Should you be taking probiotics? Or prebiotics?

by Dr Suk Cho February 28, 2019

Should you be taking probiotics? Or prebiotics?

Walk into any pharmacy or grocery store, and you will likely see tons of probiotic products on several shelves offering a myriad of benefits from supporting your gut health, to boosting immunity, to weight loss 

The popularity of probiotics has grown exponentially in recent years. Consumers can get probioticin the form of supplements as well as from foods like yogurt, kefir, sauerkraut, kimchi, fruit juices, cereals, sausages, cookies, candy, granola barspet food and even in cosmetics. The global probiotics market reached about $35 billion in 2015 and there are predictions that it will reach about $66 billion by 2024 according to the consulting firm Grand View Research. 

So, what are probiotics? 

Probiotics are live microorganisms usually bacteria, but certain yeast can also be considered probiotics.  The most common forms found on the market are various strains from Lactobacillus spp., Bifidobacterium spp., and Saccharomyces boulardii.  Probiotics supposedly improve or restore the gut flora and provide health benefits when consumed.   

They are typically consumed on a regular basis or taken when consumers are on antibiotics to grow the microorganism that are reduced by antibiotics as well as to combat potential gastrointestinal issues like diarrhea. Aside from digestive disorders there are even hyped-up of claims of cancer treatment. 

Do probiotics work?  

This is the billion-dollar question. And, contrary to many advocatesI personally think we do not have conclusive evidence that probiotics can help healthy individuals. Some of my key points are outlined below:   

  • No doubt, there have been a vast number of research papers published relating to probioticsHowever, a closer look at the science underlying microbe-based treatments shows that most studies to date have failed to reveal any benefits for healthy individualsMore research is needed on the health benefits of probiotics since you cannot make conclusion based on indirect changes in certain biomarkers in your blood. One example is probiotics supporting a healthy immune system because there are some changes in biomarkers like cytokines (Interleukin 6 or IL-6, TNFetc).   
  • The evidence more strongly supports the fact that probiotics can help individuals suffering from a few specific intestinal disorders (diarrhea, ulcerative colitis, etc)Several combined analyses of dozens of studies have concluded that probiotics may help prevent some common side effects of treatment with antibiotics since antibiotics tend to annihilate entire communities of bacteria in the intestine, killing both beneficial bacteria as well as problem-causing bacteriaAnd one can get diarrhea due to possible colonization of bacteria (and other gastric issues)Adding yogurt or probiotic supplementthat contain Lactobacillus spp during a course of antibiotics seems to decrease the chances of subsequently developing these issues. 

Marketing is ahead of science by creating hyped benefits of probiotics. Here are key points that show how probiotics may not work as well as marketers claim:  

  • Our digestive system is made of tens of trillions of microbiotaIntroducing 1 -12 strains of the most common lactobacillus species and bifidobacterium species by a general supplement will not necessarily properly propagate the right colonies in your digestive systemIf it does create colonies, there is no clear evidence that it can help healthy individuals.   
  • These probiotics are very delicate, they are killed by heat, moisture, and stomach acid, and as they are being digested. And here is a very important point, most probiotics that are added to typical herbal powders or shakes are not guaranteed to survive the manufacturing processThat is why you see them on the ingredient listing of the label, but there are no claims regarding their live numeration (like 1 billion organism per serving).  In my experience, most of these probiotics are dead when they reach consumers because special care was not applied during the production and storageThey are delicate microbes!!!  If you still want to purchase live and guaranteed probiotics, then get a product with numeric claims (i.e. I billion live organismetc). Even if some of the probiotics manage to survive and fortify in the intestine, there would likely be far too few of them to dramatically alter the overall composition of one's internal micro-ecosystem. Whereas the human gut contains tens of trillions of bacteria, there are only between 100 million and a few billion bacteria in a typical serving of yogurt or a microbe-filled pill before it enters your mouth and stomach, and they will be reduced to a few organisms as they enter your intestinal systemResearchers from the University of Copenhagen published a review of seven randomized, placebo-controlled trials investigating whether probiotic supplements change the diversity of bacteria in fecal samples. Only one study of 34 healthy volunteers found a statistically significant change, and there was no indication that it provided a clinical benefit.  There are spore forms that are being marketed today.  These are robust microorganism, but there is no readily available long-term safety data (especially if one has a gastric bleeding due to ulceration) 
  • Only few strains that are being introduced to your gastrointestinal system will not alter ecosystem of your flora. We all have unique composition of microflora and they are not static. They are constantly changing.  At this stage, we have no idea which “good” bacteria can cause what changes and how they will benefit us. Most scientists do not understand the dynamic of microbiota system when certain types of bacterial strains are introduced and how they would be helpful.   
  • These probiotics are not native strains of bacteria that you were born with. As we age, our micro-ecosystems change. We still do not know the roles and functions of these trillions of microorganisms. 

What about the human microbiome?  

