Is it true that dysbiosis as a diagnosis does not exist, and probiotics are useless?

Both doctors and patients write off numerous problems with the gastrointestinal tract to dysbiosis. The main method of treatment in this case is the purpose of probiotics that are designed to populate the intestines with useful bacteria and save the patient from unpleasant symptoms. Especially often, a course of probiotics is prescribed in parallel with antibiotic treatment. We decided to check whether such actions are justified from a scientific point of view.

Dysbiosis is one of the most popular diagnoses among therapists and pediatricians. They tend to explain not only problems with the stomach and intestines, but also diseases such as Bronchial asthma, allergies, psoriasis, acne, and also headache, dull hair and fragility of nails, fast fatigue, a decrease in concentration of attention and jumps in blood pressure. One of the most common causes of dysbiosis They think Reception of antibiotics, as they, struggling with pathogenic bacteria, at the same time kill “good”. Therefore, enough often Doctors prescribe Together with the course of antibiotics of probiotics. Different Probiotic, Prebiotic And Eubiotic The additives are presented in pharmacies in a wide range and are released without a prescription. Also Set in The intestines are useful bacteria They promise manufacturers of yogurts and other dairy products and even toilet paper.

In the post -Soviet medical space, dysbiosis is usually understood as a certain change in the composition of bacteria in the large intestine. However, in foreign practice, in particular in the international classification of diseases (ICD-10), such There is no diagnosis. Candidate of Medical Sciences Vladimir Vasilenko Calculatedthat, “carrying out a search in the world scientific database on Medline medicine by the key word DysBacteriosis (“ Dysbacteriosis ”), we will learn that it is present in the headlines of 257 scientific papers published from 1966 to 2000, 250 of them in Russian -speaking medical journals, four more belong to the authors from the former socialist Camps ".

Moreover, although in Russia exists row Laboratory tests (for example, sowing feces for dysbiosis and analysis of microbial markers by gas chromato-mass spectrometry according to Osipov) designed to confirm or refute the diagnosis of the patient, practicing evidence-based medicine experts and the results of doubt. Alexey Gollenko, candidate of medical sciences, gastroenterologist, Explains: "The norm for them was invented by the unknown on what principle a few decades ago." He also comments on the history of the creation of the diagnosis: “[Scientist] first revealed a group of people with dysbiosis by Kala, and then conducted a blood test in them. That is, this assumption is allowed. And otherwise, this analysis is difficult to call this analysis as anti -scientific pumping out of the population. ”

About the meaninglessness of such analyzes also expressed Tatyana Tikhomirova in the column of an authoritative scientific pupil “Popular Mechanics”: “The fact is that gut bacteria basically live not in its lumen, but on a thin film on the gut itself. At the same time, only those who die, those who are unlucky, did not have enough space, or a small part of those bacteria that prefer clearance are torn (and fall into the lumen). And an analysis for dysbiosis takes into account only those bacteria that live in a lumen. Recently, DNA of microbes taken using a biopsy of the intestinal wall were analyzed. At the same time, it was found that more than 75% of all inhabitants were never cultivated at all! ”

The lack of recognition of the disease in other countries, questions to the methodology of analyzes and to the interpretation of their results, as well as the insufficient knowledge of microorganisms of the colon leads us to the conclusion that the concept of "dysbiosis" It cannot be diagnosis. Maximum this word can be characterized by some violations without indicating the cause of their occurrence. This is precisely the danger of making such a diagnosis by a doctor of patient complaints. Specialists Evidence medicine note that in this way much more serious diagnoses can be missed and not detected: irritated intestines, crown disease, lactase deficiency and even cancer.

The most frequently prescribed groups of drugs with a diagnosis of dysbiosis-probiotics (contain useful bacteria in dried or dissolved form), prebiotics (are not digested and not absorbed in the upper sections of the gastrointestinal tract, but are fermented by the microflora of the large intestines and stimulate its growth and vital activity) and euphony) and euciotics) and euciotics) and euciotics) and erupiots (living microorganisms and their life products that have a normalizing effect on the composition and biological activity of the microflora of the digestive tract). The same names are used in advertising of all kinds of biologically active additives (dietary supplements), as well as “living” yogurts and other food products “for the intestines”.

