Probiotics for diarrhea

What is diarrhea?

The WHO defines diarrhea as the passage of loose or liquid stools three or more times a day. If stools are frequent but formed, it is not considered diarrhea.

Diarrhea may be accompanied by fever or vomiting and usually does not last more than 7 days. It is usually a symptom of an infection of the digestive system caused by bacterial microorganisms, viruses or parasites.

According to WHO, diarrheal diseases are the second leading cause of death in children under five years of age. They are preventable and treatable diseases. Annually, 525,000 children under 5 die from diarrhea, hence the importance of having therapies such as probiotics for diarrhea.

Causes and symptoms of acute diarrhea

Acute diarrhea is a common health problem in both children and adults and its causes may be diverse. Although in many cases the exact cause cannot be identified, it is known that microorganisms are largely responsible. Viruses are the most common cause of acute diarrhea in adults, followed by bacteria and parasites.

Microorganisms causing diarrhea

Microorganisms, such as viruses, bacteria and parasites, can trigger episodes of acute diarrhea in adults.

Viruses, in particular, are the most frequent cause of diarrhea. Examples of viruses that can cause diarrhea include rotavirus, norovirus and adenovirus.

But if we talk about bacteria, among the species most commonly responsible for acute diarrhea are Escherichia coli, and bacteria of the Salmonella and Campylobacter genera, while some parasites such as Giardia lamblia can also be the cause.

Common symptoms of acute diarrhea

Symptoms of acute diarrhea may vary from person to person, but some of the most common are:

• Frequent bowel movements
• Liquid evacuations
• Abdominal pain
• Swelling
• General feeling of malaise.

In addition, it is possible to experience nausea, vomiting and fever in some cases.

These symptoms usually last from one to three days, but in some cases may be prolonged.

Treatment of Diarrhea with Probiotics

Diarrhea causes high dehydration and loss of mineral salts and electrolytes, so the basic treatment for diarrhea consists of rehydrating the body. Although this treatment will restore the body's water balance, it will not reduce the duration of diarrhea or improve stool consistency.

To achieve the latter, we can add probiotics to the rehydration treatment and thus make the duration of diarrhea shorter and the stool less and less liquid and with greater consistency.

Mechanism of action of probiotics

The mechanism of action of probiotics is to help restore the intestinal microbiota (formerly known as intestinal flora) that the body has naturally and prevent the presence of pathogenic microorganisms by creating a hostile environment for them.

This hostile environment is achieved through a process of competition, where the good bacteria prevent the presence of the so-called bad bacteria, a reduction in pH, the synthesis of antimicrobial substances and a stimulation of the body's immune system.

In this way, the natural balance of the microbiota ( bacterial flora) is restored and intestinal permeability is reduced. Probiotics also help to reduce inflammation and reduce the symptoms of diarrhea and improve digestive well-being.

In recent years, numerous studies, reviews and meta-analyses have been published demonstrating the efficacy of probiotics in the treatment of acute diarrhea, being in fact one of the pathologies with the greatest use of probiotics.

Beneficial effects in the treatment of diarrhea with probiotics

Generally, the beneficial effects of probiotics on diarrhea are manifested by a reduction of its duration by at least one day and a decrease in the number of stools on the second day.

In addition, with the administration of probiotics, in most cases, diarrhea has a total duration of less than 4 days.

It should be taken into account that the positive effect exerted by probiotics in the treatment of diarrhea depends not only on the probiotic species but also on the strain used, something that is often forgotten.

Moreover, this effect is directly related to the dose administered, being more effective the higher doses with values from¹⁰⁹ or¹⁰¹⁰ cfu/day.

What are the best probiotics for diarrhea?

There are many, very many probiotics, but only a few have shown their ability to treat diarrhea. Among them are Lactobacillus rhamnosus GG, Saccharomyces boulardii and Lactobacillus reuteri.

Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii are, respectively, a bacterium and a yeast and are, according to the WGO World Gastroenterology Organization and in line with ESPGHAN in its latest 2022 report, some of the probiotics that have most clearly demonstrated their efficacy in the treatment of diarrhea.

Thus, there are studies on Lactobacillus rhamnosus GG that show a reduction in the number of diarrheal episodes compared to the control group administered a placebo⁽¹⁾.

There are other studies, such as the one conducted with 200 children, 100 of whom were administered the fungus Saccharomyces boulardii and the other 100 were given placebo. The conclusion of this study was a significant reduction in the duration and number of stools in children with diarrhea⁽²⁾.

In addition to these two microorganisms, there are others recognized by these organisms, such as the Lactobacillus reuteri strain DSM 17938⁽³⁾.

