Gut health has become big business – and many of us have adopted probiotics as part of our daily routines. But does science support the use of these ‘good bacteria’?
Probiotics remain popular, despite almost constant debate about their effectiveness among the medical community. They’ve taken us on a bit of a roller-coaster over the years, from ‘yes, probiotics are a necessity’ to ‘hmm… perhaps they do nothing at all’, to where we find ourselves today. Where should they be positioned on this spectrum?
The probiotic boom
The probiotic industry has seen major growth in recent years: in 2017, it was estimated to be worth more than R527
million in South Africa, and is predicted to reach over US$66 billion globally by 2024. You’ll find probiotic pills and drinks in pharmacy aisles (and fridges) and in health and wellness stores all over the country. Probiotic foods, beauty products and even pet products are also widely available. This is largely due to the rise of scientific interest in the microbiome, ecosystems of micro-organisms and bacteria interacting throughout the body.
Many of the estimated 39 trillion bacteria in the gastro-intestinal system have been found to be effective at crowding
out harmful microbial invaders, leading to the seemingly logical conclusion that introducing more probiotics into our
systems would result in better health.
What we know now
Past research has suggested that probiotics may, indeed, be helpful in treating specific conditions – including bronchitis, eczema and diarrhoea – and might help reduce the risk of heart disease. Preliminary research also suggests that probiotics might help reduce symptoms of irritable bowel syndrome, although no conclusive evidence has been found as yet.
While probiotics have undoubtedly shown potential to do good in these studies, strong, reliable scientific evidence
is still lacking regarding their effectiveness in preventing or treating most health conditions. Most studies have also failed to find any real benefits to probiotics in healthy individuals, with some experts stating that it’s probably not worth taking them if you aren’t in physical distress.
Another issue is that consuming probiotics could amount to a mere drop in the ocean, as the gut contains tens of trillions of bacteria, while a probiotic pill or food serving can only deliver a few hundred million or billion. While that may sound like a substantial amount, it’s likely too few to have a dramatic effect on the internal ecosystem. Add to this the fact that different bacterial strains interact in vastly different ways, and further differ according to the gut of each individual, making it difficult to predict how a probiotic might react with them. Particular species and strains of
bacteria have even been included (and sold) in probiotics, due more to the fact that manufacturers knew how to grow them in large numbers than because of their health-promoting properties. Some of these bacteria aren’t even able to survive the highly acidic gut environment.
An influential 2018 study has cast further doubt on the overall effectiveness of probiotics. Led by Dr Eran Elinav, head of the microbiome focused research group at the Weizmann Institute in Rehovot, Israel, the study found that some individuals (referred to as ‘resisters’) simply expelled the probiotics from their bodies, while others (‘persisters’) responded well to them, with the probiotics successfully colonising their guts.
The same Israeli researchers conducted a second study which suggested that taking probiotics after a course of antibiotics could actually be harmful. While we’re often advised to take them to replace the micro-organisms and bacteria lost after antibiotics, standard probiotics might hinder the natural replenishment of our gastro-intestinal
systems and prevent them from returning to normal.
The study leaves room for further exploration of the effectiveness of probiotics, but suggests a change in how we’ve been thinking of and using them. ‘This suggests that probiotics shouldn’t be universally given as a one-size-fits-all supplement,’ said Elinav in a public statement. However, the research team also conceded that in the future, it may be possible to increase the potential benefits of probiotics by tailoring them to the individual, based on the existing
microbes found in their gut.
Should you continue to take them?
In short, if your gut’s already healthy – probably not. The microbiome is a vastly complex series of interactions which differ from one individual to the next, meaning it may not be possible to drastically modify it in any meaningful way using such a simple solution. However, if you’ve experienced notable benefits from using probiotics, it may be that you’re a ‘persister’ and could be reaping the benefits of the mysterious bacteria.
Real benefits of probiotics have been recorded: for example, a 2014 review by global independent research network Cochrane found that they may be especially useful in neonatal intensive care units. When beneficial bacteria were added to nutritional regimes, they seemed to significantly reduce the risk of fatal gut disease, necrotising enterocolitis, which predominantly affects premature babies.
Although it hasn’t been conclusively proven and the reasons aren’t entirely clear, many sufferers of IBS have also reported relief of symptoms like bloating, constipation, abdominal pain and diarrhoea while taking probiotics. Researchers have suggested that this might be due to probiotics making it more difficult for harmful microbes to
grow, but there isn’t enough data for them to recommend specific strains or amounts of bacteria.
Probiotics remain something of a mystery, but continue to reveal promising potential. It’s likely that they’ll be tailored and become beneficial to specific microbiomes in the future, ushering in a host of new and effective treatments, so we aren’t giving up on them yet.
FEATURE: CAITLIN GENG PHOTO: FOTOLIA.COM
The information in this article is not intended to be a substitute for professional advice, diagnosis and treatment. Always consult your GP or a medical specialist for specific information regarding your health.