. LynnCS: Thanks for your nice feedback.

        re: limiting nuts
        I’m in a similar position in that I get too many calories and thus cutting down on some calorie-dense foods like nuts would be a good idea for me. For the most part, I stopped making these cheeses, because I thought they were so delicious, and I didn’t have a working “stop button.”

        But I think the cheeses are still great for special occasion treats and serving to guests.

        Good luck!

      1. Scott: No. These aren’t super-burning questions for me. So, I didn’t even remember that post. But in thinking back on it, I don’t remember seeing answers over the intervening years. Now I’m curious again.

        Update: I still love those cheeses, but I know better than to make them too often, because I have a hard time eating those very calorie-dense foods in appropriate amounts.

  4. Oh my! This gives hole new meaning to…Eat Sh*t! And who wants to be the “Stool Pigeon” for this one? Thank goodness it’s Evidence Based ;)

  5. If you have ever had c-diff, which I had, the thought of using the power of poop is just a way to get rid of something that is much worst than the thought.

  6. What I don’t understand about these companies producing supplements and probiotics that are falsely labeled is why someone doesn’t sue them for false advertising or something along those lines. Don’t we as consumers have any protection that what the label says is what we’re actually getting? Any attorneys care to comment?

  7. Wouldn’t this give you a bladder infection? Fecal matter is not meant to go through your digestive track (tract?). That’s why we wash our hands after we poop and before we make lunch. (yeah, and keep it AWAY from the blender!)

  8. Disturbingly, we found that only 4 of 13 products (31%) were in accordance with label claims.

    Is there a way to find out which 4 products were in accordance with label claims?
    Thank you

  9. I love the effective use of pauses that Dr. G used to emphasize how and where they derived the stool samples.
    Great detective work! Sniffin’ out the bad guys just like a Blood Hound!

  10. Poop is called waste for a reason; It should be eliminated from the body. The idea of putting it back in the body is absolutely disgusting. Surely, there must be better alternatives to populate the digestive system with probiotics.

  11. The whole probiotics thing confuses me. I thought we needed more bacteriodetes and less fermicutes – yet all the probiotic strains in products i looked up were fermicutes. Won’t that tip the balance the wrong way…?

    1. sorry, excuse my spelling – I mean Firmicutes and Bacteroidetes (knew I should have looked them up before typing the comment!)

      1. I suspect the strains are chosen based on those in the general population. And yes, Bacteroidetes (favored by vegan diets) are better, as gram-negative Fermicutes may provide a dose of endotoxins with every meal containing saturated fats.

        1. That first review cited above is so interesting. The role the gut microbiota might play in obesity is fascinating. And how quickly our gut bacteria can change amazing! Within 24 hours it can be a whole new population! Good read.

  12. What happens to the NG transferred bacteria while in the stomach acid? I’ve read concerns about taking probiotic pills that weren’t enteric coated because of stomach acids.

    And to be honest, although both sound unpleasant, I’d choose enema over NG tube any day. I’ve read that slow-drip, retention style enemas supposedly don’t trigger the need to empty one’s bowels.

  13. Simply put, this video is a total waste of time. I utilize this website to be informed not amused. In no way are any of us more informed about making a practical decision to use or not use probiotics from having watched this video. In regard to probiotic use, http://www.consumerlabs.com is way more helpful – though they do charge a small membership fee for the year. Sorry Dr. Gregor, I am a fan but you really struck out on this one.

    1. I respectfully disagree. We learned that there is still much to learn about probiotics. That actually is important. They are worth trying with patients but may not make a difference. The fecal part is Dr. Greger’s humor. Must we always be stuffy and professional?

      1. I have read about fecal transplants for months now. Great to have more detail on what is a life-saving procedure for some people. Would I choose the enema or the nasal method? Not sure, but I absolutely know I would choose this treatment if it could save me from a c. diff. infection. I love the practicality of it and, it works. Kudos to the people who came up with this! I agree that Dr. Greger’s humor makes it entertaining, as well as educational!