The popular frenzy surrounding probiotics is fueled in large part by surging scientific and public interest in the human microbiome. This has been a hot topic for both scientists and the media.  Microbiome projects worldwide have been launched with the goal of understanding the roles that these symbiotic organisms play and their impact on human health. Our individual microbiomes help determine our unique DNA, predisposition to diseases, body type or body weight, and much more.  Many scientists are beginning to recognize the importance of microorganisms inhabiting the human body in health and disease.  t’s been said by some researchers that up to 90 percent of all diseases can be traced in some way back to the gut and health of the microbiome.   

I am excited about the future of the human microbiome project. However, adding probiotics to create an optimal microbiome might be wishful thinking at this stage. At this point, it’s mostly guess work with bacteria that are not native to your body hoping that they will provide some health benefits. I personally would not waste my money on them unless you have taken antibiotics or have had diarrhea- If the diarrhea persists (If diarrhea persists, please seemedical professional before you decide to treat your symptoms with probiotics). 

How do you influence Microbiome? 

In summary, there is no simple blue print for how we can change our microbiomes or types of microbiota we harbor in our body. Your microbiome is not static but very dynamic.   

In addition to adding to your microbiota, any changes in an ecosystem can affect the balance of microbiota that lives there as well. In the gut, one food can influence the balance of microbes living in our guts.  Throughout our lives, we shape our own microbiomes on daily basis, and they adapt to changes in our environment.  Foods, daily environmental microorganism exposure, and stress level will impact your microbiome.   

The bottom line is that the expensive probiotics you consume may be a tiny drop in a 55 gallon drum in making changes to the microbiomeThe idea that consuming probiotics can boost the ability of already well-functioning native bacteria to promote general health is dubious.  

Your gut flora is highly sensitive to your diet, and studies show that an unbalanced gut flora is linked to numerous diseases. Food and prebiotic fibers can help correct this balance, ensuring that your gastrointestinal system functions at its optimal.   

What are prebiotics? 

Prebiotics are a special plant fibers or polysaccharides that nourish the good bacteria that already exist in your digestive system. They are the food that sustains the growth and propagation of your good microbiota. While probiotics can be viewed as introducing good bacteria into the gut, prebiotics are the food and fertilizer for the good bacteria that already exist in your digestive ecosystem.   Prebiotics help your own good bacteria grow, improving the good-to-bad bacteria ratio and encouraging the optimal microbiome that you were meant to possess. 

In our modern diet, most of us do not meet the requirement of basic daily fiber intake of 28-35g. We rarely eat plants or plant parts that possess high prebiotics.  How many of you have 5-10 g servings of prebiotics from chicory root or acacia tree on daily or weekly basis? We do not digest the plant fibers of prebiotics. These fibers are used to promote the growth of many of the good bacteria in our digestive system to provide many digestive and general health benefits. Prebiotics, unlike probiotics, are not destroyed in the body. They are not affected by heat, water or stomach acid. I am a huge proponent of prebiotics and fibers as you can see in many of our products. 

Why do you add prebiotics to Joy Nutritional products? 

  1. Because our diets lack fibers and prebiotics.   
  2. Youdigestive system has been damaged from your poor lifestyle and food intake. We want to provide complete supplement that supports the health of your digestive system and is gentle on your gut but creates a healthier microbiome for overall health. Humans are meant to eat balanced meals that contains good macronutrients like protein, fat and good carbs that contain prebiotic fibers (not just protein and fat) 
  3. Digestive health is important not only for the mechanics digesting food but the state of your overall microbiome and your health.  We can’t fix your digestive system and microbiome overnight. 
  4. Our product contains, glucomann, healthy fiber that can be used to complement whatever weight loss or weight maintenance system you are using. It complements them nicely by providing your body gentle digestible protein, fiber and prebiotics to manage your hunger and provide sustainable macronutrients throughout the day.   

References: 

  1. Nature Reviews Gastroenterology & Hepatology Volume 11, Pages 506–514 (2014) 
  2. Gastroenterology., Volume 126, Issue 6(May 2004), Pages 1620-1633 
  3. The Journal of NutritionVolume 125, Issue 6, 1 (June 1995), Pages 1401–1412 
  4. Best Practice & Research Clinical GastroenterologyVolume 18(April 2004), Pages 287-298 
  5. Nature Volume 449, Pages 804–810 (18 October 2007) 
  6. Nature Volume 473, Pages 174–180 (12 May 2011) 
  7. Science Volume 308, Pages 1635–1638 (2005) 
  8. Science Volume 312, Pages 1355–1359 (2006) 
  9. Nature Volume 457, Pages 480–484 (2009) 
  10. DNA Res. 14, 169–181 (2007) 
  11. Science 328, 994–999 (2010) 
  12. PloS one, Zhou, (2014) - journals.plos.org 
  13. Pediatrics, (April 2008), Volume 121 / Issue 4 
  14. BMJ (2007), Pages 335:340 
  15. Nutrition Research, Volume 35, Issue 7(July 2015), Pages 566-575 
  16. Clinical Oral Investigations, (September 2013), Volume 17, Pages 1627–1634
  17. Eat Yogurt, Battle Cancer?, (April 2010)
Dr Suk Cho
Dr Suk Cho


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