Popular gut probiotic craps out in randomized controlled trial

(arstechnica.com)

126 points | by zdw 273 days ago

23 comments

  • njtransit 273 days ago
    It’s interesting that both groups had their number of bowel movements double or more. Perhaps a lot of constipation is actually dehydration.
    • mirekrusin 273 days ago
      Like this magic pill to loose weight that you need to take before every meal with large glass of water, where pill is optional.
      • tyre 273 days ago
        or Emegen-C or hangover cures
        • jeltz 272 days ago
          If they contain some salt they are better than just water.
    • Nifty3929 273 days ago
      If you take one of these little pills with a large glass of water for every alcoholic beverage you drink, then it will prevent hangovers.
    • gus_massa 272 days ago
      I agree, and that's why they used a "randomized triple-blind placebo-controlled clinical trial".
    • datavirtue 273 days ago
      Bingo. These finding probably aren't much of a surprise to many. Hydration is huge, as is having a well functioning and diverse biome that you feed regularly with raw fruits and vegetables. I have had my biome die back to the point of medical emergency and had to restore it. Keifer, various Greek yogurts, etc did nothing to help. I took half a bottle of a few pills that were loaded with different strains. Not only did it restore bowel function to its former glory, it improved my health overall and I feel like a teenager again (46). I was deficient and suffering for decades and just thought it was normal. It dawned on me that most people are likely suffering.

      I'm far too overweight for my liking but now I don't feel fat. Restoring the biome made me stronger and more resilient (my muscles stay stronger between workouts). I just feel good all the time now. Before this I had psychologically written myself off as dying and was ready to accept my fate.

      • dylan604 272 days ago
        > These finding probably aren't much of a surprise to many.

        Conversely, you might be surprised at how many this is new information. Just because you learned something does not mean everyone hearing the information at the same time. Some people require hearing/reading something new only one time, others takes many attempts. I think the number of people that walk around with a suboptimal fluid intake is much higher than we might hope, especially in the USA

      • lukevp 273 days ago
        This sounds super interesting. The pills you are talking about are probiotics? Have some links to which ones you took and maybe some research you did about this?
        • datavirtue 272 days ago
          Check my other replies for the brands. I don't think it matters as long as the quality is assured. I had known about probiotics for decades but never realized how fundamental they were to overall health. When I was going through this I just thought about my symptoms and took a hail Mary with this treatment. Bowel movements were extremely stressful at that stage. I was depriving myself of anything solid to alleviate the issues but overall I was not getting better. Previous to that I was doing fine, or so I thought. I never ate out, rarely ate meat or anything processed.

          You will know when it's restored, you can even eat garbage (meat, processed foods) and your gut will process it and move on. You should be able to notice the subtle changes when you eat something that does not digest readily. It's not the acid and body mechanics, it's mostly the bacteria giving you life by breaking down nutrients and solids. Feed it what it needs and it will sustain itself. Raw and fermented vegetables.

          • maxerickson 272 days ago
            Meat is nutritious and very satisfying per calorie, it is not "garbage". To think it is garbage is to have a very confused view of nutrition.
            • consteval 271 days ago
              Ultra processed red meats are garbage. They contain far too much saturated fats and not nearly enough nutrients. Even their protein per calorie is not particularly good.

              Humans of the past ate game meat. Very low fat, and almost all unsaturated fat. Closer to an avocado than a steak.

      • kbmr 272 days ago
        Which pills specifically did you take?
      • hn_version_0023 272 days ago
        You should return and tell us with some specificity what you took.
        • datavirtue 272 days ago
          I'm hesitant to mention brands. Any independently tested product with a wide variety of strains should be good. I started on Physicians Choice from Amazon and followed up with Garden of Life (not sure who sells it). During repair phase I would only eat salads made of hand shredded green and purple cabbage and kale. Equal amounts cabbage kale mixture and shredded ice berg lettuce. I used ranch dressing and added other vegetables and crushed corn chips. To each his own.

          These were huge salads. I couldn't even think of eating anything else after I finished them.

