Do Probiotics Work?

A (Greatly Truncated) Response to the Question of Whether Probiotics are Overrated

Probiotics: myth or miracle?

It’s the kind of grab-your-attention, oversimplified headline we are used to in the media. But, I was grateful to be asked for my opinion on an article of this name:

Probiotics: myth or miracle?

So here is the quick 10-minute version of my opinion on this, straight from my Facebook response.

This article is better than I expected from the headline – at least they correctly cited some conditions there is evidence for treating with probiotics, such as IBD and traveller’s diarrhoea. Until the concluding line! Just focus on consuming good quality yoghurts, my foot! Do they exist?! Aside from the ones you make yourself, that is. There are two problems with this statement.

Problem number one: numbers in yoghurt are too low.

For therapeutic effect – that is, not just to “stay healthy” (never mind that most people trying to “stay healthy” have symptoms or conditions they could be treating nutritionally) but to treat a condition, you simply need higher numbers than are in yoghurt – especially standard store-bought yoghurt. Problem number two: strain specificity. While a healthy gut has hundreds of different species and strains (and by extension we can assume we need to be consuming these, unless of course we have a perfect gut microbiome handed down from a mother with a perfect microbiome, have never had antibiotics etc) to actually treat a health condition (such as ulcerative colitis) the specific strains used in the research are necessary. Assuming that taking Inner Health is going to correct all our microbiomial shortcomings is analagous to taking a multivitamin and expecting it to correct the health problems arising from the epigenetic problems from the MTHFR polymorphism (i.e. doesn’t work).

This article has picked and chosen a couple of conditions there is evidence for. Actually, there is evidence for probiotic treatment of urinary tract infections, thrush, bacterial vaginosis, allergic rhinitis, eczema, diarrhoea from chemotherapy, cow’s milk protein allergy, irritable bowel syndrome, lactose intolerance, diarrhoea from radiation, viral gastroenteritis. The bottom line is strain specificity.

Asking “do probiotics work?” is like asking “does physiotherapy work, or is it overrated?” Work? For what? What kind of physiotherapy approach/technique? We don’t give staged basal expansions (i.e. breathing exercise) for patellar maltracking (i.e. a biomechanical problem at the knee). Choose the intervention according to clinical reasoning, basic science, clinical experience and, ideally and where available, the evidence base. We need to remember that a lack of available evidence to show effect is not the same as availability of evidence showing no effect.

And make no mistake: with the very real problem of antibiotic resistance, the price we pay for being too skeptical about probiotic therapy is prohibitively high.

Sure, there’s a lot more research to be done. But there is research available, and not making ourselves aware of it (and thus failing to educate our patients) is a mistake. I am so glad to see physios interested in the concept of the microbiome and probiotic therapy. What I find discouraging is the idea that people will read an article like this on probiotics and fail to change their habits (overusing antibiotics, failing to incorporate fermented foods into the diet, not considering probiotics and adjuncts to therapy for their particular health condition) due to a misinterpretation that the probiotic thing is overrated and a fad.

And by the way, as the article points out, prebiotic foods ARE incredibly important!Take home message: don’t just lucky dip and hope for the best. See a functional medicine practitioner! Or at least read their blogs 🙂

Perhaps start with this one on the role of the microflora in a healthy and balanced vagina.

And please…tell me about your experience with probiotics by commenting below!

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