Truth or Myth: Everyone Should Take Daily Probiotics

Myth: Everyone should take a probiotic supplement daily. 

Truth: Probiotic supplementation may not be necessary for everyone. 

A probiotic is defined as a microorganism that maintains or restores beneficial bacteria to the digestive tract when consumed (from food or a dietary supplement). 35,000 species of probiotic bacteria have been identified and each strain has a unique effect on the human body – some of which we know and others we don’t (1). Intentional strain-specific probiotic supplementation has been shown to improve a variety of conditions such as IBS, IBD, atopic dermatitis, anxiety, depression, and more (2, 3, 4). Probiotics are useful in promoting diversity in the gut microbiome. To help simplify the concept and emphasize the importance of microbial diversity, consider a school system, and all the various members (staff, parents, and children) to make it a rich and productive environment. If one school hired only P.E and math teachers, the output from the school would be very different than one that hired a balance in subject matter experts and administrative staff. Likewise, you would imagine that a school that has only math and P.E teachers would attract a different student body than one that was more established and well rounded. Just as in a school system, diversity in the organisms that live in the gut is key for its balance. 

Although probiotics do not always colonize (take residency and stay) in the gut microbiome, they are able to shift the community dynamics of the gut and modulate the immune system (5). For example, let’s think of probiotics as temporary substitute teachers brought in to enrich the school’s environment until permanent teachers are hired and established. Although we do not have a full understanding of how probiotics work, we know that particular strains have a positive effect on the overall well being of the human host. 

Although the probiotic picture painted thus far looks inviting, potential harm may exist when probiotics are supplemented. In cases of acute pancreatitis, some cases of gut dysbiosis and possibly after the use of antibiotic treatment, probiotic supplementation is not advised (6). In order to be classified as a probiotic, the supplement has to contain live bacteria in therapeutic dosing of 1 billion CFU (colony forming units). Many of the probiotic supplements on shelves are very poor quality, lack adequate amounts of the probiotic strain needed to be effective, and contain contaminants that are harmful to our health (7). Quality certification programs exist through third-party organizations (ConsumerLab.com, NSF International, and USP) to ensure products meet acceptable limits for contaminants (7). However, these certifications are optional and still, many supplements that have not gone through additional testing for safety and efficacy sit on our shelves. Therefore, determining if probiotic supplementation is right for you and what products are best for your health goals, it is important that you work with a qualified practitioner instead of arbitrarily plucking a supplement off of a grocery store shelf. 

Key Takeaways: 

• Everyone should be leery of over-the-counter probiotic supplementation. 
• Although probiotic supplementation has therapeutic uses, we can get a broader range of probiotics, assisting in the diversification of the gut microbiota, by eating fermented foods. These include fermented vegetables and condiments like sauerkraut and pickles. A few more include kombucha, kefir, yogurt, and beet kvass. 
• When purchasing fermented foods and dairy, look for “raw” or “unpasteurized” on the label. The process of pasteurization kills the microbes that make these foods uniquely beneficial. 
• Supporting your gut with a nutrient-dense diet rich in a variety of plant foods is a better course of action for supporting a healthy gut microbiome than the arbitrary implementation of a probiotic supplement. 
• Probiotic supplementation in the presence of a highly-processed Standard American Diet is likely useless. 
• If you believe you would benefit from a probiotic, work with a qualified practitioner to help you determine which supplement would be best for your needs. 

If you have any additional questions regarding this topic, please submit them to Kristen at asktheRD@wellstyles.org. 

Questions? Contact us at AsktheRD@wellstyles.org 

By Lauren Ruegg, DNP

References

1. Ballantyne, S. (2017). Paleo principles: The science behind the paleo template, step-by-step guides, meal plans, and 200 healthy & delicious recipes for real life. Las Vegas, NV: Victory Belt Publishing.
2. Moayyed, P., Ford, A. C., Talley, N. J., Cremonini, F., Foxx-Orenstein, A. E., Brandt, L. J., & Quigley, E. M. (2010). The efficacy of probiotics in the treatment of irritable bowel syndrome: A systematic review. The British Medical Journal, 59, 325-332.
3. Messaoudi, M., Violle, N., Bisson, J., Desor, D., Javelot, H., & Rougeot, C. (2011). Beneficial psychological effects of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in healthy human volunteers. Gut Microbes, 2(4), 256-261.
4. Weston S, Halbert A, Richmond P, et al Effects of probiotics on atopic dermatitis: a randomized controlled trial Archives of Disease in Childhood 2005;90:892-897
5. Corthésy, B., Gaskins, H. R., & Mercenier, A. (2007). Cross-talk between probiotic bacteria and the host immune system. The Journal of Nutrition, 137(3), 781S–790S. doi: 10.1093/jn/137.3.781S
6. Suez, J., Zmora, N., Zilberman-Schapira, G., Mor, U., Dori-Bachash, M., Bashiardes, S., … & Horn, M. (2018). Post- antibiotic gut mucosal microbiome reconstitution is impaired by probiotics and improved by autologous FMT. Cell, 174(6), 1406-1423.
7. US Food and Drug Administration. Dietary Supplement Current Good Manufacturing Practices and Internal Final Rule Facts. http://www.fda.gov/Food/GuidanceRegulation/CGMP/ucm110858.htm. Accessed September 6, 2019.