Probiotics: Because Asians Can Sell Anything
    By Hank Campbell | October 5th 2012 04:01 AM | 18 comments | Print | E-mail | Track Comments
    About Hank

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    Are you a probiotic manufacturer who has become annoyed you are not allowed to market microbes that can help cultivate “intestinal flora” for consumers? Did the European Food Safety Authority tell you to stop claiming your magic potion reduces the chances of people developing diarrhea or respiratory tract infections? Did the U.S.A. force you to stop advertising that Activia yogurt and DanActive dairywhatever helps avoid colds or flu and force you to pay $21 million as part of a class-action settlement with the Federal Trade Commission and 39 states?

    Do you wish you could go back to those glory days of 2008 when no one got all science-y and skeptical about the miracle cure du jour? There's no reason to give up and sell your company to or some other questionable supplement company just yet. Actually, I have good news: Asian countries don't care what you claim.

    There is a reason Yakult has sales of $174 million and climbing in China - and that reason is because if you bribe the right government officials, you can claim your drink helps with immuno-regulation and improving intestinal flora and no one will mind. Hire pretty women and celebrities to repeat the message and see how it goes.

    That's not to say the U.S. is nonsense-free. It is still the largest market for crazy probiotic claims. Dermot Doherty, Malavika Sharma, Adi Narayan, and Yuki Yamaguchi writing at BusinessWeek say the worldwide market for probiotic stuff could grow to $42 billion by 2016 and the U.S. will likely still be out in front unless New York City bans all food in their quest to personally nanny each and every resident there.

    How did we get where we are, with probiotics so big despite any evidence they do anything outside placebo levels?  Well, we got here the same way that lots of crazy ideas take hold; a kernel of scientific truth and then some aggressive marketing.  The science is that lots of microbes in our guts are helpful. It's everything else about probiotic marketing that is made up.

    The microorganisms in our guts have been co-evolving with us for as long as we can imagine so biologists have learned a few thing about them during that time. Because we have space in our guts where pathogens can take up residence, it is beneficial to have good microorganisms filling that  area instead. What is questionable is how any number of 200 modern probiotic food products can suddenly 'fill' that space and block out bad stuff.  Further, microorganisms make that Vitamin K which helps us digest our food. Also good. The problem is that no one really knows which of those live microorganisms - probiotics - are helpful. And if you can't say for sure which ones aren't helpful, you can imply that your expensive yogurts are helpful. Within reason. 

    So manufacturers are just creating stuff with different strains of bacteria and selling it. Activia even trademarked its bifidus regularis, and they claim a slight benefit, but how much yogurt are you going to eat every day and how much are you willing to vomit due to eating so much of it to get that nebulous benefit?  Because in normal usage, there is no known benefit outside the sugar pill noise range. 

    As Dr. Mark Crislip at Science-Based Medicine puts it
    When you give probiotics to normal humans you are introducing, relative to the number and quantity of bacteria that are already there, a small amount of foreign bacteria. Continuing our metaphor, it is like trying to put a putting green in an Amazonian rain forest. For normal people, it makes no microbiologic sense to take probiotics.
    Does that sound like a $42 billion industry to you?  It sounds to me like I got into the wrong business. 

    Some studies even shoot for being part of the cultural lexicon and claim probiotics may be good for the brain - in mice, anyway. Probiotic bacteria is changing the vagus nerve signaling, they contend, but they don't know by what bacteria mechanism. I mean, that would be scary to consumers if the science of GMOs were that unclear but introducing unknown microbes directly into your body is apparently not an issue because it is sold in health food stores.  Good luck figuring out that intellectual schism, because if you put circles over people who are anti-GMO and over people who are pro-magic yogurt and see who is in both, you don't have a Venn diagram, you basically just have the same circle.  Scicurious at Scientific American blogs is simultaneously curious, hopeful, skeptical and shocked and rightly discourages us all from thinking yogurt will cure depression.

    Kirsten Tillisch, a gastroenterologist at UCLA, did a study in a small group of human females and found that after taking probiotics the women reacted differently to angry and sad faces. "At the most basic level, we show that by changing the bacteria in the gut, we change the way the brain responds to environmental cues" Tillisch told Allison Aubrey at NPR.

    Here is why you should be skeptical anyway; I am not a big regulation guy but I am a common sense one, and a regulatory definition of probiotics doesn’t even exist so who knows what these people are really selling. There are no FDA authorized health claims for probiotics in the USA.  I know, it doesn't matter to people who buy Dr. Bronner's Magic Soaps All-One but want warning labels on corn syrup, this is big business, after all.

