Taking probiotics before surgery is a topic of debate among healthcare professionals. Probiotics are live microorganisms that can provide health benefits when consumed in adequate amounts. Many people take probiotics for gut health, and some hope that taking probiotics prior to surgery can reduce complications and speed recovery. However, the research on perioperative probiotics is limited and findings are mixed. There is not yet sufficient evidence to make a firm recommendation for or against taking probiotics before surgery. As with any supplement, it’s best to discuss with your surgeon whether probiotic use is appropriate in your individual case.
What are probiotics?
Probiotics are live microorganisms, typically bacteria or yeasts, that provide health benefits when ingested. Some common probiotic strains include:
– Lactobacillus: This is a type of friendly bacteria found in the gut, vagina, and mouth. Common species include L. acidophilus, L. rhamnosus, and L. brevis.
– Bifidobacterium: Common species include B. longum, B. breve, and B. lactis. Bifidobacterium normally resides in the colon.
– Saccharomyces boulardii: This yeast may help restore healthy gut flora and digestive function.
– Streptococcus thermophilus: Found in yogurt, this probiotic helps crowd out harmful bacteria.
Some foods that contain probiotics include yogurt, kefir, sauerkraut, kimchi, miso, tempeh, and kombucha. Probiotics are also available as capsules, gummies, powders, and liquids.
When ingested, probiotics pass through the stomach and small intestine before reaching the large intestine. There they may help:
– Keep the gut microbiome in balance
– Support immune function
– Aid digestion and nutrient absorption
– Prevent overgrowth of harmful microorganisms
– Reduce gut inflammation
Some people use probiotics to help treat digestive issues like diarrhea, constipation, gas, bloating, and irritable bowel syndrome (IBS). Probiotics may also help prevent and treat vaginal infections, urinary tract infections, and eczema.
Why take probiotics before surgery?
There are several reasons why someone might consider taking probiotics before and/or after surgery:
– Prevent antibiotic-associated diarrhea: Antibiotics are often given before and after surgery to prevent infection. While antibiotics kill harmful germs, they can also wipe out beneficial bacteria in the gut microbiome. This can lead to antibiotic-associated diarrhea, a common postoperative complication. Taking probiotics may help restore gut flora.
– Reduce risk of infection: Probiotics may help crowd out potentially harmful bacteria like Clostridium difficile in the intestines. This could theoretically reduce the risk of surgical site infections.
– Improve recovery of bowel function: Anesthesia and medications given during surgery can slow down the intestines, leading to postoperative ileus (delayed return of normal bowel function). Probiotics may help get bowel movements back on track sooner.
– Shorten hospital stay: By preventing issues like infection and ileus, probiotics may facilitate a quicker recovery and discharge from the hospital.
– Reduce inflammation: The trauma of surgery triggers inflammatory pathways throughout the body. Probiotics can help calm these responses, especially in the intestines.
– Strengthen the immune system: Probiotics interact with gut-associated lymphoid tissue (GALT), a key component of immunity. This assists the body in healing after surgery.
– Improve nutrition status: Probiotics may improve digestion and nutrient absorption of food and supplements given after surgery. This supports recovery.
However, it’s important to note that these benefits are theoretical. More research is needed to know whether perioperative probiotic use truly achieves these outcomes.
Are there risks to taking probiotics before surgery?
While probiotics are generally considered safe, there are some potential risks to taking them prior to surgery:
– Infection in immuno-compromised patients: There is a small chance probiotic strains could seed an infection in patients with weakened immune systems. This is most concerning for patients undergoing organ transplants or cancer surgery.
– Contamination of surgical sites: Although unlikely, there is a hypothetical risk that probiotics could travel through the bloodstream and colonize surgical wounds. Further research is needed.
– Antibiotic resistance gene transfer: Probiotics could theoretically exchange genetic material with harmful bacteria, making the bacteria antibiotic-resistant. However, this risk is still speculative.
– Adverse reactions: A minority of patients report side effects like gas, bloating, and diarrhea from probiotic use. Reactions are more common in seriously ill patients.
– Interactions with immunosuppressants: Probiotics may potentially interact with immunosuppressant drugs sometimes prescribed after organ transplant surgery. More research is warranted.
Overall, the risks associated with short-term probiotic use around the time of surgery appear very low. But as with any supplement, patients should weigh these potential risks versus unproven benefits.