    2. Sounds like Consumer Labs has a real conflict of interest in how it conducts its business. I’m all for finding out which supplements are what they say they are, but I don’t believe I’ll trust a company that takes money from both consumers and the companies it’s rating.

      I belong to Consumers Union and they don’t let companies pay for reviews like Consumer Labs evidently does.

      http://healthwyze.org/index.php/component/content/article/348-evaluating-the-evaluators-from-consumer-labs.html

  14. I turned it off after hearing about “picking a nice soft specimen” (turd) and about to put it in the nose … no thank you. TMI.

  15. I find the video misleading since I seen the same procedure in another video
    and the fecal matter was injected in the colon and not through the nose.

    1. Verdad go to sources cited above. There all the articles referenced are listed for you to read. It was through the nose.

    1. Yes it is, but only a single dose.

      “In one of the less appetizing but more brilliant experiments in the field of vitamin b12 metabolism in the 50’s, Sheila Callender (7) in England delineated that human colon bacteria makes large amounts of vitamin B-12. Although the bacterial vitamin B-12 is not absorbed through the colon, it is active for humans. Callendar studied vegan volunteers who had B-12 deficiency disease characterized by classes megaloblastic anemia. She collected 24-h stools, made water extracts of them, and fed the extracts to the patients, thereby curing their vitamin B-12 deficiency.”

      http://ajcn.nutrition.org/content/48/3/852.full.pdf

  16. How on earth did this study pass an ethical review board? How could none of the patients object? I think you are going to get a huge dose of e.coli amongst the other probiotics. I’d rather go with isolated probiotics or none at all. Tough to say if you’ve been exposed to antibiotics, but I remember my uncle leaving cheese on the top of the fridge to get more rank, thinking this would build his intestinal flora. This was some 25 years ago!

  17. Believe me, someone with a bad case of UC (or even a mild case) would be the first person in line for an enema. Transplanting a normal gut population back into a sick one sounds like a rational idea. The only issue I have with Dr. Greger is that he didn’t reveal the RESULTS of the studies he showed us! He usually caps off a topic with the Aha! moment- when he shows us the results that back his point. No such moment here. We’re left to track down those articles via PubMed or Sage or DeepDyve. C’mon Doc! No teasers!

  18. Dr. Gregor, have you figured out from the studies which was the most
    accurate brand of probiotics to take? What’s your recommendation?

  19. Dear Dr. Greger.

    I have question not strictly related to this topic but still there is some connection to the enema. I would like to know if there is some scientific information about the enema itself. For example it is bad idea or even dangerous to do shallow enema after excretion? Respectively douching the region between anus and rectum with the help of the shower head? Does the warm water from boiler pose a threat to the health? Should be used only boiled water? And what about oxygen or other gases which could be introduced into the rectum or further? I thing it is know fact that the rectal mucous membrane is much more sensitive, with non regulated absorption and without defense mechanism in compare to the gastric membrane. What do you think?

    Thank you in advance.

    1. Hi Lara: The important thing to remember about taking a probiotic: Be sure to take one containing multiple species of bacteria, as your gut needs to maintain the proper balance of bacteria to stay healthy and boost your immune system. Most high-quality probiotics contain the right balance.

    1. I am not familiar with that brand and there are many out there, making it difficult to figure out which to select. It looks like a suitable option, if you want to try that one. Align is a good one and is available in local pharmacies. (I suggest Align not because of any connection to the company, but because of personal experience.) This article offers some good information: http://www.medscape.com/viewarticle/719654_11

    2. What’s difficult is that they are in the process of dying as soon as they leave the factory. How long have they been on the shelf? Even in the refrig they are decaying. If you want to know if your probiotics are still good, put a little sugar water or milk in a saucer then dump the probiotic capsule into the mix. By morning the good probiotic will be gel, the dead will not.
      BTW, there are zillions upon zillions of probiotics in a healthy gut, you would be wasting your money to buy a probiotic that has only 1 or 2 billion probiotics in them, might as well lick the back of your hand and be done with it. Always get a brand that has at least 50 -100 billion per cap. The best and cheapest way is make your own Kefir water. Last time my mother was having a painful GI disturbance, the Kefir water quieted it down within minutes

