Probiotics do not work miracles, but they *might* help.
Probiotics, probiotics, probiotics. Who would have ever thought that bacteria could become such an obsession in this germ-fearing era? You can find probiotics naturally in fermented foods (oh hey, yogurt!) or in capsule form as dietary supplements. (Check out these top food sources of probiotics.)
People around the world have always eaten these foods—like kimchi and miso—but recently interest in them has grown exponentially. Back in 2002, the World Health Organization and the Food and Agriculture Organization of the United Nations jointly released an evaluation of the essential criteria for and potential benefits of probiotic foods, and a new curiosity in gut health emerged and has continued to grow.
So, are probiotics worth their health halo? HealthiNation asked gastroenterologist Anthony Starpoli, MD, what doctors know about probiotics and their possible effect on gut health.
1. Probiotics are bacteria that inhabit your digestive tract.
Although foods and supplements may boast of their probiotic properties, you actually already have them living in your colon. The living microorganisms in your GI tract create what’s known as your “gut flora” or “microbiome,” according to the National Institute of Diabetes and Digestive and Kidney Diseases. A healthy gut flora is crucial for proper digestion.
“The idea is to replenish what we think might be some deficiency,” says Dr. Starpoli. In other words, if you’re lacking in healthy bacteria in your digestive tract (and dealing with diarrhea or constipation as a result), eating probiotic foods or taking probiotic supplements could replenish your microbiome. (Here are other reasons you may have diarrhea every day.)
But it’s a bit of a “shotgun approach,” according to Dr. Starpoli. There’s no magic number to aim for when it comes to controlling your gut flora population, so it’s impossible to know if you have a probiotic deficiency or how many probiotics to take to see a benefit.
2. Probiotics may help with certain bowel diseases.
What doctors do know is that probiotics have been shown to alleviate some symptoms of bowel disorders, like irritable bowel syndrome and inflammatory bowel disease. (Here are signs your stomach pain is IBS.)
When researchers assessed 1,793 patients with IBS, they found that taking probiotics reduced symptoms like abdominal pain and bloating better than placebos, according to a 2015 meta-analysis in World Journal of Gastroenterology. That’s good news, considering IBS is still a bit of a mystery with no clear cause and no perfect treatment.
However, that doesn’t mean probiotics can prevent gut issues in everyone. Researchers are still studying what strains of probiotics are most effective—and why—for people with digestive disorders as well as the general population, according to the National Center for Complementary and Integrative Health (NCCIH).
3. Ask about taking probiotics with antibiotics.
Another situation in which probiotics may help is after taking antibiotics to treat an infection. After you’ve taken antibiotics, “you know that you’ve altered the microbiome,” says Dr. Starpoli. “Antibiotic exposures put you at risk for clostridium difficile,” an infection in the intestines that causes diarrhea, nausea, and abdominal pain, according to the U.S. National Library of Medicine.
Your doctor may recommend taking probiotics after a period of taking antibiotics to restore the healthy population of bacteria in your gut.
4. Be choosy about your probiotic sources.
Don’t fall for a marketing scam. Just because a product claims to be a probiotic treasure trove doesn’t mean it will actually help your gut health.
“You need to know if [the probiotics] were tested in humans,” says Dr. Starpoli. Many studies on probiotic efficacy are small in scale (with 20 or fewer participants) or are tested on an animal population.
Plus, probiotics come in a variety of strains, which could range in their effects on your health. “Probiotics in pill form, [compared to] a yogurt, are going to have a greater variety and a greater number of these bacteria,” says Dr. Starpoli. But that doesn’t necessarily make these capsules superior to yogurt: “We don’t really have a metric to decide how much is good—or not.”
And finally, the cost of probiotics is a real thing to consider. Top-rated probiotic brands can cost more than $30 for a few dozen capsules. Given the lack of hard evidence to support its health benefits, you have to question whether this is a worthwhile investment for you.
Ultimately, probiotics aren’t a cure for digestive problems, and you’re likely to see good results by making lifestyle tweaks. “To maximize your wellness, you should have a good lifestyle, get your rest, [and] eat a balanced meal three times a day,” says Dr. Starpoli. Learn more lifestyle habits for better digestive health here.
Dr. Starpoli is a board-certified gastroenterologist who is affiliated with Lenox Hill Hospital-Northwell Health, Mt. Sinai-Beth Israel Medical Center, and NYU Langone Medical Center.
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People ask about probiotics all the time.
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Probiotic supplements are bacterial or
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certain bacterial that inhabit the colon.
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The idea is to replenish what we
think might be some deficiency.
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The problem is that we don't really
know what the deficiency is,
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so it's a little bit
of a shotgun approach.
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People will have some abdominal complaints
or some irregularity in their bowel
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habits, bloating, and they think that the
probiotic is going to solve their problem.
00:00:36,120 --> 00:00:39,870
We have certain probiotics that
have been studied in IBS and
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Inflammatory Bowel Disease.
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And both for IBS and Inflammatory Bowel
Disease, we know that there been studies
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showing that people have had better
symptom relief on those probiotics.
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But that doesn't mean that others
don't modulate the system.
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But we don't know how to
modulate the microbiome,
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I think there's a lot we don't
know about the use of probiotics.
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There are situations where people
have had antibiotic exposures.
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That will be different because you know
that you've altered the microbiome.
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Antibiotic exposures put you at risk for
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You need to know if they
were tested in humans.
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I think that's important, and
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the efficacy assessed in the human
population, not in animal population.
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Probiotics, in pill form,
over, say, a yogurt are going
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to have a greater variety and
a greater number of these bacteria.
00:01:30,510 --> 00:01:36,260
Again, we don't really have a metric
to decide how much is good or
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not, except what has been
used in certain trials.
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And you have to weigh that against the
expense, they're really quite expensive.
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And how much people are going to pay,
versus also the benefit.
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I think people's apparent use
of probiotics is unfounded.
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To maximize your wellness,
you should have a good lifestyle,
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get your rest,
eat a balanced meal three times a day.
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That's what you should do,
00:02:01,688 --> 00:02:06,119
I don't think that that includes
necessarily taking supplements.
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Clostridium difficile infections. Washington, DC: U.S. National Library of Medicine. (Accessed on January 20, 2021 at https://medlineplus.gov/clostridiumdifficileinfections.html.)
Complementary health approaches for irritable bowel syndrome: what the science says. Bethesda, MD: National Center for Complementary and Integrative Health, 2015. (Accessed on January 20, 2021 at https://nccih.nih.gov/health/providers/digest/IBS-science.)
Didari T, Mozaffari S, Nikfar S, Abdollahi M. Effectiveness of probiotics in irritable bowel syndrome: updated systematic review with meta-analysis. World J Gastroenterol. 2015 May 14;21(10):3072-84.
Guidelines for the evaluation of probiotics in food: report of a joint FAO/WHO working group on drafting guidelines for the evaluation of probiotics in food. Geneva, Switzerland: World Health Organization, 2002. (Accessed on May 30, 2018 at http://www.who.int/foodsafety/fs_management/en/probiotic_guidelines.pdf.)
Probiotics. Bethesda, MD: National Center for Complementary and Integrative Health, 2015. (Accessed on January 20, 2021 at https://nccih.nih.gov/health/probiotics.)
Symptoms & causes of irritable bowel syndrome. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases. (Accessed on January 20, 2021 at https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/symptoms-causes.)
Your digestive system & how it works. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases. (Accessed on January 20, 2021 at https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works.)