How can probiotics and prebiotics help you? What the research says - CancerChoices



Probiotics are living microorganisms that provide a health benefit, and prebiotics are fibers that feed these friendly bacteria, mostly in your gut. These therapies, found in certain foods or as supplements, can manage gastrointestinal symptoms and some body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more factors common in cancer, and they may lead to better recovery from surgery.

How can probiotics and prebiotics help you? What the research says

We summarize the clinical evidence for each medical benefit here. We begin with our assessment of the strength of evidence within each category, followed by a brief summary of individual studies or reviews of several studies. In assessing the strength of evidence, we consider the study design, number of participants, and the size of the treatment effect (how much outcomes changed with treatment).

To see more details, click the plus sign to the right of any section.

The most-studied and commonly used organisms in probiotic preparations are lactobacilli and bifidobacteria,1Power SE, O’Toole PW, Stanton C, Ross RP, Fitzgerald GF. Intestinal microbiota, diet and health. British Journal of Nutrition. 2014 Feb;111(3):387-402. although many other organisms have been studied. Differences in which specific probiotics are used may contribute to conflicting findings across studies.

Some evidence shows that individuals respond differently to probiotics, with some people being sensitive and others resistant to colonization by the species in a probiotic treatment. Diet directly impacts the composition of your microbiome, and so both your diet and the existing composition of your microbiome may influence your sensitivity to probiotics.2Zmora N, Zilberman-Schapira G et al. Personalized gut mucosal colonization resistance to empiric probiotics is associated with unique host and microbiome features. Cell. 2018 Sep 6;174(6):1388-1405.e21. 

Careful attention to the details of studies may help you determine whether you (or your patients) are likely to benefit from the treatments described.

Improving treatment outcomes

Are probiotics and prebiotics linked to improved survival? Are they linked to less cancer growth or metastasis? Do they enhance the anticancer action of other treatments or therapies? We present the evidence.

Advanced cancer

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of longer progression-free survival among people with advanced kidney or lung cancers undergoing immune checkpoint inhibitor treatment also treated with probiotics

Probiotics combined with other therapies

Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of complete remission in a single person with high grade, non-muscle involved bladder cancer refractory to Bacillus Calmette-Guerin treated with intravenous pharmacological ascorbate and subcutaneous mistletoe along with several supplements

Weak evidence of good health and wellness among people with cancer treated with probiotics, intravenous vitamin C, and other supplements and medications

Optimizing your body terrain

Do probiotics and prebiotics promote an environment within your body that is less supportive of cancer development, growth, or spread? We present the evidence.

See Optimizing Your Body Terrain ›

Find medical professionals who specialize in managing body terrain factors: Finding Integrative Oncologists and Other Practitioners ›

Body weight

No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on measures of body weight among adults with metabolic syndrome treated with various strains of probiotics or synbiotics in a combined analysis of studies

Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of lower measures of body weight among overweight or obese and insulin-resistant people treated with pasteurized Akkermansia muciniphila

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of lower measures of body weight among women with polycystic ovarian syndrome treated with synbiotics

Preliminary evidence of more excess weight loss after for gastric surgery for morbid obesity among people treated with a probiotic

No evidence of an effect on measures of body weight or composition among overweight, obese, or prediabetic people treated with prebiotics in 2 small studies

High blood sugar and insulin resistance

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of lower fasting blood glucose and insulin levels and a weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently toward lower blood sugar among people with type 1 or 2 diabetes or prediabetes treated with probiotic, prebiotic, or synbiotic supplementation

Insufficient (conflicting) evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently) of an effect on fasting blood sugar, insulin resistancea condition in which cells in your muscles, fat, and liver don’t respond well to insulin and can’t efficiently take up glucose from your blood for energy, or insulin among adults with metabolic syndrome or metabolic disorders treated with probiotics or synbiotics

