NERD ALERT: Probiotics: waste of money or something we need?

It feels like everywhere you look we are being told that Probiotics are the key to a ‘healthy gut’. They are in supplements and added now to foods, drinks and even baby formula.

Are they really worth your time and money?

Here is what the science says: get ready for the nerd-a-thon! (n.b. It can be a bit dense so I have broken it down in to Q&A type questions)

So we’ve established that having a healthy gut is absolutely crucial for a developing baby (click here for a reminder as to why it is so important) including building immunity, helping filter out environmental toxins, mineral absorption and helping build sound neuro and emotional development. We also know that the starting basis of a healthy gut developing (which is built in the first three years) is from the mother via method of birth, from breastmilk and from the mother directly (skin/contact etc). 65% of your immune system ‘lives’ in your gut so if you’re considering the best start for your baby - a healthy gut is the way to go:

‘Colonisation of the intestinal microbiome during infancy represents a critical time in shaping infant acute and chronic immune-mediated disease susceptibility...increasing bacterial diversity during this time period could be an effective preventative strategy.’ (1)

We also suspect it may also play a role in neurodevelopment: is this the case?

Apparently so:

‘The assembly of the gut microbiota occurs during the first three years of life, starting from birth, where there is a rapid rate of colonization and expansion of gut bacteria. This process coincides in time with the intense synaptogenesis and pruning in the cerebral cortex during early life...Therefore, perturbations of gut microbiota colonization and maturation by environmental factors may influence brain development.’ (2)


So, how do we optimise this?

Well. The first logical step is to ensure your own gut is in tip top condition before, during and after pregnancy. Taking probiotic supplements during pregnancy and even giving them to a new baby have been cited by some therefore as the way to go:

‘Recently, a number of studies have demonstrated the existence of a link between the emotional and cognitive centres of the brain and peripheral functions...Therefore, the use of bacteria as therapeutics has attracted much interest.’ (3)

But, do they really work?


Article spoiler: the answer is: science is not sure...yet and… it depends which ones….  

Here is what we do know:

We know that the starting basis of a baby’s gut is not only from birth onwards which was the previous thinking. Evidence is now suggesting that it starts as early as in the womb:

‘Until recently, the idea that foetuses were sterile in the uterus and that the microbial colonization of the new-born started during and after birth had been widely accepted. However, nowadays, this belief has been challenged by evidence of microbes in placenta and other tissues surrounding the foetus, such as umbilical cord blood after vaginal and caesarean birth. Several studies have analysed the meconium of new-born babies and showed the presence of bacterial populations.’ (4)

This is why it is so crucial to keep your own gut in the healthiest position before conception and during pregnancy.

Probiotics: can they help us do this?

A look at the positives and negatives (yep there are some potential negatives…) for taking probiotic supplements before, during and after pregnancy:

First and foremost you probably know what a Probiotic is - roughly - but what is it really?


Well, it is a multi billion dollar industry for one thing, but part of the issue is that the definition is pretty broad and vague. The World Health Organisation’s definition: ‘live microorganisms, which when administered in adequate amounts confer a health benefit to the host’:


The issue of having such a broad definition (which encompasses foods, formula, animal feed and pharmaceutical products) is the trouble with regulation, including manufacturing controls - so automatically it is hard to say what really has an effect and what doesn’t. That’s your starting point, particularly when you’re looking at over the counter probiotics that are available for everyone to buy.

The most commonly used OTC strains are Bifidobacterium and Lactobacillus. Interestingly enough an article by Quin, Estaki and Gibson suggests that the reason why these are the most used is not necessarily because they are so important and abundant in the human intestine, but, because they are easy to cultivate as result of prolific use in the dairy industry. (5)

What does more controlled clinical research say?

Well, it is conflicting and it's also important to remember that these are not the type of probiotic that you get from a shop or a food product, this relates to specific highly controlled administered bacteria.

First question: what do you define as ‘having an effect’?

Our understanding of the gut and its power is still in its relative infancy which is the first important point to note, everyone is different and we don't quite know what the ‘optimal’ balance is. However, we know that having enough diversity and avoiding heavy imbalance is key.

So, do probiotics boost the diversity?

This is a huge question and has mixed results. Some studies showed no increase in diversity at all, with one study looking at probiotics taken from 36 weeks gestation to 3 months post parturition showed no effect on offspring diversity at either 3 months or 2 years.

However, we did see something occur in other studies….

One recent study indicated that perhaps it wasn’t diversity of the population that was altered but perhaps how the existing colony actually behaved that was changed.

‘This coculture of probiotic bacteria affected the metabolic shift in the gut microbiota….rather than by changing the gut microbiota composition’ (7)

This study for example showed that when probiotics were administered to babies there was a substantial increase in IgA in the baby’s stool (this is an antibody which plays a crucial role in the immune system). However, even more confusingly that did not seem to correlate to better health of the babies and in fact there was some suggestion of more incidence of infection in these babies. (6)

Other studies have looked at mood alterations post probiotic administration using MRI and have found an effect. Similarly there has been research done suggesting some prenatal admission can help reduce skin conditions like eczema and dermatitis. Further, there has been a lot of use of certain probiotics on very low birth weight premature babies (to reduce risk of a very threatening condition: NEC) but once again the actual clinical results remain somewhat inconclusive at this stage.

