12 Mar Probiotics: Have you Been Misled?
Paul A. Goldberg, MPH, DC, DACBN, DCBCN
Goldberg Tener Clinic
Successfully Reversing Chronic Disease Since 1976
One of the most popular health and nutrition topics over the past four decades has been “Probiotics.” As with many health subjects, commercial interests have manipulated this topic leading to exaggerations and distortions. Let’s sort out the reality vs. the hype.
Interest in the role of gut bacteria began with the work of Élie Metchnikoff, a Russian Scientist whose research in 1882 led to his discovery of white blood cells known as phagocytes and the role of the immune system. He along with another German Jewish Scientist Paul Erlich are considered the Fathers of Immunology.
Metchnikoff developed the theory that aging is caused by toxic bacteria in the Gastrointestinal Tract and that lactic acid could limit their growth. Based on this he advocated the use of lactic acid cultures as found in yogurt. He attributed the longevity of some Bulgarians to consumption of these products. Yogurt and other fermented foods were thus destined to become health food staples.
By the 1980’s numerous companies were selling probiotic supplements. As a Professor of Microbiology and Clinical Nutrition I lectured and wrote on the systemic effects the environment of the GI Tract had upon health. Addressing the role of the gut microflora was an integral part of the discussion.
The composition of what is now known as the Microbiome drew increasing attention by scientists, practitioners, laboratories and vendors. The publication of the Hygiene Hypothesis by Dr. David Strachan further increased interest in Bacteria Cultures known as “Probiotics”. Today the sale of “Probiotics” is estimated at between forty and fifty billion dollars per year with a hundred plus different manufacturers of Probiotic Products in the marketplace.
What Is a Probiotic?
Probiotics are defined by the World Health Organization as “live microorganisms that confer a health benefit on the host.”  The term “probiotic”, however, is commonly misused by products that do not meet this criteria.2
From 2003 to 2007 I was served as a Consultant to a Probiotic Vendor, Garden of Life, Inc. as a Senior Director of Research and Physician Education. My task was researching various strains of probiotic bacteria and lecturing to physicians on Rheumatoid and other Autoimmune Disorders and their GI relationships, including the application of different probiotic bacteria strains. I continued my clinical work with patients as well having the opportunity to utilize probiotic strains with them. Enveloped in the industry I was able to investigate the world of probiotic products, how they are produced and to investigate the research surrounding them.
I witnessed a good deal of confusion among both physicians and the public regarding probiotic supplementation and gut health. This can be traced in part to the probiotic industry with many promoting probiotic products to the public utilizing industry hype rather than sufficient knowledge of microbiology, the function of the GI tract, immunology and clinical experience. To laypeople and professionals alike the term probiotic is simply an umbrella term for products that put good bacteria in the gut and solve digestive and immune disorders. This is not, however, always the case.
Ignorance regarding Probiotics is not for a lack of research. A literature search for probiotics will return over 19,000 results including some of the most widely read and reputable scientific publications.  In my work as a Professor educating physicians in professional seminars I catalogued and reviewed many of these studies. This body of research on probiotics, however, has not substantiated all the myriad of claims made by manufacturers and vendors of these products.
There are three important areas in understanding Probiotics I would bring to the readers attention:
Probiotics are not simply Probiotics.
Probiotics is an umbrella term used for different bacteria with vastly differing properties put together in diverse combinations, manufactured in a variety of ways with significant differences in quality control. Bacteria come in widely diverse species and genres. Some bacteria depress or stimulate one aspect of the immune system and others do the opposite. Some are best used in allergic disorders and others are best avoided. Type 1 helper (TH1), but not type 2 helper (TH2), cells produce interleukin (IL)-2, gamma-interferon and tumor necrosis factor-beta. TH2, but not TH1, cells express IL-4, IL-5, IL-6 and IL-10. Different cytokine patterns lead to different functions of the two types of T cells. These functions can be inhibited or enhanced by the types of bacteria present in a probiotic product. The right probiotic variety or combination for one patient with one issue can be a very poor choice for another.
There are Contra-Indications for Probiotic Usage.
In addition to the need to choose the right probiotic for the patient some patients should not be using them at all. When they are used (timing) is also a critical variable. Too often the public and practitioners simply utilize products based on hearing that something is “good for you.” Good for who and good at what time are pertinent questions to ask. Every person is a world unto themselves with widely different situations and no diet, supplement or program should be universally applied to everyone. Among immune-compromised individuals probiotics can lead to infections. In patients with severe bowel overgrowth the sudden introduction of vast numbers of additional bacteria can further overburden the immune system. Even with the common practice of taking a probiotic product post antibiotics there are questions as to its efficacy. A 2018 study reported that post antibiotics, probiotics could delay gut microbiome reconstitution.  Bottom line : Supplement abuse is common among patients and probiotics are commonly mis-used.