No evidence of an effect on insulin levels, blood sugar, fasting plasma glucose, insulin resistance, or insulin-like growth factor-1 among postmenopausal, overweight, and obese women with hormone receptor-positive breast cancer treated with a synbiotic

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of lower blood sugar and insulin resistancea condition in which cells in your muscles, fat, and liver don’t respond well to insulin and can’t efficiently take up glucose from your blood for energy among adults, most of whom are diabetic or prediabetic, treated with probiotics

Good evidence of lower markers of high blood sugar and insulin levels, but no evidence of an effect on peripheral and adipose tissue insulin sensitivity, among adults treated with dietary prebiotics (not specific to cancer)

Hormone imbalance

Changes in hormone levels seen in the studies here may not be beneficial in every situation. Your oncology team needs to determine whether any changes would be favorable for your condition.

Modest evidence of lower levels of ghrelin, a “hunger hormone,” among overweight or obese people treated with prebiotics or synbiotics

No evidence of an effect on leptina hormone that helps regulate energy balance by inhibiting hunger or pancreatic polypeptide levels among prediabetic people treated with prebiotics in a small study

No evidence of an effect on sex hormones during a low-calorie diet among overweight and obese people with hormone-receptor positive (HR+) breast cancer treated with a synbiotic in a small trial

Preliminary evidence of lower testosterone but no evidence of an effect on luteinizing hormone or follicle stimulating hormone among women with polycystic ovarian syndrome treated with synbiotics

Preliminary evidence of a lower marker of stress after elective orthopedic or colorectal surgery among elderly people treated with probiotics

Immune function

Increased immune system activation is not always beneficial, so your oncology team needs to determine whether immune activation would be favorable in your situation.

Preliminary evidence of higher immune activation after surgery among people with liver or colorectal cancer treated with a synbiotic or probiotic

Preliminary evidence of higher immune activation among overweight or obese and insulin-resistant people treated with a probiotic

Preliminary evidence of greater immune responses after liver removal among people with biliary cancer involving the hepatic hilus treated with synbiotics both before and after surgery compared to only after surgery

Inflammation

Good evidence of less inflammation after surgery among people with colorectal cancer treated with probiotics or synbiotics

Preliminary evidence of lower markers of inflammation during chemotherapy and radiotherapy among people with cancer treated with a synbiotic

Preliminary evidence of lower markers of inflammation among healthy young volunteers treated with a probiotic, whether with or without prebiotics but stronger effects with prebiotics

Modest evidence of lower markers of inflammation among people with inflammatory conditions, including cancer, treated with probiotics

Strong evidence of one lower marker of inflammation (TNF-α) but not others (C-reactive protein and interleukin-6) among people eating fermented foods: probiotic yogurt (unsweetened and with live cultures), kefir, tempeh, natto, kombucha, miso, kimchi, sauerkraut, or cultured cheese

Insufficient (conflicting) evidence of an effect on inflammation among people with inflammatory conditions treated with prebiotics

Oxidative stress

Insufficient (conflicting) evidence of an effect on oxidative stressan imbalance between free radicals and antioxidants in your body in which antioxidant levels are lower than normal; this imbalance can cause harmful oxidation reactions in your body chemistry among diabetic people treated with probiotics

Your microbiome

Good evidence of a better microbiome status among people with cancer treated with probiotics, including during chemotherapy and surgery

Preliminary evidence of greater gut bacterial diversity and higher levels of the main short-chain fatty acids during chemotherapy after colorectal cancer surgical resection among people treated with probiotic tablets

Preliminary evidence of less disruption to the gut microbiome among people with cancer treated with probiotics

Preliminary evidence of beneficial changes to the fecal microbiome among people with diabetes treated with probiotics

Preliminary evidence of higher abundance of microbial genera after surgery among people treated with probiotics

Preliminary evidence of beneficial changes in the microbiome among healthy people treated with probiotics

Preliminary evidence of less bacterial vaginosis among people treated with oral probiotics