Hmmm…

Confusing? Yes!

The reality is there seems to be some potential impact but on the whole we are not quite sure exactly what at the moment. In a nutshell when it comes to Probiotics: At this point in time there is just not enough conclusive evidence:

‘Despite this wealth of information, the effect of probiotics and prebiotics is still largely unexplored, and numerous gaps and inconsistencies exist when the studies are compared. Differences in quantity of dose, type of strain, type of prebiotic, assessment of gut microbiota, duration of intervention, standardization of neurological measurements, variety and complexity of neurological symptoms, study design, and cohort size make it difficult to confirm evidence of efficacy.’ (8)

As for giving them to a healthy term-baby? well, once again, the jury is still very much out:


‘Probiotics have been proposed to influence a wide range of health outcomes presumably by altering the intestinal microbiota and consequently immunity but research is limited on clinical effects of probiotic exposure during infancy’. (9)


So, what’s the conclusion and what do we do instead??


First and foremost, it appears that buying and using over the counter probiotics has limited proven benefit at this stage based on manufacturing, quality and non-specific or non-personalised use. If you have a serious health issue there may be a case for very targeted high quality administration or even fecal transplant (yes, you read that right) which has shown much better results. Of course you need to consult an expert for this. However, for the rest of us, it seems when it comes to improving gut health there is a better way to spend your money - here is the good news:

Research shows that diet and stress do have a meaningful impact on the health of our gut:

‘It is worth noting that the abundance of Firmicutes increased and that of Bacteroidetes and Actinobacteria were reduced….in mice fed a Western-style diet….Diets and different nutrients have been reported to productively and markedly shape gut microbiota communities’ (10)

Diversity matters and that comes from eating a diverse range of whole, unprocessed foods -click here for all you need to know about what food can bring to the gut party. It also includes feeding the existing bacteria we have in the gut - and that's where prebiotics come in: Click here to learn more.

We also don't currently quite know which are the ‘right’ bacteria to have, and what is ‘right’ for each individual. We do know that having a significant imbalance (dysbiosis) is most certainly not good. So the first thing to do is to prevent imbalance and promote diversity, particularly before, during and after pregnancy when breastfeeding:

‘lower Bifidobacteria counts are associated with serious neonatal infections and lower neurodevelopmental outcomes.’ (11)

For a baby, what they eat also applies and it links directly to your gut health:

‘The bacterial communities present in the breast milk have been suspected of being transferred from the mother’s intestine via an enterprising-mammary pathway mediated by the immune system….therefore it has been suggested that alterations to the mother’s intestinal microbiota...may change the colonisation patterns in their infants and resulting immunity’ (12)

The impact of breastfeeding on a baby’s gut is an interesting topic in itself - more to come on that.

So: conclusion?

We would probably all like to believe that taking a sachet of probiotics can give us a miracle boost and maybe it can. The reality is that at this point we just don't know for sure and the reality is that what you can buy currently yourself probably isn't going to cut it. They are also quite expensive, so for now it is probably worth saving your money and directing it towards eating better quality organic whole foods, particularly ones that have been shown to improve the gut health. Feed your belly.

References:

  1. QUIN C, ESTAKI M, GIBSON DL: Probiotic supplementation and associated infant gut microbiome and health: a cautionary retrospective clinical comparison: Scientific Reports. 2018, 8: 8283

  2. CERDO T, RUIZ A, CAMPOY C: Probiotic, Prebiotic and Brain Development: Nutrients: 2017 Nov: 9(11): 1247

  3. CERDO T, RUIZ A, CAMPOY C: Probiotic, Prebiotic and Brain Development: Nutrients: 2017 Nov: 9(11): 1247

  4. CERDO T, RUIZ A, CAMPOY C: Probiotic, Prebiotic and Brain Development: Nutrients: 2017 Nov: 9(11): 1247

  5. QUIN C, ESTAKI M, GIBSON DL: Probiotic supplementation and associated infant gut microbiome and health: a cautionary retrospective clinical comparison: Scientific Reports. 2018, 8: 8283

  6. QUIN C, ESTAKI M, GIBSON DL: Probiotic supplementation and associated infant gut microbiome and health: a cautionary retrospective clinical comparison: Scientific Reports. 2018, 8: 8283

  7. AZAD AK, SARKER M, LI T, YIN J: Probiotic Species in the Modulation of Gut Microbiota: An Overview: BioMed Research International: 2018:

  8. CERDO T, RUIZ A, CAMPOY C: Probiotic, Prebiotic and Brain Development: Nutrients: 2017 Nov: 9(11): 1247

  9. QUIN C, ESTAKI M, GIBSON DL: Probiotic supplementation and associated infant gut microbiome and health: a cautionary retrospective clinical comparison: Scientific Reports. 2018, 8: 8283

  10. AZAD AK, SARKER M, LI T, YIN J: Probiotic Species in the Modulation of Gut Microbiota: An Overview: BioMed Research International: 2018:

  11. CERDO T, RUIZ A, CAMPOY C: Probiotic, Prebiotic and Brain Development: Nutrients: 2017 Nov: 9(11): 1247

QUIN C, ESTAKI M, GIBSON DL: Probiotic supplementation and associated infant gut microbiome and health: a cautionary retrospective clinical comparison: Scientific Reports. 2018, 8: 8283

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