Let’s Talk About Probiotics

You may have seen the recent BBC headline about probiotics, calling them ‘quite useless’, based on feedback from a recent study in Israel. Before you rush to throw out your probiotic supplements, let’s take a closer look at the facts.

In my clinical experience, probiotics aren’t useless at all and there is a wealth of clinical evidence which supports my view. It really depends what product you’re using, how strong the dose is, how consistently you’re taking it and what you’re trying to achieve.

There’s a general assumption that the role of probiotics is to repopulate the gut with ‘friendly’ bacteria, restoring the balance by muscling in on the ‘unfriendly’ bacteria. In fact it’s far more complex than that and we’re only really scratching the surface when it comes to our understanding of the gut microbiome, because it’s a vast and rapidly developing area.

It’s not as simple as restocking the gut with the good stuff. The way that probiotics seem to work is by improving the terrain in the gut so that the resident ‘friendly’ bacteria can thrive.

As they travel through the gut, probiotics will reduce levels of inflammation which can help to limit the growth of harmful bacteria and ease digestive discomfort, such as bloating and wind or inconsistent bowel movements. They also help to support a robust immune function by influencing the action of specific proteins in the gut, which makes them incredibly helpful when it comes to keeping you fit and well. Anyone consistently susceptible to colds and other infections would do well to consider whether they might benefit from probiotic support.

The Israeli research is based on a study of 25 people, taking one combination of probiotics for 4 weeks and examining whether the bacteria had established itself in the gut.  The conclusion was that the probiotics lingered briefly before passing out of the body and therefore couldn’t be effective. Here are a few reasons why I won’t be paying any attention to this study:

• Testing whether the probiotics had established themselves in the gut is rather missing the point. Probiotics are by nature transient and usually stay in the gut for about two weeks, so in this sense, the results of the study aren’t surprising. It’s the work that they do as they travel through the gut that is important, relieving inflammation and influencing proteins that communicate with the immune system.
• There are many different types of probiotics which contain a range of strains, have different levels of potency and which will target different issues. One size really doesn’t fit all in this context. This why I usually run a stool test before recommending a product for a client, so we can identify the status of the different gut bacteria and select the most supportive product.
• 4 weeks is nowhere near long enough! I usually recommend clients take probiotics for about 3 months, especially if they have been struggling with long-term digestive issues. I’d normally expect to see an initial improvement in symptoms after about 6 weeks.
• The 25 subjects were selected on the basis that they didn’t have an imbalance in the gut. The study concluded that there was no significant change to the status of the gut bacteria in at least half the participants. It may have been a different story if they’d chosen subjects with a gut imbalance.
• The dosage of 5 billion bacteria, twice per day, is tiny compared to a therapeutic dose of around 30 billion
• Probiotics are useful and not useless! There is a wealth of evidence related to their impact on antibiotic-associated diarrhoea, for example. I repeatedly see the positive impact in my clinic, with clients who struggle with IBS symptoms such as loose stools, bloating, cramping and constipation; they support optimum function of the immune system and may help to prevent to development of allergies and intolerances.

As well as using probiotic support, there are lots of ways that the right diet can help to support a healthy gut environment, in particular by focusing on fermented foods. In my new Eat Yourself Well course on immune-boosting foods, I devote a whole session to the importance of gut immunity and we’ll be cooking up some tasty foods for you to try. There are still a few places left, if you’d like to get your immune system in great shape for the winter and you can book your tickets HERE.

A few final tips on probiotics:-

• Make sure you choose the strains which will be most supportive for your health goal e.g. post-antibiotics, pre-holiday or anti-fungal. If you’re not sure what’s right for you and don’t have access to specialist support, opt for a broad spectrum product which contains multiple strains, as this could act as a catch-all. Two of my favourite clinical products are Ecodophilus and Symprove.
• Remember to be consistent – probiotics aren’t like vitamin C, where a quick blast can be effective. The effect is cumulative and will build up over a period of weeks.
• You don’t have to take supplements if you don’t want to. Fermented foods such as kimchi, kefir, sauerkraut or kombucha can all provide similar support for the gut.
• I’d be wary of using any of the self-styled ‘probiotic’ yoghurt drinks, if you’re looking for a therapeutic approach. The levels of bacteria are often very limited and they tend to be very high in sugar which is extremely disruptive to the gut environment.

In short, there’s still a lot we don’t know about the gut microbiome and it’s a hugely exciting and rapidly developing area of research. Even if we still don’t fully understand the exact mechanisms behind the effectiveness of probiotics, we do know that they can be highly effective in relieving unpleasant digestive symptoms. It’ll take more than a  4-week study of 25 people to convince me that probiotics are “useless”!

If you’ve been diagnosed with IBS and have been putting up with niggling digestive symptoms for years, you might benefit from a WellWellWell nutrition consultation. The right nutrition can be very supportive and may help to relieve a range of issues, such as bloating, wind and inconsistent bowel movements. Contact me if you’d like to arrange a free 20-minute telephone assessment.