Are pre­scrip­tion pro­bi­otics worth the money?

A well-nour­ished gut has be­come as cov­eted a health goal as com­plet­ing the rings on your Ap­ple Watch, so Dr Me­gan Rossi puts per­son­alised pro­bi­otic pre­scrip­tions un­der the mi­cro­scope

Women's Health (UK) - - IN THE KNOW -

We sus­pect you could cor­rect an er­ro­neous pronunciation of lac­to­bacil­lus. You may have even con­sid­ered brew­ing your own kom­bucha, and you’re in good com­pany around here if you’re just a lit­tle bit turned on by talk of ‘live cul­tures’. For a sub­ject that’s got a lot to do with poo, gut health is pretty sexy th­ese days, and, with links to good di­ges­tion, men­tal well­be­ing and a strong im­mune sys­tem, you can see why. Pro­bi­otic sup­ple­ments them­selves are noth­ing new – ev­i­dence sug­gests that they help sup­port the nat­u­ral bal­ance of bac­te­ria in your gut when it’s been dis­rupted by treat­ment or spe­cific ill­nesses – but some com­pa­nies are now claim­ing that a per­son­alised ap­proach is best. The prom­ise is that, for around a hun­dred quid (granted, a hefty price tag) and a stool sam­ple in the post (did I just say gut health was sexy?), they can iden­tify which bac­te­ria you’re lack­ing and pre­scribe a pro­bi­otic supp unique to your needs. If it sounds too good to be true, that’s be­cause it prob­a­bly is – for now, at least. There’s ev­i­dence to sup­port tak­ing pro­bi­otic supps in cer­tain sce­nar­ios. Dur­ing a course of an­tibi­otics, they can sup­port your gut de­fences, which will be damp­ened by the drugs, help­ing to pre­vent di­ar­rhoea*. And, if you suf­fer from IBS, they could help re­duce symp­toms, al­though it’s not cer­tain which strains are ef­fec­tive*. Also, some va­ri­eties could help keep tummy trou­ble at bay when you’re trav­el­ling abroad*. But sci­en­tists are yet to prove for cer­tain what the spe­cific ben­e­fits are for healthy peo­ple. The prob­lem? A fam­ily of pro­bi­otics – such as lac­to­bacil­lus – con­tains hun­dreds of dif­fer­ent strains, each of which can have a hun­dred dif­fer­ent func­tions in the body. Test­ing ev­ery one is im­pos­si­ble, at least with ex­ist­ing tech­nol­ogy, as each strain is con­stantly chang­ing. And even the stuff we know to be ‘good bac­te­ria’ doesn’t have an RDA, mean­ing we don’t know the op­ti­mal amount. So no lab – no mat­ter how much you pay – can as­sess ex­actly what you might be miss­ing in or­der to top you up ac­cord­ingly. As for the idea of ‘mi­cro­biome dys­bio­sis’ – or un­bal­anced bac­te­ria – it’s ba­si­cally fake news. So, if we’re not there yet, where are we? Sci­en­tists are us­ing stool sam­ples to build on their knowl­edge of bac­te­ria lev­els in the gut. Then there are fae­cal trans­plants – which in­volve (brace your­self ) a poo sam­ple from a healthy donor be­ing in­serted into the body of an ill per­son – used to treat a se­vere ill­ness called clostrid­ium dif­fi­cile in­fec­tion. But fork­ing out for your own army of bac­te­ria? Nice, but, like mono­grammed lug­gage, prob­a­bly not worth the money. What, then, can you do for your gut bac­te­ria? Well, eat­ing a wide range of fruit, vegeta­bles, nuts and seeds has a pre­bi­otic ef­fect, which means that your gut bac­te­ria feed off their di­etary fi­bres. Fer­mented foods can also be help­ful. Like pro­bi­otic sup­ple­ments, there isn’t clin­i­cal ev­i­dence yet to show that the live cul­tures in foods like kim­chi, sauer­kraut and kom­bucha have any real im­pact on your mi­cro­biome, but if you like the taste, what’s the harm? My ad­vice? Sip on some ke­fir and sit tight un­til the sci­ence catches up.

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