Probiotics for antibiotic-associated diarrhea

In addition to acute diarrhea, there is also the diet associated with antibiotic consumption.

This is a problem derived from the high use of antibiotics in developed countries, which leads to an alteration of the intestinal microbiota and ultimately causes a decrease in microbial diversity. There is a loss of microbial metabolism and as a result, an osmotic diarrhea due to an excess of liquid in the intestine.

As a consequence, there is less resistance to colonization and, therefore, an increased risk of infections by pathogenic species. Studies have shown that up to 30% of patients treated with antibiotics experience episodes of diarrhea associated with their administration.

Not all antibiotics predispose to diarrhea in the same way. There are studies that show that 20% of diarrhea incidences occur in treatments with amoxicillin-clavulanic acid, although there are also other antibiotics that are associated with diarrhea, such as cephalosporins and clindamycin.

The benefits of the use of probiotics depend not only on the strain itself, but also on the particular antibiotic that caused the diarrhea, the age of the patient and whether or not the patient was hospitalized.

Numerous studies have shown that the simultaneous administration of antibiotics together with prebiotics helps to reduce the symptoms of this type of diarrhea. Specifically, the most studied probiotics for the prevention of these symptoms are mainly Saccharomyces boulardii and Lactobacillus rhamnosus GG, although the doses should not be less than¹⁰¹⁰ cfu/day and the administration of the probiotic should be done from the beginning of the antibiotic treatment, at least within the first two days from the beginning of the antibiotic intake and not waiting for the diarrhea to start with the probiotic treatment.

Preventing diarrhea with probiotics

In addition to treating diarrhea, probiotics can also be used as a preventive measure. If you have had recent contact with someone who has had acute diarrhea, taking probiotics and prebiotics can help prevent its onset. These beneficial microorganisms act as a protective barrier in the intestine, preventing the proliferation of diarrhea-causing agents and preventing their adhesion to the intestinal lining.

Lifestyle and healthy habits should also be taken into account to reduce the risk of diarrhea.

Safety and recommendations on the use of probiotics

The safety of probiotics in immunocompetent patients is generally accepted, with few major adverse effects reported.

However, it is important to keep in mind that these findings cannot be directly extrapolated to immunocompromised patients due to the lack of specific studies in this group of individuals.

Considerations in immunocompromised patients

For patients with compromised immune systems, such as those with autoimmune diseases, HIV or who have received transplants, more careful evaluation is required before initiating the use of probiotics.

It is essential to consult a specialized health professional to evaluate the possible benefits and risks in each particular case.

Availability and forms of consumption of probiotics in Spain

In Spain, probiotics are widely available as probiotic supplements that can be purchased in pharmacies or online stores and as probiotic foods, such as some dairy products that can be purchased in supermarkets.

In the case of supplements, it is possible to find different presentations and brands, each one with a certain series of probiotic strains. It should be taken into account that probiotics are adjuvants in the treatment of acute diarrhea, so it is recommended to prioritize rehydration therapy as a fundamental part of the management of this disease.

The form of administration of probiotics varies according to the presentation, with options in the form of capsules, tablets, powders or milk drinks.

It is important to follow the instructions for use and the manufacturer's recommendations for maximum effectiveness.

Their conservation is important since they are microorganisms and it is possible that certain supplements require refrigeration in a refrigerator. If this is not the case, it is advisable to store probiotics in cool, dry places and away from direct sunlight.

Do not forget to take into account the expiration date to ensure its quality and efficacy. These types of supplements do not usually have a long shelf life.

Scientific evidence and future perspectives

Analysis on the use of probiotics in the treatment of diarrhea.

Probiotics have been the subject of numerous studies to evaluate their efficacy in the treatment of acute diarrhea. In general, it has been observed that probiotics, especially certain strains such as L. rhamnosus, S. boulardii, Lactococcus lactis and B. lactis, can be effective in reducing the duration of diarrheal symptoms.

A comprehensive review of the scientific evidence to date shows that, while there is insufficient support to recommend the widespread use of probiotics in the treatment of acute infectious diarrhea, the probiotic Lactobacillus reuteri has shown promise.

This specific probiotic has shown positive results in reducing the duration of diarrhea in some studies. However, it is important to keep in mind that the quality of the studies varies and most have been conducted in the pediatric population.

More high-quality research, especially in adults, is needed to have conclusive results and to determine the effectiveness of probiotics in the treatment of acute diarrhea.

Need for more high quality studies

Despite the research conducted so far, more high-quality studies are needed to comprehensively evaluate the effects of probiotics in the treatment of acute diarrhea.

