Do Probiotics Help With Benzodiazepine Withdrawal Symptoms?

Do probiotics help with benzodiazepine withdrawal symptoms?

Not in any way that anyone can promise. The evidence that probiotics ease benzodiazepine withdrawal is limited. Fermented foods such as yogurt and kefir are a reasonable, low-risk thing to try for an unsettled stomach. A probiotic supplement is not a treatment for withdrawal, and nothing replaces a slow taper.

The question usually comes from someone whose stomach has been wrong for weeks. There is bloating after every meal, nausea in the morning, cramping, and constipation one week followed by loose stools the next. Patients have a name for it, benzo belly.

Often, that person has also been told that the problem is anxiety, or has been treated as someone with an addiction. Neither is right. A person who took a benzodiazepine as prescribed, and whose body adapted to it, has physical dependence. Physical dependence is not addiction.

That distinction matters for the stomach too. Cleanses and gut repair kits are sold to people who believe a drug has to be flushed out of them. There is nothing to flush out, only a nervous system that adapted to a medication and needs time to adapt back.

What is benzo belly, and why does withdrawal upset the gut?

In Chapter III of the Ashton Manual, Professor C. Heather Ashton lists gastrointestinal symptoms among the physical symptoms of benzodiazepine withdrawal. Her table names nausea, vomiting, diarrhea, constipation, pain, distension, and difficulty swallowing. She writes that the picture can look like irritable bowel syndrome, and a companion article describes the gut symptoms of benzodiazepine withdrawal in more detail.

She also notes that quite a few people have gone through hospital tests of the digestive system, and that usually no abnormality is found. That result is frustrating to hear. It is also good news, because it points to a gut that is irritable, not one that is diseased.

Why would a medication for anxiety or sleep upset digestion on the way out? Professor Ashton’s explanation is that the symptoms may be partly due to overactivity in the autonomic nervous system, which controls the movement and secretions of the gut and reacts strongly to stress. She adds that there are benzodiazepine receptors in the gut itself, and she is candid that their function is not clear.

Think of the gut as a long conveyor belt, with the nervous system holding the speed control. During withdrawal the control is jumpy, so the belt runs too fast one day and too slow the next. A probiotic changes what is riding on the belt. Whether it does anything to the speed control is the part that has not been shown.

What are probiotics?

Probiotics are live bacteria and yeasts of the kinds thought to be helpful in the gut. They come as food, such as yogurt and kefir with live cultures, or unpasteurized sauerkraut and kimchi. They also come as supplements, capsules and powders that list bacteria such as Lactobacillus and Bifidobacterium and count them in the billions.

The idea is simple. The gut holds an enormous population of bacteria that take part in digestion, and adding friendly ones is supposed to keep it in good order.

Is there evidence that probiotics ease benzodiazepine withdrawal?

Unfortunately, there is very little. Whatever probiotics may do for ordinary digestive complaints, nobody has shown that they ease benzodiazepine withdrawal. That is true for the gut symptoms, and it is even more true for anxiety, insomnia, and low mood.

Articles on this subject often go further. They say that a probiotic calms anxiety, restores gamma-aminobutyric acid (GABA), the brain’s main calming chemical, or repairs a gut that the medication has damaged. Those are large claims, and none of them has been established in people who are tapering off a benzodiazepine.

Withdrawal is not a matter of the brain running out of GABA in the first place. In the first chapter of the Manual, Professor Ashton explains that with long-term use the receptors become less responsive, and in Chapter III she describes the result, a nervous system left overexcited until it adapts again. Nothing in a capsule of bacteria has been shown to speed that up.

The rest is clinical experience, and it varies. Some patients find that yogurt or kefir settles the stomach a little. Others notice nothing, and a few feel more bloated than before.

Fermented foods are the low-risk way to try probiotics.

Yogurt, kefir, sauerkraut, and kimchi are ordinary foods that people have eaten for generations, and they fit inside the normal healthy diet that Professor Ashton describes in Chapter III. And, if they do nothing, little has been lost.

