How do experts use probiotics and/or prebiotics? - 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 do experts use probiotics and/or prebiotics?

Both medical groups and integrative experts provide recommendations for probiotics and prebiotics in treating people with cancer. Learn more about the approaches and meanings of recommendations. See Integrative Oncology Programs and Expert Guidelines ›

Clinical practice guidelines

Evidence supports the use of probiotics containing Lactobacillus spp. for prevention of chemoradiotherapy and radiotherapy-induced diarrhea in patients with pelvic malignancy.

Published protocols, programs, and approaches

These protocolsa package of therapies combining and preferably integrating various therapies and practices into a cohesive design for care, programs, and approaches by leaders in integrative cancer care use or recommend probiotics and prebiotics.

We do not recommend specific integrative protocols or programs but provide information for you to evaluate with your healthcare team.

Lise Alschuler, ND, FABNO, and Karolyn Gazella

The Definitive Guide to Cancer:

Alschuler and Gazella recommend probiotics to protect against or treat disruption to the microbiome:

  • After surgery
  • Gut-associated lymphoid tissue (GALT) support
  • For digestion
  • During radiation to reduce diarrhea
  • Hormone balance
  • Immune system
  • Inflammation
  • Reversing 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 and improving insulin sensitivity
  • Bladder cancer
  • Breast cancer
  • Colon cancer
  • Pancreatic cancer
  • Stomach cancer

The Definitive Guide to Thriving after Cancer:

Alschuler and Gazella describe positive influences of probiotics:

  • Immune system
  • Inflammation
  • Hormonal balance
  • Insulin resistance
  • Digestion and detoxification

Keith Block, MD

Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009.

The integrative Block Program has recommendations to people who are at different places along the cancer continuum:

  • Those who’ve been recently diagnosed
  • Those in treatment
  • Those who’ve concluded treatment and need to remain vigilant to prevent recurrence

Prebiotics and probiotics are recommended for these uses:

  • As part of core diet plan
  • Diarrhea secondary to antibiotic or radiation enteritis

Lorenzo Cohen, PhD, and Alison Jefferies, MEd

Cohen L, Jefferies A. Anticancer Living: Transform Your Life and Health with the Mix of Six. New York: Viking. 2018.

This book introduces the concept of the Mix of Six, which is identical to six of our 7 Healing Practices ›

Dr. Cohen and Ms. Jefferies explain that while each plays an inde­pendent role, the synergy created by all six factors can radically transform health, delay or prevent many cancers, support conventional treatments, and significantly improve quality of life.

Pre-and probiotic foods are part of anticancer eating patterns.

Gerald M. Lemole, MD; Pallav K. Mehta, MD; and Dwight L. McKee, MD

Lemole GM, Mehta PK, McKee DL. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.

These doctors present easy-to-incorporate lifestyle changes to help you “turn on” hundreds of genes that fight cancer, and “turn off” the ones that encourage cancer, while recommending lifestyle approaches to address each type.

Use of probiotics with colorectal cancer:  

  • Before surgery to reduce side effects after surgery
  • After treatment

Neil McKinney, BSc, ND

McKinney N. Naturopathic Oncology, Fourth Edition. Victoria, BC, Canada: Liaison Press. 2020.

This book includes descriptions and uses of many natural and complementary protocols for cancer in general and for specific cancers. It also includes information on integrative support during conventional cancer treatment.

Probiotics are recommended to protect against or treat disruption to the microbiome from cancer treatment

  • Protect against gut bacteria translocation to liver/blood during immunotherapy/chemotherapy
    • Avastin, cisplatin, carboplatin, and oxaliplatin
    • Gemcitabine and capecitabine  
  • For diarrhea after surgery
  • Protect the gut
  • Protect immunity during radiation
  • Radiation-induced diarrhea, proctitisinflammation of the lining of the rectum, and reduce risk of radiation-related gut fibrosis
  • Bladder cancer treatment
  • Reduce breast cancer risk 
  • Colorectal cancer:
    • Prevent polyps from converting to cancer
    • During treatment
  • Liver and gallbladder cancer: during treatment

Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO

Parmar G, Kaczor T. Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition. Medicatrix Holdings Ltd. 2020.

