Probiotics: Do you really need supplements?

Probiotics are microorganisms such as bacteria and yeast that have beneficial properties. They are “good bacteria” that live in the body and help defend the body from infections.

Since the discovery over a century ago, there has been a lot of research into this topic and probiotic supplements have become a multimillion-dollar industry. Many take probiotics supplements to help keep them healthy.

Probiotics, prebiotics and synbiotics are terms that are often thrown around. But what do these terms refer to? And do you really need these supplements?

Probiotics are live bacteria that colonize the gut and decrease the chance of the bad bacteria taking over. Prebiotics are plant-based foods that contain fiber and other nutrients to allow for growth of the good bacteria in the gut. Synbiotics are a combination of these two.

Here we will discuss probiotics as these are the most common of the three supplements. Most of the ones on the market are derived from food sources such as cultured milk products. They are living organisms and play a vital role in preventing illness.

Do probiotics have a positive impact on your health?

Taken as an oral supplement, it can potentially prevent harmful microorganisms from taking over and causing disease. Probiotics are also potentially helpful in treating some types of diarrhea. This is currently a hot topic and probiotic research is ongoing. There are studies that have shown probiotics can shorten the duration of diarrhea by about 24 hours. This has not been specifically studied in traveler’s diarrhea, but the data so far is promising.

One of the most exciting discoveries in recent years has been the realization that our microbiome plays key role in our well-being. This includes protection against infection, drug metabolism, vitamin synthesis, nutrition, as well as in response to disease.

Disruption of our normal microbiome, known as ‘dysbiosis,’ may play a vital role in the development of a range of diseases, such as inflammatory bowel disease, obesity, diabetes, and cardiovascular disease.

This suggests that it may be possible to prevent or cure disease by regulating this microbiome. This is where probiotic supplements may be beneficial. Probiotics can also potentially help bolster your immune system.

Studies have shown that probiotics may reduce the risk of infection with Clostridium difficile which is a serious infection of the colon and my prevent a recurrence once infection has occurred.

To date, most of the research on probiotics has been focused on sick people. However, there is good evidence that probiotic supplementation in healthy adults can have some benefit.

How does adding good bacteria to the gut help?

The gut (aka the gastrointestinal tract) plays a central role in defending the body against disease. More than half of all the cells that produce proteins the body uses to fight disease (antibodies) are found in the gut.

These cells recognize the bugs that can cause disease, mark and destroy them. They also remember these bugs so they will be able to react faster the next time you are exposed.

Probiotic supplements may help promote the ability of your gut to fight disease causing bacteria. Since the gut is a major part of our immune system, keeping your gut healthy may potentially prevent you from getting sick.

Exactly how probiotics are beneficial is incompletely understood. However, three general benefits have been described.

1 - Suppression of disease causing bacteria

2 - Improvement of intestinal barrier function

3 - Modulation of the immune system

Not all probiotics are the same. As a result, benefits observed clinically with one species or with a combination of species are not necessarily the same.

Although yogurt is commonly recommended as a source of probiotics, it’s important to note that in the United States dairy products are pasteurized. This may potentially kill the good bacteria.

So...which one should you take?

Studies have found that Saccharomyces boulardii may reduce the risk of traveler’s diarrhea. The evidence to support the effectiveness of this and other probiotics in preventing traveler’s diarrhea is limited and suggests that probiotic efficacy varies widely depending on the individuals underlying health condition and the travel destination.

The most commonly studied beneficial probiotics include lactobacillus rhamnosus GG (labeled as “LGG” on probiotic packages) as well as lactobacillus reuteri and saccharomyces boulardii.

Despite all the good news about probiotic supplements, there is evidence that suggests taking probiotics can have serious side effects.

There are recent studies suggesting that probiotics can evolve in the gut after administration, becoming less effective and perhaps even harmful.

Probiotics have been able to evolve quickly and compete better with the existing gut flora, allowing them to become the predominant organisms in the gut. Based on this, it is hard to definitively say that probiotics have no downside.

Like most supplements, probiotics are not regulated by the US Food and Drug Administration.

Even if you do find pills that contain what you are looking for, there's a small chance the pills could do you harm. This is especially true for people with weak immune systems. For example, people on chemotherapy for cancer should be extra careful. That's because probiotics could cause an infection.

If you do choose to take probiotics supplements you need to make sure the benefits outweigh the risks and if you find that it’s the right choice for you, shop around. This is a multi-million dollar industry. Prices vary significantly.

Ideally, look for the ones that do not require refrigeration and contain Lactobacillus rhamnosus GG (labled as “LGG” on probiotic packages) as well as lactobacillus reuteri and saccharomyces boulardii. Of note, Lactobacillus acidophilus has been studied and shown to have no significant benefit.

The key is to get lots of these organisms into your system, so be sure to check the number of bacteria on the package.

If you are taking it for protection against travelers diarrhea, start taking the probiotic supplements several days before your trip. This allows the seeding of these “good” colonies in the gut prior to travel. With beneficial probiotics already present in the gut before you leave, your natural immunity will be optimized.

Keep in mind that even though probiotics may prevent or shorten the duration of traveler’s diarrhea, you can’t always count on that. So be prepared and plan accordingly based on your travel destination. Take appropriate measures to protect yourself and minimize your risks.

Ultimately, taking any supplement is a personal choice. Personally, me, my wife and three little boys take a probiotic supplement daily. Does it make a difference? Most likely not. To date there is no proven benefit. For us the risk-benefit ratio favors taking the supplement. This may not be the case for everyone.

Please remember that medical information provided by us must be considered an educational service only. This blog should not be relied upon as medical advice and does not replace your physician’s independent judgement. Please seek the advice of your physician or healthcare provider regarding any issues related to your health.