According to a survey by the National Center for Health Statistics, 3 million more adults in the United States used probiotics or prebiotics in 2012 than did in 2007. Between 2014 and 2018, sales of probiotic supplements grew from $299.9 million to $395.35 million. By the year 2027, the global probiotic supplements market is expected to experience an annual growth rate of 10.43 percent, reaching $3.28 billion by 2027.

What is the engine driving all this growth? According to recent reports, it’s because of the increasing prevalence of digestive diseases and diarrhea, due to changing food habits and lifestyles. Should you hop on the probiotics supplement bandwagon, or are you better off sticking with fermented foods?

Why All the Talk About Probiotics?
About 3,000 years ago, Hippocrates — the “father of medicine” — declared that “death sits in the bowels,” adding that “bad digestion is the root of all evil.” He may have been more correct than we realized.
Interestingly enough, “probiotic” means “for life.” Probiotics are defined as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host” — the hosts being human beings.

Scientists have been aware of these organisms for a long time. At the beginning of the 1900s, Louis Pasteur — the scientist who came up with pasteurization — identified the microorganisms required for the process of fermentation. These were the good bacteria present in milk.

At about the same time, another scientist named Ilya Ilyich Metchnikoff, a Nobel Prize winner found that people living in rural Bulgaria, despite poverty and a difficult climate, lived much longer than European city-dwellers. His research led him to believe it was the yogurt the people regularly consumed that protected them. He theorized that the microorganisms in the yogurt — what we know as probiotics today — were counteracting the effects of the digestive system on illness and aging.

Good and Bad Bacteria Living Together Harmoniously
He went on to form the basic theory of the microbiome that we have today: the idea that the gut is filled with a thriving community of good and bad bacteria and if the balance between the two is thrown off, the bad bacteria run amok, causing damage in the intestine and, eventually, throughout the body.
As for the fermented foods in which good bacteria come from, they’ve been around for thousands of years and were often used for nutritional and therapeutic purposes. Yogurt, cheese, kefir, and other fermented foods have long been a staple of the healthy human diet.

“The history of probiotics goes parallel with the evolution of the human race,” write researchers in a 2015 study, “… can be traced back to the ancient times, nearly 10,000 years ago.”

Recently, scientists gained new tools that have allowed them to study the microbiome in-depth, accelerating the research and opening our eyes to how much the gut affects everything else in the body.

We now know that a healthy microbiome can promote overall health and wellness, which has led people to shower their guts with supplements of good bacteria in the hopes of experiencing optimal health or at least solving certain digestive ailments. The question is, do probiotic supplements really help?

What We Know About the Microbiome So Far
Scientists have learned a lot about the microbiome since the early 1900s. We now know that inside the digestive tract are trillions of microorganisms, including bacteria, fungi, and viruses. This community is unique to each person and varies depending on genetics, the birthing process (natural or Cesarean), diet, lifestyle, where we live, and more.

The microbiome starts developing at birth when microbes colonize the human gut during delivery. Studies have found that babies delivered naturally have greater gut bacterial counts than those delivered by Caesarean section because of the contact they make with the mother’s vaginal and intestinal bacteria.

We know that taking antibiotics — the opposite of probiotics — kills both the good and bad bacteria we have in the gut and can dramatically alter that community. The body rebuilds over time, but overuse of antibiotics may create longer-lasting problems.

Diet has been found to have a large influence on the microbiome, with the typical Western diet, in particular — which is high in fat and sugar and low in fiber — resulting in a less diverse and, therefore, less-healthy microbiome.
We also know now the health of the microbiome has a far bigger impact on overall health than we suspected.
Currently, we have evidence that it affects:

•  Digestion
•  The health of the gastrointestinal tract (unhealthy microbiome linked with Crohn’s disease, ulcerative colitis, and even irritable bowel syndrome)
•  Strength of the immune system
•  Mental health — an unhealthy microbiome has been linked with depression
• Several studies that have been published during the last decade or so have also linked gut microbiome to diseases and conditions like autism, anxiety, obesity and heart disease.

This area of study is very complex, however, and scientists will continue to dive into it for years to come. Meanwhile, there is much that remains unknown. For one, we still can’t define what a “healthy” microbiome looks like exactly, and we have no way to test a person’s microbiome to find out if it’s healthy or not.
We don’t know which microorganisms perform best for us as there are so many to study. Which ones do we need to enjoy good digestion, for example, or long life?

Perhaps most importantly, we don’t know whether taking probiotic supplements is helpful or harmful when it comes to health.

