We’re busy reviewing the evidence on probiotics. While we’re working, we share the original summary from our predecessor website, Beyond Conventional Cancer Therapies.

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Probiotics

Key Points

  • Before using this therapy, consult your oncology team about interactions with other treatments and therapies. Also make sure this therapy is safe for use with any other medical conditions you may have.
  • Probiotics are living microorganisms (bacteria and some yeasts) that can support gut and immune health when consumed in sufficient numbers.
  • Examples of probiotic foods are yogurt, kefir, sauerkraut, tempeh and kimchi.
  • Probiotics may reduce treatment-related diarrhea during chemotherapy and radiation treatment.
  • Yogurt consumption reduced risk of conventional adenoma, especially adenomas with high malignant potential in men, with probiotics likely contributing to the effect.
  • Probiotics improved immune response and the intestinal microbial environment in colorectal cancer patients.
  • Used in several integrative programs and protocols and in traditional medical systems (Ayurveda and traditional Chinese medicine).

Probiotics, Prebiotics and Synbiotics

Probiotics are living microorganisms (bacteria and some yeasts) that, when consumed in sufficient numbers, can provide health benefits that go beyond basic nutrition, such as supporting gut and immune health and keeping the gut microbiota in balance. Examples of probiotic foods are yogurt, kefir, sauerkraut, tempeh and kimchi. Probiotics are typically consumed in foods such as yogurt and other fermented foods. The effects of probiotic supplements separate from dietary sources are not always reported in the scientific literature.

Prebiotics are dietary fibers that feed the friendly bacteria in your gut. Most prebiotics are soluble fiber substances like inulin, found in chicory root and foods like bananas, onions, jerusalem artichokes, jicama, garlic and others. Some supplements are also used as prebiotics, such as larch arabinogalactan (Web MD).

Your helpful bacteria turn inulin and other fibers into energy for the colon cells and create protective immunity. Inulin is increasingly being added to a number of processed foods and probiotic supplements.

Synbiotics simply means consuming both prebiotics and probiotics together.

The evidence for taking probiotic supplements is mixed, with benefit so far mostly among people undergoing colorectal cancer surgery.

Clinical Practice Guidelines

The Society for Integrative Oncology’s 2009 guidelines on botanicals cite research indicating that probiotics are useful in reducing enteritis related to radiation therapy and Fluorouracil (5-FU), as well as reducing diarrhea induced by 5-FU and Irinotecan.1

Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

See cautions (below) about possible interference of probiotics with immune checkpoint inhibitors.

Lab and Animal Evidence

Click or tap to open.

Optimizing Your Terrain

  • Improved immune response5
  • Glycemia:
    • Lower fasting blood sugar, insulin, and homeostasis model assessment for insulin resistance (HOMA-IR) index among women with polycystic ovarian syndrome with pro-/synbiotic supplementation in a meta-analysis of RCTs6
    • Increased insulin sensitivity and insulin, plus decreased BMI, weight and waist circumference, in women with polycystic ovarian syndrome drinking a beverage supplemented with synbiotics compared to an unsupplemented beverage or controls in a small RCT7 
  • Microbiome balance:
    • Use of probiotics around the time of surgery improved the gut microbiome of people undergoing colorectal cancer surgery.8
    • Adding food enriched with prebiotics may possibly improve the condition of your microbiome, as shown in preliminary clinical studies.9
    • Lowered the gut pH10
  • Inflammation:
    • Lower C-reactive protein (a marker of inflammation) among women with polycystic ovarian syndrome with pro-/synbiotic supplementation in a meta-analysis of RCTs11
  • Hormone balance:
    • Lower total testosterone among women with polycystic ovarian syndrome with pro-/synbiotic supplementation in a meta-analysis of RCTs12
    • Lower testosterone in women with polycystic ovarian syndrome drinking a beverage supplemented with synbiotics compared to an unsupplemented beverage or controls in a small RCT13 

The prebiotic inulin is increasingly being added to a number of processed foods and probiotic supplements. Using inulin supplements may possibly improve the condition of your microbiome, although the evidence is not strong yet but is growing.14

Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

  • During chemotherapy and radiation treatment, probiotics may reduce treatment-related diarrhea.15
  • Colorectal cancer:
    • Reduced incidence of diarrhea induced by chemoradiotherapy, especially grade 2 or higher16
    • Reduced the portion of colorectal cancer patients experiencing irritable bowel symptoms or symptoms of depression, and improved function-related quality of life and cancer-related quality of life scores in a small trial17
  • Conflicting findings on whether the use of prebiotics, probiotics or synbiotics at the time of surgery in patients undergoing colorectal cancer surgery reduces the development of infectious complications18
  • Improved quality of life and chemotherapy-related side effects including appetite loss, fatigue, pain, nausea and vomiting and diarrhea with a combination omega-3 fatty acid and strain-specific probiotic19

Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Clinical Evidence

  • Yogurt consumption reduced risk of conventional colorectal adenoma, especially adenomas with high malignant potential, in men. Probiotics in yogurt are thought to contribute to this effect.20
  • Preliminary but mixed evidence that probiotic therapy may decrease the risk of developing colorectal cancer21 with different effects from different species22

Lab and Animal Evidence

Click or tap to open.

Cautions

People with melanoma taking over-the-counter probiotic supplements before treatment had lower diversity of gut microbes and a 70% lower chance of response to cancer immunotherapy treatment with anti-PD-1 checkpoint inhibitors.24 Our comments on this:

  • It’s not clear whether people who were taking the supplements had experienced events that altered their microbiome—such as recent antibiotic use—and were working to re-balance it with probiotics. People taking antibiotics before treatment also had lower microbe diversity. If people taking probiotics also had altered microbe balanaces, then we don’t know whether the probiotics themselves or the underlying imbalance was the real culprit in the reduced response to immunotherapy.
  • We also don’t know how probiotic use in this study related to the food choices that promote a healthy microbiome.
  • Until we can answer questions such as these, we caution against assuming that probiotic use is linked to poor treatment response. In the meantime, we urge caution in using probiotics before immunotherapy.

Neil McKinney, ND, and Lise Alschuler, ND, FABNO, do not give probiotics if the absolute neutrophil count is 1.5 or less.2526

CancerChoices advises consulting your physician before taking probiotic supplements. It may also be a good idea to work with a healthcare provider experienced in using probiotics in people with cancer, as many different types of probiotics are available, and taking the appropriate probiotic for your particular situation is important.

The About Herbs summary on Probiotics lists contraindications to taking probiotics as well as adverse events and herb-drug interactions.

Dosing

CancerChoices does not recommend therapies or doses, but only provides information for patients and providers to consider as part of a complete treatment plan. Patients should discuss therapies with their physicians, as contraindications, interactions and side effects must be evaluated.

Dosage recommendations are available from these sources:

Integrative Programs, Protocols and Medical Systems

  • Programs and protocols
  • Alschuler & Gazella complementary approaches:27
    • Post-operative support
    • Bladder cancer
    • Breast cancer
    • Colorectal cancer
    • Gastric cancer
    • Pancreatic cancer (to reduce infection risk after Whipple procedure)
    • Healthy digestion
    • Hormone balance
    • Immune enhancement
    • Anti-inflammatory support
    • Insulin-resistance reversal
    • Managing diarrhea
    • Enhancing immune activity
    • Reducing inflammation and systemic inflammatory diseases
    • Reducing anxiety and depression
    • Improving insulin sensitivity
    • Improving digestion and detoxification
    • Reducing cancer risk
    • Reducing risk of dysbiosis from antibiotics
    • Colorectal cancer
  • Block program28
    • Core diet plan
    • Preventing/managing diarrhea from antibiotics
    • Radiation-induced enteritis
    • High-intensity nutritional support diet for cachexia (wasting)
  • Lemole, Mehta & McKee colorectal cancer protocol29
  • McKinney protocols30
    • Post-op diarrhea
    • With radiation therapy to protect gut and immune competence
    • Treatment-related diarrhea
    • With platin drugs (such as cisplatin) to prevent gut bacteria translocation to liver/blood
    • Protocol for better nutrition
    • Side effect alleviation protocol
    • Health restoration and creating healing conditions—detoxification
    • Cancer risk reduction plan
    • Reducing dysbiosis risk from antibiotics
    • Breast cancer
    • Colorectal cancer
  • Traditional systems
    • Ayurveda
    • Traditional Chinese medicine