      • calf 272 days ago
        Wait what. I am 99% convinced my gas and bowel problem, an impairment at this point, is IBS or SIBO that started 12 years ago. I never thought a about just taking a half bottle of pills to see what would happen, I am going to have to look into this.
        • olyjohn 272 days ago
          What the hell? Half bottle of what pills? Are you and the parent a bot?
          • datavirtue 272 days ago
            Half a bottle over two weeks. Geesh.
          • magicalhippo 272 days ago
            Probiotic pills presumably.
        • elcritch 272 days ago
          I’m assuming the parent meant pills with few different strains. Seems like a massive dose of a few different strains would approach that of a fecal transplant.
        • datavirtue 272 days ago
          You can't just slam pills. The pills contain the bacterium. You have to send it raw vegetables to feed it so it multiplies and sustains itself.
          • calf 272 days ago
            Oh no, I was confused because a lot of people say to try probiotic pills, but for many people they just don't work. So when you originally wrote half a bottle that confused me, I interpreted it as you were doing something different than those who tried probiotic pill supplements.

            Could you describe your dosage? Was it a one pill per meal and you saw results after a few weeks? And you said raw vegetables to help it. I would like to try that, and any other specific things you did that worked.

      • captain_coffee 272 days ago
        what did you take - specifically?
    • MostlyStable 272 days ago
      That's plausible, but also, could be the frequent things just getting better on their own over time.
    • MilnerRoute 272 days ago
      I actually thought it was misleading of the headline to say the probiotic crapped out...

      A lot of people take probiotics to improve their general digestion (and not specifically for constipation). But it sounds like the study didn't even look at any of the other uses at all...

  • the_sleaze_ 273 days ago
    Best gut related health I ever had was living in France and eating stinky raw cheeses and different fermented foods. Like clockwork.
    • darth_avocado 273 days ago
      There’s two different effects hidden in that statement

      > living in France

      I have had similar experience where my gut health was immediately, noticeably better in Europe. I was eating the same foods and somehow it was better.

      > Eating stinky raw cheeses and different fermented foods

      Raw and fermented foods in cultures across the world are linked to better gut health. However, industrial fermentation and packaging won’t help you as much because the diversity of microbes drops and packaging often kills most of them. We need to bring back the culture of home fermentation.

      • murukesh_s 273 days ago
        >I have had similar experience where my gut health was immediately, noticeably better in Europe. I was eating the same foods and somehow it was better.

        Could be due to you being in a better mental state. Gut-brain axis is very evident for me personally. If I am tense gut is the first to get affected.

        • 4gotunameagain 272 days ago
          The refusal to over-industrialise food in Europe (compare to the US) leads to higher quality, more "natural" food.
      • FredPret 273 days ago
        Another possibility: dishwashers are more rare in Europe - the soap residue some of them leaves on irritates some stomachs.
        • looperhacks 272 days ago
          That sounds counter-intuitive? I doubt most people take the time to rinse everything off with clear water. Dishwashers on the other hand always have a rinsing step
          • AyyEye 272 days ago
            There is enough residue left over that even diluted 1:10 its still cytotoxic. [1]

            I seem to recall a post here a while ago showing that dishwasher residue was genotoxic as well but can't find it atm.

            [1] https://www.sciencedirect.com/science/article/pii/S009167492...

          • pfdietz 272 days ago
            Maybe the problem is rinse aids in dishwashers? These prevent spotting on glass by adding detergent.

            I just put water in the rinse aid dispenser of my dishwasher.

            • selcuka 272 days ago
              > I just put water in the rinse aid dispenser of my dishwasher.

              Curious... Rinse cycle already uses plain water, so you are adding water to... water?

              • pfdietz 272 days ago
                It's to keep the annoying "fill the rinse aid dispenser" light from always being on.
            • bluGill 272 days ago
              redacted, see correct info in replies
              • pfdietz 272 days ago
                I don't believe that's true. To quote wikipedia: "Rinse aid (sometimes called rinse agent) contains surfactants and uses Marangoni stress to prevent droplet formation, so that water drains from the surfaces in thin sheets, rather than forming droplets."

                Looking at the back of a bottle of Finish Jet Dry (which I have refilled with water), the original stuff's first ingredient (after water) is "C 12-15 Alcohols Ethoxylated Propoxylated". These are nonionic surfactants, and are not what one normally means by "alcohol" (ethanol).

                I can understand where the idea came from. Drinks like wine will exhibit sheeting on the sides of glasses too. The concentration of alcohol needed for that to happen is probably too high in a dishwasher, I'd imagine.

