Probiotics are a popular supplement, and brands have proliferated in recent years. But is the product worthy of the hype? With so many types to choose from, it can be confusing for consumers looking to improve their digestion and overall health.

First, it’s important to understand what probiotics are and what they do. “Probiotics are microorganisms that have potential beneficial properties for humans,” explains Dr. Jonathan Seccombe, a gastroenterologist on staff at Barnes-Jewish West County Hospital and Missouri Baptist Medical Center. “They work by altering the bacteria in the intestine. Most over-the-counter products have been derived from food sources, especially cultured milk products.”

Seccombe attributes the increasing popularity of probiotics to their easy accessibility without a prescription and low instance of side effects. “Those patients looking for a more ‘natural’ approach to their care may favor a probiotic over a prescription medication,” he says. “There is strong evidence supporting their use in treating inflammatory bowel disease, antibiotic-related diarrhea, infectious diarrhea, irritable bowel syndrome (IBS) and food allergies.”

Scientists also are becoming increasingly interested in the gut as a gateway to overall health. “ There has been an exponential rise in the number of studies evaluating the role of probiotics in all types of diseases,” says Dr. Christine Hachem, a SLUCare gastroenterologist. “An interesting study, for example, demonstrated that the gut microbiome from obese mice transplanted into lean mice seemed to predispose the lean mice to become obese.”

However, even for gastrointestinal conditions in which probiotics have been shown to be beneficial, they are rarely the sole treatment. Some patients tend to respond better than others, and mainstay therapies usually are still the first-line treatment. “It is difficult to translate the research evidence of probiotics down to what the public sees, as there are so many probiotics on the market that don't necessarily match what was studied in the research arena,” Hachem says. "Talking to your doctor about the composition and colony count of the probiotic may be helpful to discern whether the marketed formulation will work.”

People who have digestive problems or diagnosed gastrointestinal diseases may benefit from probiotics, but there’s little evidence to suggest that people who have normal digestion need a probiotic supplement. “In fact, in some cases, probiotics can increase flatulence and abdominal discomfort, creating a problem where there wasn’t one in the first place,” Seccombe notes. “In addition, many probiotics are not classified as drugs, but as dietary supplements, which are not regulated by the Food and Drug Administration (FDA); and may contain additional ingredients that could potentially be harmful to the body.”

People who are immunosuppressed from chemotherapy or other health conditions should avoid probiotics because they may already have a dysregulated immune system and be at risk for these beneficial microorganisms to actually cause infections, Hachem adds.

“There is a huge market for probiotics, but not as much evidence to support the market to date,” Hachem concludes. “There are definitely some subgroups where certain probiotics have benefit, but the data for the average person is probably still not great. Stay tuned, as a lot more data looking at probiotics is likely on the horizon.”

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