This book provides information on the treatment of 24 cancers, plus the most effective treatments of the most common symptoms affecting cancer patients while they undergo chemotherapy, radiotherapy, or surgery.

Probiotics are recommended to balance the microbiome:

  • Bladder cancer
  • Colorectal cancer
  • Esophageal cancer
  • Head and neck cancer
  • Stomach cancer

David Servan-Schreiber, MD, PhD

Servan-Schreiber D. Anticancer: A New Way of Life. New York: Penguin Books. 2009.

This book provides tips on how people living with cancer can fight it and how healthy people can prevent it.

Prebiotic and probiotic foods are recommended for gut and immune system health.

Nasha Winters ND, FABNO, LAc, DiplOM and Jess Higgins Kelley, MNT

Winters ND, Kelley JH. The Metabolic Approach to Cancer. 2017. Chelsea Green Publishing.

This book’s metabolic approach to cancer is a “naturopathic nutrition program that uses the medicinal powers of traditional foods, therapeutic diets and non-toxic lifestyle approaches as cancer counteragents and preventives.“ The program focuses on 10 terrain elements and how to assess them and bring them into balance.

Dr. Winters suggests trying to look for as many different strings of bacteria in supplements as possible. Research has found that our microbiota is most active at night, so the ideal time to take pro- and prebiotics is before bed. Rotate your brand of probiotics every ninety days to get the most benefit from the various stains. Keep in mind that cooking foods reduces existing prebiotic content by 25–75%, so consuming [prebiotic] foods in their raw state is optimal.

Use of prebiotic and probiotic foods and supplements

  • During chemotherapy and radiation to the pelvic area 
  • After a course of antibiotics
  • Improve immunity by balancing T-helper cells
  • Improve mood: anxiety and/or depression

Other expert assessments

Donald Abrams, MD, and Andrew Weil, MD

This 2014 book recommends use of prebiotics and probiotics to reduce risk of gastrointestinal cancers.

Oncology Association of Naturopathic Physicians

A 2018 survey identified probiotics as one of the most frequently identified interventions used by members of the Oncology Association of Naturopathic Physicians: Seely D, Ennis JK, McDonell E, Zhao L. Naturopathic oncology care for thoracic cancers: a practice survey. Integrative Cancer Therapies. 2018 Sep;17(3):793-805.


Microbiome, surgery, and probiotics

CancerChoices Senior Clinical Consultant Laura Pole, RN, MSN, OCNS: Integrative physician and CancerChoices advisor Keith Block, MD, and other clinician researchers suggest using prebiotics or probiotics before and after surgery to reduce the risk of infection and keep the protective inner lining of the intestines (mucosal barrier) healthy.1Block KI, Block PB, Gyllenhaal C. Integrative treatment for colorectal cancer: a comprehensive approach. The Journal of Alternative And Complementary Medicine. 2018 Sep/Oct;24(9-10):890-901. This is backed by research: Use of probiotics around the time of surgery improved the gut microbiome2Aisu 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. and protected the intestinal lining’s physical and biological barrier3Liu D, Jiang XY, Zhou LS, Song JH, Zhang X. Effects of probiotics on intestinal mucosa barrier in patients with colorectal cancer after operation: meta-analysis of randomized controlled trials. Medicine (Baltimore). 2016 Apr;95(15):e3342. after colorectal cancer surgery.

I encourage you to consult your surgeon and/or an integrative oncologist—such as a naturopathic oncologist or functional medicine physician—to recommend specific probiotics you can take as well as other measures to protect and restore your microbiome. See Finding Integrative Oncologists and Other Professionals ›

Keep reading about probiotics and prebiotics


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


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: January 31, 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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