          • pxndxx 272 days ago
            Yeah but dishwasher soap is a different kind of soap, it's way stronger. Plus dishwashers also use rinse aid which has its own set of problems.
        • homarp 272 days ago
          • FredPret 272 days ago
            I'd love to see this stat but I don't have access - mind posting the gist of it?
        • pas 272 days ago
          the travel makes people on average bodily better. usually a lot of walking involved, which has a lot of health benefits, especially for folks who come from the US
      • waihtis 273 days ago
        > my gut health was immediately, noticeably better in Europe

        Its because a lot of the weird artificial junk that are allowed to be put into your food is illegal in Europe. Even things like popular sweeteners have been shown to have a negative effect on your gut health.

        • azinman2 273 days ago
          Europe puts plenty of E numbers in their food (the US just spells it out versus hiding it under a number). There are things illegal in the US that are used in food in Europe. A lot of the time, at least for things like pesticides, the different is country of origin of manufacturer.
          • jenny91 272 days ago
            E numbers have very little to do with this. They are just a way to categorize food additives.
            • mikrl 272 days ago
              Growing up in the EU in the 00s there was always the public health concerns of E numbers causing this or that.

              Ironic in a way, because E numbers mean that the specific chemical has been cleared as a foodstuff in the EU, IIRC.

              Though I suppose it’s more concerning if an approved substance has some unforeseen effect versus an unapproved one and you’d want to investigate further.

              I guess it shows how government regulation of naturally occurring substances (though perhaps synthesized, or refined) carries with it a new set of incentives, and reasons to be political. Not that I’m against regulation, but it’s hard if not impossible to have a truly politically neutral approach.

            • azinman2 272 days ago
              What else would you characterize “ weird artificial junk” as?
              • literalAardvark 272 days ago
                E numbers cover everything that can be added to food. Some examples would be E164 Saffron, E290 carbon dioxide, E428 gelatin.

                None of these are anywhere near the "weird chemicals category". You'll find that all euro foods have Es in them, but it doesn't mean they have half-tested industrial food additives in them.

                • azinman2 272 days ago
                  Those are very selective things you picked.

                  E100–E199: Food coloring, such as turmeric (E100) and paprika (E160c)

                  E200–E299: Preservatives, such as sulfur dioxide (E220)

                  E300–E399: Antioxidants and acidity regulators, such as ascorbic acid (E300)

                  E400–E499: Thickeners, stabilizers, emulsifiers, and gelling agents

                  E500–E599: Acidity regulators and anti-caking agents

                  This is pretty much the spectrum. Red 40, aka Allura Red AC aka E129 is illegal in the US, legal in the EU, and carries a warning in the EU. Let’s not pretend that the wonderful world of chemicals and industrialization doesn’t exist in Europe.

                  • literalAardvark 272 days ago
                    No one is pretending anything. I said all foods in the EU have E numbers in them, but it doesn't mean they have industrial chemicals.

                    Allura red isn't illegal in the US.

                    Also, just wondering, what do you think is the problem with turmeric and paprika?

        • sroussey 273 days ago
          The preservatives in flour / bread / etc are illegal in Europe. My sister is allergic and can’t have any bread in the USA. But can in France and Italy.
          • raydev 272 days ago
            Please share the names of these preservatives.
          • ara_ohanian 271 days ago
            [dead]
          • waihtis 273 days ago
            Yeah, things like titanium dioxide are considered a carcinogen by the International Agency for Research on Cancer (IARC) yet FDA says its safe for use in food. But i guess trust the science and authorities
            • pas 272 days ago
              IARC usually says that something has carcinogenic potential, which is almost completely useless information for something that we already ingest in absurd quantities without a cancer epidemic.
        • raydev 272 days ago
          > a lot of the weird artificial junk that are allowed to be put into your food is illegal in Europe

          What are some examples? A list would be helpful.

          • Spooky23 272 days ago
            I don’t follow this too closely, but having been in Europe for a few weeks, the food tastes noticeably better and is often cheaper than the US.

            One of the things you notice is shorter ingredient lists on prepared food. The ingredients in Italy for McDonald’s French fries are: potato, salt, oil. In the US there’s 7-8 including hydrogenated soybean oil and flavor/color agents. Oreos were similarly different, and arguably better tasting.

            I believe they regulate flavors and coloring additives differently, and many people feel both of these type of items can be problematic.

