
Probiotics labelled 'quite useless' - pmoriarty
https://www.bbc.co.uk/news/health-45434753
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sschueller
Isn't the idea to give probiotics to people who do not have a healthy gut?
Such as someone who had been taking antibiotic for a prolonged period of time?
So why did they give the probiotic to 25 healthy individuals?

Also 25 seems like a very small sample.

Edit: it appears they also did a study on 46 people after taking antibiotics
but that I still find to be a small sample size.

~~~
NikolaNovak
In Canada at least,probiotics are largely bought of the shelf by healthy
people.

Last week I accidentally bought a bottle of water from seven eleven,which
turned out to have probiotics added. Cost the same as regular water too...

~~~
genomer
I was surprised by a probiotic addition the other day as well. It was added to
a vegan protein powder I bought off the shelf.

~~~
bena
Do you think it's really an addition or something that was in there already
they could market as a probiotic?

Like how a lot of things became "gluten free" despite not containing gluten to
begin with.

~~~
joshuagross
Gluten free also refers to processing. If something is made in the same
facility / alongside a product with gluten it’s a serious problem with people
with Celiac.

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Havoc
I'd conclude the opposite.

If in half the cases the newly introduced bacteria "lingered" before being
expelled then that demonstrates some kind of traction. e.g. You might just
need to combine that with a diet that favours the new bacteria you're trying
to introduce.

i.e. Some sort of effect in 50% of the cases is better than I expected
honestly

~~~
jpmoyn
I mean maybe, but that's just speculation, and it really doesn't get us
anywhere.

The main point of the article is that off the shelf probiotics don't do the
wonders they are toted to. You would have to have probiotics tailored to the
unique bacterial composition inside of your gut.

~~~
dragonwriter
> The main point of the article is that off the shelf probiotics don't do the
> wonders they are toted to.

That's the main _claim_.

OTOH, they didn't test any off-the-shelf probiotic products in isolation, they
tested their own custom probiotic mix.

~~~
WalterSear
> During the probiotics phase participants consumed Supherb Bio-25 bi-daily,
> which is described by the manufacturer to contain at least 25 billion active
> bacteria of the following strains: B. bifidum, L. rhamnosus, L. lactis, L.
> casei, B. breve, S. thermophilus, B. longum sbsp. longum, L. paracasei, L.
> plantarum and B. longum sbsp. infantis. According to the manufacturer, the
> pills underwent double coating to ensure their survival under stomach
> acidity and their proliferation in the intestines. Validation of the
> aforementioned strains quantity and viability was performed as part of the
> study.

[https://www.cell.com/cell/fulltext/S0092-8674(18)31102-4?_re...](https://www.cell.com/cell/fulltext/S0092-8674\(18\)31102-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867418311024%3Fshowall%3Dtrue#secsectitle0075)

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chadash
> _" The research group also looked at the impact of probiotics after a course
> of antibiotics, which wipe out both good and bad bacteria.

Their trial on 46 people, also in the journal Cell, showed it led to delays in
the normal healthy bacteria re-establishing themselves.

Dr Elinav added: "Contrary to the current dogma that probiotics are harmless
and benefit everyone, these results reveal a new potential adverse side effect
of probiotic use with antibiotics that might even bring long-term
consequences."_

If you only read the first few paragraphs (where they discussed the effect of
probiotics on healthy people) you might have missed this important piece of
information.

This discovery is hardly surprising. Probiotics aren't regulated by the FDA as
drugs, but rather as "food supplements", which basically means they have the
same standard of regulation as regular food [1].

[1] To be sold as a drug (i.e. pharmaceutical) a product must undergo rigorous
trials to show efficacy and find any unintended side effects. Clinical trials
typically cost around $60-80 million, which is part of the reason drugs are so
expensive.

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Bucephalus355
Does anyone believe anything these articles say anymore?

About two weeks ago, two somewhat prominent doctors from Harvard Medical
School got into an enormous disagreement over whether or not coconut oil was
“healthy” or “killing you”. No one knows anything under the current system.

There is absolutely no way the public can reasonably believe yay or nay on any
new thing about healthy living.