What does the research say about taking probiotics before surgery?
There are a limited number of studies examining perioperative probiotic use. However, the findings of this emerging research are summarized below:
– May help prevent diarrhea after cardiac surgery: A 2019 meta-analysis found probiotic use significantly reduced the risk of diarrhea in patients undergoing cardiac procedures. The effect was greatest with multi-strain probiotics started after surgery.
– Reduces risk of wound infection after colorectal surgery: A 2015 meta-analysis reported that probiotics decreased surgical site infections by about 50% following colorectal operations when initiated shortly after surgery.
– Shortens ICU and hospital stay: A 2018 meta-analysis demonstrated probiotic administration around the time of abdominal surgery shortened length of stay in the intensive care unit and hospital overall.
– Improves outcomes after liver transplant: A small 2019 study gave liver transplant patients probiotics orally and via enema beginning one day before surgery. The probiotic group had significantly lower rates of infection and faster recovery of bowel function.
– No effect seen in pancreaticoduodenectomy: In a 2021 double-blind study of patients undergoing pancreatic tumor surgery, perioperative probiotics did not reduce post-op complications versus placebo.
– Not beneficial for overall infection risk: A 2018 Cochrane review concluded probiotics did not lower the overall risk of infectious complications after gastrointestinal surgery. But strain-specific benefits were noted.
So in summary, probiotics show promise for reducing specific complications like diarrhea and slower GI recovery after surgery. However, more evidence is still needed to recommend universal perioperative probiotic supplementation given the mixed results.
What are the best probiotic strains to take before surgery?
If you decide to take probiotics around the time of surgery, these strains have the most evidence for benefiting surgical recovery:
– Lactobacillus plantarum: This strain demonstrated particular efficacy for reducing infections in cardiac and colorectal surgery patients in multiple studies.
– Saccharomyces boulardii: There is strong evidence that this yeast probiotic can prevent antibiotic-associated diarrhea when used perioperatively. It also reduces recurrence of C. difficile infections.
– Bifidobacterium longum: Studies indicate this strain helps speed the recovery of bowel function after major abdominal surgery.
– Lactobacillus acidophilus: This probiotic is frequently studied for preventing diarrhea linked to antibiotic use. Very limited evidence shows it may help after surgery.
– Multi-strain formulas: Combination probiotics seem to have greater efficacy than single strains alone. Look for products containing diverse Lactobacillus, Bifidobacterium, Saccharomyces, and Streptococcus species.
Probiotic strains not shown to benefit surgical recovery include L. rhamnosus GG, L. reuteri, L. casei DN-114001, and Bacillus coagulans.
Should you take probiotics before and/or after surgery?
There are reasonable arguments for initiating probiotics both before and after surgery:
Reasons to begin probiotics *before* surgery:
– May reduce baseline gut inflammation preoperatively
– Allows time to establish gut colonization with beneficial strains
– Early colonization could theoretically better resist pathogenic overgrowth
Reasons to begin probiotics *after* surgery:
– Avoids chance of seeding infection into surgical sites
– Clears gut before introducing new bacteria strains
– Can target proven benefits like diarrhea prevention
– Easier to implement for unplanned surgeries
There is no consensus on the ideal timing. Recent studies demonstrating benefit have implemented probiotics anywhere from 7 days before surgery to immediately after surgery. Beginning probiotics a few days prior to planned elective surgeries is likely the best approach. But discuss timing with your surgeon.
Should you take probiotics after taking antibiotics?
Evidence strongly supports taking probiotics after a course of antibiotics to restore healthy gut flora. Antibiotics are commonly given before and after many major operations. Taking probiotics after antibiotics may be especially beneficial if you experience antibiotic-associated diarrhea. High quality probiotics can repopulate the gut with favorable bacteria that get depleted by antibiotic treatment.
Do surgeons recommend taking probiotics before or after surgery?
Most surgeons do not have a universal recommendation for probiotic use around the time of surgery. Practices vary. Some surgeons may recommend probiotics selectively for patients at high risk of diarrhea or infection. Others may advise patients to avoid probiotics due to unproven benefit and hypothetical (though unlikely) risks.
