While there may be debate around the use of probiotics for the treatment of certain diseases, the evidence is clear for the average healthy individual. Probiotics are not needed to support a healthy gut microbiome, with efforts to address lifestyle factors and diet of greater benefit. Read our complete review of Probiotics here. This consensus is based on 7 experts answers from this question: Are probiotics necessary for a healthy microbiome?
All of us are colonised with a diverse and complex array of microbes with whom we have established a strong symbiotic relationship. Over 95% of all microbes found on the human body can be found in the gut, and thanks to recent advances in our ability to study these microbial communities, an ever-growing list of diseases linked to the microbiome has emerged.
With the health-savvy acutely aware of this revolution in microbiome-science, there has been an explosion of commercially available probiotic products claiming to boost your gut health and support a healthy microbiome. But, in the face of all this hype, how does the evidence really stack up … are probiotics all they are cracked up to be ?
What are probiotics and why are we obsessed with them?
From yoghurts to beer or popping a capsule, probiotics come in a variety of conventional and totally unconventional forms, but ultimately they are a collection of bacteria aimed at boosting the numbers of “good” bacteria in the gut to offer benefits to the host.
While the concept of probiotics has been recognised in scientific literature for over a century, interest from the general community has really only sparked in the past few decades. This is almost certainly driven by advances in technology that have allowed us to study the link between the microbiome and human health/disease in much greater detail resulting in a panoply of diseases with which a disrupted microbiome is associated (associated does not mean caused by).
Now, in 2019, we are obsessed with supporting our gut health and consequently, the microbiome is all the buzz. This is, in some ways a wonderful achievement, with a new generation of people engaged with gut health and disease prevention. On the other hand, this unrivalled enthusiasm from the public has been exploited by the probiotic industry, a huge and rapidly expanding market set to grow to more than US$96 billion by 2020.
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The probiotic craze is miles ahead of the science
In order to have a meaningful impact on the host, probiotics must establish themselves within the gastrointestinal environment, a process called colonisation. Dr Robert Rastall from the University of Reading , notes that probiotics “do not permanently colonise the gut”, highlighting that if they did it would be bad news for the commercial industry as we would only need to take a single probiotic pill.
Most probiotics have only been shown to transiently colonise the gut, meaning that when you stop taking them, their [presumed] effects disappear. Nonetheless, if and when these probiotics colonise the gut, we have very little understanding of how they impact the host’s physiology and there is somewhat of a blackbox between giving the probiotic and the clinical outcome.
This also raises the point that there isn’t just a single probiotic that will be the cure to all microbiome-related diseases or the promoter of eternal health. One of the biggest limitations in our ability to demonstrate any benefit of probiotics is the fact that we really do know what a “healthy” microbiome is. Dr Emma Allen-Vercoe from the University of Guelph, explains that “scientists are still working to determine wha defines a ‘healthy‘ microbiome”, adding that many factors contribute to an individual’s microbiome composition, so much so that each person’s microbiome is unique. This means that it is very difficult to have clear and objective read outs of what a “healthier” microbiome actually looks like, and whether this is the same from person to person.
Probiotics are also only likely to represent one of many aspects that contribute to health and disease. “Taking probiotics without addressing lifestyle issues is not enough” highlights Dr Mahmoud Ghannoum, adding that factors such as sleep, exercise, stress and diet all impact the composition of the microbiome and must also be addressed to support a healthy gut. Given the uniqueness of our microbial communities, it is also likely that probiotic strategies need to be personalised taking into account an individual’s genetics and lifestyle factors. This concept was recently discussed in a study published in Cell, with authors reporting person-, region- and strain-specific colonisation patterns that were linked with unique factors relating to the host and their microbiome.
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Is there a single probiotic that can cure all microbiome-related diseases?
What are some lifestyle factors that impact the composition of the microbiome?
Can lifestyle factors like sleep and exercise impact the effectiveness of probiotics?
Have we been fooled?
The simple answer is no. Taking a probiotic supplement is not likely to cause harm to an immunocompetent, generally healthy individual. There is evidence to suggest that they may help restore the gut flora after a course of damaging antibiotics. But, evidence also exists showing no benefit, with one study reporting delayed recovery of the microbiome when probiotics were used. Similarly, there is evidence that probiotics can reduce the duration and severity of the common cold, explains Robert Rastall, but the mechanism underpinning this finding remain elusive.
The underlying reason for why we as a community have become seemingly obsessed with probiotics is their lax regulatory constraints. Unlike conventional medications, probiotics are regulated as dietary supplements. This speeds up the process to get probiotics on the shelves and means broader (scientifically unsound) claims can be made with fewer repercussions (take note of the wording next time you are at the supermarket: e.g. “may offer immune benefits”). There has even been reports of blatant disparities between the types of bacteria claimed on the label and those actually present.
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Can taking probiotics cause harm to a generally healthy individual?
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The Consensus
86% of our Metafact experts agreed that probiotics are not necessary for a healthy microbiome. While the definition of a healthy microbiome remains unclear, Dr Emma Allen-Vercoe notes that there are many healthy people in the world who do not/have never taken probiotics, and so it is unlikely that probiotics are necessary for good health.
If you would like to learn more – we recently conducted a major review probiotics asking 30 global experts to share the facts on key questions regarding probiotics. You can read it here.
The probiotic hype has moved far beyond the science. While there may be no harm in taking probiotics, it may be a costly choice with limited benefits. Instead, look after your microbiome with a balanced, high fibre diet, establish a consistent sleep pattern, exercise regularly and control your stress.
Learn more with Consensus AI Academic Search Engine:
What are alternative ways to maintain a healthy microbiome without taking probiotics?
Can a balanced, high-fiber diet help maintain a healthy microbiome?