The answer may surprise you!
No matter the details of your digestive issues, you’ve probably heard about the potential benefits of taking a probiotic supplement. With lofty claims to improve digestive disorders, promote a balanced microbiome, improve gut integrity, and more, probiotics have successfully been marketed as the key to better digestive health. But are these buzzy (and oftentimes expensive!) supplements really the answer to all your digestive issues? At Alyssa Lavy Nutrition & Wellness, we specialize in digestive health – and we get asked about probiotics all the time! Keep reading to hear our thoughts!
First things first: What are probiotics?
Probiotics are living microorganisms that can be consumed through food or dietary supplements and are considered to have a known health benefit. They have gained popularity for their role in restoring and/or maintaining the bacterial balance of the gut microbiome, which, if you’re not familiar, is a collection of trillions of microbes living in the large intestine that influence digestive health. Probiotics may be found naturally found in some fermentable foods such as yogurt, kimchi, sauerkraut, and kombucha, although not all of these foods will always contain probiotics. As food sources are limited and some individuals may have dietary restrictions that further limit their options, many individuals prefer dietary supplements to get their daily dose of probiotics.
Are all probiotics the same?
If there’s one thing you take away from this blog post, it should be that no one probiotic supplement is right for everyone. Instead, probiotics are what we call strain specific. There are tons of different probiotic strains, first named by their genus, then their species, and then their strain. Different strains of probiotics have been linked to different health benefits. Probiotic supplements can contain a single strain or a multitude of strains in different amounts of colony-forming units (CFUs), or number of bacteria per serving. Sound complicated? It is! That’s why it’s incredibly important to work with your doctor and/or registered dietitian to determine (a) if a probiotic supplement is right for you, and (b) what strain(s) will be most beneficial in reaching your health goals. Taking a random probiotic and hoping for the best is sort of like taking a random over-the-counter medication that is not necessarily specific for your ailment and hoping for the best!
Who should consider taking a probiotic supplement?
Perhaps one of the biggest misconceptions is that everyone needs to be taking a probiotic supplement, especially those experiencing digestive troubles. However, contrary to what popular Instagram influencers may say, gastrointestinal experts have only deemed probiotic supplements effective for a small handful of digestive issues. The American Gastroenterological Association (AGA), an organization made up of physicians and scientists, recently provided updated, evidence-based guidelines regarding when probiotic supplementation should be used. It may come as a surprise to you, but their recommendations only included 3 specific settings:
1. For the prevention of Clostridioides difficile (C. difficile) infection in adults and children taking antibiotics
2. For the management of pouchitis, a complication of inflammatory bowel disease (IBD)
3. For the prevention of necrotizing enterocolitis in preterm, low birthweight infants
Specific strains have been identified to potentially provide benefit in these conditions, so it’s important to remember that not just any ol’ probiotic will work.
AGA has stated that the evidence for probiotic supplementation in many other populations, including those with irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) incuding Crohn’s disease and ulcerative colitis, and others is insufficient and inconclusive and at this time probiotic supplementation is not recommended.
So, I shouldn’t take a probiotic supplement for my IBS?
In short, probiotic supplements for the treatment of IBS are often not necessary or recommended by AGA and other governing bodies and should not be used as a first line of treatment. While the first line treatment will vary depending on the individual and their specific situation, oftentimes diet/lifestyle changes, medication, improving the gut-brain connection and possibly using supplements with more substantial evidence would be more evidence-based and more beneficial – and, oftentimes, a combination of these interventions can be very effective. However, there are a small number of probiotic strains that some research suggests can improve IBS symptoms and may be worth bringing up with your doctor or registered dietitian, particularly if you have tried other management options without significant relief.
The most researched probiotic strain for IBS management is Bifidobacterium longum 35624. Found in Align Probiotic Digestive Support, several studies have found this specific probiotic strain beneficial to patients with IBS. A 2022 observational study showed that thirty days of Bifidobacterium longum 35624 reduced symptom severity and improved quality of life in patients with IBS, especially those with the most severe forms. There have been several other studies that have shown similar results. Additionally, there has been some research supporting the use of other probiotic strains in the management of IBS over recent years.
It is important to note that although these studies and several others do show significant potential for the use of probiotics in IBS, the research on this topic is still in its infancy and often performed on small sample sizes. Further research is needed to establish probiotics as an effective form of treatment for patients with IBS.
Can taking a probiotic supplement be harmful to my health?
While probiotic supplements are generally deemed safe for consumption, there are certain situations where taking one may actually worsen your IBS symptoms. For example, many individuals with IBS also suffer from small intestinal bacterial overgrow (SIBO). In this case, adding more bacteria, even beneficial strains, may worsen SIBO and the digestive symptoms that accompany it. Additionally, many probiotics also contain prebiotics, some of which can be high in FODMAPs and may worsen IBS symptoms for those who are FODMAP sensitive. Last but not least, probiotic supplements (like all supplements) do not require FDA approval and regulation before being marketed and sold, making their labels, health claims, and ingredients questionable.
In summary, probiotics can be very helpful in certain populations – and we will likely find in the future that there is evidence to support the use of more probiotic strains for many different conditions – especially as we are learning that many health conditions are linked to our gut microbiome. However, the research on probiotics is truly in its infancy and, while probiotics have gained popularity and become trendy, the science is not quite there to back up many of the claims you may have heard at this time. Working with your healthcare team is the best way to make sure that you are targeting your management strategies to your specific needs.
This blog post was written with the help of Lauren Pappalardo, a dietetic intern completing her MS/DI at Pace University.