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Do Probiotic Supplements Really Work?

If the eyes are the window to your soul, then the gut microbiome is the window to our health.  That’s what I usually tell my clients right from the get-go.

The hot topic that I continue to encounter over and over again when it comes to gut health is this: Do probiotic supplements really work?

Let’s take a closer look…

Probiotics burst onto the health and wellness scene in the early 2000s (though they were first discovered in the 1890s) and despite their sudden rise to popularity, they haven’t faded away like a fad; instead they are now a staple topic of discussion within the wellness community and seem to be added to every product possible.

The average consumer can now obtain commercially produced and synthetic probiotics in pill form, hand soap, face wash, while eating their favorite cereal, or even incorporated into their mattresses.  Surely something this widespread and obviously valued by consumers must live up to the hype, right?

I can provide an answer to that: yes—but not in the format currently being sold to you. Below I’ll bust some myths touted by the food industry and provide guidance on how to make probiotics actually work for you.

Grocery Bug Feeding Frenzy: If you cannot produce your own, is store-bought really fine?

The first myth in need of busting: eating the same strains regularly will greatly benefit you (think to eat Activia once a day for months on end, as they suggest).

The first issue with eating the same strains daily:

Strains selected for mass-produced products are often chosen for their cost-effectiveness, rather than their efficacy.

For example, two of the most common strains (Bifidobacterium and Lactobacillus) have been readily cultivated since their discovery in 1890. They’re the original probiotic, time-tested, cheap to produce, and totally old school.

The other issue with readily available synthesized strains: even when they are from the right bacterial family, many are too weak to survive a stomach acid bath.

In fact, the most common strains used as yogurt starters (Lactococcus, L. bulgaricus, and S. thermophilus) are incapable of surviving the stomach and therefore never even make it to your gut, let alone colonize it.

I’m not bashing lactic acids; they’re certainly not harmful. I just think people need to be aware that they only pass through your system and mask the symptoms of having a disturbed gut—they don’t actually “fix” anything. As soon as you’re done taking that yogurt, pill, or drink every day the benefits disappear.

The final problem with taking supplements: when they are taken alongside fermented foods and beverages (like kombucha or yogurt) it can be ‘overkill’– you’re basically taking a “bulldozer” to your gut!

As I said in my Well + Good interview there are no magic pills or shortcuts, even kombucha has its caveats.

Resisters and Persisters: Which are You?

You may be thinking by now ‘wouldn’t it be better to risk it and take at least one supplement a day?’

Sure, supplements are a great option for those in a pinch, but those pills you are popping may not even work for you. That’s right, the latest studies on the subject have busted the persistent myth that any probiotic is a useful one.

It turns out people fall into one of two groups: resisters or persisters.

Research conducted at the Weizmann Institute of Science provided probiotics to individuals and chose to not only test their stool but to actually take a trip inside their intestinal tracts and pool samples of their gut flora as well. They chose to do this to confirm colonization actually occurred, rather than just confirm that the strains survived the stomach.

The results were unique: the standard strains managed to colonize the guts of some patients (persisters) but not others (resisters)–even when the probiotic could be found in the stool it wasn’t always in the gut (where it needs to be!).

Previous studies into the efficacy of probiotics used stool alone as a proxy to determine microbe activity in the GI tract.

This study shows ‘stool count can lie’ so relying on stool samples alone could be misleading to future researchers, and might have skewed the studies of the past. One researcher from the study summed up their findings by simply stating “the benefits of the standard probiotics we all take can’t be as universal as we once thought.”

The other major result of this study: for persisters (those whose gut microbiota are readily colonized), continuing to ingest the probiotic did not increase their benefits. Once the strain was successfully introduced to their gut, it remained.

This is why I don’t believe in taking probiotic supplements day in and out, indefinitely. If you’re a persistor the benefits such as a decrease in IBS symptoms, a reduction in the complications of infectious diseases and the prevention of allergy development and reduction of symptoms should arise quickly due to the successful diversification of your gut. If you’re a resistor, daily supplementation is simply a band-aid that doesn’t resolve the real issues within your system.