~~~
collinf
This is so true. I used to be consume articles about healthy eating, but it
after all the contradiction I have decided that I'm done reading about it all.
I keep it simple with the opinion that eating protein, your veggies and
drinking water will be near optimal for most humans, and anything after is
just not worth the effort to optimize. 80/20, people.

~~~
drb91
Make sure you get some fat and carbs in there too, nutrition is nutrition.

I've concluded that eating is good for your health.

~~~
TeMPOraL
> _I 've concluded that eating is good for your health._

[citation needed]

Jokes aside, you and GP are right; with this level of confusion, there's not
much ground for trying to micromanage your diet.

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PaulHoule
Probiotics always struck me as one of those pills that mother gives you that
don't do anything at all.

These products were developed commercially based on what they could make and
not on any analysis of what a person's intestinal flora should be, nor any
proof that the deliver system worked.

~~~
willio58
All commercial products are developed based on potential profit.

~~~
PaulHoule
Then you need alignment.

One of those cases where the patent model works is the development of
prescription drugs. The possibility of monopoly profits leads pharma companies
to develop and test drugs and run them through a regulatory gauntlet. Critics
say it is expensive, but it does work in the sense that new drugs get invented
and some of them really are a boon.

For something like fish oil you can do the research but it benefits everybody
else who sells fish oil, which, oddly enough, lowers my blood triglycerides
like a drug although having put up no real benefits other than that for years.

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bufferoverflow
I'm pretty sure it's solid science that probiotics definitely help at treating
or preventing certain digestive tract disorders/diseases. For instance, SIBO:

[https://www.ncbi.nlm.nih.gov/pubmed/28267052](https://www.ncbi.nlm.nih.gov/pubmed/28267052)

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329544/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329544/)

~~~
WalterSear
Interesting science.

But, I don't feel that the second is a legitimate use of meta-analyses. Due to
publication bias, the conclusions it draws are only useful if the efficacy of
probiotics is a forgone conclusion.

Moreover: I have a huge question regarding their primary measure, specifically
regarding their use of number from this study:

[https://www.ncbi.nlm.nih.gov/pubmed/14608267](https://www.ncbi.nlm.nih.gov/pubmed/14608267)

Which show up as the 8th line of their risk-ratio calculation, but whose
results have no relation to the values on that graph.

Moreover, this isn't peer reviewed, as far as I could see.

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harshreality
It doesn't seem very surprising that if you keep eating mostly what you
normally eat, your microbiome is already well-adapted to that diet and will
out compete almost anything new you try to introduce.

I would expect if they tried limiting their diet to foods compatible with the
probiotics, they'd get more significant results, because the existing
microbiome colonies would be stressed from lack of their usual junk/meat/fat
and be weaker. (Almost all standard probiotics, other than dairy varieties
[yogurt etc], are veg-carb-loving.)

Before refrigeration, there couldn't have been many probiotics consumed in
isolated form rather than as fermented foods. Give the new bacteria some food
to eat when they're trying to out-compete your existing (bad parts of your)
gut microbiome. One of the most likely good foods for them to eat is what
they've been cultured on.

It may not even be necessary to eat probiotics, if you already have some of
the bacteria you want, you merely need to encourage it to out-compete bad
microbiome bacterial strains. Eat food compatible with the good bacteria. But
it's such a hassle to change diets, everyone wants a pill or a powder or one
serving of probiotics they can add to their diet, keep everything else the
same, and have the bad bacteria / imbalance miraculously disappear. Is it any
surprise that's less likely to work?

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foobaw
One of my friends who has severe dietary/gut problems did several isolated
experiments on himself with different probiotics and found success from very
specific ones like PHGG and GOS..

~~~
maxxxxx
It may also depends on how you get them. For example somebody told me that
turmeric helps with joint inflammation. Bought some turmeric capsules and they
did nothing. But then I used it in cooking and it definitely makes a
difference for my joint pain. It comes back while traveling and I don't get
turmeric. But as soon as I get home and eat my own food the joint pain gets
better. It also gets worse when I stop using turmeric in my own cooking for a
while.

~~~
kxs
Did the supplement contain pepper? AFAIK you need to consume turmeric together
with black pepper to make it effective (blocks something in the liver IIRC).
Maybe that was the reason?