Good for who and good at what time are pertinent questions to ask.
The Terrain/Environment Determines The Bacteria
“The primary cause of disease is in us, always in us.”
Antoine Beauchamp, 1883
Louis Pasteur and Antoine Beauchamp were two famous Microbiologists of the 19th century.Pasteur is considered the author of the “germ theory” that promotes the notion that microorganisms are the basic cause of disease and formed the basis of Allopathic Medicine.Antoine Beauchamp put forth an opposing theory, that of the biological terrain i.e. that the internal environment of the body is the primary factor that determines the state of our internal well being either fostering good health and healthy microflora or fostering poor health and unhealthy microflora. This is much like your flower or vegetable garden. Regardless of the quality of seeds you plant if the soil is not appropriate in regards to its pH and mineral content, the seeds will not grow well, if at all. Likewise when we have a nurturing, healthy, internal gut environment, good bacteria (“Probiotics”) will flourish. If the internal environment is poor good bacteria will not flourish and be replaced by abnormal or pathogenic bacteria.In sum, the internal environment of our bodies, the biological terrain is the major determinant of the types and numbers of bacteria we harbor, not just the number of probiotic pills, powders and liquids we swallow.
Stool Testing: Before and After
Over the past forty years I’ve conducted thousands of stool microbiology’s on patients. No longer surprising to me is that patients who have long taken large amounts of probiotics frequently show abysmally abnormal stool bacteriologies with large numbers of pathogens growing and often no or few healthy bacteria present. Subsequent to restoring their health and Re-Creating their bodies, without the use of probiotic products, we see a renewal of healthy microflora and a disappearance of the pathogens that were there previously. The before and after studies presented below illustrate this. Establishing a healthy internal environment by establishing the right conditions for the health of the individual allows robust, healthy growth of healthy bacteria to occur.
The following test results are from patients at the Goldberg Tener Clinic. These are before / after Stool Microbiology test results. The green column lists normal, healthy colonic bacteria. Growth of these bacteria should be robust (3+ or 4+). The yellow column lists abnormal bacteria and the pink column pathogenic (disease producing bacteria.
Patient 1: Psoriatic Arthritis
Note there is very little to no growth of normal, healthy flora in the “Before” test result despite the patient’s regular use of probiotics. There is significant growth of abnormal and pathogenic flora. In the “After” result, there is a renewal of healthy microflora and a disappearance of the pathogens that were there previously. This was accomplished without the use of probiotics. The patient’s gastrointestinal function improved significantly and her Psoriatic Arthritis was reversed.
Patient 2: Ulcerative Colitis
Note there is very little to no growth of normal, healthy flora in the “Before” test result despite the patient’s regular use of probiotics. There is significant growth of abnormal flora. In the “After” result, there is a renewal of healthy microflora and a disappearance of the abnormals that were there previously. This was accomplished without the use of probiotics. The patient’s gastrointestinal function improved significantly and his Ulcerative Colitis was reversed.
There is a place in health care for appropriate use of Probiotic Products if used rationally with knowledge of the types and kinds needed in each situation as well as when to use them and when not to. Using fermented vegetable foods such as sauerkraut and KimChee can often bring about the same if not better results if additional probiotic support is needed.
A truly ideal way to support anyone’s microbiome is to grow an organic garden. In this fashion we obtain exercise, sunlight and excellent food to establish a healthy internal gut environment. An additional step would be to periodically eat a few of the vegetables right from the organic garden, without washing them. Simply choose a clean leaf or vegetable assure it is clean of dirt and take a few bites. You will thus ingest probiotic bacteria growing on the plant furnishing it to your gut along with the plants nutrients and have the satisfaction that you grew it!
Related Articles by the Goldberg Tener Clinic
- Tackling Inflammatory Bowel Disease Part I
- Tackling Inflammatory Bowel Disease Part II
- Bacterial Overgrowth of the Small Intestine (SIBO)
- Eosinophilic Esophagitis, Gastritis and Colitis
- Problems with Ant-Acids
- A Radio Interview with Dr. Goldberg: Irritable Bowel Syndrome and Inflammatory Bowel Disease
- Serious Considerations Regarding Colonoscopy
- The Facade of Functional Medicine
Chronic Disease Reversal Case Studies
 Health and Nutrition Properties of Probiotics in Food including Powder Milk with Live Lactic Acid Bacteria, World Health Organization and Food and Agriculture Organization of the United Nations, Rome (2001)