Can Probiotics and Prebiotics Help You?

Two months ago, Sally was diagnosed with a bladder infection. When the first antibiotic didn’t fix the problem, her doctor gave her a different one. Within 3 days of starting the second antibiotic, she developed diarrhea. After a week of misery, she called, asking for help.

"I'm trapped in my own home," she wailed. “I can’t walk past my bathroom without having to go.”

I suggested she start taking a probiotic, and she called back a week later to report that her bowels were back to normal.

Probiotics are “friendly” microorganisms that live in our intestines and vagina. They include more than 400 separate bacteria, yeast, and parasites strains that help us absorb nutrients and metabolize our food.

Probiotics have another important job: they discourage the growth of “unfriendly” bacteria and other organisms that can make us sick. Probiotics can “crowd out” other organisms by using up available space and nutrients.

Some probiotics secrete antibacterial compounds like hydrogen peroxide, lactic acid, or acetic acid.

Sally’s second antibiotic killed off the bacteria responsible for her infection but attacked her “good” intestinal bacteria as well. Eliminating her “friendly” bacteria left room for some “bad” bacteria to multiply and cause a condition called antibiotic-associated diarrhea.

Taking probiotics can decrease the risk of antibiotic-associated diarrhea by over 50%. Unfortunately, it isn't clear how protective they are against a common cause of antibiotic-associated diarrhea, a bacteria called Clostridium difficile or C. diff.  

The 3 most common probiotics shown to help keep our intestines in balance are Lactobacillus, Bifidobacteria, and a fungus called Saccharomyces.

Lactobacillus makes lactic acid, which increases the acidity of vaginal tissue. This helps protect you from both bacterial and yeast vaginal infections. The bacteria Gardnerella is an organism that typically lives in your vagina.

Some antibiotics can disrupt that balance and allow the overgrowth of certain bacteria, causing inflammation and an infection called bacterial vaginosis. Along with lactic acid, Lactobacillus secretes hydrogen peroxide, which is deadly to Gardnerella bacteria, helping to prevent bacterial vaginosis.  

The fungus Saccharomyces, available as Florastor®, has been shown to help prevent antibiotic-associated diarrhea. There is also evidence that taking both Lactobacillus and Bifidobacteria bacteria is more effective at treating antibiotic-associated diarrhea than either organism by itself.

Lactobacillus has more than one strain. Some strains are good at adhering to the lining of your intestine. In contrast, others can overcome or push out "bad bacteria" that already have established themselves. One of the best ones for adhering to your gut lining is Lactobacillus GG, available as the product Culturelle®.

There is now a lot of interest in using prebiotics instead of probiotics to help your intestines and vaginal tissue stay healthy. Prebiotics are different than probiotics because probiotics are actually living organisms, while prebiotics are carbohydrates. Prebiotics work as support staff to your probiotics, feeding them and encouraging their growth by the way they change your intestinal environment.

Prebiotics work like “Miracle Grow®” to help certain bacteria and fungi grow and multiply. They are less expensive than probiotics because they don’t have to be protected from excess heat and preservatives.
6 Tips for Maintaining a Healthy Intestinal Environment:

1.  Eat live yogurt.
 Eating yogurt with live cultures can be an excellent way to get Lactobacillus into your intestine. Beware: most commercial yogurt brands are processed and do NOT contain live bacteria. Check the label.

2.  Avoid acid-blocking medicines.
Stomach acid is an effective defense against the overgrowth of unfriendly bacteria in your intestine. Powerful acid-blocking medicines like omeprazole (Prilosec®), lansoprazole (Prevacid®), and pantoprazole (Protonix®) tame heartburn by decreasing the amount of acid that is pumped into your stomach. Unfortunately, the decrease in stomach acid puts you at an increased risk of getting antibiotic-associated diarrhea.

3.  Choose probiotics containing more than one organism.
There is good evidence that taking both Lactobacillus and Bifidobacteria bacteria together to treat antibiotic-associated diarrhea works better than either organism by itself.

4. Store probiotics properly.
Probiotics are living organisms and need controlled conditions to stay viable. Whether at room temperature or in the refrigerator, be sure to observe any storage recommendations and avoid extreme heat like in a parked car in the summer on the way home from the store.

5. Try fermented foods.
Fermented foods are some of the best and least expensive prebiotics. If you like sauerkraut or kimchee, eating it regularly can help support a healthy balance of intestinal bacteria.

6. Time your probiotics for maximum effectiveness.
Start taking probiotics within 2-3 days of beginning an antibiotic, and continue for at least 3 days afterward.

Dr. Louise Achey, Doctor of Pharmacy, is a 42-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com. ®2021 Louise Achey