In recent years, probiotics have been touted as a health panacea. But the supplements are still shrouded in mystery. They contain live microorganisms that support or increase the “good” bacteria in the body, according to the Mayo Clinic. And all these tiny living things combine to create your microbiome, which drives overall health and well-being. That’s the theory, anyway.  

Today, probiotics are added to foods and sold over the counter as supplements at drugstores and supermarkets. But while taking them is easier than ever, do they work? Should you add them to your daily routine?  

For answers, we turned to Geoff Wall, PharmD. He’s the director of the Drake Drug Information Center and professor of clinical sciences at Drake University in Des Moines, Iowa.  

What is the microbiome? 

Wall: Your body harbors billions of bacteria, fungi and viruses. Together, these living creatures are known as microbiota. Your microbiome is your microbiota plus their genes and the substances they make. Microbiota carry out many functions. They aid digestion. They protect against certain diseases. They boost metabolism and produce vitamins. They affect mental health. We each have a unique microbiome. The human body cannot function normally without it. 

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What role does the microbiome play in gut health? 

Wall: Most bacteria in your microbiome live in your gut. Your gut includes your mouth, esophagus, stomach, pancreas, liver, gallbladder, small intestine, colon and rectum. Decades of research shows that gut microbiota play 2 big roles. They help you digest food and absorb nutrients, and they help protect your gastrointestinal [GI] tract from unwanted germs that can cause GI infections. 

Newer research suggests that the gut microbiome also helps to control inflammation. Experts believe that if you disrupt the gut microbiome with bad bacteria, you might increase your risk of health issues beyond the GI tract. Examples include lung and heart disease or joint issues. How and why? That is still being researched. 

What is in an over-the-counter probiotic pill?

Wall: In most cases, we don’t know. Probiotics are not regulated by the U.S. Food and Drug Administration. When it comes to OTC probiotics, it’s a “buyer beware” situation. 

Probiotics should have high numbers of microorganisms that make up the gut microbiome. The most common bacteria in over-the-counter (OTC) probiotics are Lactobacillus and Bifidobacterium. Many supplements also include live yeasts, the most common being Saccharomyces boulardii. The types and amounts of bacteria and yeast vary from brand to brand. A good rule of thumb is to look for those 3 ingredients while shopping for probiotic supplements. 

When are probiotics truly helpful? 

Wall: Since probiotics aren’t regulated, it’s been hard to carry out controlled studies on how well they work. We have the most data on how probiotics have helped individuals taking antibiotics. Antibiotics kill bad bacteria. But when taken by mouth, they can also harm good bacteria in your gut and disrupt the balance in the microbiome. This can lead to stomach issues such as diarrhea. 

Studies have shown that taking a probiotic a few hours after an antibiotic dose can reduce these symptoms. Still, this hasn’t been proven by clinical trials and does not work for everyone. 

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Should you take probiotics for your general health?

Wall: For an average healthy person, taking a daily probiotic isn’t helpful. That said, if your immune system is healthy, taking probiotics likely won’t cause harm, except maybe to your wallet. 

Now, if you have something such as irritable bowel syndrome and your gut microbiome is disturbed? A probiotic could help by restoring some of that good bacteria. There’s also no harm in trying probiotics for more severe GI diseases such as Crohn’s disease and ulcerative colitis. But again, it’s hard to find any clinical trial data that can speak to the benefits of these supplements. That’s why it’s always a good idea to check with your doctor before adding any supplement to your routine. 

What are some other ways to improve gut health?

Wall: Your gut health is affected by your lifestyle, especially your daily food choices. For good gut function, eat a well-rounded diet rich in whole foods. You can’t do much better than eating fruits, vegetables, legumes and beans. These foods are all great sources of fiber, which feeds the good bacteria in your gut. You can also eat foods that contain live and active cultures, such as yogurt, buttermilk, cottage cheese and kombucha. These foods are natural probiotics. They restore the good bacteria and yeast in the gut microbiome. Bottom line? It’s always better to manage your gut from food, when possible. In most cases, that will be more effective than an OTC pill. 

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Additional sources
Overview of probiotics:Mayo Clinic  
Overview of the microbiome: Microbiome (2020). “Microbiome definition re-visited: old concepts and new challenges.”