Question 2
As stated in the article, only preliminary data from a pilot study exists to
support the use of probiotics for improving liver chemistry tests and
decreasing markers of hepatic inflammation in those with NAFLD. Would you
recommend the use of probiotics to a patient that has NAFLD knowing the
research is only preliminary data? Why or why not?
posted by Jamie Smythe @ 10:17 AM
32 comments
32 Comments:
I don't think I would have a problem recommending a probiotic to these patients. Even though this is preliminary data it does show positive results and to my knowledge there is no harm in using a probiotic for NAFLD. I think that there is enough research showing positive results for probiotics in general that taking one would not be a bad idea.
I agree with Stephanie. After looking at several studies it is clear that they are not sure if it is one probiotic strain or a combination of several that is beneficial. I believe that the clinical application of probiotics can be effective, safe and confidently recommended. One thing I would make sure to tell my patient is that it is not a complete cure but to be used to maintain good health.
I think that it may be too early to be recommending probiotics to a patient based on their NAFLD. While it is important to remain up-to-date with current research, when there is not enough evidence in a certain area to be more sure about the relationship between the two factors I think we need to be very careful of what we recommend to the patient. Although in this case, I do not think that it would hurt to recommend a probiotic to most patients because of the possible health related benefits. We simply do not want to give patients false information though.
I think I would tell the patients there has been some early data supporting, but as with anything potentially seen outside the scope of my practice I would recommend the patient talk to their doctor about initiating this treatment before actually doing so.
Brooke,
I agree that this is very early information which is why I would not want to clearly say "this works" however I think that providing new information to patients is also part of what we do as health providers. So I am a little torn on this, but would definitely recommend they speak to their doctor before doing anything.
I would not have a problem recommending a probiotic as long I knew the pt's past medical history and it was appropriate. A probiotic is not likely to hurt the pt in this instance. I would not be likely to tell the pt that a probiotic will cure or even treat their condition based on the research though.
I would not have a problem recommending a probiotic as long I knew the pt's past medical history and it was appropriate. A probiotic is not likely to hurt the pt in this instance. I would not be likely to tell the pt that a probiotic will cure or even treat their condition based on the research though.
It seems like most of us are in agreement that they would give the pt a probiotic but would not tell them it is a treatment. Stephanie makes a great point when she says that there is enough research to show that it benefits general health and this is something I would tell a pt.
I would encourage the use of probiotics if the pt was experiencing large amounts of diarrhea or other GI irritation, but I wouldn't necessarily recommend it for the NAFLD disease state.
I like how Stephanie put it that it couldn't hurt to add a little more probiotics in one diet thought =).
I would recommend probiotics for digestive health but not based upson this preliminary study for NAFLD. I might mention the preliminary data, just to inform the client of what is happening in the research field, however, I wouldn't say that this data is completely proven yet. I think you should be honest with your clients and not try and sell a product for a different purpose that has been tested in only a preliminary trial.
I don't think I would recommend a patient use probiotics to treat NAFLD because it is such preliminary data and because weight loss and diet composition have been found to be so effective. I think the patient may consider it a quick fix and become less likely to follow other parts of the treatment plan. It would just depend on the patient and their level of dedication to and knowledge of their treatment plan. However, if the patient was experiencing GI irregularity, and I planned to discuss the use of probiotics, I would definitely bring up this research and the potential benefit of probiotics.
Tiffany, I agree that having the patient discuss the use of probiotics with their doctor is a good idea. We as RDs could give them the pros/cons of using them, discuss the extent of benefits shown in recent research, and majorly discuss the benefit of weight loss, calorie restriction, and diet composition (lower CHO and saturated fat and higher in lean protein, fiber, and omega 3’s)in their disease treatment. After that discussion, the patient could have a much more informed conversation with their doctor.
Emily-
You make an interesting point that individuals might take a recommendation for probiotics as a quick fix. If more research comes out supporting probiotics I think it would be very important to stress to patients that it is not the end all cure.
No, I would not have a problem recommending this to a client. While not large scale studies have shown help the pilot studies did show that it could be beneficial. Many overweight/obese individuals with metabolic syndrome have disrupted intestinal bacteria which have been shown in larger studies. This could help with other issues and keep their immunesystem strong while we are trying to make other lifestyle changes even if their were no direct benefit to the NAFLD.
Tiffany and Emily,
I am not sure if I like the idea of telling them the research and then telling them to talk to their doctor about using pro-biotics. I feel like this is mainly a nutritional issue and in the clinical setting we are the nutritional experts. Knowing the research and the risk/benefits of the treatment I feel like we should give the pt a definite answer and not give them more questions for their doctor. I feel like it undermines our position as a R.D. I could be wrong though as I have not done my clinical rotations so don't know the SOP of the hospital maybe this would be a good conversation to have the pt talk to their doctor with?
