In past blog postings on the topic of probiotics, I have discussed the role of beneficial intestinal bacteria in maintaining health.  A normal healthy intestinal flora acts to inhibit growth of detrimental microorganisms in the intestinal tract.  The “good” bacteria that comprise the majority of a normal intestinal flora also produce substances that promote the health of the bowel.  Additionally, much of our body’s immune system exists in the intestines and there is evidence that the bacteria living in our intestines interact with our immune system, enhancing its function.

The proportion of the several hundred different species of bacteria that comprise the intestinal flora is different from one individual to another.  The specific mix of the trillions of microorganisms that compose an individual’s intestinal flora is established very early in life.  This unique, individual intestinal flora tends to be maintained throughout life.  Abnormalities in normal intestinal anatomy or function, as well as treatment with antibiotics, can sometimes result in disruption of a normal intestinal flora.  With this disruption of the flora, it is possible that a less beneficial and sometimes even harmful, bacterial population may inhabit the bowel.  The impact upon the intestinal flora, following a course of antibiotics, is usually temporary.  However, with anatomical or functional impairments of the intestines, the establishment of an unhealthy intestinal flora can be longstanding.

Probiotic supplements containing billions of live bacteria in each dose are used in an attempt to reestablish a healthy intestinal flora.  Taking probiotics once or more per day, may result in a beneficial change in the type of bacteria that inhabit the intestine.  Following antibiotic therapy, probiotics may speed the return to the normal intestinal flora.  Probiotic supplementation could then be discontinued.  In the cases of abnormal intestinal anatomy or function, probiotic therapy, when successful, will likely need to be ongoing.  Stopping probiotic therapy, in this case, would be likely to result in the intestinal flora reverting back to the less healthy makeup in a short period of time.

Therefore, for the home TPN consumer who is considering a trial of probiotics for issues not related to antibiotic therapy, long-term supplementation should be anticipated, to maintain any benefits experienced from this therapy.  While probiotics are generally regarded as safe, you should always discuss any plans to start probiotics with your healthcare providers.  There are some medical conditions in which some or all probiotic formulations should be avoided.  Some alterations in intestinal anatomy, such as lack of a colon, may result in probiotics providing no benefit.

There are a multitude of probiotic products on the market, with varying types and numbers of microorganisms between different products.  The differences between various products could make a significant difference in their potential effectiveness from one person to another, but studies in this regard are quite limited.  It is also important to realize that these products are classified as food supplements.  As such, they are not subjected to the same scrutiny as drugs.

As we further examine the use of probiotics, I will expand my discussion on who may benefit from their use.  We will also consider factors that may distinguish one product from another in terms of selection and cost.