Photo: iStockphoto. Illustration by Corina Lo
When Sandy Parks* brought her four-month-old daughter to a mom-and-baby meet-up in her Toronto neighbourhood in the fall of 2017, she wasn’t expecting to drop $200. The first-time mom was nervous about introducing solid foods and was eager to hear from the guest speaker, a holistic nutritionist. The speaker talked about the importance of gut health for babies and recommended giving infants a daily probiotic supplement. Parks ended up buying a several-month supply on the spot. She liked the idea that she was taking this extra little step to try to keep her daughter as healthy as possible. “I strongly believe it can help, and I see it as risk-free,” she says.
If you’ve spent any time on a Facebook parents’ group or even idly chatting with other tired parents at the playground, you’ve probably heard some variation of the pitch Parks heard about the wonders of probiotics. Colicky baby? Try probiotics. Gassy baby? Probiotics. Your kid’s on antibiotics? Probiotics! From capsules to powders to drops to yogurt drinks, probiotics are a booming business, and some parents swear by them. But is there any actual science to back up all the marketing hype and crowd-sourced remedies?
Every one of us has a unique microbiome—the trillions of microbes that live inside each of our bodies—and research has increasingly shown that these organisms play a critical role in our overall health and well-being. Bacteria and other micro-organisms, like viruses and fungi, start colonizing babies’ intestines immediately after birth. The composition of babies’ microbiomes is influenced by many different factors, including the type of birth (vaginal or C-section), what they eat and their environment (including, for instance, whether there are pets in the home).
The probiotics in food and supplements are specific strains of live microbes that have been shown to provide health benefits when consumed in adequate amounts. The theory behind supplementing with probiotics is based on the idea that since certain microbes perform particular biological functions in our gut, when the balance of those microbes is out of whack—like when we’re taking antibiotics—we can experience health issues. And by ingesting billions more of those beneficial microbes, we can help restore our microbiome and our health.
Although scientists are still trying to find out exactly how probiotics help our gut and improve our health, Dragana Skokovic-Sunjic, a clinical pharmacist in Hamilton and lead author of probioticchart.ca, a guide aimed at doctors and pharmacists that analyzes the research behind different probiotics on the Canadian market, says it’s less about replenishing and more about helping the existing bacteria in our gut restore balance and do their jobs. “There is a misconception that probiotics will help repopulate or colonize the gut,” says. “But that is not the case.”
The probiotic brands you find on grocery store and pharmacy shelves make all sorts of claims: from vague language about improving kids’ overall gut health to more specific claims that they can cure diarrhea, colic and other childhood ailments. As parents, it can be hard to figure out if kids need probiotics and which ones to buy if they do.
The good news is that there is a growing body of solid scientific research looking into probiotics and their effectiveness. And, in Canada, probiotic supplements are regulated under the Natural Health Product Regulations, so any claims on the labels must be approved by Health Canada, and any specific therapeutic claims require scientific documentation.
But when it comes to whether probiotics work, that depends on what it is you expect them to do. Under Health Canada’s regulations, all licensed probiotics are allowed to claim that they “help support intestinal/gastrointestinal health,” and similar language has been approved for probiotics in food. This idea that probiotics are generally good for the gut is what leads many parents, like Parks, to invest in daily supplements, even when their children are otherwise healthy. But don’t expect your doctor to recommend this practice at your kid’s next checkup. Catherine Pound, a paediatrician at the Children’s Hospital of Eastern Ontario (CHEO) and chair of the Canadian Paediatric Society (CPS) Nutrition and Gastroenterology Committee, doesn’t think there is strong enough evidence for her to recommend probiotics to her healthy patients. “I don’t think the research is there yet on taking them every day as a preventive medicine,” she says.
Gregor Reid, a professor of microbiology and immunology at Western University who has been researching probiotics and the human microbiome for more than 30 years, admits that there is a lot we still don’t know about exactly how probiotics work, but says there is a growing body of research behind probiotics as a form of preventative healthcare. “Beneficial microbes influence our health in ways we are just beginning to understand,” he says. “But I believe they can help your immune system."
While the research may not yet be sufficient for medical doctors to endorse a daily probiotic regimen for all kids, CPS does recommend some specific probiotic strains for a few conditions.
For example, Pound says one place where research has led to the widespread acceptance of probiotics is in NICUs. Preterm infants in hospitals across the country are now routinely given a specific strain of probiotics that has been found to prevent necrotizing enterocolitis (NEC), a dangerous condition in which a portion of a newborn’s bowel dies. Reid is glad this has finally become standard practice: When his twins were born prematurely 1992, he saw another baby in the NICU die from NEC and he wondered if getting beneficial microbes into the bowel could help.
The Canadian Paediatric Society also recommends doctors consider suggesting probiotics be taken alongside courses of antibiotics. Several strains of probiotics have been found to help prevent diarrhea from antibiotics. Reid compares giving antibiotics to a child under four, whose gut is still developing, to “carpet bombing” their microbiome. “I think if a child is on antibiotics, they should absolutely be taking a probiotic at the same time and for a month after,” he says. Pound says she now routinely discusses probiotics with parents when prescribing courses of antibiotics.
