The reasons for getting diarrhea can be many; from various infections, antibiotics use, Inflammatory Bowel Disease (IBD), Irritable Bowel Disease (IBS) or intense endurance exercise. In common for all these conditions they influence our gut microbiota, and all benefit from treatment with probiotics . It is known that a changed microbiota can give bile salt deconjugation changes leading to changes in stool volume and consistency. Other important functions of the gut microbiota is metabolic (salvages calories, production of short-chain fatty acids, amino acids, vitamin K and folic acid); prevention of colonization by pathogens and immunologic functions .
Antibiotics cause diarrhea by several mechanisms, one is that some antibiotics decrease the concentrations of anaerobes, leading to reduced metabolism of carbohydrates and a resultant osmotic diarrhea. Also, during, and in the recovery phase after antibiotics use, there is a risk of pathogenic bacteria to colonize the gut. One such pathogen is Clostridium difficile, in some severe cases treated with stool transplants , or with probiotics . To prevent colonization of pathogens, probiotics supplementation could be used, to “outnumber the bad bacteria”. Generally probiotics are given in conjunction with antibiotics, to prevent diarrhea, and several clinical studies have shown that the risk of antibiotic-associated diarrhea is reduced when given probiotics [4, 5]. A study in mice showed that probiotics do not colonize the intestine themselves, however, probiotic supplementation does significantly change the types of bacteria that are present . Another important issue is that pathogenic bacteria are able to evolve and can acquire resistance to antibiotics. Since probiotics can be used as partial replacement or together with antibiotics treatment, and thereby prevent secondary infections, antibiotic resistance evolvement could be limited .
It is common with problems with diarrhea during intense endurance exercise, especially running, and the main causes are ischemic, mechanical, and nutritional factors; all affecting the gut . The gut microbiota have a key role in inflammatory response, metabolism and energy expenditure during intense exercise, and thus probiotics can be an important tool to improve athletes’ general health and performance .
The microbiota composition has an important role in conditions like IBD and IBS, and dietary restrictions and the addition of lactic acid bacteria (probiotics) has a good effect on symptoms in these conditions [9-12]. A study comparing double-coated to non-coated probiotics in treatment of diarrhea in IBS patients showed stronger effect in the double-coated group, showing the importance to protect the probiotic bacteria in their way to the colon for better efficacy .
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