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.
Safety and precautions
If you are immunosuppressed, consult an oncology dietician to see if you have any restrictions on eating unpasteurized, fermented, or cultured foods.
Expert consensus
A systematic approach to assessing consensus found 100% agreement among experts that “probiotics have a favorable safety profile in patients with a range of lower GI [gastrointestinal] symptoms typically managed in primary care or general practice” after reviewing evidence from 50 studies.1Hungin APS, Mitchell CR et al; European Society for Primary Care Gastroenterology. Systematic review: probiotics in the management of lower gastrointestinal symptoms—an updated evidence-based international consensus. Alimentary Pharmacology and Therapeutics. 2018 Apr;47(8):1054-1070.
Side effects
Few adverse events are reported with probiotics use for bowel symptoms.2Sun JR, Kong CF et al. Efficacy and safety of probiotics in irritable bowel syndrome: a systematic review and meta-analysis. Saudi Journal of Gastroenterology. 2020 Mar-Apr;26(2):66-77; Li B, Liang L et al. Efficacy and safety of probiotics in irritable bowel syndrome: a systematic review and meta-analysis. Frontiers in Pharmacology. 2020 Apr 3;11:332; Asha MZ, Khalil SFH. Efficacy and safety of probiotics, prebiotics and synbiotics in the treatment of irritable bowel syndrome: a systematic review and meta-analysis. Sultan Qaboos University Medical Journal. 2020 Feb;20(1):e13-e24.
Use of probiotics, prebiotics, or both, can cause gas and cramping for three or four days. Symptoms often resolve after that.3Winters N. The Metabolic Approach to Cancer. White River Junction, Vermont: Chelsea Green Publishing. 2017.
Case reports of probiotics from the genera Lactobacillus, Leuconostoc, Pediococcus, Enterococcus, and Bifidobacterium isolated from infection sites have led researchers to postulate that these probiotics can move within the body (translocate). Probiotic translocation is difficult to induce in healthy humans, and even if it does occur, detrimental effects are rare. Despite this, various reports have documented health-damaging effects of probiotic translocation in immunocompromised patients.4Liong MT. Safety of probiotics: translocation and infection. Nutrition Reviews. 2008 Apr;66(4):192-202. Five case reports showed probiotic-related bacteraemia/fungaemia/positive blood cultures in an analysis of 25 studies including 2242 people.5Hassan H, Rompola M, Glaser AW, Kinsey SE, Phillips RS. Systematic review and meta-analysis investigating the efficacy and safety of probiotics in people with cancer. Supportive Care in Cancer. 2018 Aug;26(8):2503-2509.
Use during pregnancy or lactation
“Probiotics do not appear to pose any safety concerns for pregnant and lactating women. Systemic absorption is rare when probiotics are used by healthy individuals, and the current literature does not indicate an increase in adverse pregnancy outcomes.”6Sheyholislami H, Connor KL. Are probiotics and prebiotics safe for use during pregnancy and lactation? a systematic review and meta-analysis. Nutrients. 2021 Jul 13;13(7):2382.
Use after antibiotic treatment
Use of probiotics may not be the quickest way to return to a pre-antibiotic treatment fecal microbiome in some situations.
References