A pair of recent studies raised questions about the use of probiotics to impart general wellness and restore intestinal flora after the use of antibiotics.1 However, there is evidence that using probiotics are beneficial to our bodies.
When people say probiotics do not work, they are usually referring to the following conclusions:1
- Probiotics do not yield general good health.
- Probiotics wash out of the body and do not permanently colonize the gut.
- Probiotics do not immediately and independently restore the gut flora to its original state prior to antibiotic use.
Probiotics are similar to vitamins, supplements and prescription drugs in that they only improve health when they correct a problem. Probiotics don’t randomly yield good health, although many believe hormones and ‘adaptogens,’ such as ashwagandha and ginseng, yield improved heath. But that’s the subject of a different article.
Databases that include probiotics list the indications for use and the level of evidence for that indication. They never list an indication for general good health, because an individual who is in perfect health and takes a probiotic or any other pill, should not expect to get healthier.
Also, it is true that probiotics do not permanently inhabit the gut. It is protection mechanism to resist foreign organisms from taking up permanent residence and potentially damaging our health similar to an infection.
Our gut bacteria is like a garden of beautiful flowers and foliage that perform actions to keep our bodies healthy and feeling good. It takes months, maybe years, of eating whole foods to grow this healthy, beautiful garden. I see probiotics as the birds, the bees, and the gardeners of this beautiful garden. They pull the weeds, and they help the garden grow beautiful, but they are not the seeds of the garden.
Probiotics do not cause this garden to instantaneously grow. It is a much more complicated process than that. At a very early age, our bodies decide which bacteria will be in growing in our garden/bodies, potential for the rest of our lives.
I came to these conclusions as a result of knowing the various mechanisms of actions for the probiotics.
One impressive probiotic is the bacillus species, which can decolonize Staphylococcus aureus2 (MRSA is drug resistant strain). Staphylococcus aureus can become a weed in this beautiful garden of gut bacteria, and the bacillus species of probiotics can eliminate it once and for all.3 Anyone who works in the area of infectious disease, will immediately understand the significance of this since Staphylococcus aureus, and often times MRSA, will colonize a person. That means the MRSA/Staphylococcus aureus lives inside the gut and the nares, and waits for an opportunity to infected the host in various parts of the body.
For the prescriber of antibiotics, it’s like playing a game of whack-a-mole. You never know where or when the MRSA will pop up as an infection. People who are colonized with MRSA are quarantined and put in isolation when in the hospital. Doctors often times prescribe mupirocin intra nasally twice a day in an attempt to decolonize the bacteria. However, it is often ineffective when the Staphylococcus aureus lives deep inside the gut. All that is changing with the discovery of probiotics.
Another probiotic that has impressed me is E. coli nissle. This probiotic, and several others,4,5 are being investigated to lower elevated ammonia levels in the blood, which occurs as a result of organ failure. These probiotics perform biochemical reactions in the gut. They change the toxic build-up of ammonia into something more beneficial. In the case of E. coli nissle, it turns the ammonia into the amino acid arginine. The end result of taking these probiotics are lower ammonia levels in the blood stream.4,5
Many of the probiotics and natural gut bacteria perform biochemical reactions in our gut, much like an extra liver. They also play a role in manufacturing the B vitamins, and vitamin K.6
This became apparent when the pellagra outbreak occurred in the southern part of the United Stated in the early 1900s. Pellagra is an overt dietary deficiency of vitamin B3, niacin. By 1926, a medical doctor had established that a diet of foods high in niacin, or a small amount of brewer's yeast, prevented pellagra. Brewer’s/Baker’s yeast is another name for the probiotic Saccharomyces.7
When I hear people say that probiotics are a waste of money, I conclude that the information of how probiotics work has not been disseminated properly and probiotics are misunderstood.
There are 5 key point to understanding probiotics:
- Probiotics are like drugs. They have different mechanisms of action. What is true for one, might not be true for another. They might even have opposite effects like weight loss and weight gain.
- Probiotics usually do not permanently inhabit the gut microflora. Our bodies resist being permanently infected by every new bacterium that enters our gut.
- Never expect any dietary supplement to yield good health. Good health comes from restoring and correcting a problem.
- When recommending a probiotic to a patient, be sure to tell them what they can expect based on the level of evidence indicated in the various databases.
- Never make a generalization like 'all probiotic don’t work because they have many actions.' Some are the weed killers in our garden of healthy gut microbiome; some perform biochemical reactions much like a secondary liver.
The best indication for probiotics is for diarrhea. Probiotics treat diarrhea by keeping the bad bacteria in check, by producing biochemicals that are astringent in action, by producing anti-inflammatory chemicals and by many more mechanisms of actions that are still being discovered.
- J Abbasi, Are Probiotics Money Down the Toilet? Or Worse? JAMA. Published online. January 30, 2019. doi:10.1001/jama.2018.20798
- NIH study finds probiotic Bacillus eliminates Staphylococcus bacteria [news release]. Bethesda, Maryland. October 10, 2018: NIH website. https://www.nih.gov/news-events/news-releases/nih-study-finds-probiotic-bacillus-eliminates-staphylococcus-bacteria. Accessed February 20, 2019.
- National Institutes of Health. Pathogen elimination by probiotic Bacillus via signalling interference. Nature. 2018 Oct;562(7728):532-537. doi: 10.1038/s41586-018-0616-y. Epub 2018 Oct 10. https://www.ncbi.nlm.nih.gov/pubmed/30305736. Accessed February 20, 2019.
- Liu J, Lkhagva E, Chung HJ, et al. The Pharmabiotic Approach to Treat Hyperammonemia. Nutrients. 2018;10(2):140. doi:10.3390/nu10020140. https://www.ncbi.nlm.nih.gov/pubmed/29382084. Published January 28, 2018. Accessed February 20, 2019.
- Kurtz C, Millet Y, Puurunen M, et al. An engineered E. coli Nissle improves hyperammonemia and survival in mice and shows dose-dependent exposure in healthy humans. Science Translational Medicine . 16 Jan 2019. DOI: 10.1126/scitranslmed.aau7975. http://stm.sciencemag.org/content/11/475/eaau7975?rss=1. Accessed February 20, 2019.
- Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 6:S43–S45(1997)
- Swan, P. Goldberger's War: The Life and Work of a Public Health Crusader (review). Bulletin of the History of Medicine. 79 (1): 146–47(2005). doi:10.1353/bhm.2005.0046.