Small portions make sense at first, because a stomach in withdrawal can object to anything new. That is also the reason to add one food at a time. When three things change in the same week, nobody can tell which one helped and which one hurt.

There is one caution. Many fermented foods are naturally high in histamine, and some patients in withdrawal report flushing, itching, or hives after eating them. The evidence here is limited too, and individual response varies.

When a food seems to cause trouble, Professor Ashton’s advice in Chapter III is to let common sense prevail and avoid it for a while. However, she also writes that a strict exclusion diet is usually inadvisable, and that with a normal balanced diet and sensible general health measures, the gut symptoms of withdrawal gradually abate.

So, the food approach is to add a little, not to take a great deal away. A companion article covers benzo belly and what to eat while tapering.

What about probiotic supplements?

Supplements are a different matter from food. In the United States, a probiotic capsule is sold as a dietary supplement, which means that it does not have to prove it works before it reaches the shelf. The strains and the amounts differ from one brand to the next.

Which strain is best for benzodiazepine withdrawal? Nobody knows. An article that names the right strain and the right amount is guessing.

In fact, Chapter III of the Ashton Manual, which covers diet and digestion, does not mention probiotics. Professor Ashton does write there that she sees “no general need for dietary supplements or extra vitamins or minerals,” and that all of them can be harmful in excess.

None of this makes a probiotic capsule forbidden. Yet, some people find that it brings gas and bloating of its own in the first days, which is hard to tell apart from benzo belly. A person with a seriously weakened immune system or a serious illness should ask their own physician before taking a probiotic supplement.

Dr. Mark Leeds, an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida, treats supplement questions as individual decisions. Some supplements cause trouble during withdrawal and some help, so each one is weighed for the particular patient, with the pharmacology in mind. A broader article asks which supplements help with benzodiazepine withdrawal and tapering.

When is a gut symptom not benzo belly?

Withdrawal is the usual explanation for a churning stomach during a taper, but it is not the only one. Blood in the stool, black stools, vomiting that does not stop, severe or worsening pain, and fever are not typical of benzo belly. Professor Ashton notes in Chapter III that some weight loss can happen in withdrawal, but weight that keeps falling deserves a look as well.

Those symptoms need a medical evaluation of their own, and vomiting blood, heavy bleeding, or severe pain needs emergency care. A probiotic should never be the reason a person waits.

Fortunately, the gut settles as the nervous system does.

How a person feels during a taper, stomach included, depends mostly on the size and the pace of the dose reductions. In Chapter II, Professor Ashton suggests steps of up to one tenth of the dose, with the pace set by the person who is tapering. The Maudsley Deprescribing Guidelines add the hyperbolic shape, in which each reduction is sized to the dose that remains, so the steps get smaller as the dose gets lower.

When the stomach flares after a reduction, the answer is a change of pace planned with the prescriber: a short hold and a smaller next step for some patients, a steady pace for others, because everybody is different. A new product is not the answer, and neither is stopping. Nothing replaces a gradual, medically supervised taper, which takes months and sometimes longer.

When the United States Food and Drug Administration (FDA) updated the boxed warning on benzodiazepines in 2020, it stated that stopping abruptly or reducing the dose too quickly can result in withdrawal reactions, including seizures, which can be life-threatening. No supplement changes that. For a seizure or any other medical emergency, call 911.

Professor Ashton writes in Chapter III that most digestive symptoms get better after withdrawal, although in a few people they persist for longer. The gut is not broken. It is waiting on the nervous system, and the nervous system needs time. Yogurt can sit beside a slow taper. It cannot stand in for one.

Dr. Leeds’ practice in Fort Lauderdale is a concierge practice, not an insurance practice, and it offers medically supervised benzodiazepine and z-drug tapering for patients in Florida. He works directly with each patient. The pace belongs to the patient, and a reduction that brings on benzo belly or any other hard symptom is a reason to slow down. Contact the office to talk about a supervised taper.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.