Should Everyone Take Probiotics?
Probiotics are touted as a game-changer for microbiome health. Most people are familiar with probiotics as a standard part of yogurt, kefir, and fermented foods like sauerkraut and kimchee. Today, however, probiotics revolve around a burgeoning industry that promotes their use for everything from improving digestion and weight loss, to reducing the number and occurrence of upper respiratory tract infections. Mainstream food manufacturers have taken to adding probiotics to foods previously found without them, riding the wave of probiotic inclusion. While extensive research does back the use of probiotics for health, there is evidence that they may not be for everyone.
Probiotics are one of the most often consumed supplements, with roughly 3.9 million adults in the United States taking a prebiotic or probiotic supplement, with up to 60% of healthcare practitioners recommending them to patients. 1 The reasoning behind this consumption in healthy people is the alleviation of gastrointestinal symptoms, bolstering the immune system, and protecting again infectious diseases. A one-size-fits-all probiotic regimen, however, may not do any of these things for some people.
Factors that set us apart can affect whether probiotics have an impact on microbiome function regardless of age, diet, antibiotic use, food supplements, underlying conditions, and circadian patterns. 2 Recently, researchers conducted a clinical research study of the effect of prolonged consumption of an 11-strain probiotic preparation. Baseline colonoscopy and endoscopy were performed, and gut microbiome levels measured. Half of the 15 participants received a generic probiotic, with the other half receiving placebo and all participants receiving follow-up colonoscopy and endoscopy. It was discovered that the probiotic strains failed to colonize in the gut of several participants. The study also noted that, based on individual microbiome and gene expression in the gut, that researchers could predict who would be able to colonize the probiotics, and who would not. This suggests that there are those who are resistant to probiotics, and for whom probiotic supplementation would not be useful. 3
In a second study, three groups of participants were given antibiotics in an effort to determine if probiotic therapy, after a course of antibiotics, returns the gut microbiome to normal. The first group received no probiotic intervention, the second was given a generic probiotic, and the third received a microbiome transplant that contained the individual’s own bacteria. Interestingly, it took months for the microbiome to return to normal in the probiotics group, and only days for the third group. 4
That probiotics did not colonize within every participant in the study suggests that they should not be given universally, but rather provided on a case-by-case basis depending on individual needs.
1. Draper K., Ley C., Parsonnet J.Probiotic guidelines and physician practice: a cross-sectional survey and overview of the literature. Benef. Microbes. 2017; 8: 507-519.
2. Zmora N, Zeevi D, Korem T, Segal E, Elinav E. Taking it personally: Personalized utilization of the human microbiome in health and disease. Cell Host Microbe. 2016; 19: 12-20.
3. Zmora et al. Personalized gut mucosal colonization resistance to empiric probiotics is associated with unique host and microbiome features. 2018, Cell 174, 1388–1405.
4. Suez J, Zmora N, Zilberman-Schapira G, et al. Post-antibiotic gut mucosal microbiome reconstitution is impaired by probiotics and improved by autologous FMT2018, Cell 174, 1406–1423.