    Yogurt is one thing, juice is just as silly. But if you buy probiotic ice cream, it means you don't even know that the pasteurization killed the real microorganisms, and then a few probiotics were added back in after pasteurization and then the freezing has killed the microorganisms you just added...oh never mind, if you buy probiotic ice cream you didn't finish this article anyway.

     Probiotic ice cream. Because this is legal in India. Credit and link: Amul Prolife Probiotic Wellness


    I think most people dink Yakult because it tastes good

    i've not tried any other products but i would not be surprised if they taste good too

    is not taste enough?


    Sure, but there is a difference between you and the gullible population.  I am exactly the opposite of a Big Regulation, Ban The World type.  I have no issue at all with capitalism selling what people want to buy and I think we need fewer restrictions, not more.   So when I ridicule something, it is not that I want it banned, it is that I don't like gullible people being exploited.  So I go after homeopathy, organic food, psychics and any number of other suspect big money enterprises because people can't be educated on everything.

    I am kind of a consumer advocate for science. If you're literate and want to spend the money on Yakult or organic soap go for it, but if you have been convinced by marketing that drinking Yakult will keep you from getting the flu, you need to read more Science 2.0.

    I eat about one yogurt per week, so the health benefit is nonexistent, yet invariably if anyone else is around they will mention the good bacteria in it. That's marketing, plain and simple, not science.
    Here's part of the recipe for Yakult's deceptive but profitable product:
    1. Create a white hat/black hat scenario with scientific veneer:
    Yakult is a probiotic; it contains billions of live and active "good bacteria." Your digestive system naturally contains trillions of all kinds of bacteria -- some are helpful, some are harmful. When you drink Yakult daily, it makes it difficult for the bad bacteria to take over . Yakult also gives you more of the good bacteria that may help balance your digestive system. _
    Notice how they say "may help balance" to cover their butts.

    2. Disguise the profit motive with an over-the-top idealistic mission:
    Yakult's mission is to contribute to the health and happiness of every person around the world through the pursuit of excellence in life sciences and the study of microorganisms. _
    3. Add lots of sugar to the product. Yakult probiotic drink is 14% sucrose (11 g out of 76 g) comparable to McDonald's Fruit'n Yogurt Parfait (at least they're not pretending to be in pursuit of happiness for 7 billion souls ) and Coke is 9.8% . 


    Thor Russell
    Havn't looked into this at all, but ironically links show up pointing to articles on this site suggesting some scientific basis for health claims:
    Thor Russell
    It's not irony, it's Science 2.0 being comprehensive.  We also have articles that affirm and debunk global warming and even meditation.  They all have catchy headlines but require reading to understand their strengths and weaknesses.  If we can't even define what microrganisms help and hurt yet 200 out of 2 billion are being sold for $35 billion per year, it is a scam.
    Thor Russell
    That bloating study defines what organism helps, it is Bifidobacterium lactis DN-173 010. I think the point is that it may only help in a small set of people with IBS, but do nothing or harm the general population. Still a medically useful and defined microorganism.
    Thor Russell
    Gerhard Adam
    Actually the bacteria is Bifidobacterium animalis, which is a pretty stable, early resident in the human gut.  As a result, it is implicated in several interactions that can promote health and stability.

    Overall, these bacteria would certainly do no harm and in some instances may be beneficial in bolstering the existing population.  Clearly there is much that we simply don't know, but then neither do the probiotic advocates.  In this case, this strain is definitely one of the "good guys".  However, for every bacterial strain like this, there are 99 others that have never even been cultured, let alone identified as to the role they take. 
    Mundus vult decipi
    Do any of these studies target people who've recently had antibiotics? I wonder how effective they are in that case.

    Now I suppose if we wanted really good probiotics, we could sell poop capsules!
    Never is a long time.
    Might as well. There are 100 billion organisms just in a gram of my poo and knowing which ones are 'good' and which are 'bad' is tough going for microbiologists, but surely someone can throw a few considered good and make a fortune in Asia.
    Gerhard Adam
    Cute, but not that simple.  The microbiota is not a fixed set of organisms and can vary dramatically between individuals.  However, it seems that those that are more closely related, tend to share more of the same bacteria.

    It does present an interesting problem in whether some diseases [especially of the gut] that may be presumed to be genetic, may in fact be related to the familial microbiota.

