From the Guidelines
Lactobacillus probiotics generally do not need to be stopped in patients with elevated liver enzymes or hepatitis, as they are typically safe and may even be beneficial in reducing liver inflammation and improving liver enzyme levels. These beneficial bacteria are part of the normal gut flora and help maintain intestinal health by competing with harmful bacteria. For patients with liver disease, particularly those with conditions like alcoholic liver disease or non-alcoholic fatty liver disease, probiotics may actually help reduce bacterial translocation from the gut, which can be a contributing factor to liver inflammation 1. Some studies suggest probiotics might help improve liver enzyme levels by reducing intestinal permeability and bacterial products reaching the liver, as seen in a review of existing meta-analyses which showed that probiotic therapy significantly decreased alanine aminotransferase (ALT) and aspartate transaminase (AST) in patients with liver diseases 1. However, if you have severe liver impairment or are immunocompromised, it's advisable to consult with your healthcare provider before taking any supplements, including probiotics.
Some key points to consider:
- Probiotics may help reduce the development of overt hepatic encephalopathy in patients with liver cirrhosis, as shown in a meta-analysis of 6 randomized controlled trials involving 496 liver cirrhotic patients 1.
- Probiotic therapy may also improve insulin resistance and reduce total-cholesterol, TNF-a, and liver aminotransferases in patients with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) 1.
- The use of probiotics is not associated with changes in body mass index (BMI), glucose (GLU), or low-density lipoprotein (LDL) in patients with liver diseases 1.
- A 2023 guideline suggests not routinely using probiotics as adjunctive therapies in critically ill patients with acute-on-chronic liver failure, but this does not necessarily mean that probiotics should be stopped in patients with elevated liver enzymes or hepatitis 1.
It's essential to note that while the evidence suggests that Lactobacillus probiotics are generally safe and may be beneficial for patients with liver diseases, individual results may vary, and patients should consult their healthcare provider before taking any supplements, especially if they have severe liver impairment or are immunocompromised. If you notice any unusual symptoms after taking Lactobacillus supplements, such as increased abdominal pain or worsening liver function tests, discontinue use and consult your doctor promptly.
From the Research
Lactobacillus and Liver Health
- Lactobacillus supplementation has been shown to have a positive effect on liver health, particularly in cases of elevated liver enzymes and hepatitis 2, 3, 4, 5.
- Studies have demonstrated that Lactobacillus can reduce liver inflammation, injury, and fibrosis, as well as improve liver enzyme levels 2, 4, 5.
- The mechanisms by which Lactobacillus exerts its beneficial effects on the liver are not fully understood, but may involve the modulation of the gut microbiota, the inhibition of hepatic bile acid synthesis, and the enhancement of bile acid excretion 4.
Potential Risks and Considerations
- While Lactobacillus is generally considered safe, there have been reports of liver abscess and bacteremia caused by Lactobacillus in susceptible individuals, particularly in those with compromised immune systems or underlying medical conditions 6.
- The use of probiotics containing Lactobacillus should be approached with caution in certain individuals, and patients should be monitored closely for any adverse effects 6.
Interaction with Liver Disease
- Lactobacillus has been shown to be beneficial in the treatment of various liver diseases, including alcoholic liver disease, non-alcoholic fatty liver disease, and cholestatic liver disease 3, 4, 5.
- The beneficial effects of Lactobacillus on liver health may be due to its ability to modulate the gut-liver axis, reduce inflammation, and improve immune function 2, 3, 4.