avatarDavid Mokotoff, MD

Summary

The article suggests that a healthy diet rich in fermented foods can negate the need for probiotics and prebiotics supplements in otherwise healthy adults.

Abstract

The article titled "If You Eat a Healthy Diet, Save Your Money Because You Don’t Need Probiotics and Prebiotics" argues that most healthy adults with a balanced diet do not require probiotics and prebiotics supplements. It discusses the popularity of these supplements, backed by extensive research on the gut microbiome's link to various diseases. The author, a retired MD, emphasizes that a diverse diet, particularly one similar to the Mediterranean diet, can naturally support a healthy gut microbiome. The article highlights the benefits of fermented foods in promoting gut health and questions the necessity and effectiveness of probiotics supplements, especially considering the lack of regulation and potential risks. It also touches on the potential benefits of probiotics in specific cases, such as after antibiotic use or for chronic constipation, and mentions a particular brand, Visbiome, as recommended by gastroenterologists.

Opinions

  • The author believes that a healthy diet is sufficient for gut health and that probiotics and prebiotics supplements are unnecessary for most healthy adults.
  • Regular consumption of fermented foods is seen as beneficial for gut health, akin to a fertilizer for the gut garden.
  • The author is skeptical about the efficacy and safety of over-the-counter probiotics, citing the lack of FDA regulation and the potential for unpredictable effects on gut flora.
  • There is an opinion that probiotics may be beneficial in conjunction with antibiotics to replenish good bacteria that are wiped out by the medication.
  • The author's personal experience with Crohn's disease and probiotics leads to skepticism about their benefits and suggests potential harm in some cases.
  • Prebiotic supplements are viewed with skepticism, likened to "vegetables in a pill," and considered less beneficial than obtaining prebiotics from a balanced diet.
  • The article suggests that the gut microbiome and probiotics field is still evolving and requires further study to fully understand their impact on health.

If You Eat a Healthy Diet, Save Your Money Because You Don’t Need Probiotics and Prebiotics

Most otherwise healthy adults with a well-rounded diet do not need them based on personal experience and professional literature review.

Courtesy of imagine.art

It is an understatement to say the topic of probiotics is hot and trendy. A Google search produced 366,000,000 links. One in four people surveyed said they were taking them daily. Parents are giving them to their children, toddlers, and even pets.

Many good and bad bacteria live in our guts, and an enormous amount of research has been done linking them, known as gut microbiomes, to multiple diseases. Everything from inflammatory bowel disease to obesity and diabetes has been associated. Probiotics contain “good” bacteria to help colonize your gut. But if you eat healthy, do you need to take them?

The type of bacteria that live in our guts is called a microbiome. I like to think of it as a gut garden. It has been estimated that there are anywhere from 300–1000 distinct types of bacteria in our gut and over 100,000,000,000,000 (trillion) living bugs, both good and bad.

Considering these numbers, it is little wonder that researching how the microbiome affects individual disease causation versus correlation has been so difficult. Indeed, a noted microbiologist, Shin Jie Yong, MSc (Res), recently wrote here on Medium why he stopped researching gut microbiota.

The theory is that we can alter our gut microbiome by swallowing these “good” bacteria as a pill or powder. The truth is, in most cases, we don’t know. However, there is good data to suggest that if we eat a healthy and diverse diet, taking them is not necessary.

I am not advising any one type of diet, although I feel that the Mediterranean diet is the healthiest. But other foods, notably fermented foods, help good gut bacteria flourish that are not in this diet. I’d like to give some perspectives from my research and experience. Let me start with fermented foods.

Evidence on Fermented Foods

Frequent consumption of fermented foods is like a good fertilizer in your garden. They should be incorporated regularly into your diet.

Fermented foods promote a healthy gut microbiome by providing probiotics, or beneficial bacteria, that enhance gut health and digestion.

These probiotics help maintain a balanced and diverse microbial community and produce valuable metabolites and enzymes that create an optimal gut environment for other beneficial microorganisms to thrive.

Regular consumption of fermented foods supports overall well-being by improving gut health. Here are a few to consider.

  • Plain yogurt, particularly Greek-style. Forget the ones with added sugars, other chemicals, and harmful emulsifiers.
  • Kefir is a tangy liquid, almost thin yogurt. Again, opt for the plain, unsweetened variety. I add a few vanilla and maple syrup drops to improve the taste, but you don’t have to.
  • Fermented vegetables like pickles, sauerkraut, or kimchi.
  • Tempeh is a fermented form of tofu.

