Are probiotics aimed at improving gut health worth the cash?

In case you're not familiar with probiotics, they're essentially live bacteria that are thought to promote a healthy gut and bestow various other benefits, including skin, urogenital and even mental health. As is typical in our culture, any idea that has some promise spawns new products attempting to capitalize on it. This, in turn, creates a large influx of anecdotal "evidence" that can end up clouding understanding of what is actually beneficial and what is just a fad.

Here's where current research stands:

♦ There is good evidence that probiotics can reduce diarrhea due to virus, certain bacteria and antibiotic therapy;

♦ There have been some small studies, albeit with significant methodological flaws, that have shown positive results when probiotics are used for fussy babies thought to have "colic." Higher-quality follow-up studies have returned differing results — ranging from no difference compared to placebo, to beneficial for exclusively breastfed babies with colic.

When parents ask me if they should give probiotics to their children, I try to stick to the evidence. It's important to note here, though, that one issue with probiotics is a lack of consistency in what the products actually contain. The variability is particularly notable as it relates to the quantity of microbes in the given product. In the original studies that showed beneficial results, doses of five billion "colony forming units" were used. Many products contain only a million, or even fewer, CFUs, so read the labels carefully.

♦ For children having diarrhea from a virus or due to antibiotic therapy, I recommend a one- to two-week course of 5 billion CFU a day, usually split into twice-a-day dosing.

♦ If parents are trying to improve symptoms of colic, I suggest they give the child a trial over a few weeks of 5 billion CFU a day, then stop and see what they think about the intervention. If the probiotics seem beneficial, keep it up for a month or two, with the understanding that most babies have resolution of colic within a few months of onset.

♦ At this time, I do not recommend using probiotics on the off-chance they might help preventatively. Until more evidence is produced that supports the safety and benefits of probiotic supplements given daily to infants and children, I recommend parents save their money and put it toward the college fund.

Fortunately, as long as parents don't keep their homes too clean, good old-fashioned dust and dirt, the original probiotics, will provide a daily dose of good bugs for kids. Additionally, parents can expose children to beneficial microbes daily by feeding infants breast milk and/or formula containing probiotics, and providing children with yogurt, cottage cheese, kimchi, sourdough bread, pickles and dark chocolate — almost as effective as, but much tastier than dust and dirt. Bon Appetit!

Matt Thompson is a pediatrician at Spokane's Kids Clinic.

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