        • SoftTalker 273 days ago
          Also non-flouridated, non-chlorinated water.
          • manoweb 273 days ago
            I lived most of my life in an alpine European village; water was chlorinated and flourinated, more than in my current US location. There was a huge difference in mineral content, US water being almost distilled (1 to 3 French degrees hardness) VS something like 15-20 in Europe
            • azinman2 273 days ago
              Water hardness varies by location worldwide, including the US.
          • pfdietz 272 days ago
            Non-flouridated is gluten-free, right?
        • hedora 273 days ago
          Most sweeteners also have been shown to cause more weight gain than sugar (they screw up your metabolism). Unless you’re diabetic, there’s literally no reason to consume them.
          • cenamus 273 days ago
            I'd like to see a source on that, because (excessive) sugar literally causes diabetes.

            And of course high sweetener consumption is must be strongly linked with in general high calorie input and overweight people trying to reduce calorie consumption.

            • Spivak 273 days ago
              Your first point probably isn't actually true. The research that first connected the two showed that across a population sugar consumption up -> diabetes rates up. But it turns out that when you control for weight the effect of sugar specifically is much much smaller. To the point where if you're a healthy weight your sweet tooth isn't moving the needle.
          • loeg 272 days ago
            No, they have not. The evidence points the opposite way (people lose more weight on non-nutritive sweeteners than sugar).
          • Spivak 273 days ago
            Oh that's not true at all. First I think they taste better, they're sweet without being syrup-y. Second it allows me to drink a lot of soda, 5+ cans a day adds up when it has calories. I have no expectation that it helps me lose weight, it's just tastier water.

            It's funny that folks will look down on diet soda but then be fine with tea and coffee and sports drinks like the bubbles make it meaningfully different.

            • riffraff 272 days ago
              5+ cans of soda a day seems unhealthy even if it's not caloric, the gas and acid will mess up your stomach.

              It is not just tastier water.

              • Spivak 272 days ago
                Given that in France "water" means carbonated water and you have to specifically ask for "still water" I can't imagine the gas being that bad for you.

                Acid I can get behind but soda is by far the least acidic thing I consume on the daily.

                • Spooky23 272 days ago
                  The carbonation creates carbonic acid in your teeth. It’s a huge driver of calories.

                  Of the of the issues with diet soda in particular is your tastes favor sweets. I used to drink 4-8 cans of Diet Dr Pepper daily. When I stopped, after a couple of weeks I found my taste preferences to be very different. I’d favor savory more attractive and sweet stuff would seem too sweet.

                  • Spivak 272 days ago
                    I can't fine anything talking about carbonic acid and calories. Is there something you're referring to?
                    • Spooky23 272 days ago
                      Sorry - it was supposed to be “cavities”. Too late to edit I’m afraid.
                    • kyleee 272 days ago
                      Maybe they meant cavities?
                      • cnasc 272 days ago
                        Probably typed “caries” and got autocorrected
      • jonnycomputer 273 days ago
        I agree about diversity. We use a very limited range of cultures in mass manufactured foods.
      • Brian_K_White 273 days ago
        But of course can never happen because it only takes a minority to cry about a few factual bad stories and present the fallacious "is it worth it" argument. "Is your epicurian enjoyment worth even one dead baby?" And a majority who have no reason to think much about it go along with it because no one will say "yes it's worth it" and few are able to articulate how the question was invalid in the first place.

        The opposite minority argument, that variety, depth, richness, are important, not luxuries, don't have their own dead babies to present. They do exist, but they aren't visible except in aggregate. You can measure a change in average health over the course of entire generations, and from that you can extrapolate the change in number or frequency of deaths, and then you could compare numbers of dead babies. But you can't obviously show any particular cause & effect because there are so many other variables, and even if you could, it took entire generations whole lives lived and died before they could benefit anyway.

        • gamblor956 272 days ago
          But of course can never happen

          Home fermentation of foodstuffs is allowed, and always has been.

          Lots of people do it. Kits are available on Amazon, and many grocery stores will even sell them in-store. As other people on this thread of have pointed out, they ferment a lot of their own foods and drinks.

          What isn't allowed is selling home-fermented stuff to others. When someone goes commercial, rules kick in to protect their customers

          • Brian_K_White 272 days ago
            What can never happen is the majority agreeing that it's good, and actually doing it, and having this become so accepted that it is no longer disallowed for selling. Without selling, most people will not get it.

            It's possible. A wave could go through where it becomes popular and the majority adopt some new attitude on that topic. But it "can never" because of the dynamic I expressed. That works against it. The new thought is not developing in a vacuum.