The division of bacteria into useful and harmful is very conditionally. Firstly, the qualitative and quantitative composition of bacteria in the large intestine varies depending on the place of living of a person. Get into an unusual environment and just Explained Problems with the gastrointestinal tract arising during the trip. Secondly, as mentioned above, the composition of the intestinal microflora has not been studied enough. Finally, thirdly, in 1 g of the contents of the colon Lives about 10¹¹ - 10¹² bacteria. The content of bacteria in dietary supplements, tablets or yogurts is many times less. Moreover, most, for example, lactobacilli coming from food, Destroyed Holly acid in the stomach for four hours. It is worth noting that the probiotic market is huge: in 2017, it amounted to more than $ 1.8 billion, and by 2024, according to economists. Reach $ 66 billion. At the same time, the drugs do not have proven effectiveness, and in some cases they do more harm than good.

A group of Israeli scientists I studied The need to use probiotics in the framework of antibacterial therapy. Having divided patients taking antibiotics into three groups, scientists appointed probiotics in one group, the second - auto -transplantation (transplantation to themselves) feces taken from them before the start of treatment, and the third group did not accept anything but antibacterial therapy itself. The fastest recovery of intestinal microflora was demonstrated by the second group. At the same time, the group, taking probiotics, was restored worse than a group that did not accept anything.

They did not provide Probiotics of healing action and on children with gastroenteritis. The study was attended by 886 children with gastroenteritis aged three months to four years. Some of them received probiotics, and part - placebo. It turned out that in a group of probiotics a moderate or severe course of the disease on a two -week segment had 26.1% of the subjects, and in the placebo group - in 24.7%. Moreover, from the point of view of symptoms (diarrhea and vomiting), there was no difference at all. There are separate ones CasesWhen the intake of probiotics contributed to fungemia - the spread of fungal infection in the patient's blood. 

IN systematic review Randomized controlled tests of probiotics in 2016 did not reveal any effects of probiotics on the intestinal microflora of healthy adults. There are separate short -term studies showing the effectiveness of individual groups of bacteria. For example, reception Lactobacillus Casei Shirota showed Among patients with chronic constipation, an improvement of 89% against improvement by 56% in the placebo group. However, as the researchers note, a probiotic is not a complete treatment, but only an addition to it.

With prebiotics - in fact, food for bacteria - the situation is more unambiguous. There is no data on their proven benefits in the treatment or prevention of any diseases. Infectious disease specialist Dmitry Troshchansky Explains: "Prebiotics are mainly carbohydrates that are in many vegetables and fruits, buying them in pharmacies is a pointless thing." Agree Aleksey Golvenko, a candidate of medical sciences and a gastroenterologist with him: “No one has yet proved that they are more useful than eating, for example, two kiwi per day or replace white bread with whole grain, less sweet and more fruits and vegetables.”

They will not cure a dozen diseases and eubiotics - supposedly living organisms inside dietary supplements or yogurts. Firstly, up to 90% of living bacteria in them Do not live Before getting to our table. Secondly, most of the "survivors" will be dissolved by hydrochloric acid, which is part of the gastric juice. And those units that will nevertheless fall into the large intestine will be so weakened that they will not be able to withstand its “indigenous” inhabitants. 

At the same time, it should not be completely attributed to the probiotics to “funmicins”. Eran Elinavov from the Waitsman Institute (Israel) predictsthat with an increase in the availability of the creation of the patient’s genetic profile, they can become personalized drugs, that is, made specifically for each patient and effective only for him. In a similar way Describe The future of probiotics and prebiotics in the journal "Trends of Microbiology", but, unfortunately, today the pharmacological industry has no such individual developments.

Thus, dysbiosis cannot be considered a full diagnosis and all the symptoms are written off on it. In most cases, when taking antibiotics, the appointment of probiotics is pointless, and sometimes unsafe. It is also pointless to overpay for “living” yogurts and dietary supplements in the hope of getting rid of a number of health problems at once. The vast majority of products promising to populate the intestines with useful bacteria are simply a marketing trick to increase sales.

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What do our verdicts mean?

Read on the topic:

1. Is it true that there are more bacteria in the human body than cells of the body itself?
2. Do probiotics help restore intestinal microflora?