Fast Five Quiz: Probiotics Facts vs Fiction

Medscape

02-07-2025

Probiotics are undoubtedly a popular choice among many Americans. Consumers cite goals ranging from bowel health and regularity to vaginal health, bone density support, and immune boosts as reasons for using probiotic capsules, gummies, and beverages. However, confusion and concern from patients and healthcare providers persist over probiotic indications, quality, and reliability.
How much do you know about probiotics and their applications? Test your knowledge with this quick quiz.
Guidance from the AAP states that current evidence does not support the universal, routine administration of probiotics to preterm infants, especially those with birth weight < 1000 g. Despite some studies showing that probiotics reduce the risk of necrotizing enterocolitis in preterm infants or infants with very low birth weight, the AAP does not recommend their use due to conflicting data regarding safety and efficacy as well as the lack of pharmaceutical-grade, FDA-regulated probiotic products in the United States.
Additionally, the AAP maintains no evidence of significant reduction of nosocomial sepsis in preterm infants is associated with probiotic supplementation. However, the American Gastroenterological Association (AGA) suggests using probiotics with specific combinations of bacterial species in infants < 37 weeks of gestational age and low birth weight to prevent necrotizing enterocolitis.
Learn more about necrotizing enterocolitis.
AGA clinical practice guidelines recommend probiotics in patients with C difficile infection only in the context of a clinical trial. Otherwise, the AGA makes no recommendations on the use of probiotics in C difficile colitis. A knowledge gap surrounds this topic as study data has been heterogenous.
Learn more about C difficile colitis.
Multiple organizations, such as the AGA and the World Gastroenterology Organisation (WGO), do not recommend probiotics for the management of Crohn's disease. According to the WGO, studies have not produced evidence that probiotics are beneficial for the remission or maintenance of remission of Crohn's disease. The AGA only recommends probiotics for Crohn's disease in the context of a clinical trial.
Learn more about Crohn's disease.
A meta-analysis of trials including a total of more than 1400 participants found that probiotic supplementation was associated with significant reductions in ALT, AST, and GGT in MASLD. Significant reductions in triglycerides, high-density lipoprotein and low-density lipoprotein cholesterols, insulin, insulin resistance, tumor necrosis factor alpha, BMI, and C-reactive protein were also observed with probiotic supplementation.
A separate meta-analysis including more than 5100 participants on the effects of probiotics on ALT, AST, and GGT in patients with MASLD also found reductions in all three liver enzymes associated with probiotic use.
Learn more about MASLD.
Per the International Scientific Association for Probiotics and Prebiotics, probiotics are defined as 'live microorganisms that, when administered in adequate amounts, confer a health benefit.' Probiotics are found in foods such as kimchi, yogurt (with live and active cultures), and certain cheeses. Prebiotics are typically fiber or other complex carbohydrates that function as metabolic food for beneficial microorganisms. Some examples of prebiotic-containing foods include flaxseeds, whole oats, and barley.
Prebiotics and probiotics might both be used to treat conditions as well as for disease prevention.
Some fermented foods, like miso and sauerkraut, contain live strains of probiotics. Prebiotics are bioactive compounds found in fiber-rich foods, such as whole grains, and undergo fermentation by bacteria in the gut.
Probiotics might be found in solid foods, supplement beverages, as well as supplement capsules and gummies. Prebiotics are present in fiber-rich foods and are also available as purchasable supplements.
Learn more about about fiber supplementation.