Probiotics aren’t the magical fix like every wellness guru claims it to be.Dr. Trisha Pasricha, MD, MPH, a gastroenterologist at Massachusetts General Hospital, recently wrote in The Washington Post that she rarely advises her patients to take probiotics.Her approach often surprises them, but it’s backed by evidence: major medical guidelines don’t support probiotics for most digestive conditions. Instead, she stresses a simpler solution — a high-fiber diet.
What the doctor says
According to Dr. Pasricha, eating fiber is still one of the most effective ways to protect your gut. “Eat a fiber-rich diet,” she wrote, pointing out that low-fiber eating patterns can permanently wipe out some beneficial gut bacteria. Once those bacterial groups are gone, they may never return, even if fiber intake improves later.By contrast, a diverse diet full of plants, nuts, and fermented foods helps your microbiome thrive. The more varied the foods you eat, the more resilient and balanced your gut bacteria become, which supports overall health.
The research on probiotics
Probiotics are defined as live microorganisms that can offer health benefits. But while the concept sounds straightforward, the research is anything but. More than 1,000 clinical trials have studied probiotics, but with different bacterial strains, doses, and outcomes. The result is a patchwork of findings, some positive, some inconclusive.Even large reviews of the data show mixed results. That’s partly because no two microbiomes are alike. Diet, genetics, and health history shape the bacteria inside each person, so a supplement that works for one individual may do little for another.
Clinical guidelines only support probiotics in a few adult cases: to reduce the risk of C. difficile infection during antibiotic use, and to treat pouchitis in patients with inflammatory bowel disease who have had bowel surgery.Regulation also lags behind marketing. The Food and Drug Administration does not treat probiotics as drugs, which means they bypass the rigorous clinical testing that prescription medications must undergo. That leaves plenty of room for overstated claims on packaging and in ads.Despite the shaky evidence, probiotics are booming. Marketed as catch-all cures, they’ve become staples of the wellness industry. Promotion outweighs science.Some patients do report real benefits, and Dr. Pasricha doesn’t dismiss that. If someone feels better after trying a reputable brand, she says that’s valid. But she cautions that probiotics aren’t for everyone and suggests talking to your doctors before buying straight off the shelf.