Using one kind of “natural” bacteria to combat another is well studied in this condition, and the offending pathogen is well known. This practice cannot be automatically translated to the treatment of other conditions. Researchers do not yet know which strains to select for specific physical and clinical conditions, the effect of different doses, or the effect on mechanisms or function.
Patients have reported weight gain and mood changes after receiving stool from overweight and/or “unhappy” donors. While this feedback may be anecdotal, there is some research linking changes in the microbiome and weight gain. (See chapter 9, “The Microbiome.”)
The Downside—Quality Control
A 2015 study at the Center tested 22 probiotic products purchased commercially and examined them for gluten. About 30 percent of them had some form of gluten that was not listed on the label. As a result, we feel that supplement labels claiming a product is gluten-free cannot currently be trusted.
This in some ways reconfirms a previous study we did showing that patients with celiac disease who regularly took supplements had more symptoms than those who did not take supplements. Interestingly, they also reported a higher quality of life. This may attest to the placebo effect of supplements—they make people better because we expect them to. The “action” would appear to be more brain than gut.
It is unclear whether the levels of gluten found in the probiotics tested posed a risk to people with celiac disease, but the results reflect the underlying problem of supplement oversight, regulation, labeling, and testing.
Are the Products Viable?
Over-the-counter pills may not be a viable source of live bacteria. The probiotics in food (yogurts and acidified milks in cold storage) are usually produced with stricter control and contain viable amounts if stored properly and consumed before the expiration date.
Like other supplements, probiotics are produced and labeled with little oversight from the FDA or other agencies that guard consumer health interests. The consumer is currently not buying the carefully regulated probiotic mixtures used in research studies.
Reading Labels—“Doctor Recommended”?
“You see what you expect to see, Severus.”
—ALBUS DUMBLEDORE IN J. K. ROWLING’S HARRY POTTER AND THE DEATHLY HALLOWS
Unethical marketing claims abound in supplement advertisements. Word-of-mouth endorsements coupled with aggressive advertising on every form of traditional and social media have fueled the supplement boom. Great examples are the products marketed as digesting gluten—a claim that is blatantly false. The pharmaceutical industry is currently developing and testing enzymes that will digest the toxic fragments of gluten that cause celiac disease, but none of the currently available products do this. (See chapter 30, “Nondietary Therapies.”)
The brain-gut connection is quite clear: We want to believe the claims, and some people actually feel better on supplements. This may be a placebo effect, but that has not been well studied. Unfortunately, supplements make many people sick from trying to correct conditions they never had.
Until we understand the composition, diversity, function, metabolic capacity, and plasticity of the microbial communities within us, attempting to manipulate them will continue to be somewhat hit-or-miss.
A Word of Advice
Real estate agents always advise: location, location, location. The microbes that inhabit the mouth are different from those found in the stomach, the small intestine, and the large intestine. Therefore, if microbes are to be studied in terms of their communication with the brain and body, researchers must first determine which bacteria and which gut area to target in any given therapy.
By inserting one type of bacteria to knock out another, what else is being destroyed or affected? The human gastrointestinal tract is a bacterial ecosystem with a genetic makeup almost 100 times the size of the human genome. We are therefore an amalgam of both our human genes and microbial “selves.” And the interaction of the two is largely unexplored territory. Probiotics are an exciting area of research but should be ingested with great caution.
There are 3 billion base pairs of nucleotides in the human genome engaged in a vast and complex dance that makes us who we are. We need to be awfully careful when we start to change the choreography, especially given our current lack of precision. When you try to move one dancer with a bulldozer, you’re pretty darn certain to scoop up more than one Rockette.
—DR. SHARON MOALEM, SURVIVAL OF THE SICKEST
Summary
Supplements are overused and understudied regarding their effectiveness and safety. It is an industry that advertises heavily but lacks thorough regulatory oversight and quality control. Heavy metals, banned animal, pharmaceutical, and plant products, steroids, untested ingredients, and prescription medications are found in various supplements.
While prescription drugs must be proven safe and effective before they are marketed, probiotics and other dietary supplements do not need to pass that test. Every year contents are withdrawn because of toxicity—after the fact. One case report of a death in a child due to contamination with a fungus is enough to dampen enthusiasm.
As a 2014 news item from Columbia University noted: “This year marks the 20th anniversary of the passage of one of the most skillful pieces of legislation ever to undermine the health of Americans: the Dietary Supplement Health and Educational Act of 1994. The result was to remove from regulation by the Food and Drug Administration any substances labeled as a dietary supplement.” It is time to take a hard look at the various vitamin, mineral, and probiotics bottles in your “medicine” cabinet and on your kitchen counter. Be well advised that you may be flushing money—quite literally—down the toilet and, more important, jeopardizing your health. Too many people are taking supplements and probiotics while removing the foods that naturally contain these vitamins and minerals from their diets.
While some dietary and medical supplementation is useful, much of it simply reflects media trends that we can enhance and increase our health with a fix-it pill. It is as enticing as it is unrealistic.
Natural does not mean safe.
A Word on Testing—What Do Antibodies Tell Us?
Test first, then you treat right.
—NORTH AMERICAN SOCIETY FOR THE STUDY OF CELIAC DISEASE
Many people complain that they are “simply lab results” to their doctors. But these tests are often the most effective way of finding—as well as ruling out—serious conditions and avoiding complications. Rushing to self-diagnose gastrointestinal distress can mask a serious condition or prolong symptoms that can be cured if recognized and treated medically. Lab tests cannot resolve every issue, and they can lead to false conclusions, but they can quickly pinpoint and/or eliminate the causes of many GI complaints.