Probiotics: Know the factsAs the use of probiotics gains popularity among consumers, experts suggest healthcare providers be aware of associated health benefits and risks
By Matt Gunn
News Editor/Writer
Probiotics - the concept of "friendly" bacteria or live microorganisms that can prevent and treat illness - is growing in popularity among some consumers. But to consume or administer probiotics is a decision best taken with a grain of salt.
As for medical use of probiotics, some research has been conducted to test the validity of using these microorganisms to treat and prevent antibiotic-associated diarrhea, Clostridium difficile, pouchitis and several other conditions. However, probiotics can also carry some potential for infection among immunocompromised patients or those with severe underlying illness, explained David P. Calfee, MD, MS, an assistant professor of medicine, hospital epidemiologist and infection control officer for Mount Sinai School of Medicine in New York.
Because these live microorganisms are increasingly being used medicinally, Calfee suggests health care providers learn more about probiotics to have a better understanding of what their patients may be consuming.
"I think people - at least health care workers - may not have a clear understanding of probiotics," Calfee added, noting that as recently as 15 years ago when he was in medical school, there was no mention of probiotics in the curriculum.
Probiotics in healthcare
As it stands, there is limited research available on the benefits or potential risks of probiotics. This lack of research is an important concern when considering how probiotic use may affect immunocompromised or critical patients-a population where extensive probiotic research has not been done, cautioned Calfee.
While there are only a small number of immunocompromised patients that have been affected by probiotics, cases certainly have been reported, Calfee said. "We just want to make sure that people are aware of the potential risks along with the potential advantages of these products."
For example, consider a situation where a patient who regularly takes probiotic supplements wishes to do so in a hospital. Then factor in the idea that the patient might not be able to consume the supplement orally, or wishes to break a capsule and mix it with something else, Calfee suggested.
"Probiotic supplements are live bacteria or fungi, made of millions of microorganisms. In a hospital, where there are at-risk patients, there could be potential for infection through the introduction of these microorganisms into the air. When considering how probiotics may affect patients in a healthcare setting, you have to think about the population in the area, not just the person who is taking the probiotic supplements," Calfee acknowledged.
While cautioning against possible risks associated with probiotics, Calfee also noted the possible benefits of probiotics to control an infection or other conditions, though he added it is important to understand what specific strains of live organisms have shown a positive effect.
A closer look
As a concept probiotics is vast because many so many different strains of live organisms can be considered a probiotic. For each of the numerous strains of a single microorganism, there could be a different effect on humans.
"At the end of the day, if you don't have a demonstrated effect on humans, then it's not a probiotic and you can't recommend it," said Mary Ellen Sanders, PhD, a probiotic microbiologist, consultant and owner of Dairy & Food Culture Technologies.
In her reference guide to probiotics, Sanders cautions against the use of probiotics among immunocompromised patients or patients with severe underlying illness. This reference guide is included in her Web site, which she and a colleague created to disseminate more accurate information on probiotics than is often marketed by supplement companies.
"Our hope was to get out science-based information on probiotics because there is a lot of bad information out there," Sanders said. "What we don't have in the probiotic industry is any third-party verification," she said. "Strictly speaking, the supplement market is not regulated-the problem is, like many things in a bottle, a consumer can't tell if it's good or not."
Even though a number of recent clinical studies have sought to identify species and strains of bacteria that can potentially reduce infections or offer users other health benefits, there is no formal training among many practicing clinicians in how to use them, Sanders explained. "Because probiotics are classified as nutritional supplements, it can become difficult to connect specific strains known for health benefits to products that are sometimes marketed by other names," she added.
Sanders recommended that patients and health care providers investigate a product or supplement before using it, selecting only those products that can be tied to tangible clinical research. Her Web site lists several consumer products that use proven, identifiable bacteria.
"Probiotics have become very popular and many patients who are having surgery are taking them," said Joan Blanchard, RN, MSS, CNOR, CIC, a perioperative nurse specialist in AORN's Center for Nursing Practice. "It's important to ask patients during their pre-operative phone call or pre-operative visit if they are taking probiotics. Probiotics may affect the course of the patients post-operative recovery."
Read more perioperative news from AORN Connections.