Comment by doix | Hacker News Reader

Comment by doix | Hacker News Reader

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I used to date a doctor that had many doctor friends, some of which were somewhat involved in creating the treatment guidelines (or something like that, I can't remember the exact details) for the NHS (the UK's national health service). I remember probiotics were specifically discussed and I asked why they weren't prescribed with/after antibiotics.

The answer was that it basically comes down to the fact that there is not enough evidence that supplementing probiotics orally does anything beneficial in the grand scheme of things. The amount of evidence that shows they do nothing beneficial or are slightly negative out-weighs the body of evidence showing that they are beneficial.

Obviously, if they work for you then keep doing what you're doing. But if people are wondering why prescribing probiotics isn't the norm, that's why.

Note: my information is around 8ish years old at this point, but I did a quick search before writing this comment and found a metastudy published in 2023 that seems to confirm nothing has changed.

> [Why probiotics are not prescribed with antibiotics is] that there is not enough evidence that supplementing probiotics orally does anything beneficial in the grand scheme of things.

The grandparent post uses the term “probiotic” but then describes what sound like “active cultures”… my reply assumes you also mean “active cultures”.

My understanding is that bacteria consumed are generally seen as “foreign” by the immune system, and are eventually eliminated. This is why there’s no benefit “in the grand scheme of things”.

However, in the “modest scheme of things”, that bacteria may help you digest food your native bacteria can’t… That effect will only continue as long as you continue to consume the cultures.

Figuring out how to create cultures that become “native” is where lot of research focuses now. Transplants using lab-grown samples from the patient’s own strains has been very promising, but this is not practical for any but the most serious health conditions.

>However, in the “modest scheme of things”, that bacteria may help you digest food your native bacteria can’t… That effect will only continue as long as you continue to consume the cultures.

This is actually where I am today. I have run out of the probiotics that I bought so I am in the stage where I will find out whether, in my case, there is any long-term change to my digestion that could be tied to the probiotic. I expect that if I see a return to the previous condition over the next few weeks then I can confirm that the effect lasts only as long as the probiotic is taken and wears off with time. I would like to see a permanent correction to the problem from this one period of probiotic treatment but that is unlikely to be the case.

Time will tell.

I had been considering making a visit to a gastroenterologist to see whether I could get on a list to do a transplant with a pooh pill. I am not a person who rushes off to a doctor every time something changes so I have to work hard to get myself into a mindset where it is acceptable. Basically, if I can manage something myself I will take that path and any long-term consequences that result are on me. That is acceptable.

The success of this probiotic supplement in changing the whole process for me to one that is a normal process leaves me with one option - self-management - that I can definitely handle. I just need to know the boundaries as far as how long to do it, the durability of the treatment, etc. It is cheap enough and easy enough that I can accept taking a simple supplement daily forever if I can demonstrate that it eliminates the really undesirable situation that I had to manage with antacids previously. When I started this treatment I had noticed that the condition was deteriorating so that on some nights I needed two Tums to handle the reflux. Like I said, I have not needed a single antacid since beginning this and that is a huge QoL improvement by itself since I can now enjoy all the spicy things that I ate anyway with no consequences, managed only by taking a daily probiotic. It isn't just the reflux. Top to bottom there were issues that have all disappeared now. I see real improvements in every part of the digestive process.

Sample size of one. No long-term data. It works for me, so far. Your mileage may vary. With that said, the whole thing was a recommendation from a family member who has been in nursing for multiple decades. I trust them.

One thing to keep in mind is medicine has a bias towards no action unless the action is provably better. I don’t mean that as a critique.

In the case of probiotics, there seem to be few to no downsides, but unclear or unrepeatable upsides. Therefore, many doctors simply chose not to use them.

Overall, this is largely a good attitude. You don’t want medicine to take wild swings at new and fad-like treatments. However, there are often times when they respond far too slowly to information that could help treatment.

I have run out of the probiotic so I am in the stage where I continue as I previously did so that I can see whether this is durable, permanent, or whether it is something that needs to be part of a continuous self-maintenance program. The treatment, probiotic capsules taken once daily, is inexpensive and easy to implement. That is right up my alley.

I can definitely say without adding all the nasty details that my whole digestive process from top to bottom has improved dramatically, returning to a normal condition during the period where I took the probiotics beginning on the first day of combined probiotic/antibiotic dosing and continuing thru today with no ill effects and nothing but positive results to report. It remains to be seen just how durable the change will be. I have a spreadsheet of all dosing treatments and now I will be updating it as I see and note the effects of stopping the probiotic. Last night was the first night with no probiotic. I'm gonna let the chips fall where they will.

please do update us

"Grand scheme of things" for an otherwise healthy person?

or...for someone like described in the story, about to have their gut wiped?

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