Are Probiotics Worth It?

By: Nick Sienkiewicz, DPT, CSCS

I’ve fielded questions about probiotics more frequently lately, so let’s set the record straight. There is no doubt that probiotics, or the beneficial bacterial strains within the human gut (and entire body for that matter), are pivotal to health. However, it gets a little more grey and nuanced when discussing probiotics as a supplement. Taking supplemental probiotics has become somewhat of a holistic silver bullet for all gut issues in our modern world. GI doctors have even jumped outside the conventional pharmaceutically-driven approach and gotten on board with probiotic recommendations as part of their medicinal protocols. The push for widespread probiotic use for gut health is well-intentioned and appears to make credible sense at first glance. Nevertheless, there is always more to the story!

Let’s go through some of the basics first. As aforementioned, probiotics refer to the beneficial bacteria residing within our bodies. It is a symbiotic relationship, as our body offers a suitable home for these microorganisms, and in return, probiotics assist and support various bodily functions. Probiotics in supplement form actually contain various strains of these beneficial bacteria and function to boost the quantity of these colonies within the gut in order to enhance their serviceability. These “good” bacteria that are dubbed probiotics are also known as commensal or keystone bacteria. On the other hand, there are other strains of bacteria that are considered negative to our health. These “bad” bacteria, like probiotics, are also commonly found in the human gut. They are referred to as opportunistic or overgrowth bacteria; denominations that imply these microbes will run rampant if permitted. Once levels of these pernicious microorganisms elevate too high, they become pathogenic and infectious. Opportunistic bacteria are considered normal in the gut if they are below certain levels, depending on the type. At numbers below the lower limit, they function harmoniously within the body and are kept in check by our immune system in conjunction with our keystone species. It’s all about the internal ecosystem being in a state of homeostasis, or equilibrium. Various strains of bacteria live in concert with each other, along with other microorganisms, including viruses, fungi and parasites. I’ve alluded to this concept in past newsletters, and used the example of Yellowstone National Park to illustrate this balance. About a century ago, the US government initiated in a movement to intentionally remove a certain percentage of the wolves from Yellowstone. In the ensuing years and decades, various species of plants and trees began to become endangered within Yellowstone. This was because the wolves technically protected those plants as an apex predator in the park. In reducing this predatorial influence, herbivorous prey animals, like deer and rabbits, were permitted to run free, reproduce safely and efficiently, and eat all of the delicious plants they desired. Over time, numbers of herbivorous animals outweighed those of the plants, and eventually decimated certain vegetative species. A similar situation can occur within the human gut. 

There is undoubtedly a time and place for supplemental probiotics. Unfortunately, most providers are unaware of this reality, let alone have the knowledge as to why and when to use probiotics. The vast majority of people with gut issues are dealing with some form of dysbiosis. This simply implies there is an imbalance in the gut bacteria, similar to the situation described above in the Yellowstone wilderness. Prior to the past few years, many healthcare providers refused to believe dysbiosis was an actual diagnosable condition. Now that it is recognized as very real issue with which many humans are dealing, probiotics have become more mainstream. The thought behind probiotics for dysbiosis is to repopulate the “good” bacteria in the gut. Since it has been shown that one or more of the keystone species are depleted in the state of dysbiosis, this is certainly sensible reasoning. However, this creates an incomplete viewpoint of dysbiosis, as treating the imbalance with probiotics is only half of the battle and analogous to removing wolves from Yellowstone. Once you understand that dysbiosis is typically accompanied by elevated levels of opportunistic bacteria (can you see how they acquired that name?!?) in conjunction with depleted probiotics, you can quickly depict a Yellowstone-esque fiasco of our body’s internal ecosystem. When the levels of commensal bacteria drop too low, opportunistic microbes begin to thrive, which further depresses the survival and function of these beneficial bacterial species. Solely increasing the number of these keystone microorganisms often fails to circumvent the strength and vigor of overgrown opportunistic microbes. You’re essentially throwing probiotics into the fire. You input new bacteria into the body via supplementation at which point they are blindsided and immediately destroyed upon entry by the resistant overgrowth bacteria (this could be other microorganisms, like fungi too). This situation is synonymous with planting more of the decimated shrubs and plants in the Yellowstone example above. Since the deer and rabbits are still left unchecked, their excessive numbers would just easily gobble up any newly planted foliage in the area. Both instances result in a futile effort that truly just accelerates the underlying issue. In dysbiosis, adding more probiotics can actually nourish and strengthen the opportunistic microbial communities just as inserting more plants would feed and reinforce the herbivorous animals in Yellowstone. 

The above mechanism is the main reason that probiotics may not be effective or beneficial for some individuals. Furthermore, many supplemental probiotics lack quality effectiveness for a couple other reasons. Firstly, some on the market barely make it past the level of the stomach. One aspect of our stomach acid is to support the immune system in eliminating microorganism that enter the body via the mouth. Our stomach acid is non-selective, meaning it does not recognize probiotics versus opportunistic organisms. Therefore, oral probiotics are technically unnatural, as our keystone strains customarily reside in the small and large intestines just past the level of the stomach. Thus, probiotic bacterial species are not accustomed to experiencing our stomach acid. Secondly, supplemental probiotics are generic and may not necessarily contain the strains of bacteria that are in need of elevation in specific individuals. Many people who have responded well and experienced health improvements likely just guessed right in choosing their particular probiotic brand. This is not meant to detract from people who have enhanced their health utilizing probiotics, or to deter people from attempting to elevate their supplement regimen with probiotics. I just believe it is important to understand these concepts and nuances before blindly purchasing the new trendy probiotic on social media. I’ve personally recommended probiotics to many individuals, but this is typically after specific testing to determine the status of commensal bacterial levels compared to opportunistic quantities (reach out if you’re intrigued). Next week, I want to get more practical on the topics discussed today and go over more effective strategies for addressing dysbiosis and utilizing probiotics!

*Disclaimer: This is not medical advice. The information is meant to be educational in nature. It is not intended to diagnose, treat, prevent and/or cure any disease or health condition. Simultaneously, the information is not stating that any supplements or methods mentioned can replace medications or any interventions prescribed by your healthcare provider. Please speak with your own healthcare provider before beginning any new supplements or making changes that may affect your health. By utilizing any of this information, you are assuming responsibility for your own health decisions and actions.