Probiotics are everywhere these days and they have several health claims attached to them. They sound great in theory, but is there any evidence backing these claims?
Our gut flora is a very intricate and complicated balance of bacteria residing in our large colon. There is a balance between the “good” bacteria (those promoting health and normal digestion as well as keeping the bad bacteria in check) and the “bad” bacteria (those that can cause infection life C. difficile). These bacteria are a vital part of our lives, and we know that they play a major role in our overall health, not just our GI system. Anything can upset this delicate balance including diet, infection, medications, and antibiotic use. So if all of these things kill off the good bacteria, it would make sense to replace those bacteria in our gut.
There is little evidence to back most of these claims, simply because the research has not been done. These products fall into the category of supplements so the FDA does not regulate them and the contents are not checked for validity. Despite the lack of studies backing most of the claims, there have been studies showing some benefits in acute GI disease. A 2010 Cochrane review did show a shortening in the duration of symptoms during diarrheal disease. There has also been some benefit shown in IBD and IBS.
I have spoken with several doctors in different specialties asking why the research doesn’t back these claims. We know for a fact that the bacteria in our gut play a critical role in our health. The logic for probiotics is there. These doctors made several good points. First, most of this bacteria never makes it to our large colon where they can exert their benefit. While many companies claim their product has enhanced properties to ensure more bacteria make it to the large colon, there really isn’t great proof of this. But lets say only a small portion of the bacteria get to the large gut, that still is better than nothing, right? I think so.
The second point they made, which is more convincing to me, is that our gut is made up of thousands of types of bacteria. Most probiotics have 2-4 types of bacteria strains in them. So you have a small amount of bacteria getting to the gut, and there are only 2-4 strains getting in. Compared to the thousands already in your colon, this seems inconsequential. What difference will this really make?
So obviously there is no right or wrong answer on whether you should take probiotics. When my patients ask I usually tell them go ahead, the harms are minimal. Do they work, probably not as much as they claim to. In fact, they probable don’t even come close to the claims they make. I still believe that the concept is there, I just think we have not perfected the system. So go ahead, take your probiotics. If you get side effects like GI upset or bloating, just stop them. As always, talk to your doctor before starting any supplements. And remember, yogurt, sour pickles, miso soup, and sourdough bread are great natural sources of probiotics that won’t empty your bank account!