Probiotics seem to have reached a tipping point?

For the last several years, there has been a LOT of hype around probiotics – also known as “good” bacteria that you can now find in all manner of supplements and fermented foods like yogurt, kefir, kombucha, and increasingly in a lot of junk food like sweetened cereal and ultra-processed energy bars.

Recently, I’ve been noticing a growing number of articles along the lines of, “Do probiotics actually work?” – and “Could probiotics actually be ‘bad’ for you?” Including the recent story in the Wall Street Journal – pasted below with my highlights and comments.

In an effort to set the record straight, I want to tell you that probiotics are neither automatically “miracles” nor “dangerous” – but the specific types of probiotics that you choose could make all the difference in whether they “work” – or not.

The “right” probiotic supplement can help you…

  • Enhance gut function (less gas/bloating and better digestion)
  • Improve mood
  • Recover from exercise
  • Bolster immune system function
  • Reduce inflammation

The “wrong” probiotic supplement might…

  • Do nothing at all (good or bad)
  • Interfere with normal microbiome balance (e.g. taking too many of the wrong strains)
  • Lead to more gas/bloating (rather than less)
  • Set off an immune system or inflammatory reaction

Choosing the “right” probiotic supplement involves selecting one that…

  • Uses specific strains that have been clinically validated for the benefit you’re seeking
    • For example, some strains help with mood, other strains help with digestion, others with immune function, etc – and most products don’t even tell you the specific strains contained – so buyer beware!
  • Combines probiotics (the bacteria) with prebiotic fibers (“food” for the bacteria) and with phytobiotics (plant nutrients that support microbiome signaling)
    • The combined approach seems to be much more effective in generating end-benefits compared to simply relying on the typical “just bugs” approach of gulping isolated bacteria, yogurt or kombucha? Again – buyer beware because not all formulas that have “more stuff” deliver a true synergy of benefits (see below).
  • Has scientific evidence for benefits of the specific finished product
    • While it makes good sense to combine bacteria with their preferred food source and with nutrients to protect them and enhance metabolism, you have to study the end product – because maybe combining one bacteria with another causes them to fight each other for resources? Maybe adding the wrong prebiotic fiber will starve the bacteria you’re trying to grow, versus enhance its growth?

Here’s a recent article from the Wall Street Journal where a very knowledgeable writer – a physician and director of an integrative cancer program – makes many of the mistakes I note above in their choice of probiotics. My highlighted version appears below (red is highlight blue is comments) – and the original article is at WSJ = https://www.wsj.com/articles/those-probiotics-may-actually-be-hurting-your-gut-health-11570721466

Those Probiotics May Actually Be Hurting Your ‘Gut Health’

The newly fashionable pills and foods meant to increase the variety of healthy bacteria in our bodies can actually have the opposite effect

By Lorenzo Cohen   Oct. 10, 2019

The idea of “gut health” entered the personal health world just a few years ago, but it has already become one of the biggest trends in nutrition. The new focus on the living microorganisms in our digestive systems has particularly fueled one fast-growing market for foods and supplements: probiotics.

Are probiotics actually good for us? Over the past decade, U.S. consumption has more than quadrupled, and in the next 10 years global sales are forecast to nearly double. But the most recent research suggests that over-the-counter probiotic supplements—the hottest growth area—could have a detrimental effect.

Correct – IF to take the “wrong” ones – or even if you take “too many” of the “right” ones. Right now, many consumers choose their probiotic products by looking for whatever is on sale (bad idea) – or products that have “high” CFUs (colony forming units – the “strength” of the probiotic) – or list “more” different types of bacteria than another product. NONE of these is a good reason to select a probiotic supplement – you need to choose base on the benefit you’re looking for and select the strain that delivers that benefit.

Probiotics are microorganisms, such as bacteria or yeast, intended to confer health benefits. They can be ingested in supplements such as pills and capsules, or in foods and beverages that are naturally rich in them or infused with them, including yogurt, kombucha or fermented vegetables. The health claims made for probiotics range from preventing tooth decay and eczema to treating diarrhea and inflammatory bowel diseases, ulcers, vaginal and urinary tract infections, and even cancer. They are most popularly associated, however, with maintaining overall gut health.

When we talk about gut health, we’re really talking about the gut microbiome, made up of the hundreds of kinds of microbiota such as bacteria, parasites and viruses that are routinely found in and on our body. The increased attention to the health of our gut microbiome is undoubtedly good. An unhealthy microbiome has been linked with a growing list of diseases and conditions, including cancer, cardiovascular disease, psoriasis, childhood-onset asthma, gastrointestinal disorders and neuropsychiatric illness like depression and anxiety. Some research also points to a link between gut bacterium and key hormones that regulate appetite and can contribute to obesity.

Correct – but the specific strains on bacteria that help with obesity are different from the strains that help with depression, which are different than the strains that help with gut health. It’s vitally important to understand the concept of “strain specificity” – that certain benefits are delivered by specific strains (and not by any “generic” probiotics).