  20. Has there been any research related to probiotic use by people without a large intestine, which work best, etc? Or how to treat diarrhea when there is no colon? Due to cancer, I had a total colectomy and an ileostomy in 1980 and stopping the diarrhea once it starts is very difficult. Any useful information would be appreciated.

    1. Most probiotic activity goes on pre-colon, in the small intestines, so I would think that taking high dose probiotics (at least 100 billion) or drinking a cup of Kefir Water every day would really help. The Colon’s main purpose is to absorb water out of the contents, it doesn’t have much more of a function, so the probiotics should help you since you have a small intestines :). Once you start making your own Kefir water it is very cheap and easy. I drink 1-2 cups a day it contains around 100 billion per tablespoon of 40-50 strains. You can buy the Kefir Water grains online for $5-10, if you treat the grains right they can keep producing and last your lifetime

  21. Fecal transfers have saved the lives of people with resistant C-Diff. It is a good thing. Nice to see that probiotics are finally hitting the spot light

  22. Hello Dr. Gregor or staff,
    wondering when to take probiotics when taking antibiotics please?
    I don’t want to take antibiotics but I have a toe infection that I have been trying to heal by soaking twice daily in Epson salts and warm water, applying TTO 2-3 times daily and using an antibiotic cream 2 times daily. Still my big toe is red & oozing clear liquid. The doctor cut my toe with a scapel so as to drain the pus and now there is no more pain. Just redness and oozing. So I think I will have to take the antibiotics though I do not want to. I have had the toe infection for 10 days.
    Any thoughts?
    If I do start the pills in a day or two when should I take probiotics, before or after the antibiotics?
    Thank you for all your help in advance!
    Ann ~ Ontario Canada

    1. That’s a good quesiotn. ​Here is a great Q&A written by Dr. Greger on​ probiotics See if this helps? Check out the last link by Dr. Klaper he is the expert!

      Thanks for your question,
      Joseph

  23. In 2008, I was diagnosed with CDiff on my second trip to the ER for severe dehydration. I was symptomatic for 9 days it took 2 weeks of harsh antibiotics, little to no appetite, weakness, severe anemia (as you are losing blood as your colon begins to shed). I lost 12 pounds and about 2 months of wellness, still to this day I take probiotics at least 3-4 times a week and I am extremely paranoid about catching it again. I would have done this treatment in half a second if offered. I am healthy now, and I was so so lucky it only took one form of treatment to begin to heal. This treatment sounds horrible, but I can attest to the fact I would have done ANYTHING to recover. People do die from this and people who recover often call themselves survivors. I was a healthy 23 yr old, I had not been using any antibiotics, had been working out, eating “healthy” compared to the standard american diet. I most likely caught it from contaminated meat at the time. I know that videos like this seem gross, but the above treatment may have gotten me on my feet faster with less side effects. It also continues to save lives.

  24. I had c-diff and was in the hospital for 5 weeks and in re-hab for 7 weeks. It was dreadful, I almost died and there were times I wished to die it was so terrible. If I got c-diff again I would gladly take a poop-cocktail in any form not only because it makes sense but it has been proven to be affective. Naturally it seems repulsive but there are many medicines prescribed to us regularly that would be repulsive if we knew what they contained, mare’s urine for one. I think one day soon there will be a c-diff medicine with feces properties but given a medical name that only those in the medical field could decipher and the treatment will be welcomed by the public. Amen…. Ruth OConnor

  25. Hi. I was hoping I could get some information. I have recently become plant-based again at the beginning of the year. Since then, the past 2 weeks I’ve had diarrhea which I can’t seem to figure out how to stop. In the past, I’ve had similar issues which actually turned out to not be GI related at all (had every procedure known to man for GI). I was wondering if there is anything to make it stop? Any suggestions would be appreciated. Thank you.