Surgeons also differ on when they advise taking probiotics in relation to surgery. Some instruct patients to stop probiotics 1-2 weeks before surgery, then restart after. Others only recommend initiating probiotics in the postoperative recovery period.
There are no formal guidelines directing surgeons on perioperative probiotic use. Practices are individualized. It is important to discuss your surgeon’s preference, as some may have strong recommendations against probiotics.
When should you stop taking probiotics before surgery?
Common surgeon recommendations for stopping probiotic use before surgery include:
– 1-2 weeks before: Allows adequate washout period before operation
– 72 hours before: Thought to clear probiotics before surgical stress
– Morning of surgery: Stops probiotic use after midnight NPO guidelines
– Upon hospital admission: Consistent with holding other oral medications
However, these recommendations are not evidence-based. Recent studies showing benefit administered probiotics up until the day of surgery or even in the postoperative period. Some experts argue abruptly stopping probiotics may disrupt gut flora at a vulnerable time.
Discuss your surgeon’s specific instructions. Unless contraindicated, continuing probiotics up until fasting for surgery is likely sufficient for most healthy patients. Stop sooner if your surgeon advises.
Are there any medical conditions where you shouldn’t take probiotics before surgery?
Some conditions where probiotic use before surgery may pose higher risk include:
– Immune deficiency: Includes HIV/AIDS, chemotherapy, and immunosuppressant medications like steroids and biologics
– Critically ill and ventilator-dependent patients
– Short bowel syndrome: May increase risk of sepsis
– Central venous catheters: Potential conduit for bloodstream infection
– Cardiac valve defects and prosthetic implants: Risk of endocarditis
– Organ transplant surgery: Interaction with anti-rejection medications
For patients with significant immune dysfunction, it may be safest to avoid probiotics for 1-2 weeks prior to surgery and restart only after recovery. Have an in-depth discussion with your surgeon about the risks versus benefits.
Can you take probiotics after surgery? What is the best time to restart?
Most surgeons allow restarting probiotics after surgery when bowel function returns and you Tolerate oral intake. Benefits after surgery may include:
– Preventing antibiotic-associated diarrhea
– Helping restore normal bowel function
– Reducing risk of infections like C. difficile
– Supporting nutrition if diet is limited
Recent studies restarting probiotics immediately after surgery have shown benefit. But many surgeons prefer waiting 24-48 hours to allow protective gut inflammation from surgery to resolve. Coordinating timing with antibiotics is also important. Discuss the optimal restart time with your surgeon.
What is the best way to take probiotics before or after surgery?
Tips for taking probiotics perioperatively include:
– Choose reputable brands that assure potency and purity. Follow product instructions.
– Take at least 1-2 billion CFUs (colony forming units) daily minimum. Higher doses around 5-10 billion CFUs are likely best.
– Take once daily, preferably in the morning on an empty stomach.
– If taking capsules, swallow whole. Don’t chew. This prevents killing strains before they reach GI tract.
– For sachets, dissolve completely in water and drink. Do not take dry.
– Avoid mixing probiotics with hot foods or liquids which can degrade strains.
– Separate dosage from antibiotics by at least 2-3 hours if taking together.
– Pay close attention to expiry dates and proper storage conditions. Heat and humidity degrade probiotics.
Follow dosage recommendations from your surgeon or pharmacist. Probiotics are very sensitive “live” products requiring proper handling.
Conclusion
While probiotics show promise for improving surgical recovery, there is not yet sufficient evidence to universally recommend for or against routine perioperative probiotic use. Potential benefits like reduced infections and faster GI recovery must be weighed against theoretical (though unlikely) risks like seeded infections in immunocompromised patients.
Most surgeons allow probiotic use before surgery in healthy patients but practices are mixed on exact timing and dosage protocols. Stopping 1-2 weeks before elective surgery provides a washout period but may not be necessary. Initiating probiotics after surgery when diet resumes may provide helpful restoration of gut flora. critically ill patients and those on immunosuppressants may be advised to avoid probiotics altogether near the time of surgery.
As with any supplement, discuss taking probiotics before or after your procedure thoroughly with your surgeon. Individual factors affect the risk/benefit ratio. Select high quality broad-spectrum brands proven in clinical studies. Probiotics likely help counteract the gut-disrupting effects of antibiotics and surgical stress. But more research is still warranted to develop definitive guidelines on their optimal perioperative use.