Do probiotics give you diarrhea
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Do Probiotics Cause Diarrhea?
Introduction to Probiotics and Diarrhea
Probiotics are live microorganisms that, when administered in adequate amounts, confer health benefits to the host. They are often used to restore gut flora balance, especially after antibiotic use, and have been studied extensively for their effects on various types of diarrhea. However, there is a common concern about whether probiotics themselves can cause diarrhea.
Probiotics and Antibiotic-Associated Diarrhea (AAD)
Prevention of AAD in Adults and Children
Several studies have shown that probiotics can effectively prevent antibiotic-associated diarrhea (AAD). A systematic review and meta-analysis of 17 randomized controlled trials (RCTs) involving 3,631 participants found that probiotics significantly reduced the incidence of AAD from 17.7% in the control group to 8.0% in the probiotic group9. Another review focusing on pediatric populations reported similar findings, with probiotics reducing the incidence of AAD from 19% to 8%2. These studies suggest that probiotics are beneficial in preventing AAD rather than causing it.
Specific Strains and Dosages
The effectiveness of probiotics in preventing AAD appears to be strain-specific. Lactobacillus rhamnosus GG and Saccharomyces boulardii are among the most studied strains and have shown significant benefits4 9. High doses of probiotics (≥ 5 billion CFUs per day) were found to be more effective than lower doses2.
Probiotics and Clostridium difficile-Associated Diarrhea (CDAD)
Efficacy in Preventing CDAD
Probiotics have also been studied for their role in preventing Clostridium difficile-associated diarrhea (CDAD). A meta-analysis of 26 RCTs involving 7,957 patients found that probiotics reduced the risk of developing CDAD by 60.5%10. Another systematic review confirmed these findings, showing a 60% reduction in the incidence of CDAD among patients taking probiotics1. These results indicate that probiotics are effective in preventing CDAD, further supporting their role in reducing, rather than causing, diarrhea.
Probiotics and Acute Infectious Diarrhea
Reduction in Duration and Severity
Probiotics have been shown to reduce the duration and severity of acute infectious diarrhea. A review of 63 studies involving 8,014 participants found that probiotics reduced the mean duration of diarrhea by approximately 24 hours and decreased stool frequency5. Another study focusing on children with acute diarrhea reported that probiotics, specifically Lactobacillus casei, improved clinical symptoms and reduced inflammatory markers6. These findings suggest that probiotics can be beneficial in managing acute infectious diarrhea.
Safety and Adverse Events
General Safety Profile
The safety of probiotics has been extensively studied, and most research indicates that they are generally safe for use. A meta-analysis of 10 trials reported no significant differences in adverse events between the probiotic and control groups9. Common adverse events, such as abdominal cramping, nausea, and flatulence, were reported but were more frequent in control groups than in those taking probiotics1.
Specific Populations
While probiotics are generally safe, caution is advised for certain populations, such as immunocompromised individuals or those with severe underlying health conditions. Some studies have reported serious adverse events in these groups, although these are rare2 4.
Conclusion
The evidence overwhelmingly suggests that probiotics do not cause diarrhea. Instead, they are effective in preventing and managing various types of diarrhea, including antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea. Probiotics also reduce the duration and severity of acute infectious diarrhea. While generally safe, probiotics should be used cautiously in immunocompromised individuals. Overall, probiotics are a beneficial adjunct to traditional treatments for diarrhea.
Sources and full results
Most relevant research papers on this topic
Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children.
Probiotics show potential in preventing Clostridium difficile-associated diarrhea in adults and children, but more research is needed to confirm their effectiveness and safety.
Meta-Analysis
Very Rigorous Journal
Highly CitedProbiotics for the prevention of pediatric antibiotic-associated diarrhea.
Probiotics effectively reduce the incidence of antibiotic-associated diarrhea in children compared to placebo or no treatment control.
Meta-AnalysisVery Rigorous JournalProbiotics and prebiotics: effects on diarrhea.
Probiotics show potential in preventing and treating various types of diarrhea, but large-scale, long-term studies are needed to confirm their long-term effectiveness.
Highly CitedProbiotics and antibiotic-associated diarrhea in children: A review and new evidence on Lactobacillus rhamnosus GG during and after antibiotic treatment.
Probiotics, specifically Lactobacillus Rhamnosus GG and Saccharomyces boulardii, show potential in preventing and treating antibiotic-associated diarrhea in children, but safety concerns remain.
Systematic Review
Rigorous JournalHighly CitedProbiotics for treating acute infectious diarrhoea
Probiotics, when used alongside rehydration therapy, appear to be safe and have clear beneficial effects in shortening the duration and reducing stool frequency in acute infectious diarrhoea.
Meta-AnalysisVery Rigorous JournalHighly CitedProbiotic Lactobacillus casei: Effective for Managing Childhood Diarrhea by Altering Gut Microbiota and Attenuating Fecal Inflammatory Markers
Probiotic Lactobacillus casei may help reduce clinical severity and intestinal inflammation in children with acute diarrhea by altering gut microbiota and reducing fecal inflammatory markers.
RCTVery Rigorous JournalHighly CitedLimitations of Probiotic Therapy in Acute, Severe Dehydrating Diarrhea
Probiotics show limited benefits in treating short-duration diarrheal illnesses like viral enteritis, with their benefits likely being limited to prophylactic usage in high-risk populations.
RCTHighly CitedProbiotics for treating infectious diarrhoea.
Probiotics may be a useful adjunct to rehydration therapy in treating acute, infectious diarrhoea in adults and children.
Meta-AnalysisHighly CitedProbiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis
Probiotics may help prevent antibiotic-associated diarrhea in outpatients and appear to be safe.
Meta-AnalysisHighly CitedProbiotics are effective at preventing Clostridium difficile-associated diarrhea: a systematic review and meta-analysis
Probiotic supplementation significantly reduces the risk of developing Clostridium difficile-associated diarrhea in patients receiving antibiotics.
Meta-AnalysisHighly Cited