New resource for gastroenterologists on using probiotics and prebiotics in clinical practice

Scientific evidence, not popular ideas, should drive probiotic and prebiotic recommendations in clinical settings. Globally, evidence is continually emerging on how probiotics and prebiotics can be effectively used in patient care but health care professionals often struggle to find out where the evidence stands for a particular condition.

The World Gastroenterology Organization (WGO) recently published an updated guideline document, aimed at helping gastroenterologists and other physicians understand appropriate clinical applications for probiotics or prebiotics. The guideline was created with contributions from experts in gastroenterology, probiotics, and prebiotics, with the efforts co-led by experts from the International Scientific Association for Probiotics and Prebiotics (ISAPP).

To create the guideline, the experts comprehensively evaluated the evidence from randomized, controlled trials on gastrointestinal conditions, including which strain or specific prebiotic substance showed a positive effect. The guideline features a list of conditions that have positive evidence for the efficacy of probiotics and/or prebiotics.

A condition was included in the list if at least one randomized, controlled trial demonstrated a beneficial effect. The guideline also includes the level of evidence supporting benefits in each condition, based on a classification from Oxford Centre for Evidence-Based Medicine.

The conditions for which probiotics / prebiotics show benefit include some well-known ones: diarrheal conditions, irritable bowel syndrome, inflammatory bowel disease and lactose maldigestion. For infants, infantile colic and necrotizing enterocolitis are included in the list. Yet positive evidence also exists for some conditions that are not often associated with probiotic / prebiotic benefits: insulin resistance, non-alcoholic fatty liver disease, H. pylori infection, and even general health-related quality of life.

The evidence summarized in the guideline reinforces the notion that not all probiotics are equal and that positive results in trials depend on which probiotics or prebiotic substances are being tested, and at what dose.

Five weeks ago this coming Tuesday I was scheduled for a ureteroplasty - basically a graft of skin from my cheek over some scar tissue in the left ureter.

After a pyelogram, and a second one to confirm the first plus a couple of other tests, the surgeon declined to perform the graft. Seems my scar tissue was gone.

This is pretty rare. Not unheard of; the surgeon estimated it was a 1 in 100 probability.

I had made just one notable lifestyle change in the months prior. Over the holidays I started drinking kombucha, the fermented tea. I was prompted by reading a 2021 study called “FeFiFo” by a couple of guys from Stanford, including the guy who runs the “Sonnenburg Lab”.

Amongst the fermented foods docs recommended to the “Fe” group was kombucha. I decided to give it a try. Found out I generally liked the stuff. I immediately picked out the “GT’s” brand and their bottles tout the amount of probiotics and its a much larger number than other brands.

I drink a bottle of the stuff each day.

I know its a longshot, but the kombucha may have enhanced my body’s ability to deal with the uretral scar tissue.

There are other, more immediate salutary effects I’ve enjoyed. But if it helped with that scar tissue it likely saved my life.

See, during that almost-procedure I also got a bag & line change on my nephrostomy. It’s a prep stage for the graft. During this work I contracted sepsis. Wasn’t until I got out of the hospital - 4 weeks ago Tuesday - that I fully comprehended just how close I came to dying.

Had that graft been performed the ensuing sepsis would have been MUCH worse. It’s highly unlikely I would have survived.

It might not have made a difference, but I’m going to drink 16oz of kombucha every day for the rest of my life.

To save on cost I’m gonna start making it myself.

Anyway, that’s my story. Happy to see this article posted.

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