    In any case, your fecal transplants have been done in cases where long-term or extreme antibiotic treatments have decimated an individual's microbiota [usually using samples from family members].

    Mundus vult decipi
    My daughter was on a very strong antibiotic, Vancomycin, after she had her wisdom teeth removed and subsequently contracted a buccal space infection. She developed clostridium difficile, more commonly refered to as C.diff. This is the bacterium that usually kills old people in nursing homes. The board-certified and highly-respected pediatric doctors at Inova Fairfax Hospital treated her with another antibiotic and a behind-the-counter, but not prescription probiotic. The article keeps refering to "normal people" not seeing any benefit to taking probiotics. What is normal? My daugher was normal before they treated her for this life-threatening infection with antibiotics. I guess you could say that antibiotics are ineffective for normal people. But I don't think you would say that antibiotics don't save lives. Obviously, when people seek remedies for some discomfort or illness, they are in a state that is not normal. I think you're safe in suggesting that people will not receive any benefit from avoiding gluten and GMO grains, or using organic soaps, or taking probiotics if they are healthy and feeling great like lucky you. The problem with this logic is: what if you're not healthy and normal? Empirical evidence has been used in the diagnosis and cure of medical maladies for thousands of years. There are many phenomena for which Science has not developed an explanation that nonetheless exist. Let's reserve our stinging rebuke of fads until Science has been given a chance to catch up. It usually does, eventually.

    Gerhard Adam
    I think the point here is in defining what is meant by "normal".  Clearly your daughter was not "normal" with respect to her microbiota, so probiotics could conceivably make some sense.  The point being that those with a normal array of gut flora wouldn't benefit from introducing ever more bacteria to an already well-populated environment.
    There are many phenomena for which Science has not developed an explanation that nonetheless exist.
    True enough, but let's also remember that when economics is involved there are even more solutions proposed than there are problems to be solved.  So, unless you wish to be victim to everyone selling snake oil, your only recourse is to rely on evidence backed data from which to draw conclusions.

    Mundus vult decipi
    That was the point I was trying to make. If what a "normal array of gut flora" is could be determined, we could say, "probiotics will work for you because the antibiotics you took last month for a urinary tract infection depleted your healthy gut flora". Until we can, it's just trial and error. And I whole heartedly agree that the marketing behind the yogurt is just crazy. You would have to eat hundreds of cups of yogurt to get the amount of live cultures in a single capsule.

    Gerhard Adam
    I agree with your essential point, but something to keep in mind is that there is no specific "normal" arrangement of bacteria.  People may have wide ranges of bacteria present, although they may fulfill the same or similar functions.  So, it isn't really possible to establish that kind of definition, moreover, it is important to remember that almost 99% of the bacteria present in our bodies has never even been cultured.  It is simply unknown.

    There is some progress being made by identifying the genomes of the bacterial presence without necessarily having to successfully culture them.
    Mundus vult decipi
    Thor Russell
    Yes at the moment, we don't really know. I know people that have taken a course of antibiotics (not for digestion related) and have reported their digestion not being quite right afterwards. They just decide to try the probiotic capsules (not yogurt) because well the doctor can't know for certain whether their natural bacteria have been disrupted anyway. Often they report feeling better, but of course you don't know if it would have happened anyway or was the placebo effect.
    Thor Russell
    Gerhard Adam
    I agree.  I recently underwent some significant antibiotic treatment and I ate just about everything with bacteria in it that I could find.  Haven't got the slightest idea whether it made a difference or not [especially since some of the gut bacteria is antibiotic resistant], but all I could envision was the "slash and burn" approach the antibiotics probably did on my gut.  :)

    Personally, I'm not convinced that we can do much to influence "goodness", but in my case, I just wanted to introduce anything that would ensure that there wasn't a void that could be populated by more pathogenic strains.
    Mundus vult decipi
    You would have to eat hundreds of cups of yogurt to get the amount of live cultures in a single capsule.
    Well, if they are welcome in the gut, they multiply. Anyway, given the overuse of OTC bought antibiotica especially in Asia, this all sounds almost like an advertisement for pro-biotic yoghurt. ;-)
    I won't even attempt to defend Hank's outlook. He is more than adequate in that regard. However, let it be said that this article points up the 'marketing magic' that has been applied to products which aren't currently being, and perhaps never will, subjected to close scientific investigation. There is a reason that caveat emptor is suggested when buying stuff.