Do you need a probiotic?
You can say this about probiotics: They’re everywhere.
One supermarket chain’s website recently listed more than 175 products, including capsules, gummies, yogurt, tonics, teas and even dog treats that claimed to contain probiotics for gut health.
Probiotics are actually live microorganisms. The bacteria and other microorganisms that live in our bodies – our microbiome – help digest food, destroy disease-causing cells, and produce vitamins, according to the National Institutes of Health. Probiotic-infused products claim to keep that system working in top form or to replace bacteria that’s been destroyed by a medical issue or perhaps antibiotics.
Among adults, probiotics and prebiotics (carbohydrates that feed bacteria) are the third most popular dietary supplement other than vitamins and minerals, according to the NIH. But do you really need to boost your body’s microbiome with over-the-counter products?
Probably not, say experts and researchers, unless you have specific medical issues such as traveler’s diarrhea or periodontal disease. For one, over-the-counter probiotic products rely on a much narrower variety of bacteria as compared to the wide range in our bodies, the NIH says. Loading up on a few types of bacteria can upset the balance in your gut.
Benefits Vary
“I personally don't recommend them to patients just because there is limited research,” says Rachel Songer, a registered dietician at Cape Cod Hospital. “I feel like the best way to improve your microbiome is through your diet, [particularly by] having a high-fiber diet. Fiber is a prebiotic, which feeds the healthy bacteria in our gut.”
Recent studies, including one by Israeli researchers in 2018, have cast doubt on the benefits of many common uses for probiotics, such as restoring patients’ gut health after they took antibiotics. Researchers found that the microbiomes of participants who took probiotics after taking antibiotics actually took longer to return to “normal” than the microbiomes of those who took did not take probiotics after a course of antibiotic treatment.
And, a 2022 study by researchers at Stanford University found that the benefits of probiotics varied among individuals who had metabolic issues such as high blood pressure or high cholesterol levels. While taking probiotics for 18 weeks helped some people lower their cholesterol, for example, others developed high insulin and blood sugar levels.
“Probiotics can be beneficial for some individuals. But it also seems that for some individuals they can make things worse,” one researcher told The Washington Post.
More Research Needed
One other thing to remember about probiotics: Supplements aren’t regulated by the U.S. Food and Drug Administration so, as with any unregulated product, there’s no sure way to know what’s in it.
And more research is needed to really prove that probiotics help, said Songer. “We still don't really know what the best strain of bacteria is or even how much, and I feel like it just varies from individual to individual.”
However, there’s no question that your gut health is important, she added.
“Basically, the healthier your gut is, the healthier you are, is what research is really showing,” she said. “So if you have dysbiosis, which is an imbalance of that bacteria in your gut, it can definitely lead to more inflammation and chronic health issues.”
If you think you need a probiotic, check with your doctor. But it’s likely that the best way to achieve a healthy microbiome is to eat a mostly plant-based, high-fiber diet. And avoid processed food, being aware that even some plant-based products – like imitation burgers – can be highly processed, Songer said.
“I just encourage a healthy diet, high in fiber, to help really improve patients’ microbiome and health in general, rather than going with a probiotic that we're not really sure is going to be beneficial,” she said.
