Probiotics: What the Evidence Supports

HEALTH · GLOBAL

Probiotics: What the Evidence Supports

What they are, where they help, strains and doses, and who should be careful

Probiotics are sold for almost everything and have decent evidence for a few specific situations, which is worth separating out.

What they are

Live microorganisms which, in adequate amounts, confer a health benefit. The effects are strain-specific, so results from one strain do not transfer to another product simply because both say lactobacillus.

Where the evidence is reasonable

Reducing antibiotic-associated diarrhoea, shortening infectious diarrhoea in children, and improving symptoms in some people with irritable bowel syndrome. Certain strains have evidence in preventing a serious gut condition in premature infants under hospital care.

Evidence for general wellbeing, immunity, weight and mood is weak and frequently overstated.

Strains and doses

Look for the full strain designation — genus, species and strain code — and the number of live organisms at the end of shelf life rather than at manufacture. A product that lists only a genus tells you nothing.

Check storage requirements, since some need refrigeration.

Prebiotics and food

Fibre feeds the bacteria you already have, and most people eat far too little of it. Fermented foods — yoghurt, kefir, sauerkraut, kimchi — are an inexpensive route and a reasonable habit.

Who should be careful

Anyone immunocompromised, seriously ill, with a central line, or a premature infant outside hospital supervision should take medical advice first, since rare serious infections have been reported.

After antibiotics

This is the situation with the best evidence. Starting a probiotic alongside a course, rather than after it, is what the trials generally tested, and it reduces the chance of diarrhoea for many people.

Ask a pharmacist, who can check for interactions and timing.

Cost

Work out the cost per day and compare against fermented foods, which deliver live cultures for far less. Neither is a treatment for a diagnosed condition.

Labels

Claims about immunity and digestion are tightly restricted in the UK and EU, which is why packaging uses careful, vague language.

Fibre

Most adults eat well below the recommended fibre intake, and increasing it is better evidenced for gut health than any supplement. Add it gradually with plenty of water, since a sudden increase causes bloating.

Wholegrains, pulses, fruit, vegetables, nuts and seeds all count.

When to see a doctor

Blood in stools, unexplained weight loss, persistent changes in bowel habit or new symptoms over fifty need medical assessment rather than a supplement.

Gut health claims

Research on the microbiome is genuinely interesting and early, and products marketed on it run far ahead of what is established. Be sceptical of anything promising to rebalance or reset gut flora.

Diet, sleep, exercise and not smoking affect it more than any capsule.

Expectations

Give any product four weeks, and see a doctor about persistent bowel changes rather than self-treating.

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