Limited evidence exists to support the use of Probiotics for the treatment of irritable bowel syndrome, other than to
control symptoms of diarrhea in some cases. Evidence is stronger to support the use of probiotic supplementation
for ulcerative colitis and Crohn’s disease. In a study of 120 ulcerative colitis patients, comparable results were
seen in relapse of the disease in patients receiving probiotic supplementation as compared to those taking the anti-
inflammatory drug, mesalamine. A second study involving 116 ulcerative colitis patients revealed similar findings.
As noted above, patients with pouchitis have also experienced benefit from the use of Probiotics, with respect to a
reduction in inflammation and pain. In general, the positive effects upon immune function and the suppression of
the inflammatory process are likely the ways in which Probiotics reduce relapse of inflammatory bowel disease and
help to effectively manage pouchitis and related inflammatory conditions of intestinal tract.5,6,11
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Dosage Range
1. Concurrent or Post Antibiotic Therapy: 15-20 billion living organisms per day8,9
2. Fibrocystic Breast Disease and Premenstrual Syndrome: 5-10 billion living organisms per day7
3. Gastroenteritis, (Prevention of Traveler’s Diarrhea), Ulcerative Colitis, Crohn’s Disease: 10 billion living
organism per day.12
Adverse Side Effects and Toxicity
Amounts exceeding 10 billion living organisms per day may lead to mild gastrointestinal disturbances. Probiotics
are extremely safe with no toxicity reported at the above recommended doses. Some probiotic preparations
contain the yeast organism Saccharomyces boulardii. In patients with compromised immune status, this organism
has produced severe, invasive fungal infections. In otherwise healthy individuals this yeast has been shown to
work synergistically with other Probiotics, producing positive health outcomes.6,13
Drug-Nutrient Interactions
L. acidophilus and B. bifidum are negatively af ected by alcohol and antibiotics.14 They may also interfere with the
metabolism of sulfasalazine, chloramphenicol palmitate, and phthalylsulfathiazole, especially L. acidophilus.15
Author’s Note on Quality Assurance
Unlike other types of supplements that can have their potencies confirmed by third party analytic methods, when
purchasing a probiotic supplement it is impossible to know the true potency of the product. This is due to the fact that
many variables can af ect the number of live bacteria that exist within the capsules at any given time. As a rule,
Probiotic supplements should be refrigerated from the time they are encapsulated until the time they are purchased by
the end user in order to slow down the division rate (germination rate) of the bacteria, as bacteria can only multiply a
fixed number of times before death of the bacteria occurs. Unfortunately, most probiotic supplements are not
refrigerated during shipping and transportation to distribution centers and on route to retail outlets, or during direct
shipment to consumers (e.g. Internet sales, catalog sales, shipped directly to the consumer’s home by mail or courier).
Thus, it is thought that a large number of probiotic products sold in the market place contain no live bacterial cultures
or a minimal concentration, by the time consumers begin using them. Bacterial germination is also much faster during
the summer time and in warmer climates, as heat is a factor that increases the cell division rate of these bacteria. As
such, the expiry date should be shortened in the summer and in warm weather areas. As a rule of thumb, it is
probably best to use a probiotic within the first three months of its encapsulation, and to purchase only refrigerated
products, and then to refrigerate the product within one’s home as soon after the purchase as possible. Keep in mind
that the use of prebiotics may be considered as a substitute for Probiotics. Prebiotic supplements can have their
potency verified through third party analysis, and do not lose their potency over time in the fashion as do Probiotics
(see Prebiotics in this document).
Finally, the first method of delivery, and likely the most effective delivery of Probiotics is through the intake of foods
that contain live bacterial cultures, such as yogurt and other soured dairy products. (see the Am J Clin Nutr 2001,
volume 73, supplement 2 edition, for more details on probiotic quality).
N.B. A 1990 study showed that most Probiotic supplements purchased in retail outlets contained no living bacteria at
the time of purchase. Thus Prebiotic supplementation and soured dairy products may be a preferred method by which
to modify the gut micro-flora.1
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1. AUTHOR. Human Intestinal Microflora. In: Health and Disease. Hentges DJ editor. New York, NY: Academic Press; 1983.
2. Schrezenmeir J, de Vrese M. Probiotics, prebiotics, and synbiotics-approaching a definition. Am J Clin Nutr 2001;73(Suppl 2):361S-4S.
3. Shahani KM, Ayebo AD. Role of dietary lactobacilli in gastrointestinal microecology. Am J Clin Nutr 1980;33:2448-57.
4. Shahani KM, Friend BA. Nutritional and therapeutic aspects of lactobacilli. J Appl Nutr 1984;36:125-52.
5. Isolauri E, et al. Probiotics : effects on immunity. Am J Clin Nutr 2001;73(Suppl 2):444S-50S.
6. Duggan C, Gannon J, Walker WA. Protective nutrients and functional foods for the gastrointestinal tract. Am J Clin Nutr 2001;75:789-