Studies over the past 10 years have shown that the greater the diversity of our microbiome, the better our health outcomes. Such diversity is also linked with lower overall body fat, reduced insulin resistance, better immune function and decreased inflammation—all important for fighting diseases.More recent research has shown connections between the microbiome and a number of different cancers, including colon, liver, pancreatic, lung and breast; emerging data also link it to melanoma. In a landmark paper by my colleague Dr. Jennifer Wargo at the University of Texas MD Anderson Cancer Center that was published in Science last year, melanoma patients with the healthiest gut microbiomes—that is, the greatest diversity of microorganisms—showed enhanced systemic and antitumor immunity as well as significantly increased odds of responding to immunotherapy. The microbiome has clearly become part of the puzzle of how cancer develops and how patients respond to treatment.

I’ve spent most of my adult life dedicated to cancer research, so when I was diagnosed with advanced melanoma just over a year ago, I felt confident that I knew exactly what I needed to do. Alongside my conventional care, my first step was to get my gut microbiome—already in good shape from my mostly vegan, high-fiber diet—as healthy as possible.

I started eating and drinking more foods that are rich in probiotics. My gastrointestinal tract felt great and everything was going along smoothly (pun intended). I assumed that the kinds of bacteria in these foods increased the diversity of my microbiome, as each one would contribute something different. But I could find little actual information available to make certain of that: Probiotics may list multiple bacteria in their ingredients, but they usually come from no more than five different major strains and often only the same two, Lactobacillus and Bifidobacterium.

After about six months, I expected my gut microbiome to be in great health. Instead, its diversity was less than before I started.

I also stopped eating refined carbohydrates (white flour, white rice, etc.) and ate less whole grains, because I wanted to lower my overall glycemic load. Extensive research shows that dietary glycemic load—a reflection of the amount of sugar in your diet—is linked with cancer risk and worse outcomes after a cancer diagnosis. We also know that spikes in insulin, due to rapid increases in glucose when eating a refined carbohydrate-rich diet, leads to inflammation—which also raises cancer risk and has other negative health consequences.

After about six months of this modified diet, I expected my gut microbiome to be in great health. Instead, to my shock, its diversity was less than before I started the diet. I had actually made the health of my microbiome worse.

My personal results were mirrored by a study that our MD Anderson team had just presented at an international meeting. The provocative findings received a lot of publicity. The preliminary results showed that patients who reported taking an over-the-counter probiotic supplement had a lower probability of responding to immunotherapy as well as lower microbiome biodiversity. But those eating a high-fiber diet were about five times more likely to respond to immunotherapy and had high gut bacteria diversity, including bacteria previously linked to a strong immunotherapy response.

It turned out that taking an over-the-counter probiotic pill could inadvertently decrease microbiome biodiversity. A study last year from Israel’s Weizmann Institute of Science similarly found that taking an over-the-counter probiotic supplement delayed reconstitution and recovery of the gut microbiome in mice and humans after antibiotic treatment.

To get my microbiome back on track, I reduced the probiotic-rich foods I was eating and drinking and I started to add more fermentable fibers from healthy whole grains like oats, buckwheat and barley and from seeds such as hemp, flax and chia. The results were startling. Not only did the diversity increase, the change completely reversed the negative effect of the probiotics-rich, low whole-grain diet and even improved my gut health over my previous vegan diet.

These type of improvements in microbiome diversity and resilience that we have seen in studies of Fundamentals and Project b3 – two product packs from Amare Global that combine specific probiotic strains, with matched prebiotic fibers, supportive phytonutrients, vitamins, minerals, amino acids, etc. In short, the ”right” way to nourish your microbiome is NOT to overload it with any one type of probiotic intervention, but to provide a range of supportive nutrients (including a background diet that is generally high in fiber and brightly colored fruits and vegetables – aka the “Mental Wellness Diet” that is based on the Mediterranean Diet).

In my case, we do not know for sure what caused the increase in biodiversity—decreasing the probiotic-rich foods, increasing healthy whole grains and seeds, or a combination of both. It’s possible that too much consumption of a narrow band of probiotics may disrupt an otherwise diverse and healthy microbiome. (Exactly!) Or it may be more important to keep up the consumption of grains because they are the main food source for beneficial bacteria. What we do know is that a low-fiber diet is associated with low biodiversity and a scarcity of healthy bacterial species, and that the microbiome flourishes with a high-fiber diet that includes fermentable fibers from whole grains and other foods.

The market for probiotic-rich designer foods is huge, and the supplement industry and technologies to manipulate the microbiome are ever-expanding. Yet I now believe that the cheapest and safest way to improve our microbiome and gut health is to make simple dietary changes to feed the development of good bacteria and crowd out the bad. There is no pill, special food, unique diet or quick fix for what ails our health and diet. The key is simply to focus on eating a diverse, whole-food, plant-centered, high-fiber diet. (Wrong! The key is to have that as your background diet – AND then to supplement in a targeted fashion to optimize your benefits).

—Dr. Cohen is director of the Integrative Medicine Program at the University of Texas MD Anderson Cancer Center in Houston and the co-author of “Anticancer Living: Transform Your Life and Health with the Mix of Six.”

 

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