Supplements: Probiotics

Probiotics are being marketed as helping you with the balance of your gut flora. While this holds true in some trials, especially when there are minor problems with diarrhea already, generally the authorities do not accept health claims for probiotics due to lack of evidence. It seems to work for my fiancee, though, and the placebo effect should never be underestimated!

What are probiotics ?

Probiotics are bacteria and yeast which are claimed by some institutions and authorities to have benefits for your body, especially for your digestive system, They consist of billions of bacteria in your digestive system which are making up to 1 kilogram of you overall bodyweight. In the gut flora there are around 400 different bacteria, some of them beneficial to your health, some of them harmful. The world health organisation defines probiotics as

"Live microorganisms which, when administered in adequate amounts, confer a health beneﬁt on the host"

Probiotics were first discussed in a background of a healthy gut and lifestyle when Elie Metchnikoff, 1908 Nobel Prize Winner, observed Bulgarians who drank sour milk and he made a connection between the bacteria in the sour milk and their healthy living. Since then probiotics have become a billion dollar business developing from a market of US$23.1 billion to US$31.3 globally in the years from 2010 to 2014.

The live organisms in probiotic products are mostly bacteria. The produce on the shelves at your local store or pharmacist usually contain Lactobacillus or Bifidobacterium. Other options can be Streptococcus, Enterococcus, Pediococcus, and Lactococcus. A live organism has to pass all of the acids in your stomach alive. This is one of the reasons apart from overselling why the labels of probiotic products seem to be very unreliable as the manufacturers state the concentration directly after production, while bacteria can day during shelf life and still have to be concentrated enough to have the impact when you consume while having to pass through your body.

If you come across products stating that they have prebiotic, probiotic and synbiotic ingredients the main component helping you are still the probiotics. Prebiotics are non-digestible organisms which are utilised as food for the probiotics so that they stay alive for longer. A mix of the two is named synbiotic.

The European Food Safety Authority has rejected all petitions by commercial manufacturers for health claims on probiotic products in Europe due to insufficient research and thus inconclusive proof of effectiveness.

In the United States, probiotic manufacturers have received warning letters of impending legal actions for using exaggerated claims of health benefits not supported by clinical evidence of efficacy.

What are the benefits of probiotics ?

Claimed benefits of probiotics are:

Treat diarrhea, especially following treatment with certain antibiotics
Prevent and treat vaginal yeast infections and urinary tract infections
Treat irritable bowel syndrome
Speed treatment of certain intestinal infections
Prevent or reduce the severity of colds and flu

Depending on the source the benefits get more overstated and wider or more moderated. If the source is mentioning or selling any products it is usually leaning towards overselling the benefits while the more clinical sources get, the more they are sceptical. Government bodies even flat down deny the validity of health claims for probiotics. Here an example on how probiotic products are being advertised:

Which completely clashes with the statements of the EU (scientifically proven??). All in all, the most benefits seem to occur, if there are any, for people who already have mild bowel irritations of some kind. For the cases for which there is evidence of benefits in studies the doses for the microorganisms to have an effect is between 1 billion to 15 billion CFU. CFU stands for colony forming unit and is a measurement to determine how many bacteria are in one mg of fluid or one gram of solid.

What are the risks of probiotics ?

They are in general deemed to be safe for healthy adults based on what I read there are only concerns in some cases. Pregnant women, children, and individuals with badly affected digestive systems from disease should stay away.

What is an imbalance of the microbiota in the digestive system ?

This was the biggest question for me while sifting through the material at hand, admittedly mainly internet sources. You will find a lot of material on that you should take care of your gut flora and that it can be easily disturbed (and fixed with probiotics for that matter), but i did not find specifics for what a healthy or unhealthy gut flora is. This is quite nerve wrecking when you want to determine what to take in and in which amounts. So just pause here and think about this whole probiotic thing.

How much do probiotics cost ?

In the range of 2 - 50 US$. Labdoor did a more extensive study on a couple of available probiotic products in the US which found that the labels are inaccurate and that there are some health benefits for over 5000 million cfu.

Conclusion

Looking at everything, i personally think that what I have read points towards that probiotics are not as effective as they made out to be. It makes sense to me that if you take antibiotics the bacteria in your gut flora get a knock and taking new ones orally can help you to get better / recover quicker. In the context of strength training and marathon running, I think it can be helpful if you experience problems with your digestive system during training on a regular basis. If that is the case try probiotics to make you feel better and therefore perform better after consulting a doctor.