            • gamblor956 272 days ago
              having this become so accepted that it is no longer disallowed for selling.

              This is a nonsensical train of thought that conflates multiple distinct issues.

              Fermented products are already widely sold in stores and restaurants. And homemade foodstuffs can already be sold but are subject to the same rules and regulations that govern foods made in commercial facility. These rules generally preclude the sale of homemade fermented foodstuffs, because the risk of contamination if the foods are improperly fermented is extremely high and most home kitchens lack the necessary equipment or facilities needed because this is all very expensive compared to consumer equipment. This is why there are so few fermented foodstuffs available at farmer's markets in the U.S.; the initial capital outlay puts it out of reach.

        • tyre 273 days ago
          okay wow deep breath, you can just ferment things at home, it’s fine, I did it twice last week
          • Brian_K_White 273 days ago
            That doesn't actually solve anything.
            • daneel_w 273 days ago
              How do you know until you've fermented something at home and risked life, limb, dead babies etc. by consuming it? I think more people die from food poisoning in restaurants each year than people do from doing something stupid while making sourdough bread, natto, tempeh, kombucha, beer, wine etc. at home.
              • elcritch 272 days ago
                Also, it’s usually pretty obvious when fermenting goes bad. My take is fermentation takes a while which really allows the biological process to become really positive or really rancid.
              • Brian_K_White 272 days ago
                It doesn't solve anything because it's an individual action to a societal problem.
                • daneel_w 271 days ago
                  There's no societal problem of hidden deaths because of fermented foods. But assuredly there is because of "safe" ultra-processed convenience foods.
                  • Brian_K_White 271 days ago
                    The societal problem is that we have low quality food. Across the board. Every where you go, all that's available is mostly low quality.

                    The option to spend more money, or have your own garden, or do some kind of home production is a vanishingly insignificant individual action that solves nothing except for like 11 people.

    • jajko 273 days ago
      My wife recently got Kombucha mushroom from a friend, and got into fermenting it herself. Its trivial to do, you need to really screw up something for it to go wrong, tons of good bacteria inside. She takes some basic precautions like avoiding metal parts (since the drink becomes acidic), otherwise its on autopilot, good bacteria outcompete everything else for resources.

      She mixes it with some cut fruits to get some sugars for fermentation, the result is very mild alcohol content (maybe 0.5%) and it tastes like cider. I mix it maybe 1:3 with water and its semi-eternal homemade drink. Can't really complain.

      That and of course french cheese, we live maybe 5km from French border and for cheese its much better place than even Switzerland (sorry guys gruyere is great but french variety is huuuuge in comparison and they even usually have specialties like old dutch gouda which is taste heaven for me and various truffle-infused ones).

      • Y_Y 273 days ago
        Fyi kombucha isn't made from a "mushroom". It's a combination of bacteria and yeast and can be found in the liquid itself or the pellicle (blob of organic tissue) that forms during fermentation.

        https://en.m.wikipedia.org/wiki/SCOBY

        • murkt 273 days ago
          Wow, hearing about “tea mushroom” (that’s how it’s called in Ukraine) for my whole life, and it’s not a mushroom!

          Fascinating.

          • zdragnar 273 days ago
            Well, it is a partly a yeast, which is a fungus, as are mushrooms. The main thing is that it is a symbiotic combination of particular yeast and bacteria strains, unlike what is used for brewing alcoholic drinks (just yeast) or fermenting dairy into yogurt (just bacteria).

            Kefir is another combination of yeast and bacteria, though different strains.

          • dyauspitr 272 days ago
            It’s called a scoby
      • bloaf 273 days ago
        There are some choices you can make that seem innocuous but dramatically increase the chances of lethal outcomes, like using corn or coconut.

        https://www.youtube.com/watch?v=yXnSYfv6bCA https://en.wikipedia.org/wiki/Bongkrek_acid

        • jajko 272 days ago
          Thank you, I would never thought about using corn for such stuff, but that coconut surprised me
    • maxerickson 272 days ago
      Are you lactose intolerant?

      A small amount of lactose can have a sort of laxative effect without causing discomfort.

    • m3kw9 273 days ago
      Gotta hit up the cheese fests now
  • XorNot 273 days ago
    This is about Bifidobacterium animalis subsp. lactis.

