Probiotics are yeasts and bacteria that live within the body and offer various health benefits. Trillions of microorganisms are already present in the human body, but individuals can also ingest these good bacteria from foods, beverages, and dietary supplements. Probiotics are highly popular in modern medicine because they promote gut health and overall wellness.
This article explores the topic of probiotics and diarrhea, explaining why an overabundance of these helpful organisms may cause diarrhea in some people.
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Understanding Probiotics
Understanding probiotics makes it easier to reap the many potential health benefits without bothersome side effects.
What Are Probiotics?
Probiotics are organisms that help the human body function at its best. They are friendly microbes in the gut that help fight off harmful bacteria and increase immunity against infections.
Examples of common types of probiotics include Lactobacillus, Saccharomyces, Bifidobacterium, and numerous others.
Mechanisms of Action
Probiotics have several mechanisms of action for optimizing gut health. Examples include:
- Improved intestinal mucosal barriers
- Exclusion of harmful pathogens
- Improved mycobacterial balance
- Neurotransmitter synthesis
- Gut immunomodulation
- Reduced growth of harmful GI microorganisms
- Improved intestinal transit
- Short-chain fatty acid production
- Reduced luminal pH in the colon
- Bile salt metabolism
- Vitamin synthesis
- Improved enzymatic activity
- Toxin neutralization
- Cytokine production
- Improved nervous system and endocrine health
Probiotics beneficially interact with gut microbiota, improving the balance of good versus harmful gut bacteria.
In addition to ingesting probiotics, individuals can apply them topically to the skin or mucous membranes where microbes commonly live.
The Relationship Between Probiotics and Diarrhea
Probiotics may be linked to diarrhea in several ways.
Defining Diarrhea
Diarrhea is a gastrointestinal (GI) disorder in which the stools are watery and loose. It can increase the need to use the bathroom. Acute diarrhea is short-term, lasting 1-2 days. Chronic diarrhea may last several weeks or longer when not treated.
The following may increase the risk of diarrhea:
- Viruses, parasites, and bacterial infections
- Intestinal bowel infections
- Food allergies and intolerances
- Celiac disease
- Irritable bowel syndrome (IBS)
- Inflammatory bowel disease (IBD), like Crohn's disease and Ulcerative colitis, as well as other intestinal diseases
- Antibiotic use
- Medication reactions
- Radiation treatment
- Gastrointestinal surgery
- Thyroid disorders
- Some tumors
Traveler's diarrhea appears because of ingesting water or food contaminated with parasites or bacteria when traveling to other countries, particularly areas with poor hygiene.
Rotavirus is a common cause of acute diarrhea in children.
While many people take probiotics to reduce diarrhea, these healthy gut bacteria can sometimes temporarily cause diarrhea.
Why Do Probiotics Cause Diarrhea?
Some people experience diarrhea after ingesting probiotics because they produce short-chain fatty acids within the gut. These byproducts are highly beneficial for gut health, but increasing probiotics via foods or supplements can cause bloating, gas, diarrhea, or other gastrointestinal symptoms.
Other reasons for short-term diarrhea include immune system modulation and changes in gut microbiota balance.
Probiotics are more likely to cause diarrhea in individuals who ingest large doses and people with sensitive guts.
The good news is that such symptoms typically resolve within a few days after an initial adjustment period.
Can Too Many Probiotics Cause Diarrhea?
Overconsumption of probiotics increases the likelihood of diarrhea. Some individuals experience strain-specific reactions. Therefore, it's vital to determine the most appropriate probiotic strains and dosing regimens based on individualized needs and tolerance levels.
Clinical Evidence and Studies
Many studies have reviewed the benefits of probiotics on diarrhea and other gastrointestinal problems, although studies examining whether or not probiotics cause diarrhea are lacking.
Review of Clinical Trials and Studies
Research reviewing the link between probiotics and diarrhea consistently shows that probiotics reduce diarrhea severity and duration — with rare exceptions.
One example is a study suggesting that Lactobacillus, Bifidobacterium, Saccharomyces, Bacillus, Enterococcus, and Clostridium probiotic strains significantly reduce the duration of acute diarrhea in children. The researchers found that Saccharomyces boulardii was the most effective probiotic for reducing diarrhea duration and the risk of diarrhea lasting two days or longer.
A review found strong evidence supporting probiotics for treating dehydration and gastroenteritis linked to antibiotic-associated diarrhea and diarrhea prevention; Lactobacillus rhamnosus and Saccharomyces boulardii were the most effective for reducing diarrhea duration.
However, some research suggests that diarrhea and other gastrointestinal problems are side effects linked to taking probiotics supplements in people with inflammatory bowel disease (IBD).
Overall, studies examining the effects of probiotics on diarrhea showed that probiotics shortened diarrhea duration by one day on average and made diarrhea go away quicker in 21 of 100 people.
Side effects of probiotics are typically minor, consisting of gas and other mild gastrointestinal issues.
Case Studies and Patient Experiences
It's uncommon to experience diarrhea from taking probiotics supplements, though some people experience irregular bowel patterns when they first begin taking such supplements. Reports of diarrhea from probiotics are rare but may develop because of a disruption in the microbiome when introducing new bacteria to the gut.
