COMMENTARY

Probiotics for Diarrhea: Are 'Bug-Drugs' the Answer?

David A. Johnson, MD

Disclosures

September 20, 2013

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Probiotics -- All the Rage

Hello. I am Dr. David Johnson, Professor of Medicine and Chief of Gastroenterology at Eastern Virginia Medical School. Probiotics: They are the rage, but are they justified? There has been a tremendous interest in the whole gut ecology and microecology, recognizing that many (if not all) diseases have some inferential relation to the gut microflora. Alterations in the gut microflora may be the rationale for diseases from obesity to diabetes.

As we try to change the microflora, there has been tremendous interest in the ingestion of organisms that can shift the microflora. We do many things to change the gut microflora. We give people antibiotics. We eat meat, and we do other things that change the normal gut microflora. The World Health Organization categorizes probiotics as volitionally ingesting an organism to promote the health of the host. The idea of ingesting live organisms certainly seems somewhat paradoxical, but it has generated a tremendous amount of interest not only in the scientific literature but also in the lay literature. There have been a number of promotional campaigns about probiotics.

In fact, in the United States, sales of probiotics and related foods have increased about 80% from 2010 to 2012 and are approaching a $1 billion-a-year industry. Worldwide, this is increasing to a $2.5 billion-a-year industry. There is a tremendous amount of interest in probiotics. Patients seem to like them because the idea of ingesting something to change their health with a pill makes sense. They don't often consult their physicians.

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