    Personally I take L. Reuteri supplements, which for me have made an unbelievable difference in suffering from IBS symptoms (and have some clinical evidence to support having an effect). This was a result a recommendation somewhere else on HN about 2 years ago now, so I'll pass it forward whenever the topic comes up.

    In my experience it took about 3 months to see effects (during which time I did feel somewhat worse), and currently if something happens - i.e. I get sick - then there's a bit of reversion towards feeling bad. But: I was also able to stop taking them for about 6-9 months before it seemed like the effect was diminishing.

    • bloopernova 272 days ago
      This has helped some folks' IBS symptoms: https://www.vsl3.com/

      Contains:

        Streptococcus thermophilus 
        Bifidobacterium breve 
        Bifidobacterium lactis (previously classified as B. longum)
        Bifidobacterium lactis (previously classified as B. infantis)
        Lactobacillus acidophilus
        Lactobacillus plantarum
        Lactobacillus paracasei
        Lactobacillus helveticus (previously classified as L. delbrueckii subsp. bulgaricus)
      
      I'll have to research L Reuteri, thank you for mentioning it.
      • eth0up 272 days ago
        Might include b. subtilis on your list.
    • graeme 273 days ago
      Which version of L. Reuteri did you take?
      • XorNot 272 days ago
        I use Biogaia Protectis by brand.
    • silisili 272 days ago
      Same. Immensely helped my gut, and uh, other things too.
  • mg 273 days ago
    There is a lot of confusion on how to interpret studies.

    The reasoning of this article seems to be "The study did not produce a significant result, therefore the treatment is ineffective".

    But that is not how to think about significance.

    Otherwise, you could show for any treatment that it is ineffective. By simply doing a study small enough to produce an insignificant result.

    • loeg 272 days ago
      True, but in this case the study sponsor is financially motivated to find a non-null result, not a null result.
    • jessriedel 272 days ago
      This mistake is so unbelievably frequent. Need a concise quip like “correlation isn’t causation”.
      • mg 272 days ago
        Yes, that might be helpful.

        First attempt:

            Insignificant does not mean ineffective
        
        Not as good as "correlation isn't causation" though. I wonder if there is a better quip. Or if the concept is too complex to wrap in a catchy statement.
        • jessriedel 271 days ago
          “Insignificance isn’t ineffectiveness”
  • nikolay 272 days ago
    Don't buy probiotics - eat quality grass-fed organic yogurt (such as Trimona [0]) and home-made sauerkraut - these have centuries of evidence. As a Bulgaria, we traditional make sauerkraut every year. It's pretty easy to have it, you just need a little more attention to it in the first weeks. The juice is amazing, too. You can buy it from Amazon [1].

    [0]: https://trimonafoods.com/

    [1]: https://amzn.to/3ZO0Sxl

    • bossyTeacher 270 days ago
      > these have centuries of evidence

      This sounds like the good old 'we have always done it therefore it must be good'. That is not evidence.

    • permo-w 272 days ago
      and by "evidence" you mean?
      • nikolay 272 days ago
        Longevity in general (don't judge by today's fully Lidl-ized & Kaufland-ized diet of modern Bulgarians). The research dates back to the 19th century and Ilya Ilyich Mechnikov [0].

        [0]: https://en.wikipedia.org/wiki/%C3%89lie_Metchnikoff

      • 2OEH8eoCRo0 272 days ago
        • jessriedel 272 days ago
          That article says

          > Epidemiological research on specific health effects of yogurt is still limited but a few studies suggest a benefit.

          It then describes three non-randomized observational studies.

          • nikolay 272 days ago
            That's the issue with nutrition - you can't really randomize as every person is on a different diet that's hard to control. Plus, how are you going to radomize when people know what they're eating - you can't create non-yogurt that's identical to yogurt for the controls!
            • jessriedel 271 days ago
              Well, you can’t blind it but you can still randomize. If your outcome variables are sufficiently objective and important (e.g., mortality or cancer risk, not just perceived health), the possibility that the causality flows through a placebo effect is much less worrying. If [people correctly believing that they ate yogurt] reduces [the incidence of cancer], great!
              • nikolay 269 days ago
                I meant to say blind, not randomize, sorry.
            • bossyTeacher 270 days ago
              So you admit that those links you posted don't constitute evidence towards the products you suggested. Interestingly enough, you were so happy to dismiss the studies about probiotics yet you are so keen not to do the same for yours even when none of them have any evidence towards its benefits
  • albertsw 272 days ago
    Huberman [1] lists several studies emphasising mucrobiota diversity and health as the major factor. These studies seen to find that the way to get it is fermented foods, like sauerkraut, kimchi, kefir etc. and that commercial probiotics don't seem to do much.

