Probiotics 101: Everything Bariatric Patients Need to Know

Article By: Rachel Ignomirello, MS, RDN, CSOWM, LDN

Rachel Ignomirello is a Bariatric Dietitian and Board-Certified Specialist in Obesity and Weight Management.

What Are Probiotics?

Even though some of us may think of bacteria as harmful or germy, bacteria can be helpful. The body itself is full of bacteria, both good and bad. Probiotics are live bacteria (microorganisms) that are referred to as the “good bacteria.” They reside in the intestines and help digest food, support the immune system, and produce vitamin K. In addition to the gut, probiotics are also found in both food and dietary supplements. The supplements, which are typically available as capsules or powders, contain a variety of bacterial strains and doses. According to a 2020 survey by DuPont Nutrition & Biosciences, about 22% of Americans were using some form of probiotic. Among adults, probiotics are one of the most used dietary supplements other than vitamins and minerals. Not to be confused with probiotics, prebiotics are food substances that feed good bacteria in the gut, and synbiotics are products that contain both prebiotics and probiotics.

What Are the Benefits?

Probiotics have shown promise for a wide range of health benefits: prevention of antibiotic-associated diarrhea, treatment of periodontal disease, and maintenance of ulcerative colitis. In addition to those specific examples, probiotics have also been used to relieve lactose intolerance symptoms, reduce allergy symptoms, and reduce the risk of kidney stones. The common strains used in supplements are Lactobacillus and Bifidobacterium, and these can help bariatric patients who struggle with lactose intolerance, gas, and bloating. Despite having quite a few clinical trials, this is still a newer area of research. For example, more research is needed to understand the effects of probiotics on obesity and weight loss.

What Are Food Sources of Probiotics?

Despite probiotic supplementation being so popular, probiotics can be found in everyday foods. Fermented foods are made from microorganism activity and are the main food source of probiotics. The following are rich sources: yogurt (with live/active cultures), kefir, kombucha, kimchi, sauerkraut, cottage cheese, buttermilk, tempeh, miso soup, pickles, and fermented soft cheeses. To keep the gut healthy after bariatric surgery, add probiotic foods once allowed in the diet progression. Patients can use yogurt as part of a meal or snack, blend kefir into smoothies, top meats with sauerkraut, make kimchi stir-fry, or even use miso dressings for salads.

What Should I Look For in a Supplement?

A daily probiotic dose of 10-20 billion CFU is encouraged for everyday digestive health, but some individuals may benefit from higher amounts (50 billion CFU) for specific clinical benefits. CFU stands for Colony Forming Units, which just measures how much bacteria are in the product. Patients should work with their bariatric team to choose a strain to meet their treatment goals. A variety of strains may be best. Since probiotics can lose potency over time, expiration dates should be checked. Some supplements may need to be refrigerated, too.

What Considerations Should I Keep in Mind?

Patients should always follow their program recommendations of when to start and stop probiotics. They are generally safe for healthy adults unless immunocompromised. Common side effects when starting probiotics include changes in bowel habits, but those usually subside after 2-4 weeks. Unless otherwise noted, probiotics should be taken with meals. If on an antibiotic regimen, probiotics should not be taken at the same time. Instead, it may be best to wait at least 2 hours before taking.

BariMelts provides general recommendations, not to be construed as medical advice. Please consult your doctor.

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