Probiotics: the Lipstick Stained Glass

Probiotics: something advertised and added  to everything from yogurt to capsules to “promote immune health and enhance supportive benefits.” The “friendly” bacteria.

Did you ever know someone who lied to you, but within their lie was a grain of truth? Yes, politicians – but now you know someone else, the entire industry trying to get you to buy their food or supplement that contains “friendly bacteria.”

Here is the grain of truth
Your colon contains bacteria that live there normally. The bacteria occupy a space, they prevent other bacteria that are harmful from occupying that space. If you get rid of some of those “friendly” bacteria, then some of the harmful bacteria can take that place and cause disease. The big, bad bacteria (ok, small, microscopic but with an attitude) that cause disease after antibiotics is called Clostridium difficile (often called C. diff), which causes “antibiotic associated colitis” that can range from diarrhea to perforation of the colon and even death.

There are other bad bacteria that, even if small amounts are ingested, can cause problems- like food-borne illness, for example – Salmonella. There have been some very good science done showing that some “pro-biotic” bacteria could reduce the infection in poultry, and in cell cultures.

There are some small studies, done with a pediatric population with antibiotic associated diarrhea that have very specific indications. For example: one type of bacteria called Lactobacillus rhamnosus (573L/1, 573L/2,573L3) shortened diarrhea caused by a virus called rotavirus, in children, but did not improve the diarrhea caused by other virus types.  The amount of that Lactobacillus found to be therapeutic was also quite specific. And, as has been noted in these publications, not all the probiotics on the market are effective.

Of the many types of bacteria out there, some have been tested in clinical situations, some have not.  Some have been found effective for one type of diarrhea (antibiotic induced, or viral induced) but not effective for another.

The amount of bacteria to be effective in these studies is also regulated. The amount found in the supplements is not. Think of pro-biotics having to have a specific number of bacteria like a pill with a dose. You know that 2 Advil will help your knee pain, and 1/2 Advil won’t do a thing, and a whole bottle of Advil can kill you– same with probiotics.  There is no regulation as to the amount of bacteria in the pills, and certainly the bacteria can grow (much like leaving food out on the counter for a day- bacteria grow quickly).

Putting bacteria in yogurt, or milk, without regard to quantity, how long they might last on the grocery shelf, or without regard to the type, is the equivalent of walking outside your house with a loaded shotgun, firing it in the air without looking, and hoping you hit a duck. When these “probiotics” including those in yogurt, have been cultured what is found in them does not correspond to the label, and sometimes the “friendly bacteria” grown are not friendly – and sometimes they are dead.

Here is the whole truth
Most of the bacteria that are used in yogurts or given in the “live probiotic” pills are not bacteria that have been tested,  to support the claims made. There have been tests done with some bacteria, and on humans with small studies and specific indications (a type of diarrhea, or a type of ulcer, with a type of bacteria with a specific amount). For the bacteria to be useful, it has to be a specific indication, with a specific kind of bacteria, and a specific quantity of bacteria. Instead, there is a “shotgun” of bacteria that are used.

A company that prides itself on healthy products has never performed any human testing on probiotics, and the ones they use are not always native to the colon.

The bacteria found in yogurt are often not the same bacteria that are found in humans. They may have the same Genus name- like Lactobacillus, but not the same species found in humans. An American Robin is Tardus migratorius – and the blackird is the Tardus merula – two different species – which act differently. Bacteria are the same – they may have a similar sounding name- but how they behave in the colon are different. But as you can see above- some bacteria, even substrains of the bacteria, are effective for some conditions, but not others. First, one needs a diagnosis – then the specific treatment.

The bacteria that are taken that are not a part of the normal colon will quickly pass through the colon and can’t be found after they are no longer taken. Of course, the alternative might be that they stick around, form a new colony- and one has to hope that it wouldn’t be a bad thing- but it could very well be.

Since the Food and Drug Administration cannot regulate this industry, they can say almost anything in vague terms, without a single bit of proof. But sometimes they cross the line, as Dannon yogurt who agreed to pay 21 million dollars to settle deceptive advertising about health benefits. The investigators accused Dannon of improperly claiming its DanActive yogurt drink could “boost the immune system” and prevent colds, flu and diarrhea in children. In June 2011, the U.S. Marshals seized the probiotic products from UAS Laboratories which included DDS Acidophilus, DDS Plus, and more. This firm also claimed the products could treat or prevent colds, flu, infections. Companies still make vague claims- but cannot make specific claims.

