The bottom line on probiotic supplements in healthy people
If you are a beer lover, than we might have some good news for you! A team from Singapore has successfully engineered beer containing probiotics! In this new breakthrough, researchers are suggesting that this new approach to supplementing the bacteria that inhabit your gut cold improve gut health and boost immune function.
The beer developed by the group at the National University of Singapore contains Lactobacillus paracasei L26, a bacterium usually found in the gut of generally healthy people. In a similar move, Adelaide restaurant Electra House, along with many others, is now serving kombucha-based cocktails, served with live cultures, enzymes, minerals, antioxidants and of course, probiotics.
So, should is it time we all put down the Yakult and grabbed a beer or cocktail? Well, the evidence on whether we should all be taking probiotics is mixed. There are certainly some clinical scenarios in which probiotic supplementation is recommended, particularly following heavy doses of antibiotics which can lead to diarrhoea and other nasty gut infections. However, the importance of probiotics in seemingly healthy people is much murkier.
What are probiotics?
Probiotics are defined as live microorganisms which, when administered in adequate amounts, confer a health benefit to the host. Put simply, they are good bacteria that are beneficial to the body. Probiotics can be found in some foods, including yoghurt and fermented products, and contribute to an overall healthy diet.
Formulated probiotics, like the ones that are now lining the shelves of almost every supermarket, chemist and health food shop, are essentially the same thing claiming to contain live microorganisms either singly or in combination. However, these over-the-counter probiotics are increasingly coming under fire for their claims, often under-delivering on the amount of bacteria they claim to be in capsule. This is further compromised by the preparation of these bacteria, with many coming in freeze-dried forms, which may affect the viability of some highly sensitive bacteria.
It has been suggested that these disparities reflect the variations in manufacturing processes and food carriers used, both of which should be considered more heavily with respect to quality control. But this is where probiotics are able to fly under the radar. Probiotics are readily sold as over-the-counter products, and as such the regulatory hoops through which they must jump are much less strict than other FDA-approved products. This is also true for the claims made regarding probiotics, with the European Food Safety Agency unable to substantiate more than 500 health claims for probiotics, including improving the immune system, treating diarrhoea and lowering cholesterol. Furthermore, without the need for a prescription, many people are routinely self-medicating with little to no guidance on effective strategies to regulate gut health.
Probiotics in healthy people, hyped-up or truly helpful?
The clinical use of probiotics is broad, with an estimated 1.6% of adults (thats 3.9 million people!) in the US reporting regular use; this makes them the third most commonly consumed natural product in the US. However, the clinical indications based on evidence-based studies are much narrower and open to continuing evaluation and scrutiny. Currently, there is evidence to support the use of probiotics for the management of:
Lactose maldigestion (Lactic acid bacteria [LAB] and Streptococcus salivarius)
Acute diarrhoea (LAB, Bifidobacterium species or Saccharomyces boulardii)
Antibiotic-associated diarrhoea (LAB or S. boulardii)
Traveller’s diarrhoea (LAB)
Clostridium difficile induced diarrhoea (LAB)
Dental caries (LAB)
Intestinal inflammation in children with cystic fibrosis (LAB)
Respiratory infection in children (LAB)
Nasal colonisation with pathogens (LAB)
Inflammatory bowel disease or IBS (LAB, Bifidobacterium species, S boulardii and drug, S boulardii alone or LAB alone)
Their use in treating cognitive disorders is also receiving attention, and has given rise to the new term “psychobiotics”, although this is still an emerging area of research.
While it might be beneficial for people with these health problems to take probiotics, the evidence is far less settled when it comes to healthy individuals despite probiotics being most commonly consumed by the general population who are otherwise healthy. So what is the current evidence for probiotics in healthy people?
Recent work published in the European Journal of Clinical Nutrition indicates that giving healthy adults probiotics, either in naturally occurring substrates, like yoghurt, or in capsules was associated with a few benefits, namely increasing the number and diversity of “good bacteria” in your gut and other sites colonised by bacteria (e.g. vagina)… but that’s not overly surprising … They also reported a reduction in abdominal discomfort associated with normal bowel movements and/or constipation, begging the question as to whether these are truly ‘healthy’ people.
Researchers also reported that there is some evidence that probiotics can boost the immune system, reducing the likelihood of developing the common cold. This remains contentious however, as it has only been demonstrated in three studies.
While all of these benefits sound promising of probiotics, it is important to consider the relevance of these findings before we start putting our hard earned cash in the pockets of the companies distributing these products. Firstly, the overarching finding was that probiotics in healthy people increased the number of good bacteria in the host, however, this has not been linked with any clear health benefit.
Secondly, authors report that the changes were short lived, meaning that as soon as you stop taking the probiotic, the bacteria return to their pre-probiotic state. They instead recommend that feeding the microbiome is a better approach to nourishing your gut. The best way to feed your microbes, a high fibre diet full of fresh fruit and vegetables.
If you have a poor diet, or a disease/condition listed above, probiotic supplementation may be beneficial in restoring a more balanced microbiome. Whether this comes in the form of naturally occurring probiotics, a capsule or a beer, well that’s really up to you. However, if you are choosing that probiotic beer at the pub next time because it makes you feel less guilty, don’t bother. Save you money, and buy some fresh fruit and vegetables to cure your hangover instead. Alternatively, red wine has been shown to act in similar ways to some prebiotics, so perhaps opt for that if you are concerned for your gut microbes.
"Here’s some simple advice: take what you spend on probiotic supplements, and use it to buy and eat more fruit and vegetables." Dr Chris Irwin, Lecturer in Nutrition and Dietetics, Griffith University.