By now, probiotics have gone mainstream. Everyone is talking about maintaining optimal digestion by supporting the gut (aka, the microbiome). While it’s interesting to learn everything there is about the gut, we can’t claim to know everything about research that’s still evolving. Sure, there are practices like ancient Ayurveda and Traditional Chinese Medicine (TCM) that focus on supporting digestion, but there’s still so much that we simply don’t know.

Take for instance H. Pylori, a pathogen known for causing heartburn and reflux (amongst other symptoms) that’s typically treated with antibiotics. However, new research shows that, in the right amount, H. Pylori is surprisingly beneficial. [1] Wiping it out could actually backfire! So, while we’re finding new pieces to the puzzle, we still don’t even know what it’s supposed to look like. Gut health is truly the new wild west.

Which is why I want to cover the pros and cons of probiotics. Or, specifically, probiotic supplements.  Just like H. Pylori, there are good and bad parts to them that not a lot of people talk about or are even aware of. I had written a 101 post on choosing the right strains and their benefits, so if you’d like a refresher or want to learn more, you can read about them here. Otherwise, let this follow-up post be your guide into the good and bad of probiotics. Are you ready? Then let’s get started!

The Pros

Here are the general pros to supplementing with probiotics:

• May provide symptomatic relief for a variety of digestive ailments, such as indigestion, diarrhea, constipation, bloating, and gas [2]
• Could help achieve remission in inflammatory disorders like ulcerative colitis (UC)- a good example would be the supplement VSL#3 [3]
• Patented, medical-grade probiotics (i.e., VSL#3, Culturelle, Bio-K, Align) are backed by clinical research and are approved by most of the medical community
• May help to prevent traveler’s diarrhea (although the evidence is mixed) [4]
• Possibly good for athletes; may prevent upper respiratory infections and support immunity [5] [6]
• Could potentially elevate mood and improve symptoms of anxiety and depression (much of the research is mixed) [7]
• May help with skin conditions like acne, eczema, rosacea, and psoriasis [8]

Cons

Now, onto the cons of probiotic supplements:

• Studies often contradict each other, and many are small and uncertain with their results.(Notice in the pros section I often had to resort to words such as may, possibly, and could? Attempting to make sense of the research will likely make you more confused. Remember, the research is always changing. Don’t assume the experts have it all figured out!)
• Most of the brands available contain dead bacteria. Dead bacteria that are nowhere near as potent as the live ones living in the gut.
• Long-term effects are unknown. And by long-term, I’m talking about years and years. Enough to create a dependency. We don’t know whether or not a probiotic should be temporary or long-term to truly be effective.
• Could prevent the gut from restoring itself after anti-biotics. (Many people think it’s important to take probiotics after antibiotics. However, new research shows that probiotics can actually keep thebacteria from re-populating the gut. Which is something we don’t want to happen. A wiped-out gut is vulnerable to being overrun by opportunistic bacteria and yeasts!) [9]
• Ironically, they can contribute to or exacerbate bacterial overgrowths, such as SIBO (small intestinal bacterial overgrowth). It seems even with bacteria the phrase “too much of a good thing” still applies! Notice how we’ve gone from selling 5 billion CFU probiotics to 100 or more? And add the growing list of drinks, foods, powders, and supplements that are now enhanced with probiotics and you’ve got an army of bacteria storming into the gut!
• Aren’t as effective as fiber. You know, the stuff found in whole foods like vegetables, fruits, nuts, seeds, and grains? Paleo, keto, vegan, vegetarian- fiber can be eaten in almost any type of diet, and most experts prefer it over probiotics. Fiber is what feeds the good bacteria down the gut, acting as a prebiotic that keeps the good guys around. Which is why it’s essential to maintaining a healthy gut. [10] [11]

Final Verdict

At this point, you may be wondering if you’ve been duped all this time. And you’re not alone. But that’s the thing with health science- it’s always changing. However, don’t give up on probiotics just yet. Many scientists believe probiotics have potential, with a few strains providing some benefit. According to Eran Elinav, an immunologist from Israel’s Weizmann Institute of Science, probiotics may one day be, “…tailored to the individual and can be prescribed to different individuals based on their baseline features… probiotics should not be universally given a ‘one-size-fits-all’ supplement. Instead, they could be tailored to the needs of each individual.” [12]

Until the time comes when we can do just that, the current consensus is to proceed with probiotics cautiously. Always talk with a qualified healthcare practitioner before supplementing. Make sure that they’re appropriate for you in your current circumstances. And on top of that, please don’t go crazy with taking 200, 150, or 300+ billion CFU-count probiotics. Most of those supplements either contain dead bacteria or are the perfect setup for bacterial overgrowth. If you want to boost your microbiome, then look no further than the food on your plate.

Sources:

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291894/
[2] https://www.ncbi.nlm.nih.gov/pubmed/23981066/
[3] https://www.gastrojournal.org/article/S0016-5085(11)00375-1/fulltext
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232657/
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232657/
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5790851/
[7] https://www.health.harvard.edu/blog/can-probiotics-help-treat-depression-anxiety-2017072612085
[8] http://www.sciencedirect.com/science/article/pii/S0190962214014078
[9] https://www.cell.com/cell/fulltext/S0092-8674(18)31108-5?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867418311085%3Fshowall%3Dtrue
[10] https://academic.oup.com/cdn/article/2/3/nzy005/4828321
[11] https://www.outsideonline.com/2365176/probiotics-less-effective-than-prebiotics
[12] https://www.eurekalert.org/pub_releases/2018-09/cp-hgs083018.php