Other uses endorsed by the CPS: to shorten the duration of diarrhea that has been diagnosed as viral and as a possible treatment for some symptoms of irritable bowel syndrome.
For parents who have spent sleepless nights with a screaming, inconsolable infant, recent research showing that probiotics might help with colic is particularly hopeful. There have been a few small studies that have shown a reduction in the duration of crying for breastfed babies with colic, and Health Canada has approved labelling for certain probiotic strains that claim to reduce colic. The CPS says there may be a role for probiotics in treating infantile colic, but that there is “insufficient evidence to recommend for or against it.” In her practice, Pound says, “if a baby is impossible to soothe for hours at a time, I will look for a cause. If parents want to try probiotics and the child is otherwise healthy, I will not discourage them from doing so.”
You may have also heard about recent research into probiotics as a potential treatment for other conditions, including eczema and allergy symptoms, respiratory tract infections and even some autism symptoms. The CPS does not currently endorse using probiotics to treat or prevent any of these conditions. The organization’s 2012 position paper on probiotics, which was reaffirmed in February 2019, notes that there are some early studies with “initially encouraging results” for atopic dermatitis (eczema), but the CPS stops short of recommending doctors consider it as a treatment option just yet. (Pound notes that because of the large volume of recent research into probiotics, the CPS guidelines will be updated in the next few years.) Parks is among the many parents who are convinced probiotics helped reduce their children’s eczema symptoms. After that initial foray into probiotics when her daughter was an infant, she didn’t give her daughter regular doses again until she had a bout of eczema at 16 months. “I tried giving her probiotic drops, and it cleared up within nine days,” she says, and she’s continued giving her the drops ever since.
But not every parent who tries probiotics is hooked. Following a tip from a fellow parent (and against the advice of her family doctor, who said there wasn’t enough evidence for him to recommend it) Toronto mom Chloe Vice tried probiotics with both of her sons when they were infants. With her eldest, she hoped the probiotics might help with gassiness, and when her youngest was a baby, she used them when he was constipated. “I was open to anything that might help, and only tried it because other parents were doing it,” says Vice. “I figured it seemed harmless.” In her case, probiotics weren’t the miracle cure she’d hoped for: She didn’t notice any change in her children’s symptoms either time.
Pound says that as research into probiotics expands, we may see new evidence emerge to support a longer list of uses. For instance, right now you will find probiotics on Canadian shelves that claim they help relieve constipation, but although Health Canada has approved this claim, this use isn’t yet endorsed by CPS. Pound says few studies have found no evidence that probiotics help with constipation in children. “But that doesn’t mean that two years from now a huge study with many more children won’t show an effect,” she says. “The truth is, there’s a lot we don’t know. It’s still early.” In the meantime, Pound says she knows some parents will continue to try probiotics whether their doctors recommend them or not.
Pound says parents’ perception that probiotics are generally safe for healthy children aligns with the evidence. “They’re bacteria, so there’s always a theoretical risk of side effects, but as a general rule, they’re well-tolerated,” she says. There is a low risk of systemic or local infections, and there have been some reports of sepsis in patients who are critically ill or have compromised immune systems, so be sure to consult with your doctor if your child is immunocompromised.
Her biggest concern when it comes to parents choosing to treat their kids with probiotics, Pound says, is that they may jump straight to the supplements without first visiting their doctor to rule out other causes of their kids’ symptoms, which might require medical treatment. “If we have a tummy issue in an infant, for example, I need to first do an assessment and make sure there is no other medical reason for their crying and discomfort,” she says.
Another potential risk associated with jumping on board with probiotics is the considerable financial cost. Putting your kid on a even a short-term dose of supplements might cost a couple of hundred dollars, money that might otherwise be spent on buying fresh fruits and vegetables, and other gut-friendly whole foods. Pound, Reid and Skokovic-Sunjic all recommend children eat a diet high in “prebiotic” foods: whole grains, and fibrous fruits and vegetables like bananas and leeks that stimulate the growth of the beneficial bacteria already in our guts.
They also recommend incorporating fermented foods that contain live bacteria, like yogurt and kimchi, into kids’ diets. “If you’re only eating processed and pasteurized foods, then you’re not getting microbes that our bodies used to get,” says Reid, noting that before the widespread use of refrigeration, pasteurization and other industrial food processing systems, we used to consume a lot more beneficial bacteria every day. And for the kind of parent who swears by her hand sanitizer and antibacterial wipes, who might feel a little grossed out by the idea of eating a bunch of live bacteria, Reid points out that we already ingest over a billion bacteria every single day from our saliva alone. “We’re swallowing bacteria all the time,” he says. “Why not add some beneficial ones?”
* name has been changed
Overwhelmed by the probiotic options? Here’s what you need to know before you buy.
1. Supplements authorized for sale by Health Canada will have a Natural Product Number (NPN). Foods containing probiotics, like yogurts and drinks, are regulated separately and won’t have one of these.
2. The label should list the specific strain or strains of probiotics in the product (for example, Lactobacillus rhamnosus GG).
3. Look for the concentration of the probiotic, expressed as colony forming units, or CFUs. The number will usually be in the billions per serving.
4. For more info, you can look up the brand name or specific strain in the federal government’s Licensed Natural Health Products Database or under the Paediatric Health section of probioticchart.ca.