Can a daily supplement treat IBS, diarrhea, and yeast infections?

By Kristina Herndon, RN 

 Medically reviewed by Allison Herries, RDN

Probiotics are live bacteria and yeast in foods, supplements, and other products that are meant to increase the healthy "flora" in or on the body. These naturally occurring microorganisms are considered "good" in that they keep "bad" bacteria and fungi in check.

Probiotics have been studied for their possible benefits in treating and preventing gastrointestinal conditions like irritable bowel syndrome (IBS) and gastroenteritis. They may even promote vaginal health by preventing the overgrowth of microbes that cause yeast infections and bacterial vaginosis.

Probiotics are found in yogurt and fermented foods but can also be purchased as dietary supplements, skin care products, and vaginal suppositories.

The most common types of probiotics sold in the United States are Lactobacillus and Bifidobacterium.1 The increasing popularity of these products has led to misconceptions about what they can and cannot do and whether they can deliver the promised results.

This article discusses probiotic benefits for digestive and reproductive health. It also details the side effects of probiotics.

Health Benefits of Probiotics

A lot of research has been devoted to evaluating the benefits of probiotics, most especially in the area of digestive health. While some of the results have been positive, other long-held health claims have been unsupported by research.

The American Gastroenterology Association (AGA) released clinical practice guidelines specifically addressing the use of probiotics in managing digestive health disorders. The guidelines were developed based on a review of available research and are intended to provide healthcare providers with evidence-based guidance about the appropriate use of specific probiotics.2

Here are some of the key findings from the research on probiotics and the AGA's guidelines:

Irritable Bowel Syndrome

The role of gut microflora in the development of irritable bowel syndrome is well established. As such, the body of research into the potential for probiotics in helping alleviate symptoms of IBS continues to grow. Several studies have found that probiotics can have a positive effect on the severity of common IBS symptoms—including abdominal pain and diarrhea.3

Although clinical research has been encouraging, it hasn't been enough to garner an official endorsement from most gastroenterologists. The AGA guidelines do not recommend the use of probiotics in children and adults with IBS except in the context of a clinical trial.2

Antibiotic-Associated Diarrhea

Other studies have focused on whether probiotics can play a role in preventing diarrhea caused by antibiotic use. Since antibiotics can kill both "good" and "bad" bacteria, the hope has been that probiotic supplements could help restore the digestive flora back to its normal state.

A 2018 review of studies from China concluded that probiotics can reduce the risk of diarrhea by 50% to 60% if taken with antibiotics, particularly the probiotics Saccharomyces boulardii and Lactobacillus rhamnosus GG.

The AGA guidelines recommend certain probiotic strains for adults and children on antibiotic treatment and other probiotics for the prevention of Clostridioides difficile (C. difficile or C. diff) infection. Of note, the AGA tempers this recommendation by saying people with severe illnesses, an aversion to the cost, or a low concern for C. difficile development, can reasonably choose not take probiotics at all.2

The specific strains the AGA recommends for adults and children taking antibiotics include S. boulardii; or the 2-strain combination of L. acidophilus CL1285 and L. casei LBC80R; or the 3-strain combination of L. acidophilus, L. delbrueckii subsp. bulgaricus, and B. bifidum; or the 4-strain combination of L. acidophilus, L. delbrueckii subsp. bulgaricus, B. bifidum, and S. salivarius subsp. thermophilus.2

Vaginal Infections

The use of probiotics in treating common vaginal infections, like bacterial vaginosis and vaginal candidiasis (yeast infection), remains controversial with some studies showing benefits and others not.

A 2014 review in the Journal of Lower Genitourinary Tract Disease would only go so far as to say that oral probiotics taken daily may prevent the recurrence of bacterial vaginosis but would unlikely offer much in the way of treatment.4

Of the oral supplements reviewed, Lactobacillus acidophilus, Lactobacillus rhamnosus GR-1, and Lactobacillus fermentum RC-14 were considered the most beneficial.

By contrast, the oral or vaginal use of probiotics has not yielded positive results in treating yeast infections, according to a 2006 review in the Journal of Antimicrobial Chemotherapy.5

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD), which consists of ulcerative colitis and Crohn's disease, is characterized by persistent gastrointestinal symptoms, including abdominal pain, bloating, blood in stool, flatulence, diarrhea, nausea, and vomiting.

Interestingly, while much of the current evidence suggests that probiotics may prevent the recurrence of ulcerative colitis, the same was not seen with Crohn's disease. Moreover, the benefits were attributed to specific probiotic strains or combinations of strains.6

In 2011, VSL#3 (a high-potency combination probiotic) and the probiotic Escherichia coli Nissle 1017 were both given an A rating at the 3rd Yale Workshop on Probiotics based on strong evidence that they sustained remission of ulcerative colitis.