Resources

References

  1. Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
  2. Raman M, Ambalam P et al. Potential of probiotics, prebiotics and synbiotics for management of colorectal cancer. Gut Microbes. 2013 May-Jun;4(3):181-92.
  3. Ranji P, Akbarzadeh A, Rahmati-Yamchi M. Associations of probiotics with vitamin D and leptin receptors and their effects on colon cancer. Asian Pacific Journal of Cancer Prevention. 2015;16(9):3621-7; Shang M, Sun J. Vitamin D/VDR, probiotics, and gastrointestinal diseases. Current Medicinal Chemistry. 2017;24(9):876-887.
  4. Hendler R, Zhang Y. Probiotics in the treatment of colorectal cancer. Medicines (Basel). 2018 Sep 7;5(3):101.
  5. Aisu N, Tanimura S et al. Impact of perioperative probiotic treatment for surgical site infections in patients with colorectal cancer. Experimental and Therapeutic Medicine. 2015;10(3):966–972; Roller M, Clune Y, Collins K, Rechkemmer G, Watzl B. Consumption of prebiotic inulin enriched with oligofructose in combination with the probiotics Lactobacillus rhamnosus and Bifidobacterium lactis has minor effects on selected immune parameters in polypectomised and colon cancer patients. British Journal of Nutrition. 2007;97(4):676–684; Anderson SW, Bazzell AF, Dains JE. An integrative review on the effect of prebiotics, probiotics, and synbiotics on infection after colorectal cancer surgery. AORN Journal. 2018;107(2):237–248; Raman M, Ambalam P et al. Potential of probiotics, prebiotics and synbiotics for management of colorectal cancer. Gut Microbes. 2013 May-Jun;4(3):181-92.
  6. Hadi A, Moradi S, Ghavami A, Khalesi S, Kafeshani M. Effect of probiotics and synbiotics on selected anthropometric and biochemical measures in women with polycystic ovary syndrome: a systematic review and meta-analysis. European Journal of Clinical Nutrition. 2020 Apr;74(4):543-547.
  7. Esmaeilinezhad Z, Babajafari S et al. Effect of synbiotic pomegranate juice on glycemic, sex hormone profile and anthropometric indices in PCOS: a randomized, triple blind, controlled trial. Nutrition, Metabolism & Cardiovascular Diseases. 2019 Feb;29(2):201-208.
  8. Aisu N, Tanimura S et al. Impact of perioperative probiotic treatment for surgical site infections in patients with colorectal cancer. Experimental and Therapeutic Medicine. 2015;10(3):966–972.
  9. Reimer RA, Soto-Vaca A et al. Effect of chicory inulin-type fructan-containing snack bars on the human gut microbiota in low dietary fiber consumers in a randomized crossover trial. American Journal of Clinical Nutrition. 2020 Jun 1;111(6):1286-1296. Mitsou EK, Saxami G et al. Effects of rich in Β-glucans edible mushrooms on aging gut microbiota characteristics: an in vitro study. Molecules. 2020 Jun 18;25(12):2806; Singh RK, Chang HW, Yan D, et al. Influence of diet on the gut microbiome and implications for human health. Journal of Translational Medicine. 2017;15(1):73.
  10. Raman M, Ambalam P et al. Potential of probiotics, prebiotics and synbiotics for management of colorectal cancer. Gut Microbes. 2013 May-Jun;4(3):181-92.
  11. Hadi A, Moradi S, Ghavami A, Khalesi S, Kafeshani M. Effect of probiotics and synbiotics on selected anthropometric and biochemical measures in women with polycystic ovary syndrome: a systematic review and meta-analysis. European Journal of Clinical Nutrition. 2020 Apr;74(4):543-547.
  12. Hadi A, Moradi S, Ghavami A, Khalesi S, Kafeshani M. Effect of probiotics and synbiotics on selected anthropometric and biochemical measures in women with polycystic ovary syndrome: a systematic review and meta-analysis. European Journal of Clinical Nutrition. 2020 Apr;74(4):543-547.
  13. Esmaeilinezhad Z, Babajafari S et al. Effect of synbiotic pomegranate juice on glycemic, sex hormone profile and anthropometric indices in PCOS: a randomized, triple blind, controlled trial. Nutrition, Metabolism & Cardiovascular Diseases. 2019 Feb;29(2):201-208.