  26. A case of diarrhea started Thursday morning which kept me in bed because of weakness. Anything I eat gurgles below and gets me charging to the bathroom. Today has been the worst day, compounded with a dry cough from a cold for two weeks. Buenos Aires pharmacies don’t sell supplements like D3 and B12 (which I asked a US friend to pack in her suitcase), so I highly doubt I’d find probiotics.

    I am concerned this will continue for days and prevent me from engaging in my normal life. Something in our water may be the cause, so I’m boiling filtered water for drinking.

    I’m 69, on a WFPB diet, active, and weigh 42 kilos. Trying not to dehydrate during this situation. What can I eat that is gentle and will stay in my system or should I just fast on vegetable broth.

  27. Jantango, As one of the moderators for NF.org, I see you left a comment which has not yet been addressed. Unfortunately, due to the volume of comments, we cannot always respond within a day so I’m afraid this response will not be helpful to you now, but perhaps it can be helpful in the future. As you read in Dr Greger’s comments relying on products labeled “probiotics” can be problematic. You have the right idea to avoid dehydration so drinking plenty of water and tea and practicing the old fashioned BRAT diet (Bananas, rice, applesauce and toast) is helpful and a gentle way to recover from simple diarrhea.
    In the future you may want to review this general self care advice for diarrhea (although knowing the harm of animal-based products, you will want to ignore advice to drink beef broth! : https://medlineplus.gov/ency/patientinstructions/000121.htm There are several approprite comments on eating a plant-based diet during recovery which you CAN rely on!) Hope that helps.

  28. It appears that three days ago (last Sunday) I ate a bit of Coconut Chutney, I made for the week and then had to throw it out, as it tasted bad. Come Monday, I developed diarrhea and it has continued as of this writing (wed morning). I am have not had diarrhea or any other medical issues in over 30 years. I eat a nutrient dense salad twice a day and then mostly bean/lentiles/wild rice etc along with lots of fresh fruits etc. I take vit D and B12. Yesterday mooning, I eat oatmeal with berries, banana, and raisins, it seem that worked ok for the day. However, when I returned home at night and was not feeling like eating, I made a smoothie with spinach, turmeric, ginger, beets, and orange and in about 30 minutes, I had to visit the toilet again. I am wondering, if Dr. Grrger has any suggestions. I am also feeling a bit of acidity developing as I did not eat the way I normally do and avoiding drinking a lot of water. I did drink Coconut water to ensure I am getting the electrolytes. Looking for some suggestions to address this fast.

  29. Hi there!
    I became a vegan on february. I follow Dr. G’s daily dozen.
    Yesterday, from noon to 7 o’clock in the evening, I ate 1/2 a yellow pitahaya, Dr.’s G favorite desert (banana with matcha powder), my two regular vegie smoothies, a kiwi, and a pomegranate. I drank a glass of tree tomato and maracuya. I got diarrhea at 10 o’clock at night.
    I suspect maracuya is what caused my stomach upset, since that has been the case in other occasions.
    I would like to know if it is advisable for me to stop eating piatahaya.
    Kind regards.

    1. Hello Marcelo, many thanks for your comment.

      As a dietitian, I wouldn’t advice you to stop eating pitahaya, until you’re not 100% sure. By what you’re explaining, I’d think that is not the pitahaya the one which is causing your symptoms, but perhaps the mix of several fruits, smoothies, and other high fiber foods in a short period of time, perhaps your stomach is not used to that.

      Maybe you can try to eat pitahaya alone, or split all your fruits and smoothies through the days, which might be better tolerated by your stomach.

      However, if you try this and the problem remains, you can cut off the problematic fruit. That wouldn’t be a problem because you already have your recommended portions of fruits and vegetables.

      Hope it helps.

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