Who Should Take Probiotic Supplements? The Surprising Answer

Who should take probiotic supplements?  It’s an excellent question.  The answer is becoming clear – and disappointing.

I get a lot of questions about probiotics:

Q: “If I eat probiotic supplements, can I eat more carbs?“ 


A: Yes, but you will get fatter.

Q: “Will probiotics help my diet?” 


A: No. Dieting will help your diet.

Q: “Will Probiotics stop my hair loss?” 


A: You’re asking a bald guy about hair loss?

Q: “Will Probiotics help my chronic explosive diarrhea?”


A: Maybe. Now, never write to me again.

“Probiotics are one of the few dietary supplements that offer legitimate benefits to most people. Sold without a prescription, they have grown steadily in popularity for more than two decades and are now surging. Unlike the vast majority of over-the-counter supplements, probiotics can relieve many health problems. However, before you begin mainlining yogurt, there are several things you should know: what can probiotics do, and (more important) what the hell are probiotics?

Probiotics are Living Organisms.

“According to NY Times Wellness Expert Jane Brody, “Probiotics are defined by the World Health Organization as ‘live micro-organisms which, when administered in adequate amounts, confer a health benefit on the host.’ Their benefits range from relieving infection-caused diarrhea, inflammatory bowel diseases, and irritable bowel syndrome to helping patients with asthma, allergy, and Type 1 diabetes.”

Translation: Probiotics are bugs that make your gut healthier.”

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The above paragraphs were taken directly from a post I wrote more than four years ago, and not all of it holds up.  The very first sentence is wrong.  It should be, “Probiotics are one of the few dietary products that offer legitimate benefits to some people”.  Probiotic supplements can help some people, not most.

Probiotics do not help asthma, allergies, or most cases of diarrhea.  Healthy people who gobble probiotic pills are buying the hype, not the benefits; if you have a healthy diet, probiotic supplements will do nothing for you.

According to Aaron Carroll, also writing in the NY Times, “What are the benefits? The most obvious use of probiotics would be in the treatment of gastrointestinal disorders, given that they are focused on gut health.  Early this year www.sciencedirect.com published a systematic review of systematic reviews on the subject.

Who Should Take Probiotic Supplements?

The takeaway: Certain strains of bacteria were found useful in preventing diarrhea among children being prescribed antibiotics. A 2013 review showed that after antibiotic use, probiotics help prevent Clostridium difficile-associated diarrhea. A review focused on acute infectious diarrhea found a benefit, again for certain strains of bacteria at controlled doses. There’s also evidence that they may help prevent necrotizing enterocolitis (a serious gastrointestinal condition) and death in preterm infants.

From ScienceDirect: “Those somewhat promising results — for very specific uses of very specific strains of bacteria in very specific instances — are just about all the “positive” results you can find.”  Legitimate studies (that were not funded by industry and that didn’t rely on a tiny number of subjects) have found that probiotic supplements can indeed help with these serious symptoms. But not with anything else.

But what about eating foods that are high in probiotic microorganisms or prebiotic nutrients?  Good news: that habit is good for anyone’s health.

Probiotics? Prebiotics? Synbiotics?  What Are They?

First, a few definitions.

Probiotics are live micro-organisms which, when administered in adequate amounts, confer a health benefit on the host.  Probiotics are commonly found in yogurt, kefir, sauerkraut, tempeh, kimchi, miso, kombucha, pickles, etc.

Prebiotics are non-digestible carbohydrates that stimulate the growth of probiotic organisms in the gut. They are found in oats, wheat, bananas, onions, garlic, leeks, asparagus, soybeans, honey, and artichokes, to name a few.

Synbiotics, a combination of prebiotics and probiotics, are found in yogurt and kefir, fermented foods like pickles, and some cheeses.

Often overlooked, Fiber, found in every fruit and vegetable, is essential for the healthy growth of probiotic organisms.

A quick summary.  Probiotics are beneficial bacteria that live in your body and offer a health benefit.  Prebiotics feed the little beasts.  Synbiotics contain both prebiotics and probiotics and still taste good, which apparently is not impossible.  Fiber is essential for the long-term growth of smart bugs.

Northern Europeans frequently consume probiotics because of their tradition of eating foods fermented with bacteria, such as yogurt and cheese. Probiotic-laced beverages are also big business in Japan. However, probiotic foods have lagged in the United States while probiotic supplements have grown rapidly; tell Americans there is a health issue and we will try to fix it with a pill.  Or a supplement.

Take Food, Not Pills, Because…

As usual, real food wins out over food supplements.  In this case, the explanation is obvious.  Our guts contain many thousands of different species of bacteria, yeasts, and fungi.  Not thousands of bugs, thousands of species of different bugs (and hundreds of billions, perhaps trillions, of different organisms.)  Our specific mix is as unique as our fingerprints.

Supplements may replace a small handful of these different species, but so what?  For good health we need significant diversity, not a few specific strains of bacteria.  Unless someone has a pre-existing deficiency of certain essential organisms or a specific health issue known to respond to them, adding a few billion random bugs will do no good.

And it gets worse.

If you go to your local health food store and purchase a beautifully labeled package of pills, you will have no way of knowing if the pills contain probiotics or cow pie. And even if the pills do have billions of hungry beasties ready to populate your intestines, you have no way of knowing if you are getting the right beasties to treat your particular problem. Cross your fingers.

Two problems.  First, no government agency regularly tests over-the-counter supplements to see what they contain. Second, there is no legal definition of ‘Probiotics’.  Someone could legally sell crunchy wafers called The BioticPro’s All-Natural Probiotic Cow Pie if the package sported a label that said, “This may (or may not) help your chronic explosive diarrhea.”

… Because Food is Better than Pills

Stick with what legitimate researchers have proven: consuming many different strains of bacteria, fungi, and yeasts, obtained naturally from a wide variety of foods, is the best way to improve your microbiota.  (Alas, these organisms will not help you lose weight. Many probiotic supplements promise that their magic ingredients will help you shed pounds but those are bulltrump claims – lies that have no supporting evidence.)

Several brands of yogurt and yogurt drinks have promised that their probiotics could relieve constipation, prevent colds, etc., but the FTC investigated them several years ago and found the claims to be false. Danone, the maker of Dannon and Activia, had to pay $21M and promise to stop making dishonest claims; General Mills, the maker of Yoplait and YoPlus, paid $8.5M and pulled their product out of the US market altogether.

So – who should take probiotic supplements?  The marketplace has been confusing for years but the recent studies have clarified the issue: unless you have one of the specific gastrointestinal illnesses referenced above, simply eat reasonable portions of fresh, healthy, fibrous foods and avoid processed foods and sugars.  Just avoid The BioticPro’s All-Natural Probiotic Products; they are a little too natural for me.

Further Reading:

Will Exercise Help You Lose Weight? The Surprising Answer.

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