If probiotics are good, should everyone take them?

probiotics

If you are on this page, you probably already know gut health is important, and that the key to gut health is the number and diversity of microbiomes  (comprised of invisible bacteria, viruses and fungi)  in the gut, also called “gut bacteria”. You may also have heard about or seen advertisements  of many probiotic supplements which claim to increase “good” gut bacteria and so improve gut health. The  question is: Does this mean everyone should start taking these probiotic supplements, given they are good for us?

First, what actually are probiotics?

Probiotics are defined by the World Health Organization (WHO) as “live microorganisms which when administered in adequate amounts confer a health benefit on the host”.  In simple terms,  they are live bacteria that, when taken sufficiently, can survive the acid environment of the stomach and increase the number of good bacteria in the gut.

Probiotics exist naturally in some foods, such as yoghurt and fermented vegetables like sauerkraut and pickles. To further capture the health benefits of probiotics, there are now an increasing number of probiotic supplements in the market that directly administer live bacteria into the gut. 

Two most common species of bacteria found in most probiotic supplements are Lactobacillus and Bifidobacterium, partly because they are typically found in many fermented foods, and partly because manufacturers are capable  of growing them in large numbers.

Do probiotic supplements really work?

Studies have found evidence for some potential benefits of probiotic supplements to people with specific health conditions, including the reduction of symptoms associated with gastrointestinal (GI) disorders such as diarrhea, constipation and irritable bowel syndrome (1, 2). 

Because most probiotic supplements are marketed to the general public, you may ask what their effects are on healthy individuals. In fact, researchers have shed a positive light on this: many studies have shown that probiotic supplements do increase the concentration of supplement-specific bacteria in the gut of healthy individuals, so may help restore balance in gut bacteria. Other benefits found include improvements in stool consistency, bowel movement, and even immune system responses.

Should we all take probiotics then?

Every coin has 2 sides – probiotic supplements are not necessarily a cure-all! A probiotic supplement that helps one person might not help someone else. In particular, there is only limited evidence for persistent health benefits of probiotics in healthy individuals (3). Once you stop taking them, gut bacteria are likely return to their pre-supplementation condition within one to three weeks. 

Also we want diversity of different species of bacteria, rather than billions of just a few species provided by the probiotics we take, which may even lead to an imbalance of gut bacteria. What is worse is probiotics may add fuel to the fire for individuals who suffer from small intestinal bacterial overgrowth (SIBO), a serious condition characterised by too many bacteria (even though they may be good bacteria!) in the gut (4, 5).

The main takeaway is: Get your probiotics FROM FOOD!

An implication of the above findings is that probiotics are likely to be beneficial to our gut health, by equipping us with more good gut bacteria. While probiotic supplements may only have transient health benefits, instead of relying on ongoing supplementation which may risk disrupting the balance of gut bacteria, it is always better and more sustainable to get probiotics from food rather than supplements.  

Beside the natural probiotics from yoghurt and fermented vegetables, foods with high fibre such as fruit and veg (get your 5-a-day!) are also great as good gut bacteria feed on fibre. It is important to our gut health to have a healthy lifestyle with a balanced diet. 

If you are conscious of your gut health but are struggling with cooking ideas, or simply want to learn more about how to maximise health benefits from your diet, then the RYH 4-week online course is for you! Providing simple recipes and shopping lists for 3 meals a day, it is easy to follow and is designed based on scientific research to help you reset your gut to Reset Your Health! 

References

1. Guarino A, Guandalini S, Lo Vecchio A. Probiotics for Prevention and Treatment of Diarrhea. J Clin Gastroenterol. 2015;49 Suppl 1:S37-45. https://journals.lww.com/jcge/Abstract/2015/11001/Probiotics_for_Prevention_and_Treatment_of.11.aspx

2. Ford AC, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014;109(10):1547-61; quiz 6, 62. https://pubmed.ncbi.nlm.nih.gov/25070051/

3. Khalesi S, Bellissimo N, Vandelanotte C, Williams S, Stanley D, Irwin C. A review of probiotic supplementation in healthy adults: helpful or hype? Eur J Clin Nutr. 2019;73(1):24-37. https://www.nature.com/articles/s41430-018-0135-9

4. Quigley EM, Quera R. Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. Gastroenterology. 2006;130(2 Suppl 1):S78-90. https://pubmed.ncbi.nlm.nih.gov/16473077/

5. Shanahan F. Probiotics: a perspective on problems and pitfalls. Scand J Gastroenterol Suppl. 2003(237):34-6. https://pubmed.ncbi.nlm.nih.gov/12797679/