These studies should address different aspects, such as appropriate dosage, duration of treatment, the most effective probiotic strains and efficacy in different types of diarrhea.

In addition, research involving specific populations, such as immunocompromised patients, is essential to determine the safety and effectiveness of probiotics in this particular group.

The inclusion of a larger number of participants in studies and long-term follow-up may also provide a more complete picture of the benefits and possible risks associated with the use of probiotics in the treatment of diarrhea.

Conclusion

In conclusion, although there is evidence to support the use of certain probiotic strains in the treatment of acute diarrhea, more high-quality scientific evidence is needed to establish clear recommendations. Future studies will be critical to improve our understanding of the benefits, optimal doses, and safety of probiotics in the treatment of diarrhea, which will allow better therapeutic options to be offered to affected patients.

Key points:

• Probiotics have shown effectiveness in reducing the duration of acute diarrhea.
• The probiotic Lactobacillus reuteri has shown favorable results in some studies.
• More high-quality studies, especially in adults, are needed to establish solid conclusions about the use of probiotics in the treatment of diarrhea.
• It is important to evaluate different aspects, such as dosage, duration of treatment and efficacy in different types of diarrhea.
• Further research is needed in specific populations, such as immunocompromised patients.

Frequently asked questions about probiotics and diarrhea

What probiotics can I take if I have diarrhea?

If you suffer from diarrhea and are looking for probiotics to relieve your symptoms, there are several options you may want to consider. One probiotic that has been shown to be helpful is Lactobacillus rhamnosus GG, a probiotic strain that can help reduce the duration and severity of diarrhea in adults and children.

Another option is Saccharomyces boulardii, a probiotic yeast that has demonstrated efficacy in the treatment of antibiotic-associated diarrhea.

You can also consider consuming probiotic-rich foods, such as yogurt with live and active cultures.

However, it is important to keep in mind that probiotics are not a miracle remedy and everyone may respond differently. It is always advisable to consult a physician before starting any supplement or probiotic, especially if you have any pre-existing health conditions.

What if I have diarrhea and take probiotics?

If you have diarrhea and decide to take probiotics, it is important to know that they can have benefits for intestinal health and in the particular case of diarrhea, some probiotics have been shown to be helpful.

By taking probiotics during an episode of diarrhea, they can help restore the balance of beneficial bacteria in the gut and improve digestive function.

Probiotics such as Lactobacillus rhamnosus GG and Saccharomyces boulardii have shown efficacy in reducing the duration and severity of diarrhea.

However, it is important to keep in mind that the effects of probiotics can vary from person to person, and not all probiotics work the same for everyone.

In addition, it is advisable to consult a physician before starting to take any supplement or probiotic, especially if you have any pre-existing disease or pathology. Your doctor will be able to guide you on the appropriate dosage and provide you with personalized recommendations based on your situation.

What is the best probiotic to restore intestinal flora?

The choice of the best probiotic to restore the intestinal microbiota may depend on several factors and the individual needs of each person.

One of the most studied and recommended probiotics is Lactobacillus rhamnosus. This probiotic strain is known for its ability to colonize the intestine and help balance the intestinal flora.

Another probiotic that has been shown to be beneficial in restoring intestinal flora is Bifidobacterium bifidum. This probiotic strain can help improve digestion, strengthen the immune system and regulate intestinal transit.

In addition, Saccharomyces boulardii, a probiotic yeast, has also been successfully used to restore intestinal flora after an imbalance due to illness or antibiotic treatment.

It is important to note that the choice of the appropriate probiotic may vary according to individual needs and that it is advisable to consult a physician or health care professional before starting any probiotic supplement.

What should I take to stop diarrhea?

If you are looking for options to cut diarrhea, there are a few steps you can take to alleviate symptoms. First, it's important to stay hydrated. Diarrhea can cause a significant loss of fluids and electrolytes, so it is essential to replenish them.

Drinking plenty of water, as well as sports drinks or oral rehydration solutions, can help restore the body's water balance.

In addition, it is advisable to avoid foods that may worsen diarrhea, such as those high in fat, spicy or spicy foods, as well as caffeinated or alcoholic beverages.

In terms of food, opting for a bland diet can be beneficial. This includes eating soft, easily digestible foods, such as bananas, rice, toasted bread and chicken broth.

Over-the-counter medications, such as loperamide, may also be considered to help reduce stool frequency.

However, it is important to note that these drugs should only be used under the supervision of a physician or pharmacist and are not recommended for use in case of fever or bloody diarrhea.

