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Cracks begin to appear in the probiotic revolution

Since our obsession began with the microbiome, probiotics have increasingly been pushed into the spotlight for their potential health benefits. Now lining the aisles of our shopping centres, chemists and health food shops, probiotics have infiltrated our daily lives... not to mention our social media newsfeeds (if I see one more recipe for DIY kombucha, I might die).

However, new research published in Cell today looked at how over-the-counter probiotics colonised the gut, and how well they helped people after a course of antibiotics. The data showed that the people taking probiotics could be clearly separated on their response, with a large portion of people termed "resisters". These resisters were an interesting phenomenon, because the probiotics simply went straight through them without attaching to the intestine wall where they are able to exert their effects.

This is an interesting finding, because it demonstrates that simply taking probiotics to be "healthier" may be a costly and pointless exercise for many people.

The other interesting finding from this study was that probiotics, often prescribed to people after a course of antibiotics, actually provided no benefit. Taking probiotics after antibiotics is widely practised on a global scale, thought to enhance bacterial health after a course of damaging antibiotics.

Compared to healthy people (in the first study), probiotic uptake was much better, indicating that when there is a deficient in the gut microbiome, probiotics will facilitate restoration of the microbiome. However, the authors also found that the probiotics hindered the original person's microbiome from fully re-establshing itself. In fact, the people taking the probiotics showed delayed colonisation of their original microbiome compared to those that received no treatment.

In contrast, if people were given a faecal transfer (poo transplant) using their own stool collected before antibiotic treatment, their gut microbiome returned to baseline levels within days.

So what does this all mean for probiotics? Well, probiotics certainly have a role in people with certain diseases/conditions, however, there is scant evidence that the general community benefit from them. This is particularly concerning with vague descriptions of health benefits that are so often tied with the marketing of these products.

This data also indicate to us that in today's era of personalised medicine, a one-size-fits-all approach just isn't good enough. As suggested by lead author Professor Elinav, we need to move to a new paradigm in which well-adjusted personalised microbiome interventions are tailored to the individual. Autologous faecal transfer is, in my opinion, offers a relatively simple and cost effective way of restoring the microbial health of the individual... we just need to get over the "icky" factor!

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