Do not use probiotics with infants or premature babies, or in people who have compromised immue systems

These products SHOULD NOT be used with infants or premature babies. While some studies show some probiotics in hospital settings, are safe – there are some “probiotics” that are not. Giving these children with immature immune systems bacteria can harm them. Stimulating the immune system with bacteria is no different than eating, drinking, or getting the normal bacteria we get every day. Humans consume lots of bacteria, including the type that are found in your gut- every day; from the food we eat, to the people we kiss, to the bottled water we drink- we consume a lot of “probiotics” daily. Save yourself some money- and kiss for your daily probiotics.

Looks like they should be asking if you want unleaded or not

There is one useful time when the probiotics work. It is called a fecal transplant. Backed by science, and fifty years of good research, people get feces from a healthy person, mix it with some salt water, and deliver it to the person with the colitis by either nasogastric tube, enema, or colonoscopy. The difference between fecal transplants, and commercial probiotics, is that the transplant works, because it is putting a normal bacteria into the person.  The patient won’t taste it or smell it – but the science behind fecal transplant works.

Probiotics are the latest unproven remedy for “everything”. Often  what a company is selling you is a capsule full of bacteria- untested, thought to be harmless, and yet not to be used with people who have “compromised immune systems.” Odd that such a warning exist if it is suppose to help “your immune health” isn’t it.

But before you buy the next pill with a probiotic, ask yourself this: would you eat food from a restaurant that had the chef’s hair in it? Would you drink out of a glass that was used by a stranger, and had lipstick on it? Because if you take probiotics you are taking bacteria that are not “normal” and have not been tested- and taking them in a higher dose than drinking out of that lipstick stained glass.

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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Latest Comments

  1. Geek Goddess says:

    A friend of mine had his gall bladder removed last year. Apparently it had been non-functioning for some time. After the surgery, he was eating yogurt every day. Just recently, he said he had been doing it to ‘re-populate’ his intestines after the surgery.

  2. Lynn says:

    I have never heard of a fecal transplant. I have heard that when a family member is sick and needs a blood transfusion, his brothers might be asked to roll up their sleeves but I can just imagine how the brothers would be approached if the sick brother needed a fecal transplant.
    I also wonder what, if anything, should be done after taking antibiotics to avoid C Diff or vaginal yeast infections. Is there anything that really works? (my son’s roommate at rabbinical school was really sick with C Diff)

  3. thedoc says:

    alas, sometimes people just think because the label says it will do it that it will. The bacteria used in probiotics are not even the most common that the colon is populated with

  4. Lynn says:

    There is also this very down side to antibiotics. It seems also now that lots of boo-boos become infected enough to require IV antibiotics. Any little bite from an insect and the person ends up as the patient of an infectious disease specialist. I would imagine that much of this comes from resistant germs. A few years ago, MRSA went through my family, infecting 2 of my kids and one granddaughter (she was admitted to pediatrics). The disease probably came from infected beach sand because usually the germs in NY die of overpopulation.
    Now as you point out, the world sees this war on germs and figures that probiotics puts them in the driver’s seat. It is a pity that it is purely wasted money.

  5. Grace Henderson says:

    I’m sorry but this is complete nonsense. Sure there are probiotics out there with absolutely no research behind them, but you fail to point out that some strains do actually have clinical trials behind them. Actimel by Danone, although perhaps not worthy of the huge claims they tried to make on ads, has human clinical trials behind it – http://www.actimel.ie/index.php?item_id=83 same with other well known strains like rhamnosus GG (one of the most researched probiotics out there) and B. lactis BB-12 – http://www.optibacprobiotics.co.uk/resource-centre/scientific-research/for-maintaining-regularity-scientific-research.html.

    By all means its fair to take a step back and question whether or not these ‘friendly bacteria’ deserve all the hype they are getting, but dont pretend none of them have any research whatsoever – when evidently, some of them do.

  6. thedoc says:

    There is a lot of research with small numbers for various forms of disease and bacteria. They do not, however, reach the level of the claims made by many of the companies- who stretch it. Nor did Dannon – who cites brilliantly those claims, and agreed to settle the lawsuit instead of submitting to the FDA studies of any types to prove their claims. What is easier? Settle for millions or submit some studies?