No evidence of an effect on oral bacterial community composition or diversity after radiotherapy among people with head and neck cancer treated with oral probiotics in a small trial

Preliminary evidence of beneficial changes in the microbiomes of people treated with prebiotics

Other terrain factors

Preliminary evidence of better intestinal pH during chemotherapy among children treated with a probiotic

Weak evidence of less intestinal absorption of aflatoxin B1 , which is associated with an increased risk of liver cancer

No evidence of an effect on trimethylamine N-oxide (TMAO)—a promoter of atherosclerosis and linked to colorectal cancer—among people with metabolic syndrome treated with Lactobacillus casei Shirota

Probiotics combined with other therapies

Preliminary evidence of comparable rates of infections and duration of neutropenic episodes, with fewer side effects among children with leukemia and solid tumors treated with a preparation of co-trimoxazole and Lactobacilli compared to framycetin, colymycin, nystatin, and metronidazole

Preliminary evidence of lower rates of infectious complication, a higher marker of immune activation (NK cells), lower marker of infection (PCT), and lower fasting insulin and insulin resistance index after surgery among people with upper gastrointestinal perforation/abdominal infection treated with probiotics, deep sea fish oil, glutamine and a commercial nutrition supplement (Nutrison)

Preliminary evidence of higher levels of brain-derived neurotrophic factor but no evidence of an effect on a marker of inflammation among people with depression and chronic diarrhea treated with electroacupuncture combined with a probiotic

Managing side effects and promoting wellness

Are probiotics and prebiotics linked to fewer or less severe side effects or symptoms? Are they linked to less toxicity from cancer treatment? Do they support your quality of life or promote general well-being? We present the evidence.

Depression

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of lower depression scores after completing cancer treatment among people with colorectal cancer treated with probiotics

Fatigue

Preliminary evidence of lower fatigue scores after completing cancer treatment among people with colorectal cancer treated with probiotics

Gastrointestinal symptoms

People with cancer treated with probiotics or synbiotics have experienced fewer gastrointestinal symptoms such as diarrhea, constipation, vomiting, and abdominal distension and have shown better bowel function after cancer treatment. Prebiotics may reduce the incidence of diarrhea during pelvic radiation therapy.

Oral symptoms

Good evidence of lower incidence and severity of oral mucositisinflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cancer during cancer treatment among people with cancer treated with probiotics

Preliminary evidence of less oral infection after completing head and neck radiotherapy among people with cancer treated with probiotic sachets

No evidence of an effect on periodontal screening and plaque index scores after radiotherapy among people with head and neck cancer treated with oral probiotic lozenges in a small trial

Quality of life

Preliminary evidence of better quality of life scores among people with colorectal cancer treated with probiotics

Stress

Preliminary evidence of less stress (no elevation in markers of stress) among people with laryngeal cancer awaiting laryngectomy treated with probiotics

Recovery after surgery

Good evidence of less infection, shorter hospital stays, and other indicators of better recovery after surgery among people with gastrointestinal cancer, including colorectal cancer, treated with probiotics or synbiotics

Preliminary evidence of fewer infectious complications after liver removal among people with biliary cancer treated with synbiotics both before and after surgery compared to only after surgery

Good evidence of lower risk of infection after colorectal cancer surgery among people treated with probiotics

Preliminary evidence of fewer infectious complications after Whipple procedure among people treated with probiotics

Symptoms not specific to cancer

Insufficient (conflicting) evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently) of an effect on anxiety among people treated with probiotics (not specific to cancer)

Good evidence of higher self-reported feelings of satiety among healthy adults treated with dietary prebiotics (not specific to cancer)

Preliminary evidence of less cognitive impairment after elective orthopedic or colorectal surgery among elderly people treated with probiotics (not specific to cancer)

Good evidence of less depression among people with symptoms of depression treated with probiotics (not specific to cancer)

Good evidence of shorter duration of diarrhea during antibiotic therapy among patients treated with specific probiotics (not specific to cancer)

