If you happened to read my post about garcinia cambogia, you know that I have a bone to pick with the diet industry and the way things are marketed.
Marketers know how to wordsmith things to make them sound amazing. You will see terms like “clinically proven…” and “doctors support the use of…” Sadly, the regulations around what they can claim is slim to none, especially for supplements. Essentially, these terms often mean nothing in terms of how legitimate the product is.
A quick online search reveals a huge number of probiotics ranging in price from $5 to $75 and claiming benefits like:
- Improved digestion
- Reduced risk of infections
- Increased energy
To be fair, the science linking gut bacteria and our health is quite compelling and exciting. As we learn more, I imagine we will unlock some really important discoveries about our health. However, research showing that specific probiotic supplements cause significant and prolonged improvement in symptoms for the average person has been less lacking.
Of course, you would never guess that based on the marketing ads.
There are a number of ways to maximize the health of your gut:
- Eat a variety of whole plant foods.
- Minimize the use of antibiotics.
- Eat dirt.
- Ok, maybe you don’t need to do this, but you don’t need to be obsessively sanitized when it comes to dirt. Please still wash your hands if you are around sick people or during flu season, but go ahead and let your dog lick your kiddo.
What about Probiotic Supplements?
Like any new health trend, there are tons of companies ready to capitalize and make a profit, but are any of them legitimate?
Unfortunately, I have not seen many studies to support the claim that a probiotic works to alter your gut bacteria beyond the time you take it. That is, probiotics may help temporarily and may be useful short-term for example to reduce GI distress after a course of antibiotics, but is unlikely to significantly alter your gut bacteria to a more healthful balance long-term.
This makes sense given that we know it is essential to have prebiotics, that is, the food that your gut bacteria eat. If you don’t change your overall diet (e.g., if you aren’t getting enough variety of fiber, like many people who follow the standard American diet) then the healthy strains added from probiotic supplements would die off, as they don’t have their preferred food source in your gut.
Probiotics for Infants?
The one possible exception is an infant probiotic I heard about soon after having my daughter in 2017. A friend of mine told me about a brand of probiotic called Evivo that is mixed with breastmilk.
The nice thing about this product is that it actually links on it’s website to a randomized controlled study, which is rarely the case for supplements.
Though it was a small study, it had it’s strengths. Results suggested that Evivo may alter the gut bacteria after the probiotic has been stopped. This part intrigued me, as I was (and am) not looking for a short-term fix of symptoms, but something that could potentially reduce my kid’s risk of problems associated with unhealthy gut bacteria for their entire life (e.g., eczema, allergies, obesity, etc).
Overview of the Study
The study included mothers and infants with both modes of delivery (C-section and vaginal delivery) who were intending to breastfeed and randomly assigned them to receive lactation support only (n = 32), or lactation support plus probiotic supplementation (n = 34).
The probiotic included bifidobacterium subspecies infantis (B. infantis), which has been shown to be lower among infants in general, particularly in resource rich countries (Frese et al., 2017). This is suspected to be due to a number of causes, including but not limited to mode of delivery, and mother and infant diet (Sirilun et al., 2015).
It is hypothesized that because breast milk contains prebiotic oligosaccharides not digestible by the infant but consumed by a limited number of species of Bifidobacterium, this probiotic supplement would allow this nutrient to be consumed and thus help with increased colonization of this beneficial bacteria (Frese et al., 2017).
Researchers gave the probiotic daily to infants on days 7 to 28 of their life, and stopped the probiotic after day 28. They assessed fecal samples on day 6, day 40, and day 60 (Frese et al., 2017).
Results
Infants that got the probiotic showed:
- Increased number of B. infantis in their stools beginning on day 10 and persisting at the same level until day 60, over 30 days after probiotic was stopped (Frese et al., 2017)
- Fewer and better formed stools (Smilowitz et al., 2017)
- Lower fecal milk oligosaccharides (suggesting these nutrients were consumed by B. infantis in the probiotic group) (Frese et al., 2017)
- No differences compared to the control group in terms of body temperature, antibiotic use, medication for gas, jaundice diagnosis, colic, eczema, illness, or sick doctor visits (Smilowitz et al., 2017)
- 90% decrease in antibiotic resistant genes compared to controls (Casaburi et al., 2019)
- Reduction in proinflammatory cytokines on days 40 and 60 compared to baseline and control infants (Henrick et al., 2019), suggesting reduced inflammation in probiotic group
Study Limitations
Findings listed above were all from one small group of patients and all appear to be conducted by the same research group. Although the study had strengths like including a control condition and have multiple assessments before and after administering the probiotic, there are several limitations to consider.