By contrast, a 2009 Cochrane review, which evaluated 23 different randomized controlled studies, found that probiotics were no more effective in preventing or treating Crohn's disease than a placebo.7

Possible Side Effects of Probiotics

Probiotic supplements are considered safe and well tolerated if taken as directed.1 Side effects of probiotics may include bloating and gas. Taking a yeast-based probiotic can sometimes cause constipation or increased thirst. Most of these side effects are mild and tend to improve once your body adapts to treatment.

Probiotics may contain allergens that can affect people with an egg or soy allergy. People with a yeast allergy would need to avoid yeast-based probiotics.

There are no documented drug interactions associated with probiotic supplements. With that said, speak with your healthcare provider before taking a probiotic if you are on antibiotics or antifungal medications. Taking these together can negatively alter your digestive or vaginal flora.

Probiotic Dosage and Preparation

Because there are many different probiotic strains and formulations, there is no set dosage. The recommended dosage will depend on the specific product. Factors like age, weight, and general health may also influence how much or little you need.

As a general rule, a probiotic should provide at least 1 billion colony forming units (CFU) per day, with dosages ranging from 1 billion to 10 billion for adults. If used in children, less than 1 billion CFU would be prescribed. Probiotic supplements are generally taken on a daily basis, ideally up to 30 minutes before a meal.8

Probiotic suppositories tend to have higher CFUs as they are meant for short-term use only. Generally speaking, suppositories should be used for no more than seven consecutive days.

What to Look For

In the United States, probiotics are classified as dietary supplements. Under this classification, the products are not strictly regulated and they can be sold without support from clinical research. With that being said, the Food and Drug Administration (FDA) forbids manufacturers from making any claims that the products can cure, treat, or prevent any disease or health condition.

To ensure quality and safety, only buy supplements that have been tested and certified by an independent certifying body like the U.S. Pharmacopeia, ConsumerLab, or NSF International. This helps ensure that products contain the ingredients and dosages they claim.

When used as a food ingredient, probiotics fall under the FDA umbrella category "GRAS," meaning they are "generally regarded as safe." 

Sources

National Center for Complementary and Integrative Health. Probiotics: what you need to know.

Su G, Ko C, Bercik, P, ET al. AGA clinical practice guidelines on the role of probiotics in the management of gastrointestinal disorders. Gastroenterology. June 9 2020. doi:10.1053/j.gastro.2020.05.059

Didari T, Mozaffari S, Nikfar S, Abdollahi M. Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World J Gastroenterol. 2015;21(10):3072-3084. doi:10.3748/wjg.v21.i10.3072

Homayouni A, Bastani P, Somayeh Z, et al. Effects of probiotics on the recurrence of bacterial vaginosis: A review. Low Genit Tract Dis. 2014 Jan;18(1):79-86. doi:10.1097/LGT.0b013e31829156ec

Falagas ME, Betsi GI, Athanasiou S. Probiotics for prevention of recurrent vulvovaginal candidiasis: a review. J Antimicrob Chemother. 2006;58(2):266-72. doi:10.1093/jac/dkl246

Floch MH, Walker WA, Madsen K, et al. Recommendations for probiotic use-2011 update. J Clin Gastroenterol. 2011;45 Suppl:S168-71. doi:10.1097/MCG.0b013e318230928b

Doherty G, Bennett G, Patil S, Cheifetz A, Moss AC. Interventions for prevention of post-operative recurrence of Crohn's disease. Cochrane Database Syst Rev. 2009;(4):CD006873.doi:10.1002/14651858.CD006873.pub2

Tompkins TA, Mainville I, Arcand Y. The impact of meals on a probiotic during transit through a model of the human upper gastrointestinal tract. Benef Microbes. 2011 Dec 1;2(4):295-303. doi: 10.3920/BM2011.0022

Tomasz B, Zoran S, Jarosław W, et al. Long-term use of probiotics Lactobacillus and Bifidobacterium has a prophylactic effect on the occurrence and severity of pouchitis: a randomized prospective study. Biomed Res Int. 2014;2014:208064. doi:10.1155/2014/208064

Updates and future direction on medical uses for probiotics. Primary Care Reports. December 1, 2014.

Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2010;2010(11):CD003048. doi:10.1002/14651858.CD003048.pub3

Choi CH, Jo SY, Park HJ, Chang SK, Byeon JS, Myung SJ. A randomized, double-blind, placebo-controlled multicenter trial of saccharomyces boulardii in irritable bowel syndrome: effect on quality of life. J Clin Gastroenterol. 2011;45(8):679-83. doi:10.1097/MCG.0b013e318204593e

Additional Reading

Cai, J.; Zhao, C.; Du, Y. et al. Comparative efficacy and tolerability of probiotics for antibiotic-associated diarrhea: Systematic review with network meta-analysis. United European Gastroenterol J. 2018 Mar; 6(2): 169-80. DOI: 10.1177/2050640617736987.

By Kristina Herndon, RN
Kristina Herndon, BSN, RN, CPN, has been working in healthcare since 2002. She specializes in pediatrics and disease and infection prevention.