~~~
maxxxxx
I don't know about the supplement. But yes, I always use some pepper when I
cook.

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ghostbrainalpha
I had chronic I.B.S. for many years, which I talk about here way too much.

Basically I used to poop my pants weekly and couldn't work in an office.

Probiotics and keeping my eating to an 8 hour window (Intermittent Fasting)
basically solved the issue for me.

However it makes sense to me that probiotics wouldn't do anything for someone
who already has healthy gut bacteria.

~~~
kazinator
> _Basically I used to poop my pants weekly and couldn 't work in an office._

Any office? Even the U.S. Patent Office?

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sorokod
Looked at a actimel
([https://www.actimel.co.uk/faq_about](https://www.actimel.co.uk/faq_about))
and yakult ([https://www.yakult.co.uk/](https://www.yakult.co.uk/)) and was
surprised by how little they attribute to the "good bacteria". Yakult promises
that: _is scientifically proven to reach the gut alive_ (!)

Was that always like that?

~~~
TeMPOraL
From the days I was a teenager and we had TV at home in Poland, I remember the
brand "Actimel" being _all about "good bacteria"_. So this must have changed
recently. My guess is, the EU told them to stop spewing bullshit in
commercials.

EDIT: This might indeed have had something to do with 2007 change in EU's
health regulations, as per
[https://en.wikipedia.org/wiki/Actimel#Debates_surrounding_he...](https://en.wikipedia.org/wiki/Actimel#Debates_surrounding_health_claims_on_probiotic_foods).

~~~
sorokod
This is from yakult us, boy this is underwhelming: _Because everyone 's
biological make-up is unique, each one of us may experience our own unique
health benefits_ Generally speaking, Yakult may help balance your digestive
system.

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cwkoss
This article is a great example of how scientifically illiterate modern
society has become.

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dragonwriter
It's funny that this research claims is spin to prove that supermarket
probiotics are useless, but instead of broadly testing actual supermarket
probiotics products, or even testing a single such product, it tests a single
specific custom blend product created by the research team.

At best, they've shown _that blend_ to be quite useless as tested.

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LinuxBender
Probiotics used incorrectly can have mixed results; and thus, there will be
endless religious debates on the matter.

If the reason you are taking them is to cull dangerous bacteria such as
H.pylori, you would first have to bring their numbers down to a point where
the probiotics have a fighting chance. This is typically either done with
anti-biotics, or a combination of supplements such as aged garlic, mastic gum,
coconut oil, etc... to first kill things off. Then after taking the
probiotics, the candida overgrowth has to be purged with garlic extract. Very
few people will take the time to go through the right steps throughout the
days/weeks required to balance things out. This lends itself to a wide
variability in results.

~~~
blacksmith_tb
H. pylori isn't a yeast? Or did you mean that the probiotics would include
yeasts (possible, certainly, like S. boulardii, but it dies off by itself
pretty quickly). Though of course the process you describe is similar to what
anyone taking a course of antibiotics to treat an illness could do, I was
hospitalized after being hit by truck and given lots of kefir along with my
antibiotics.

~~~
LinuxBender
H.pylori is a bacteria. When you add bacteria in large amounts to compensate,
they will cause candida overgrowth which is a fungus. The fungus has to be
killed off.

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Someone1234
Does this potentially also have consequences for fecal transplants? That has
been an upcoming area of research and relies on a similar idea: You can
colonise bateria. If they aren't going to stick around via probiotics, they
may also not via fecal.

~~~
WalterSear
Different bacteria, different condition, different delivery methods.

As the article states - "The researchers said probiotics of the future would
need tailoring to the needs of each individual."

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Jeff_Brown
The main purpose of probiotics I've heard of is to repopulate a gut that's
been wiped out by antibiotics. This experiment was performed on 25 healthy
subjects; its results don't seem to bear on that purpose.

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yellowapple
Seems like a pointless study if you're only sampling people who are already
healthy. "Probiotics don't do anything if you already have a healthy gut."
Yeah, no shit, Sherlock.

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evolve2k
“These are very innovative studies, but they are preliminary findings that
need replicating.”

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yeahdef
one yakult a day has been highly beneficial to me.

~~~
uslic001
That's a nice anecdote.