First, the study had small samples. All the above findings were based on this one sample, and the fecal samples were analyzed using various technologies. Finally, the studies were conducted by the same research groups and some of the funding came from the industry that sells the probiotic product Evivo. I would love to see an independent group replicate these findings. If that were to occur, findings would be considerably more compelling.
My Takeaways
What to feed or not feed your infant child is an extremely personal decision, but my hope with this post is to present the evidence and allow you to make an informed choice.
For me, the evidence of potential benefit is compelling enough to make it worth a try. From the research I have reviewed, I have not seen anything to suggest that healthy individuals are harmed by probiotics. At worst, they may just be a waste of money.
This is the first study I’ve seen to suggest a potential benefit of probiotics beyond the period someone is taking them. If this probiotic can in fact add B. infantis and then continued breast milk can supply the oligosaccarides to continue feeding these beneficial bacteria, then its possible this effect could continue later in the infant’s life. That said, much more research is needed to confirm whether this is the case, and I hope the researchers will conduct these longer term studies.
I gave this product to my daughter when she was 7 months old, for 2 months. I reviewed the evidence again, and plan to give it to my son a bit earlier, just for a month this time. I figure, it will either help create a longer lasting colonization of B. infantis or not. I saw no negative side effects with my daughter and I hope the same will be true for my son.
Also, this research sheds light on the fact that if we are seeing some of these promising findings in infants, and we are not seeing any studies like this in adults, perhaps provides further evidence that probiotics in adults are currently claiming much more than they are actually doing. That is, if probiotics could do this in adults (show increased beneficial bacteria months after people stopped the probiotic), wouldn’t we have seen a study like this already?
What Do You Think about Probiotics?
What have your experiences with probiotics been? Helpful? Unhelpful? Do you think they are worth their cost? I would love to hear from you!
Have you seen promising research for probiotics in adults or otherwise? I’d love to hear about studies I may have missed.
This blog is intended for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
References
Casaburi, G., Duar, R. M., Vance, D. P., Mitchell, R., Contreras, L., Frese, S. A…. Underwood, M. A. (2019). Early-life gut microbiome modulation reduces the abundance of antibiotic resistant bacteria. Antimicrobial Resistance and Infectino Control, 8, 131.
Frese, S. A., Hutton, A. A., Contreras, L. N., Shaw, C. A., Palumbo, M. C., Casaburi G….Underwood, M. A. (2017). Persistence of supplemented Bifidobacterium longum subsp infantis EVC001 in breastfed infants. mSphere, 2, e00501-17. https://doi.org/10.1128/mSphere.00501-17.
Henrick, B. M., Chew, S., Casaburi, G., Brown, H. K., Frese, S. A., Zhou, Y., Underwood, M. A., & Smilowitz, J. T. (2019). Colonization by B. infantis EVC001 modulates enteric inflammation in exclustively breastfed infants. Pediatric Research, 86, 749-757.
Sirilun, S., Takahashi, H., Boonyaritichaikij, S., Chaiyasut, C., Lertruangpanya, P., Koga, Y., & Mikami, K. (2015). Impact of maternal bifidobacteria and the mode of delivery on Bifidobacterium microbiota in infants. Beneficial Microbes, 6, 767–774. https://doi.org/10.3920/BM2014.0124.
Smilowitz, J. T., Moya, J., Breck, M. A., Cook, C., Fineberg, A., Angkustsiri, K. & Underwood, M. A. (2017). Safety and tolerability of Bifidobacterium longum subspecies infantis EVC001 supplementation in healthy term breastfed infants: a phase I clinical trial. BMC Pediatrics, 17, 133.