The probiotic industry has a dirty secret: It’s creating a billion-dollar business based on twisted science.
If you are wondering, “do I need probiotics?” Consider this: Probiotics — the healthy bacteria highlighted on most yogurt products — are being added to everything from popcorn to muffin mixes.
According to a report by Grand View Research, the market for probiotics supplements is expected to reach $7 billion in the next 7 years.
Here’s the thing: That business is built on a little bit of science…and a lot of fiction.
“There are many products labeled with the word ‘probiotic’ in the U.S., but not all are responsibly formatted or studied for health benefits,” says Mary Ellen Sanders, Ph.D., executive science officer of the International Scientific Association for Probiotics and Prebiotics.
The science is that probiotics are good for you — but only if you have a condition that requires their use.
That’s not something you’ll want to hear if your pantry and fridge are filled with probiotic-infused foods.
“The benefits of probiotics in foods — especially foods that aren’t fermented dairy products — is questionable, at best,” says Shira Doron, M.D., professor of medicine and attending physician in infectious diseases at Tufts University School of Medicine.
Unfortunately, that’s just the tip of the iceberg. In addition to food, many probiotic supplements fail to live up to the promise on their label.
Unless you have a specific condition that’s been shown to benefit from probiotics, you likely don’t need them.
“There is no evidence that it is essential to take probiotics to be healthy,” Sanders adds.
Her next point may be even more important:
“You don’t need probiotics if you are healthy,” Sanders says.
The Hype (and Mythology) of Probiotics
Probiotics are live microorganisms that feed the healthy bacteria in your gut. Most people treat probiotics the same way they would a multivitamin.
In theory, the benefit of a multivitamin is that it helps make up for deficiencies from your diet. So, if you have a good multivitamin (that’s an entirely different story), and if you don’t have a great diet, then it might offer you some benefits.
Here’s the thing:
Probiotics do not function like multivitamins.
Whereas multivitamins can have a benefit for anyone because it helps support deficiencies, probiotics are really designed to help treat, improve, or solve dysfunction.
You need probiotics if your microbiome (i.e. your gut health) is messed up. This means that taking probiotics can be very helpful if you suffer from a condition such as irritable bowel disease.
But if not, then your use of probiotics might not be doing as much good as you hoped.
The Probiotic-Gut Relationship: It’s Complicated
You might be wondering:
How does a billion dollar business get built on something as shaky as “maybe this will be good for you?”
It all starts with the extremely complex nature of your gut.
It’s so complicated that science needs much more time to figure it out. “The human microbiome may have as many as 200 trillion microorganisms and up to a thousand species,” Doron says.
That’s a lot of biological ground to cover, which is why probiotics are still a field that scientists are trying to understand.
“There are a variety of things we think happen, but we don’t know how that all works,” Doron says.
Three reasons why what you see on probiotic labels isn’t necessarily reflective of what it will do for your body:
- Different probiotics may work differently (and again, there hundreds of different types)
- Each probiotic may have more than one effect
- Not everyone responds the same way to a specific strain
Researchers are currently trying to figure out potential benefits that have shown hypothetical promise.
One theory is that when probiotics reach your gut, they digest available carbs and produce short-chain fatty acids. Those acids then fuel other beneficial microbes in your gut, in turn, producing more fatty acids.
Why should you care?
Because short-chain fatty acids are known to create a healthy microbiome, and they improve colon health.
Another theory is that when some probiotics reach your small intestine, they interact with the immune cells lining your organs. This may lead to a positive immune system response, such as a decreased incidence of respiratory tract infections or improved response to vaccines.
Sanders says some studies suggest that probiotics improve gut barrier integrity, which is why you’ll hear probiotics recommended for some digestive issues.
But, at this point, all of this is hypothetical. Probiotics might be amazing, but — in healthy people — we don’t know if they have extended benefits.
So…What Do Probiotics Really Do?
Probiotics help people with specific conditions where gut dysfunction is a problem. Consider it one of nature’s best medicines if you suffer from:
- irritable bowel syndrome and inflammatory bowel disease
- diarrhea and constipation associated with those conditions, or from taking antibiotics
- liver disease
But, any benefit is specific to the strain of probiotic, and even the transport of the good strains is still a work in progress. That’s because we still don’t know if good strains that we can create in a supplement — or a food like yogurt — can survive the environment in your stomach and then have a positive impact in your gut.
“Any probiotic, even a combination product, is just a tiny drop in the bucket,” Doron explains. “In our group’s research, we saw that when subjects took a probiotic containing lactobacillus, we couldn’t even detect a change in lactobacillus abundance” within their gut.
What If I’m Healthy? Will Taking a Probiotic Help Me?
Always consult your doctor if you have an immune disorder or any serious underlying illness before taking a probiotic.
If you are generally healthy then there aren’t too many downsides. If you take a supplement, give it a month, trust yourself, and see how your body responds. It’s possible that you’ll feel better — but know that studies indicate the positive outcomes you experience could be a placebo effect.
“That’s worthwhile if you feel better, but it’s also expensive,” Doron says.
If you are healthy, curious, and OK with spending the extra money, feel free to try a supplement. As we mentioned, it could have benefits for immunity and creating more short-chain fatty acids to help your gut. But only time will tell if this is the case for people with no health problems.
If I have a health condition, what should I do?
First off, skip the fortified foods. And skip microbiome tests that will allegedly help you understand what probiotics you need to eat.
“At this point, an individual cannot look at their microbiota and come to conclusions about their health, Doron says. “There are still more questions than answers.”
Your best bet is to consult a doctor who understands your condition and is also well-versed in probiotics. Doron suggests researching academic medical centers and looking at the profiles of physicians in the field you need.
“Check [for doctors whose] interests include subjects like ‘probiotics’ and ‘microbiome,’” Doron says. “The field is still young, and even for the world’s experts, there are way more questions than answers when it comes to manipulating the human microbiome for health purposes. But there are certainly doctors in a variety of fields who take an interest in this area of research or do research themselves and use the knowledge they have gained in their medical practice.”
Remember, you’re trying to fix a dysfunction, which is the real health benefit of probiotics.
Follow your doctor’s recommendation down to the strain and dose. The strain will be a long name and often include a number, such as L. acidophilus NCFB 1748.
The “dose” is the big number on the label, such as 10 billion, which indicates the colony-forming units, or CFU. Higher isn’t necessarily better, so follow your doctor’s advice.
Avoid any products that list the CFU “at time of manufacture.”
“That’s a red flag,” Sanders says. Counts of the live microbes decrease over time, so you want to know the CFU through the end of shelf life.
The front of the box will typically say the total CFU count; the side label may list the CFU for each strain. Look for whichever your doctor recommends. And if the product is refrigerated at the store, keep it in the fridge at home to ensure you don’t kill off more CFU.
The last thing to look for is any seal from a third-party verification program to be sure that what the probiotic contains what the label says it does.
At this time the ISAPP is working with the United States Pharmacopeia (USP) on a verification program, USP labels (ordinarily a good sign of quality) are not yet available. You may, however, find NSF International, which is legitimate. But note that statements like “quality guaranteed” do not mean they have been verified by third parties.
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