Risk Factors and Susceptible Populations
Certain factors increase the risk of probiotic-related diarrhea in susceptible populations.
Identifying High-Risk Groups
Groups of people at high risk of probiotics-related side effects include:
- Individuals with pre-existing gastrointestinal conditions
- People who are immunocompromised, including those taking immunosuppressant drugs
- Critically ill individuals
- Young children
- Infants, particularly those born prematurely
However, specific research regarding the safety of probiotics is limited, and probiotic supplements appear safe for healthy populations.
Potential risks should be considered in high-risk individuals versus the possible health benefits of probiotic supplements.
For example, cases of severe, fatal infections were reported in premature infants given probiotics. Therefore, the FDA warns about such risks in infants and other at-risk groups.
Other potentially harmful side effects in specific populations include the transfer of antibiotic resistance genes and the production of harmful substances by probiotic organisms. Fungemia (fungi in the blood) has been reported in individuals using probiotics containing a yeast called Saccharomyces cerevisiae.
Furthermore, some reports suggest several probiotic supplements contained microorganisms that were not listed on the supplement facts labels.
Monitoring and Managing Risks
Signs to watch for when beginning to take probiotics supplements include the following symptoms:
- Gas, bloating, or flatulence
- Diarrhea or other stool changes
- Nausea
- Abdominal pain
- Unpleasant taste in the mouth
- Incontinence
- Fatigue
- Cough
Seek medical advice if symptoms last more than a few days, are severe, or signs of infection develop (e.g, fever, chills).
Managing and Preventing Probiotic-Induced Diarrhea
There are several steps individuals can take to manage and prevent probiotic-induced diarrhea.
Gradual Introduction of Probiotics
To lessen the risk of developing diarrhea from probiotics, begin with a low-dose regimen and gradually increase probiotics doses over time as instructed by a healthcare provider. Track any symptoms and report them to a specialist. Researchers describe low probiotic doses as less than 10 billion colony-forming units (CFUs) and high doses as at least 10 billion CFUs.
Choosing the Right Probiotic Strain
More research is needed to determine which probiotic strains are the least likely to cause diarrhea and other symptoms. However, the National Institutes of Health suggests that Lactobacillus and Bifidobacterium species of probiotics are unlikely to cause harm to healthy individuals.
Research indicates that Lactobacillus strains are most effective for treating infectious diarrhea at doses of at least 10 billion CFUs. Saccharomyces boulardii (1 billion to 10 billion CFUs daily for 5-10 days) reduces diarrhea duration and stool frequency.
Developing personalized probiotic therapies based on an individual's medical history, risk factors, current probiotics intake, and health goals is highly beneficial.
Lactobacillus and Bifidobacterium are some of the most frequently recommended and studied probiotics.
Dietary and Lifestyle Considerations
In addition to taking probiotic supplements under the direction of a healthcare provider, there are many other ways to maximize gut health, such as diet and healthy lifestyle adjustments.
Foods often containing probiotics include:
- Kefir
- Yogurt
- Miso soup
- Kombucha
- Pickles
- Kimchi
- Sauerkraut
- Tempeh
Foods and drinks typically provide lower levels of probiotics than dietary supplements.
Other ways to support gut health include:
- Consuming prebiotics
- Staying hydrated
- Supporting electrolyte balance
- Exercising regularly
- Getting enough sleep (at least 7-8 hours per night)
- Limiting or avoiding antibiotics
- Minimizing stress
It's also helpful to avoid added sugar and highly processed foods while emphasizing whole foods.
Doctor's Perspective
Healthcare providers should use research studies and updated guidelines to determine whether their patients should take probiotic supplements.
Guidelines for Recommending Probiotics
Recommending probiotics to improve gut health is beneficial for healthy individuals not in high-risk categories. It is crucial to assess patients' medical histories and health statuses before tailoring probiotics recommendations based on their specific needs.
Addressing Patient Concerns
Educating patients about the potential side effects of probiotics is helpful. Encourage them to begin with low doses and monitor possible side effects. Provide reassurance and support, encouraging patients to follow up with any concerns or bothersome severe side effects.
Patient's Perspective
Probiotics offer numerous health advantages when used appropriately.
What Patients Need to Know
It's vital to understand that while probiotics are commonly used to reduce the severity or duration of diarrhea, consuming too much too quickly can cause short-term diarrhea and other gastrointestinal symptoms.
Using probiotics safely involves consulting with a healthcare provider, starting with low doses, and gradually increasing probiotics-rich foods or supplements in the diet over time. Report any adverse side effects to a medical provider right away.
Self-Monitoring and Reporting
It's highly beneficial to keep a symptoms diary when beginning probiotics supplements. Use the diary to self-monitor symptoms and their severity. If alarming symptoms or diarrhea persist over several days, communicate with a healthcare provider.
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Key Takeaways
- Probiotics present foods and dietary supplements offer numerous beneficial effects on gut health.
- While probiotics are often used to treat diarrhea or reduce the risk of developing it, they can also cause short-term diarrhea in sensitive individuals, at-risk groups, and people ingesting large doses too quickly.
- Probiotics often help reduce diarrhea and improve gastrointestinal health in the long term.
- It's vital to be informed about probiotic use and consult with a healthcare provider before taking such supplements to establish which strains and dosages are the most appropriate based on individualized needs.
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