If diarrhea persists for more than two days or if other worrisome symptoms are present, it is essential to seek medical attention.

What kind of yogurt is good for diarrhea?

Yogurt as such contains probiotics, specifically the species Lactobacillus delbruekii and Streptococcus thermophilus. But if we want to choose a yogurt for diarrhea, it is advisable to opt for those that contain other added probiotics, which, in addition to helping restore intestinal balance, help us fight diarrhea.

Look for yogurts or fermented milk products that indicate on their label the presence of probiotic strains such as Lactobacillus acidophilus or Bifidobacterium bifidum.

In addition, it is important to avoid yogurts containing added sugars, as these may worsen diarrhea. Opt for plain, unflavored yogurts or yogurts sweetened with natural ingredients such as honey or fresh fruits.

Remember that everyone may respond differently, so it is advisable to consult a doctor before introducing any new food into your diet, especially if you have pre-existing health problems.

Which people should not take probiotics?

Although probiotics are generally safe for most people, there are certain cases in which it is advisable to avoid taking them or consult a physician before taking them. Some situations in which caution should be exercised include:

• People with weakened immune systems: Those with compromised immune systems, such as HIV/AIDS patients or those undergoing chemotherapy, should talk to their doctor before taking probiotics, as they may be at increased risk of infections related to probiotic bacteria.
• Patients with serious illnesses: If you have a serious illness, such as chronic heart or lung disease, or if you have undergone major surgery, it is advisable to consult a physician before taking probiotics.
• Allergic or sensitive individuals: Some people may be allergic or sensitive to certain types of probiotics. If you have a history of food allergies or adverse reactions to probiotics, it is important to seek medical guidance before consuming them.

In any case, it is critical to consult a physician before starting probiotics, especially if you have any pre-existing health conditions or are taking medications, to make sure they are safe and appropriate for you.

How long to take probiotics for diarrhea?

The recommended duration of taking probiotics for diarrhea may vary depending on the individual and the severity of symptoms. In general, it is suggested to take probiotics for at least 1 to 2 weeks to allow beneficial microorganisms to colonize the intestine and help restore the balance of the intestinal flora.

However, it is important to keep in mind that each person may respond differently and results may vary. Some people may experience significant improvements within a few days, while others may require a longer period of time.

It is advisable to follow your doctor's instructions or the manufacturer's instructions for the specific probiotic you are using. In addition, if diarrhea symptoms persist or worsen after a reasonable period of time, it is important to seek medical attention for further evaluation.

Remember that probiotics are supplements and should not be considered a replacement for proper medical treatment. It is always advisable to consult a physician before starting any supplement, including probiotics, especially if you have any pre-existing health conditions.

How to take probiotics to treat diarrhea?

The way to take probiotics may vary depending on the product and the manufacturer's indications. However, in general it is recommended to follow these guidelines:

• Read the product instructions and follow the dosage instructions.
• It is preferable to take probiotics on an empty stomach or before meals to maximize their absorption.
• Choose a probiotic containing specific strains recommended to treat acute diarrhea.
• Consult your physician or pharmacist for personalized recommendations.

Are probiotics effective in different types of diarrhea?

Probiotics have been shown to be effective, especially in cases of acute diarrhea caused by viral gastroenteritis. However, evidence for their effectiveness in other types of diarrhea, such as that caused by bacteria or parasites, is limited. Further research is needed to determine their impact in these cases.

Are there any side effects associated with the consumption of probiotics?

In general, probiotics are safe for most people, however, in rare cases, mild side effects such as gas, bloating or stomach upset may occur. These symptoms usually disappear on their own and do not require treatment. It is important to keep in mind that each person may have an individual response to probiotics, so it is advisable to follow the manufacturer's directions and consult a healthcare professional if adverse reactions occur.

(1) Oberhelman RA, Gilman RH, Sheen P, et al. A placebo-controlled trial of Lactobacillus GG to prevent diarrhea in undernourished Peruvian children. J Pediatr. 1999;134(1):15-20. doi:10.1016/s0022-3476(99)70366-5

(2) Sharif MR, Kashani HH, Ardakani AT, Kheirkhah D, Tabatabaei F, Sharif A. The Effect of a Yeast Probiotic on Acute Diarrhea in Children. Probiotics Antimicrob Proteins. 2016;8(4):211-214. doi:10.1007/s12602-016-9221-2

(3) Szajewska H, Urbańska M, Chmielewska A, et al. Meta-analysis: Lactobacillus reuteri strain DSM 17938 (and the original strain ATCC 55730) for treating acute gastroenteritis in children. Benef Microbes. 2014;5:285-293.

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