Should You Be Taking Probiotics?
Starting in the later 1990s, supplement manufacturers began distributing probiotic supplements in a variety of forms, from powders to tablets to drink mixes. Companies producing probiotic foods like yogurt, kefir, and kombucha also began to advertise their products as good for digestive health because of their probiotic content.

Consumers started to get the message. Probiotics were healthy and could help counteract the damage done by antibiotics as well as make digestion smoother and easier. Probiotic supplements began to fly off the shelves.
There are a few problems with these products, however. First, because they’re sold as dietary supplements, they’re not regulated by the US Food and Drug Administration (FDA), so we have to rely solely on the companies producing them to deliver quality products that contain what they say they do.

Reading the Label Not Always Useful
Various tests on supplements in the past — including probiotic supplements — have revealed that many don’t contain what’s listed on the label. One test conducted by ConsumerLab.com found that eight of the products contained less than 1 percent of the claimed number of live bacteria. Six had only a few thousand live bacteria — not nearly enough to do any good.

Second, there is no recommended daily intake for probiotics. How many do you need? No one knows, because science hasn’t answered this question yet and because everyone’s microbiome is different. What you need may be completely different from what another person needs.

A bottle may contain around 10 billion colony forming units (CFUs), but is that enough? According to one test, just one serving of fermented vegetables contained the same number of good bacteria as an entire bottle of probiotics, which leads to the question of whether those supplements are helpful at all.
On top of that, even if the bottle says each serving gives you 10 billion CFUs, there’s no way to know if you’re getting that many when you take the supplement. Manufacturers typically refer to the number of CFUs present at manufacture, but exposure to heat, moisture, and oxygen can all affect the survival of the probiotics.

Third, there is the question of whether the probiotics in a supplement can survive the harsh stomach acid to make it to the intestines where they need to be. The American Nutrition Association states that in general, “Lactobacillus, Bifidobacterium and Streptococcus species do not need enteric coating as they can survive passage through the stomach.
However, L. bulgaricus and S. thermophilus, as well as, Leuconostoc and Lactococcus species, cannot survive passage through the stomach.”

Some manufacturers are adding coatings or putting their products into shielded capsules to help protect the bacteria, but this remains an area of continuing research.

Foods also have a wider variety of microorganisms than supplements do, which may be one of the ways they promote good health. Probiotic supplements have only a limited number of species — those that scientists believe are most beneficial, based on what they know so far — but considering we have so much to learn, that’s not a huge vote of confidence.
Then, there’s the cost. Often, probiotic supplements cost more for the CFUs you get than fermented foods do. Probiotics are being added to some food products now, like smoothies, nutrition bars and even chocolates but, so far, we have no evidence about how well any of these cultures may perform in the human body.

Best Foods to Eat for Probiotics
Considering all the information above, it’s probably best to start with fermented foods before turning to probiotic supplements. That brings us to the next question: which foods are best?

There are some fermented foods that people mistakenly believe contain live cultures of healthy bacteria. Those that are heat-treated, for example, have inactive cultures as the heat kills them. Bread is baked, for example, so it doesn’t contain any probiotics. Sauerkraut, too, is often canned, which can result in a few active cultures. Beer and wine undergo processing that removes live bacterial organisms.

Fermented foods that do provide live cultures include the following:

•  Yogurt ― look for those labeled “contains live cultures or active cultures” rather than those that say “made with active cultures”
•  Kefir
•  Most cheeses like Gouda, mozzarella, cheddar, and cottage cheese
•  Unheated sauerkraut
•  Kimchi
•  Kombucha tea
•  Apple cider vinegar
•  No heat-treated apple cider
•  Fermented vegetables like beets and mustard greens
•  Pickles
•  Traditional buttermilk, not cultured buttermilk

There are some situations where a probiotic supplement may help. Talk to your doctor, but if you suffer from irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD), constipation and/or diarrhea or if you’ve just gone through a round of antibiotics, it may be helpful to try a quality supplement for a few months. Several studies have shown the benefits of probiotic supplements when used in people with these conditions.

To find a quality supplement, check for the following on the label:

•  What microorganisms are present? Look for those with multiple strains.
•  How many CFUs are in each serving? Look for numbers in the billions, not millions.
•  What is the expiration or “best by” date?
•  Storage recommendations — should it be refrigerated?
• Do be aware that probiotic supplements can cause side effects in some people, including:
•  Bloating
•  Constipation and diarrhea
•  Anxiety or irritability

If you experience any of these, try a different supplement.