    Was the research done with the yogurt, or cultures- was it done for a very specific indication and if such does that translate to everyone? The federal judge made this very clear, as did other cases.

    Probiotics will have a role in treatment- but to do so they have to be tested first for safety, then efficacy. Until then you have a marketing department taking a group of studies and telling them they can have food instead of medicine.

  7. Lynn says:

    Is it possible that by giving probiotics, we are giving a greater amount of specific bacteria than exist in nature in the gut and therefore risk causing disease, genetic mutation, or abnormal growth patterns in children? I did see in one site where that was a concern. I am interested in this topic because two sets of grandchildren go to a pediatrician that tells my children to give probiotics whenever the kids are put on antibiotics. I don’t know why this doctor feels that this is necessary but I do see some children’s vitamin products with probiotics added. None of this stuff is cheap but could be covered by insurance if the doctor writes an order, even if it is sold OTC. It is one of those probably unnecessary but hyped up health supplement that would not improve health as much as grass fed organic beef or some other expensive but healthy food.

  8. thedoc says:

    The tests certainly have not been done- but they are not giving more bacteria than we have in the colon.

  9. Jonathan says:

    (Health and Beauty) Let me preface this by saiyng that I am a firm believer in probiotics and regularly take kefir and enhanced yogurt as a part of my daily diet. So when I got my 30 day supply, I really didn’t notice a difference. All I can say is that I feel good, have not been sick (everyone in my office has had colds) and everything seems to be working fine down there. I will say that I’ve been slightly more gassy after starting with the Sustenex supplements, but I can’t say for sure they are the cause though I suspect they may be. So let me just focus on the pro’s here: 1. Convenience it is easier to take a capsule than eat a container of yogurt. No refrigeration needed. 2. Calories 0 vs. the 150 calories in 8oz of plain yogurt. 3. Sugar Free Even plain yogurt has sugar, this doesn’t. 4. Right kind of bacteria many yogurts don’t have the proper mix of bacteria to promote intestinal health. 5. Targeted the probiotics make it to the small intestine while those in food may be destroyed in the stomach. 6. Price at about 50a2 a serving, this is a good deal. Now you won’t get the other dietary benefits that you get with a good dairy product, but then again that is not why you are getting this, right? If you don’t mind investing a little time, this home Kefir making kit is another good way to go. To summarize, I’ve been happy with the results. But the only way to know for sure it to try it yourself. UPDATE: I just finished my 30 day supply and I have to say that right after writing this review, the gassy aspect passed. Perhaps because I started taking it with a fiber supplement, who knows. I do know this though. Almost everyone at my office and all of my family had colds this past month. I did not. Did the Sustenex boost my immunse system and help me ward off illness. Perhaps. I think next time I’ll get the 90 day supply.

  10. thedoc says:

    There is no way to know about your immune system- and your own self as a test subject is never a good way to look at science. Probiotic is just a word for some- and if you buy probiotics over the counter you have no idea what you are getting, if the bacteria you are getting are even alive. People who buy probiotics need to know this: you have no idea what you are getting and there is no regulation to it. So, no- you didn’t boost your immune system – you just bought some junk and got lucky

  11. Robert says:

    If the brand of probiotics did contain live bacteria of the kind that are found in the human gut, how come you have to keep taking the capsules? Couldn’t you just take them a few times and then the bacteria would grow by itself?

  12. thedoc says:

    considering there are over 100 trillion bacteria in the gut- one would have a hard time imagining that a capsule with a few million bugs is going to make a difference. You hit a nail on the head

  13. Joe Spataro, MD says:

    Well said, Terry,
    To amplify on your point, as you well know, none of he supplements have to pass muster as a drug i.e. they are both safe and effective.
    The efficacy of any supplement is never guaranteed, just alluded to in the big print.
    Of course, in the small print is the required disclaimer…
    “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”

  14. Joe Spataro, MD says:

    Well said, Terry,
    To amplify on your point, as you well know, none of he supplements have to pass muster as a drug i.e. they are both safe and effective.
    The efficacy of any supplement is never guaranteed, just alluded to in the big print.
    Of course, in the small print is the required disclaimer…
    “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”

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