Written by: Dr Anubhav Jain
We often take probiotics thinking they will help fix our gut issues. But more often than not, they aren’t doing much. Probiotics may be living bacteria that help the body digest food but they have to interact with an entire community of bacteria, viruses and fungi, what we call the gut microbiome, and this is unique to each individual. Which is why they cannot have a uniform effect.
The gut microbiome differs from person to person
Individual microbiomes vary, meaning a probiotic supplement that helps one person could disrupt another, causing gas or bloating. That’s because the probiotic strain in your supplement may not be right for your specific issue; they can displace beneficial native bacteria even. This has risks, especially for immunocompromised individuals, potentially leading to infections or side effects like diarrhoea.
Patients who suffer from sensitive guts or slow gastrointestinal motility may find themselves with more gas, bloating, cramping, or discomfort after introducing probiotics in their diets. The reason is that the additional bacteria can create a greater amount of fermentation and digestion in their intestines than would occur from normal digestion and eat through the excess sugars that contribute to gas formation.
Nobody knows which bacterial strain can work
Most commercially available products do not contain the right bacteria specifically for each individual’s medical condition. Each person’s gut has trillions of different types of microorganisms and, therefore, it’s difficult for a physician to determine the exact mix of microbes that need to be present to correct the imbalance within a person.
Most of the over-the-counter probiotics have a limited number of the bacteria, mostly commonly used micro-organisms. If these probiotics pass through the stomach and reach the intestines, they may not be present in sufficient numbers to colonise the intestines effectively or may not survive the cardiovascular (blood and lymph) systems to make their way to the intestines. Consequently, they will not work to correct the problems in the digestive tract that were originally causing the problems.
Also, by using a generic strain, you may take longer to determine what the actual cause of your symptoms is. Generic strains sometimes worsen bloating and discomfort in some cases. Research shows mixed results regarding the effectiveness of probiotics for chronic gut conditions.
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They don’t solve all gut problems
Many times, probiotic supplements do not provide relief from symptoms because the cause of gut problems may actually be outside of just a lack of healthy bacteria. Multiple issues may require medical attention and not probiotics. These include blood in stools, colorectal cancer, H. Pylori infection and Inflammatory Bowel Disease (IBD). All of these have an inside problem that is either inflammatory, infectious, or structural.
I have had patients who took probiotics for six months to address blood in the stool and abdominal pain. Then they were diagnosed with IBD or colorectal cancer. In cases of IBD, the gut lining is damaged and inflamed, and so anti-inflammatory or immunomodulating medications must be used. Those who have H.pylori infection often experience stomach acidity and continue to have persistent pain after taking probiotics. Here only antibiotics and acid-suppressing medicine can work.
Probiotic supplements are not regulated
The packaging may make tall claims but keeping probiotics, which are living organisms, alive through manufacturing, transport and storage in controlled conditions, is a tough task. The user cannot check if their favourite probiotic brand is feeding them dead bacteria.
If you have an ongoing gastrointestinal issue, consult a doctor so that you do not miss any underlying medical condition. Include whole and fermented food in your diet for better results.
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(Dr Anubhav Jain is senior consultant, gastroenterology and unit head, Max Hospital, Gurugram)