The implications of such a study are obvious: a “one size fits all” approach to probiotics (think supplements) is not a silver bullet and may not readily benefit everyone. Just like a diet, the standard probiotic doesn’t work for every individual the way it’s claimed to do.

This is actually a tenant of my practice, and why I incorporate the rules of diversity foods as well as lifestyle applications. It’s also why I developed Wild Mediterranean, a health philosophy to eating and living well, which provides a plethora of fermented whole foods and plant polyphenols that readily promote diversity in the gut.

So how do you know which you are?

By testing your gut bacteria of course. Those researchers at the Weizmann Institute found that they could predict who would be a persistor or a resistor based on their baseline microbiome. This is why I always emphasize the importance of checking your gut bacteria annually–it could save you a lot of time and trouble.

The Final Myth: Probiotics vs. Antibiotics

Probiotics may not work when you have a healthy gut that simply resists (sheds) them, but it’s common knowledge that eating Activia after a heavy round of antibiotics is the best way to bounce back. Is it really though?

Those same researchers at the Weizmann Institute sought to see if they could find anything surprising about probiotic use post-antibiotic use. Antibiotics certainly ‘cleared the way’ for the probiotics, even in the resistors. However, they, in turn, wreaked havoc, by impeding the growth of the natural strains that had colonized the patient’s microbiome prior to having taken any form of medication or supplementation.

This wouldn’t be a problem if you happened to have nothing but terribly bad strains in your gut, but the average healthy person simply looking to increase diversity within their already stable microbiome would be deeply adversely affected. They would, in fact, be inhibiting their return to a balanced and healthy state. Dr. Elav, one of the researchers on both studies conducted at the Institute noted that taking the probiotics was “worse than not doing anything” and concluded that the current dogma regarding probiotics may need to be reexamined.

Such potential for unpleasant side effects of probiotics is already being discussed, even if the science has yet to catch up.

In fact, it’s the main concern of world expert and bacteriologist Dr. Jeroen Raes of the Katholieke Universiteit Leuven in Belgium. He notes that unlike with drugs, there are no established protocols to determine adverse effects of bacteria.

The Real Takeaway: Diversity trumps Uniformity

So what’s a health-conscious person to do in the face of such stark reality? Focus on what we do know, based on science.

The first thing to keep in mind: A healthy gastrointestinal microbiome is dependent on diversity– the dietary diversity that is; the kind that can be best obtained by eating seasonal foods and a lot of plant fiber. Why?

An ecosystem that lacks diversity tends to be less hardy than an ecosystem in which many different species are present.

This is true regardless of whether the environment of the ecosystem in question is the human gut, an ocean, or any other habitat.

This idea is supported by a solid body of evidence, including recent studies that have looked into the stability and functions of the human gut microbiota.

This is why I counsel my clients to think of their ideal gut as a natural, undisturbed (our guts are too often disturbed the Standard American Diet and modern life), ecosystem composed of a wide variety of different life forms such as viruses, fungi, and bacteria. If your gut were a farm you’d seek to avoid monoculture development and focus on a multi-culture way of life.

It’s also why I developed my Wild Mediterranean approach, which focuses on fostering this formula. If probiotics are the monoculture method, Wild Mediterranean is its multi-culture counterpart.

If you want one simple practice to implement from my method, I cannot stress enough the power of fermented whole foods. The lactic acid bacteria present in sauerkraut, kimchi, and other similar fermented vegetables produce substances that are toxic to various types of gut pathogens. These foods stimulate your immune system by contributing some genetic diversity to the microbiota and help to reduce the pathogen load in the gut.

You can also incorporate more apple cider vinegar into your diet. It’s fermented, delicious and in my interview for Aaptiv Magazine, I note that that the organic acids, flavonoids, polyphenols, vitamins, and minerals found naturally in apple cider vinegar could boost gut health.

After all, your gut microbiome literally feasts off the plant phenols found in ACV.

Don’t forget to take your prebiotics a well to get the most bang for your health buck. They’re the other half of the dynamic duo and are indigestible plant fibers that boost the strains of beneficial bacteria in your gut–think of them as fuel for your new strains.

The grand takeaway: As long as you’re introducing your gut to a wide variety of strains, you’ll reap benefits far greater than what is offered commercially.

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