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of less constipation among people treated with probiotics (not specific to cancer)

No evidence of an effect on gastrointestinal function after elective orthopedic or colorectal surgery (not specific to cancer) among elderly people treated with probiotics in a small trial

Preliminary evidence of lower markers of enzymes indicating liver dysfunction among overweight or obese and insulin-resistant people treated with a probiotic (not specific to cancer)

No evidence of an effect on pain intensity after elective orthopedic or colorectal surgery among elderly people treated with probiotics in a small trial (not specific to cancer)

Preliminary evidence of maintained quality of life scores among home-living adults receiving tube feedings enriched with prebiotics (not specific to cancer)

No evidence of an effect on sleep quality after elective orthopedic or colorectal surgery among elderly people treated with probiotics in a small trial (not specific to cancer)

No evidence of an effect on stress among people with symptoms of stress treated with probiotics in a combined analysis of studies (not specific to cancer)

Modest evidence of less perceived stress among healthy volunteers treated with probiotics (not specific to cancer)

Preliminary evidence of a lower marker of stress 5 to 7 days after elective orthopedic or colorectal surgery among elderly people treated with probiotics (not specific to cancer)

Good evidence of less surgical site infection, pneumonia, or sepsis, plus shorter duration of antibiotic administration and hospital stays after surgery (not specific to cancer) among people treated with synbiotic therapy

Preliminary evidence of lower incidence of multiorgan failure, septic complications, and mortality among people with severe acute pancreatitis treated with synbiotics (not specific to cancer)

Probiotics combined with other therapies

Probiotics with glutamine and fish oil: preliminary evidence of lower rates of abdominal pain, flatulence, and diarrhea after completing radiotherapy among people with abdominal or pelvic cancer treated with probiotics, glutamine, and fish oil

Probiotics and electroacupuncture: preliminary evidence of fewer symptoms of depression and diarrhea among people with depression and chronic diarrhea treated with electroacupuncture and probiotics

Reducing cancer risk

Are probiotics and prebiotics linked to lower risks of developing cancer or of recurrence? We present the evidence.

Bladder cancer

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of lower risk of recurrence among people with superficial transitional cell carcinoma of the bladder treated with an oral probiotic

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of lower risk of bladder cancer among people eating fermented dairy foods (yogurt, kefir, cultured cheese)

Breast cancer

Preliminary evidence of lower risk of breast cancer among women drinking beverages containing Lactobacillus casei Shirota 4 or more times a week

Colorectal cancer

Preliminary evidence of better epithelial barrier function and a weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently toward lower colorectal proliferation after colorectal polypectomy among people treated with a synbiotic

Good evidence of lower risk of colorectal cancer among people eating fermented dairy foods as a whole

Preliminary evidence of lower atypia grade of tumors and fewer tumors or aberrant crypt foci among people with prior colorectal tumor removal treated with a probiotic dairy product

No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on the number or size of recurring tumors among people with prior colorectal tumor removal, resected colon, or more than 5 aberrant crypt foci treated with a probiotic or prebiotic in small trials

Gastrointestinal cancer

Colorectal cancer is listed separately.

Good evidence of lower risk of esophageal cancer among people eating fermented dairy foods (yogurt, kefir)

Keep reading about probiotics and prebiotics

Author

Nancy Hepp, MS

Lead Researcher
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher

Andrew Jackson, ND

Research Associate
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Andrew Jackson, ND, serves as a CancerChoices research associate. As a naturopathic physician practicing in Kirkland, Washington, he teaches critical evaluation of the medical literture at Bastyr University in Kenmore, Washington. His great appreciation of scientific inquiry and the scientific process has led him to view research with a critical eye.

Andrew Jackson, ND Research Associate

Reviewer

Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Last update: August 28, 2024

Last full literature review: November 2022

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care, and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocialtherapy, and acupuncture therapies and self carelifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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