This would be a quick mention in my healthy eating speech. Low-fat plain Greek yogurt is a good source of probiotics as well as a low in carb food and a lean protein source (0 grams of fat). It is a food that fits within the dietary guidelines that this article suggests as beneficial. I would not recommend a probiotic supplement at this time.
I agree Ali, discussing research with clients helps to build rapport. This lets them know that you are up-to-date on current research and teaches them to be critical about research themselves.
I do not think that the use of probiotics would be harmful, but I do not know if I would be comfortable recommending them to a NAFLD patient based on preliminary data. Probioics have many health benefits and have been proven to be safe, but I do not think I would recommend using them as a means to improve the status of NAFLD patients until more data surfaced.
Emily, it caught my eye when you talked about patients possibly taking the information about the probiotics and think it is a "quick fix". I think as we are speaking with patients, it is very important to understand them and be very conscious of their tendencies. Many people out there like to gasp on to preliminary information and obsess over it, taking it way too far. That is why we also need to be cautious of who we mention this information to.
I would not recommend probiotics to a patient with NAFLD unless they had other issues that evidence has shown is helped by probiotic use. We've learned how important it is to use evidenced-based research and to critically evaluate the literature and I'm not sure preliminary data is a strong enough reason to make recommendations to patients. I think it gives us something to keep an eye on while we wait for more research.
I don't believe I would recommend probiotics specifically for NAFLD patients. If there isn't enough research to backup the recommendation I don't think a recommendation would be appropriate. However, if the patient is very interested in current research on this topic, I might mention that preliminary research on probiotics has shown decreasing markers of inflammation and just make sure they understand that this research is not thoroughly examined
I do agree with everyone that adding probiotics to a diet can never hurt, and there always health benefits. Brooke I completely agree with you that I would just use caution with suggesting probiotics specifically for NAFLD inflammation
Probiotics are healthy whether someone has NAFLD or not so I do not see any harm recommending them. However, I do think it is important to explain to the patient/client that the research is preliminary and this may or may not help them with their NAFLD.
I would definitely recommend probiotics, whether the patient had NAFLD or was perfectly healthy. Probiotics have been shown to help with various health issues such as diarrhea, vaginal yeast infections and urinary tract infections, IBS, reduce bladder cancer recurrence, speed treatment of intestinal infections, and prevent eczema in children. If there is no evidence against the use of probiotics for this disease, why not give it a try?
Prevent or reduce the severity of colds and flu
Regarding Kevin's comment on Greek Yogurt...while I typically agree that a food-source is better than a supplement, I know from experience that the yogurts don't always have the same strains and don't have it in the same amounts needed to make a difference in someone's health. In this case, because research has not shown which strains might be beneficial, I would recommend use of a supplement that has as many strains as possible. I looked at Chobani's yogurt and it only has 3 strains but says nothing about the CFU content in the yogurt. Ideally, they will do more research on it to identify which strains are helpful for NAFLD, if any.
I would not recommend a patient begin a probiotic regimen based on the preliminary data. If a patient is already consuming probiotics on a regular basis, I would encourage them to stick to their routine (providing it doesn't push them over their calorie limit). I would focus on whole foods and exercise, and leave the probiotics up to the clinicians for further research. Pilot study data is not appropriate for evidence-based practice.
While the research data is preliminary, I think recommending probiotics would certainly not be harmful. I would not necessarily recommend a supplement, but rather that participants obtain probiotics from food sources, such as non-fat yogurt, that could be beneficial in helping stay within the calorie intake guidelines.
Yes, I would still recommend probiotics to a patient with NAFLD because probiotics have many other health benefits. While the data might be preliminary regarding probiotics and NAFLD, there is a large amount of data regarding general GI health and probiotics. I believe that everyone could benefit from taking probiotics and if their disease state is also improved, that's great.
I agree with many others that are saying that they wouldn't recommend probiotics based solely on the preliminary data that has been found. I would mention the data that has been found but also go into the other benefits of probiotics.
I would advise a patient that there is preliminary data that suggests the use of probiotics could assist in improving their NAFLD. There would be no harm in the use of the probiotic, so I would just make sure the information was presented clearly and that this is not a cure. From there I would let the patient decide whether or not they wanted to use the probiotic and possibly discuss it with their doctor as well.
Amy, great point about needing to know what strains and dosage levels of probiotics would be therapeutic for patients with NAFLD. As you pointed out, not all food sources and supplements are created equal!
Kevin,
I like the idea of recommending Greek yogurt. But, when I recommend it to students, faculty and staff during my Health Promotion and Wellness nutrition consults they are not keen on the texture of the products. What I found helpful in undergrad was when we tested different yogurts and found that the simplest yogurts that didn't even advertise about increased probiotics were the ones with the most strains. I think just recommending consumption of yogurt would be helpful for NAFLD and NASH.
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