ST. JOHN'S, N.L. — You may have seen the television spots.
A healthy-looking office worker meanders around the open workspace spooning yogurt out of a small container.
She looks happy. So happy, in fact, that in place of her stomach, there’s a superimposed torso of a belly dancer in full wiggle.
The ads for Activia came out in 2008 and helped usher in an explosion of marketing campaigns for products featuring probiotics, or “good” bacteria.
Yogurt is made from bacterial culture and milk, so there’s been no mystery about its contents. But the benefits of that ingredient have captured imaginations in the past couple of decades, boosted in large part by research into fighting gastrointestinal disease through the use of probiotics.
The term is a broad one.
“Probiotic means the opposite of antibiotic,” said Dr. Peter Daley, an infectious disease specialist at Memorial University’s school of medicine. “It’s something that’s giving you live organisms as a treatment.”
But Daley’s treatments are a little more involved than just popping a supplement or snacking on yogurt.
He deals with patients with severe C. difficile intestinal infections (the bacteria is named for the fact it’s difficult to grow in a laboratory).
A relatively new approach called fecal transplant has changed the outlook for many of these people.
“The idea of a fecal transplant is to try to give someone else’s microbes to a patient who is sick because of their own microbes being disordered.”
In Daley’s case, that means giving 20 large capsules that contain the complete “ecology” of someone else’s intestine. The pills are usually frozen to help them go down.
If you think that basically means feeding a patient someone else’s poop, you’re right.
“It’s exactly what we’re doing, and we make it very clear to the patient when they finally consent,” Daley said.
Why would anyone agree to it?
“My experience is that the patient is more than happy to try to get relief from the chronic diarrhea problem that they have.”
“Probiotic means the opposite of antibiotic."
— Dr. Peter Daley
Daley’s capsules are nothing like the supplements found on store shelves.
A small survey of local health food outlets found that interest in probiotic supplements varies. Some are doing a brisk business, while others aren’t selling many at all.
“It’s not something I’d invest in,” joked one retailer.
But no one reported a rise or fall in sales.
There is some evidence to suggest probiotics may help as a preventive measure, such as taking them with antibiotics to maintain the balance of good bacteria that may otherwise be killed off by the drug.
There’s one small problem with consumer supplements, though.
Part of the stomach’s purpose is to break down harmful bacteria that are routinely ingested through daily intake of food and drink.
The capsules given for fecal transplant have a coating that prevents them from being digested by stomach acids. The microbes pass through the stomach and are released in the colon.
“But the average, over-the-counter probiotic is not protected from the stomach, so that means (the bacteria) is killed on its way down to the colon,” said Daley.
3.9 million Americans have taken some form of probiotics with many hoping to improve their gut health. But what does the...
Posted by American Gastroenterological Association (AGA) on Tuesday, June 9, 2020
Probiotic guidelines
Guidelines released last week by the American Gastroenterology Association throw cold water on a lot of presumptions about the benefits of probiotics.
It does not recommend using them for much of anything, other than possibly prevention of diarrhea while taking antibiotics.
“Reading through them, I’m not surprised they’re not big on probiotics as a treatment, because really the evidence is not there,” Daley said.
“It’s not scientifically black and white that there’s a benefit.”
That doesn’t mean they don’t hold any promise.
“There might be some benefit,” he said about their use with antibiotics. “It’s not a slam dunk.”
Moreover, the research is still very new. It’s focusing on a lot of possible fronts, including a possible link between gut microbes and neurological problems such as autism.
But for everyday use, Daley is skeptical.
“I would not recommend with patients that they take probiotics when they’re perfectly healthy.”
Peter Jackson is a Local Journalism Initiative reporter covering health for The Telegram.
