As a physician who specializes in the treatment of gastrointestinal disease, I often ask new patients these two questions: “What treatments have you tried?”, and “Did they help?” Probiotics are time after time the most common response to this question. And if the probiotics had helped, that patient wouldn’t be sitting in front of me asking for my opinion. But there in front of me the patient sits, reporting little or no difference in symptoms after spending a significant amount of money on different types and brands of probiotics.
Why don’t probiotics work? Are they a just scam? Do we even need them if they don’t seem to help our symptoms? My answer to this is a resounding NO — probiotics are not a scam. Probiotics, which are a spectrum of beneficial bacteria that mostly colonize our large intestine, are incredibly important to overall health. They are documented to improve immune system function, prevent the development of antibiotic-associated and infectious diarrhea, decrease allergies, and they may even decrease your likelihood of developing cancer and coronary artery disease (1). Probiotics are by no means a scam. It is just that a deficiency or imbalance of probiotics in the colon is far from the only reason why people develop chronic intestinal symptoms.
So if probiotics aren’t the answer, what is? The answer to this question can vary greatly from person to person. This is why seeing a doctor that specializes in gastrointestinal illness can be incredibly helpful. Here are the top five conditions I see that are not helped by probiotics alone.
SIBO: SIBO is a disorder caused by an over-abundance of bacteria in upper intestinal tract (aka small intestine). The most common SIBO symptoms are gas, bloating, diarrhea, constipation, excessive abdominal fullness, and abdominal pain. While probiotics are typically a necessary part of the treatment of SIBO, they will only be helpful once we have eradicated the SIBO bacteria and treated the imbalances in the gut that allowed SIBO bugs to overgrow in the first place.
Multiple food intolerances: Patients with undiagnosed food intolerances can present with a variety of intestinal symptoms. The most common symptoms being abdominal pain or discomfort, GERD, belching, diarrhea, constipation, and excessive gas. Food intolerances can also cause systemic symptoms like fatigue, brain fog, irritability, weight gain, headaches, and joint or body pain. We can develop new food intolerances at any point in our lives, especially if there have been recent stresses on the body or gut.
Enzyme deficiencies: Many patients confuse digestive enzymes and probiotics, thinking that they are the same thing. But enzymes are entirely different substances with a very different function. When you eat a meal and the food hits your stomach, your pancreas secretes a very specific blend of enzymes that help you to break down food into tiny molecules that can then be absorbed through the intestinal lining. A similar but slightly different “enzyme” is hydrochloric acid, which is secreted by your stomach to assist in this same process. Lastly, the gallbladder releases bile which has a similar function as well. If food is not completely broken down by this specific constellation of enzymes, then we will not be able to absorb all the nutrients it contains. Additionally, undigested food traveling through the intestinal tract leads to fermentation, which causes belching, excessive bloating, gas, and potentially constipation or diarrhea. Down the line, long-term enzyme deficiencies are a direct cause of SIBO, GERD, and malnutrition, among other conditions.
Increased intestinal permeability (“leaky gut syndrome”): Leaky gut syndrome is a condition that results when the intestinal lining is damaged. In a perfectly healthy gut, the inner lining of our intestinal tract is held together securely by “tight junctions”, or cells that adhere very tightly to one another. These tight junctions allow only very small substances through, like water and micronutrients that we are absorbing from our food. But these cells can become inflamed and damaged, which then makes the area “leaky”. A leaky tight junction allows many substances to travel through the intestinal lining and hit the bloodstream that should not be allowed to do so — things like bacteria, larger food particles, and toxins (2). This can lead to variety of downstream effects in the body, including numerous inflammatory conditions as well as the development of more and more food intolerances over time. When I do food intolerance testing on a patient and they have more than 20 significant intolerances, I can be pretty sure that they also have leaky gut syndrome. When treating this condition, it is important to treat whatever caused the irritation/inflammation in the first place as well as repair the damage to the intestinal cell wall.
Celiac disease: About 1% of the population has Celiac disease, and this diagnosis is often misdiagnosed by physicians as IBS. Celiac is an autoimmune disease that causes patients to create antibodies against gluten, the main protein in wheat. This antibody reaction occurs specifically in the first part of the small intestine, which becomes essentially a “war zone” against gluten. As the battle rages on, the resulting inflammation damages the intestinal walls and causes severely increased intestinal permeability. These patients need strict gluten removal as well as treatment for any potential nutrient deficiencies that have resulted from short or long-term malabsorption. While probiotics are often helpful in the treatment of Celiac disease as well as many of these above conditions, they will not address the majority of the disease process and must be used in combination with a well-rounded treatment protocol.
Dealing with chronic intestinal issues can be incredibly frustrating and confusing. Often patients get little improvement with a single-system approach like probiotics, even though probiotics in and of themselves are often needed. This is where working with a trained medical professional can make all the difference. The key to a successful treatment protocol with low relapse potential is making sure to diagnose and treat ALL underlying conditions in a simultaneous fashion. Only then can the GI tract begin to heal and regain its normal function.
Dr. Katie Nuckolls is a naturopathic physician and owner of Thrive GI: Natural Digestive Medicine in Vancouver, Washington. She currently sees patients that live in Washington, Oregon, and Arizona using telemedicine. For more information, visit our contact page or schedule a free 15-minute consultation online.
(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045285/
(2) https://journals.physiology.org/doi/full/10.1152/japplphysiol.00536.2015