Reviewed by Dietitian Kelly Plowe, M.S., RD
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Key Points
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Probiotics may help prevent C. diff infections after taking antibiotics or following surgery that leads to pouchitis.
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A high-fiber diet rich in fermented foods lays the groundwork for good gut health.
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Consult a healthcare provider if you experience issues like bloating, weight loss, or abdominal pain.
Probiotic supplements are often touted as a solution for various digestive issues, but do they actually work? To find out, we consulted leading gastroenterologist Trisha Pasricha, MD. Her insights may shift your perspective on probiotics. While these supplements can be beneficial in certain instances, they are not a cure-all and might not be necessary for most individuals.
“The probiotic industry is worth billions, yet for many, they don’t provide the miraculous results they claim,” Pasricha explains. Emerging evidence indicates that a fiber-rich diet is far more effective for supporting the microbiome and enhancing gut health. “If you’re looking to invest in your gut, I recommend starting there,” she adds.
To dive deeper into when probiotics may be beneficial and why a diet aimed at gut health is often more advantageous, keep reading.
When Probiotic Supplements Are Beneficial
According to Pasricha, most people likely do not need to take probiotic supplements. In fact, the American Gastroenterological Association (AGA) generally advises against using probiotics for most digestive concerns due to insufficient clinical evidence.
While existing research on probiotics is plentiful, variations in study methods, strains, dosages, participant demographics, and findings make it difficult to draw clear conclusions about who may benefit, states Pasricha.
However, there are specific situations in which probiotics may be helpful for adults, supported by clinical guidance:
Preventing C. difficile Infection During Antibiotic Use
Research indicates that certain probiotics can reduce the risk of developing a bacterial infection known as Clostridioides difficile (C. diff), especially when antibiotics are involved. A well-balanced microbiome helps fend off infections like C. diff, but antibiotics can disrupt this balance, increasing susceptibility to infections.
It’s crucial to note that not all probiotics will be effective for this purpose. Researchers highlight specific strains and combinations that can help prevent C. diff, including S. boulardii, a 2-strain blend of L. acidophilus CL1285 and L. casei LBC80R, among others.
Management of Pouchitis
For individuals with inflammatory bowel disease who have undergone bowel surgery and developed pouchitis, specific probiotic combinations may offer benefits. Research indicates that an 8-strain combination—including L. paracasei subsp paracasei, L. plantarum, L. acidophilus, L. delbrueckii subsp bulgaricus, B. longum subsp longum, B. breve, B. longum subsp infantis, and S. salivarius subsp thermophilus) may be helpful.
In Most Cases, Probiotics Are Not Essential
“Some people do report feeling better while taking probiotics, and personal experiences can be valid,” Pasricha notes. “However, I often see patients who invest considerable money in supplements without addressing the underlying causes of their symptoms, which may include factors like stool consistency, fiber consumption, gastrointestinal motility, or stress.”
The AGA advises the use of probiotics only when a clear, documented advantage exists. They highlight the lack of evidence supporting probiotics for treating C. difficile infection, ulcerative colitis, Crohn’s disease, or irritable bowel syndrome (IBS).
All the hype surrounding probiotics—especially claims related to detoxification—can lead to unnecessary apprehension and may detract individuals from addressing real health concerns, Pasricha warns.
“If someone is experiencing persistent issues like bloating, discomfort, weight loss, or bleeding, relying on a probiotic instead of seeking proper medical assessment is misguided,” she advises. “Supplements can create a false sense of action while essential concerns remain unaddressed.”
Prioritizing a Healthy Diet Is Typically More Beneficial
Whole foods offer gut health advantages that probiotics cannot replicate, according to Pasricha. Foods particularly beneficial for gut health include fermented options such as kimchi, sauerkraut, plain kefir, miso, and yogurt with live cultures. Additionally, fiber-rich foods—like fruits, vegetables, whole grains, legumes, nuts, and seeds—are crucial as they nourish beneficial gut microbes and support a diverse microbiome.
“The greater the variety of plant-based foods you consume—fruits, vegetables, legumes, nuts, and whole grains—the more resilient your microbiome becomes,” Pasricha states. “Supplements cannot replace that essential foundation.”
Guidelines for Choosing Probiotic Supplements
If you’ve ventured into the world of probiotic supplements, you’re aware of the vast array available. However, not all probiotics are created equal. Differences in strains, dosage, and efficacy can significantly affect their effectiveness.
“Quality can vary between brands, so selecting a product backed by a reputable third-party can offer some peace of mind, though it won’t change the limitations surrounding the evidence,” Pasricha cautions.
Since probiotics are not regulated by the FDA like medications, they do not undergo the same rigorous testing. “This lack of regulation complicates the establishment of strong, universal guidelines,” Pasricha emphasizes. Furthermore, the quality and potency can differ significantly from one product to another.
Be cautious of any marketing claims related to detoxing or cleansing—these often should raise concerns. Pasricha agrees: “Any product promoted with fear-based narratives should be approached with skepticism.” Probiotics are generally safe for healthy individuals, but those who are immunocompromised or critically ill should exercise caution, she adds.
Final Thoughts from Our Expert
Probiotic supplements can be beneficial in specific cases, such as when preventing C. diff during antibiotic treatment or when managing pouchitis after bowel surgery. However, substantial evidence supporting their broader use remains insufficient. If you have digestive concerns like bloating, weight loss, or pain, it’s advisable to consult a licensed healthcare professional instead of investing in supplements that may not be effective.
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