Here’s Why Diet is Better Than a Pill

“More research needs to be done on probiotics in general and probiotic supplements, but it’s always better to get your nutrients from food rather than supplements,” Daniel-MacDougall (a PhD Epidemiologist at MD Anderson Cancer Center in Texas) says. “They just don’t deliver the same benefits as food.”

Supplements, vitamins, and probiotics are not regulated as closely as medications regarding dosages, bio-availability, and disease treatment and prevention indications.

Therefore, “Unless your doctor prescribes probiotics for a specific purpose, stick to getting them from foods like yogurt that may have other nutrients, like calcium.”

What About Prebiotics?

Prebiotics are the foods that gut bacteria eat, and a good diet should supply enough of them. Again, the Mediterranean diet is more than adequate in providing the essential nutrients to keep your good gut bacteria happy and healthy. A variety of fruits and vegetables are the key here.

Some prebiotic products are marketed directly to the consumer. I liken them to fruits and vegetables in a pill. I am skeptical of these as one brand is much more expensive than real food, is not certified organic, does not provide the same amount of fiber as eating the actual food, and does not provide the percentage of nutrients.

In 2019, the FDA issued this company a warning about misleading advertising. And in July of 2023, the company settled a $1.1M false advertising claim.

How About Constipation?

There is, however, some evidence that probiotics help with chronic constipation. This issue is still being studied and debated. Yet, if you suffer from chronic constipation, ask your doctor about trying probiotics and which ones they recommend.

My Personal Experience as a Patient

I developed Crohn’s disease late in life. After failing a biologic medication and repeated episodes of bowel obstruction requiring hospitalization, I had surgery to fix my intestinal stricture (blockage) in January 2022.

Since then, my symptoms have been better, but I was having alternating days of constipation and then diarrhea.

I asked my doctors about taking a probiotic, and they said to try it. It gave me no relief. I was also taking a laxative when I was constipated. Finally, I stopped the probiotics and all laxatives, and my bowel movements are now mostly normal.

My case is anecdotal, but it raises an interesting question. Could taking probiotics be harmful? In my case, I believe they were.

Again, you are experimenting with hundreds of different bacteria in your gut, which may not be entirely risk-free. Many brands are on the market, and the FDA does not regulate them. And they can alter your internal gut flora, leading to unknown and unpredictable effects.

I read one statistic that almost 10% of all vitamin and supplement sales in the USA are now for probiotics. They are also being marketed for pets and children. It is close to a billion-dollar industry.

Hundreds of probiotics are sold over the counter, meaning they do not require a doctor’s prescription. It is hard to sort them all out.

However, three gastroenterologists (stomach and gut specialists) at some point all recommended I take Visibiome. It does require refrigeration and has good documentation of its effectiveness. Multiple references are listed on their website.

Let’s Talk About Antibiotics

Antibiotics are the opposite of probiotics. They kill both good and bad bacteria. They are critical in treating bacterial infections. Probiotics might help replacing good bacteria after a course of antibiotics. This topic is well-covered in the medical literature.

For example, one study I reviewed suggested taking them together to replace the good bacteria that the antibiotics are wiping out.

A recent and larger study stated, "The authors found that taking probiotics alongside antibiotics can prevent or lessen some antibiotic-induced changes to gut microbiome composition. Probiotics can also help protect species diversity and even restore the populations of some friendly bacteria such as Faecalibacterium prausnitzii, which reduces inflammation and promotes a healthy intestinal barrier.”

The Bottom Line

  • If you are otherwise healthy, eat a good diet with many fruits and vegetables rather than taking probiotics. Again, I like the Mediterranean Diet. Add in some fermented foods for good measure.
  • If you are suffering from chronic constipation, ask your physician about taking a well-studied probiotic like Visbiome.
  • You definitely do not need to take a pre-biotics pill unless you cannot or won’t eat a good diet. I am wary of “vegetables” in a pill.
  • If you are taking an antibiotic drug, there is good evidence that taking probiotics along with it could reduce nasty gut side effects, like diarrhea, caused by the drug.
  • Finally, the whole field of gut microbiome and probiotics continues to evolve and needs further study. Everyone is different, and hundreds of good and bad bacteria live in your gut, making definitive studies difficult. Hundreds of probiotic brands are not the same and do not need to prove effective to be sold. Buyer beware.

If you enjoyed this story, you may also check out the perspectives of a neurobiologist Matt Williams-Spooner, Ph.D., who wrote about the microbiome from a different angle in this article titled Recent Discoveries and Potential Breakthroughs in Microbiome Health.

Thank you for reading my story. I wish you a healthy life.

I am a retired MD passionate about culture, health, science, medicine, and food. Get an email whenever I publish by clicking on my profile below.

Probiotics
Diet
Supplements
Health
Microbiome
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