Should You Be Taking A Probiotic?
Photo by Tom Nagy
By Lauren Sherman
Gut health. It’s something we hear about more and more frequently from doctors, nutritionists, and gurus alike, who often claim that a “clean” gut is the key to curing ailments like diarrhea, bloating, constipation, or even acne. A healthier digestive track makes for stronger immune system, they say.
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To help along your gut, many experts suggest taking a probiotic, either in food or supplement form. Sales of probiotics are estimated to reach $44.9 billion globally by 2018, according to a report by Albany, N.Y.-based Transparency Market Research. Many foods, from kefir to kimchi, contain probiotics, but it’s the supplements—lactobacillus acidophilus, bifidobacterium, lactobacillus plantarum—that people are really crazy over. In fact, taking a probiotic has become almost as commonplace as taking a multivitamin. We discuss them openly at dinner parties, comparing strains and makers. Celebrities, including Anna Paquin and Lauren Conrad, are regularly spotted carrying bottles of kombucha, a fermented tea that contains probiotics. Jamie Lee Curtis is practically synonymous with Activia, the probiotic-filled yogurt she shills on TV. For many of us, probiotics are a part of what we consider a healthy diet and daily regimen. (I personally take one that was recommended to me by my mother-in-law.)
And studies have suggested that in some cases, probiotics may indeed help. A 2012 report by the non-profit global policy think tank Rand Corporation said that probiotics may reduce the risk of developing diarrhea when taking antibiotics. A 2013 study out of UCLA said that ingesting fermented milk can affect activity in the area of the brain where emotions and sensations are processed. And a 2014 report published in the British Journal of Nutrition lactobacillus rhamnosus—found in Culturelle—could help women lose weight.
Yet there are still many unanswered questions about probiotics.
What Is a Probiotic?
“Essentially, they’re bugs in a capsule,” says Satish S.C. Rao, MD, PhD, an American Gastroenterology Association fellow and the director of the Digestive Disease Center at Georgia Regents University. But if you want to get technical: “Probiotics are active bacteria that have been grown and cultured in the laboratory and are believed to be helpful or beneficial to the human microbiome, or the human gut.” Probiotic supplements are not regulated by the FDA, which means they are not tested as a drug.
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Do Probiotics Work?
Maybe? “There’s been a lot of anecdotal evidence that suggest [taking a probiotic] could help a lot, but it’s hard to frame it in a scientific way,” says Nicholas Chia, PhD, associate director of the micobiome program at the Mayo Clinic’s Center for Individualized Medicine in Rochester, Minnesota. “The probiotic field is not one that has included a lot of controlled clinical trials, so there’s no firm answer.” Unfortunately, researchers just don’t know enough about the bacteria that live in our body to know how to treat them. “We have more bugs in our body than body cells,” explains Rao. “Which are good? Which our friends? Which are healthy, which are not healthy? Research is providing early clues, but more needs to be done. The little snippets of information are patchy and haven’t been reproduced.” For instance, the authors of the UCLA fermented milk study also wrote that they weren’t sure whether or not it was a good thing that the substance can affect brain activity.
What does seem to truly work for those with serious, serious gastrointestinal issues is fecal microbiota transplantation. That’s when fecal bacteria of a healthy individual is implanted — usually via enema — into someone suffering from clostridium difficile, an infection that can cause severe diarrhea. But it’s a serious procedure that comes with its own risks. “It’s for people who can’t leave their house, or their toilet,” says Chia.
Are Probiotics Safe?
Seems so? “I think, for the most part, they’re fairly benign,” says Chia. However, there can occasionally be complications. Rao says he has patients who have reported brain fogginess while taking probiotics. While most humans colonize probiotics in the large bowel, some colonize them in the small— an area of the body that actually doesn’t have a lot of bacteria. “By and large they are generally safe,” he says. “But when they colonize in the small bowel they are harmful and potentially cause symptoms.”
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Should I Be Taking a Probiotic?
You probably won’t have trouble finding a doctor who recommends taking a probiotic, but there are certainly some who will flat-out refuse to do so. If you want to go rogue, probiotics are available over the counter: you can easily pop by the drug store and buy a bottle without consulting your physician. However, there are some probiotics, like VSL #3, that claim to be so potent that the makers urge they be used only under medical supervision. “You shouldn’t take a probiotic as if it’s a multivitamin,” says Rao.
No, Really, What Should I Do?
If you’re suffering from one of the many symptoms probiotics are meant to relieve, the first thing you should do is take a hard look at your diet and your exercise regimen. “The things you eat, like complex carbohydrates and fiber, can feed your microbiome and make it more healthy and functional,” says Rao. Adds Chia, “Variety in your diet is very important. Eating a healthy, unprocessed foods from a variety of sources will encourage a [healthy gut]. I really suggest letting your micro biome do what it does.”
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