  14. García-Peris P, Velasco C et al. Effect of a mixture of inulin and fructo-oligosaccharide on Lactobacillus and Bifidobacterium intestinal microbiota of patients receiving radiotherapy: a randomised, double-blind, placebo-controlled trial. Nutrición Hospitaliaria. 2012 Nov-Dec;27(6):1908-15; Chambers ES, Byrne CS et al. Dietary supplementation with inulin-propionate ester or inulin improves insulin sensitivity in adults with overweight and obesity with distinct effects on the gut microbiota, plasma metabolome and systemic inflammatory responses: a randomised cross-over trial. Gut. 2019 Aug;68(8):1430-1438; Birkeland E, Gharagozlian S et al. Prebiotic effect of inulin-type fructans on faecal microbiota and short-chain fatty acids in type 2 diabetes: a randomised controlled trial. European Journal of Nutrition. 2020 Oct;59(7):3325-3338; Biruete A, Cross TL et al. Effect of dietary inulin supplementation on the gut microbiota composition and derived metabolites of individuals undergoing hemodialysis: a pilot study. Journal of Renal Nutrition. 2021 Jun 11:S1051-2276(20)30286-7; Li L, Xiong Q et al. Inulin-type fructan intervention restricts the increase in gut microbiome-generated indole in patients with peritoneal dialysis: a randomized crossover study. American Journal of Clinical Nutrition. 2020 May 1;111(5):1087-1099; Chu JR, Kang SY et al. Prebiotic UG1601 mitigates constipation-related events in association with gut microbiota: a randomized placebo-controlled intervention study. World Journal of Gastroenterology. 2019 Oct 28;25(40):6129-6144. 
  15. Wang YH, Yao N et al. The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: a systematic review and meta-analysis. European Journal of Clinical Nutrition. 2016;70(11):1246–1253; Garcia-Peris P, Velasco C et al. Effect of inulin and fructo-oligosaccharide on the prevention of acute radiation enteritis in patients with gynecological cancer and impact on quality-of-life: a randomized, double-blind, placebo-controlled trial. European Journal of Clinical Nutrition. 2016 Feb;70(2):170-4.
  16. Wang YH, Yao N et al. The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: a systematic review and meta-analysis. European Journal of Clinical Nutrition. 2016;70(11):1246–1253.
  17. Lee JY, Chu SH et al. Effects of 12 weeks of probiotic supplementation on quality of life in colorectal cancer survivors: a double-blind, randomized, placebo-controlled trial. Digestive and Liver Disease. 2014;46(12):1126–1132.
  18. Anderson SW, Bazzell AF, Dains JE. An integrative review on the effect of prebiotics, probiotics, and synbiotics on infection after colorectal cancer surgery. AORN Journal. 2018;107(2):237–248; Aisu N, Tanimura S et al. Impact of perioperative probiotic treatment for surgical site infections in patients with colorectal cancer. Experimental and Therapeutic Medicine. 2015;10(3):966–972.
  19. Golkhalkhali B, Rajandram R et al. Strain-specific probiotic (microbial cell preparation) and omega-3 fatty acid in modulating quality of life and inflammatory markers in colorectal cancer patients: a randomized controlled trial. Asia-Pacific Journal of Clinical Oncology. 2018 Jun;14(3):179-191.
  20. Zheng X, Wu K et al. Yogurt consumption and risk of conventional and serrated precursors of colorectal cancer. Gut. 2019;gutjnl-2019-318374.
  21. ,Hendler R, Zhang Y. Probiotics in the treatment of colorectal cancer. Medicines (Basel). 2018 Sep 7;5(3):101.
  22. Lamichhane P, Maiolini M et al. Colorectal cancer and probiotics: Are bugs really drugs? Cancers (Basel). 2020 May 5;12(5):1162; Drago L. Probiotics and colon cancer. Microorganisms. 2019 Feb 28;7(3):66.
  23. Jacouton E, Chain F, Sokol H, Langella P, Bermúdez-Humarán LG. Probiotic strain Lactobacillus casei BL23 prevents colitis-associated colorectal cancer. Frontiers in Immunology. 2017 Nov 17;8:1553.
  24. AACR 2019: Diet may influence gut microbiome and response to immunotherapy. ASCO Post. February 28, 2019. Viewed June 24, 2021; Spencer CN, Gopalakrishnan V et al. The gut microbiome (GM) and immunotherapy response are influenced by host lifestyle factors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Research 2019;79(13 Suppl):Abstract nr 2838.
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