    [1] https://www.hubermanlab.com/newsletter/6-key-tools-to-improv...

  • trilbyglens 273 days ago
    Should be noted that constipation relief is far from the only benefit that probiotics provide to your gut biome. Healthy gut biome has been linked to lower levels of depression and lots of other things seemingly unrelated.
    • raincole 273 days ago
      > Should be noted that constipation relief is far from the only benefit that probiotics provide to your gut biome.

      You mean claimed to provide.

      • hanniabu 273 days ago
        Anecdotal but I'm on a very strict diet, to the point where I have the same thing every meal, every day. There's certain probiotics I take that help bowel movements and some that slow things down. It's very repeatable and given I eat the same thing every meal every day and I'm on a regular eating and activity schedule that leaves very little other variables.

        My guess is that for regular people the benefit is insignificant but it's greater for people with issues (dysbiosis).

        And the type of dysbiosis you have will determine the effect of the probiotics. For some it can slow motility or cause constipation and others increase motility or cause diarrhea.

        There's so many internal variables with your gut microbiome and there's a general lack of reliable methods to test your microbiome. This makes tests like these really difficult and also makes it difficult to treat digestion issues. Because of this, all gastro doctors can really do is slap on IBS/IBS label but not really have a course of action with any decent success rate.

    • homebrewer 273 days ago
      Read the article, placebo was just as effective as these "probiotics".
  • samuraijack 273 days ago
    Why is it interesting to just test one brand of probiotic with a single strain of bacteria?

    Surprised to see it on arstechnica and HN.

    • SammyStacks 272 days ago
      Yeah, both the title and content of the arstechnica are spreading misinformation. The mainstream media has always been terrible at accurately representing the findings of a given academic study, but this is disappointing.

      The study was conducted with people who had chronic constipation as measured by complete spontaneous bowel movements (CSBMs). A bowel movement qualifies as a CSBM if the individual had not used a laxative within the last 24 hours. Prior to intervention, participants had a mean of 0.77 CSBMs/week with an SD of 1.0. That is quite extreme so the results of the study cannot be generalized to the general public.

      Additionally, both the probiotic group and control group experienced positive effects, even if the probiotic group didn't outperform the control group. That's extremely meaningful and requires further investigation. Perhaps the belief of taking a digestive supplement caused individuals lower stress and/or motivated other healthy lifestyle changes? Science shouldn't be viewing the placebo effect as evidence that something else is BS; we need to view the placebo effect as a psychological tool to effect positive change.

      Finally, the study tested only one bacteria strain. I have not seen any recommended probiotic supplement that includes only one strain of bacteria.

      More research is needed; the title is clickbait and the article doesn't sufficiently emphasize the major limitations of the study. Really a shame to see that type of reporting.

    • loeg 272 days ago
      The companies selling products containing that bacteria would like to sell more units. Agree that the null result is not super interesting.
  • jonnycomputer 273 days ago
    For what it's worth, I always thought that yogurts, etc. are better at slowing down digestion/dealing with diarrhea than constipation.
    • guilhas 272 days ago
      That is my experience too. Although *google says this probiotic is associated with both diarrhea and constipation, by improving gastrointestinal health

      And would probably depend on what caused their constipation

  • uslic001 271 days ago
    Gastroenterologist here: Almost all probiotics are just a placebo with good marketing. There are a few that actually help like Florastor for C difficile colitis (https://florastor.com/) and VSL#3 for Ulcerative Colitis (https://www.vsl3.com/). Stop wasting your money.
  • gojomo 273 days ago
    I'd never heard a single strain could affect constipation, so these results unsurprising.

    Where attention to the gut biome has really saved lives is when a person has massive Clostridium difficile overgrowth – which is more associated with uncontrollable diarrhea than constipation. This state of extreme illness is typically only possible because prior antibiotic use cleared out the natural variety of commensal bacteria that normally keeps this particular strain at bay (or totally absent).

    In such cases, people near death can bounce back after a full-spectrum "fecal microbiome transplant" (FMT) where all of the hundreds-or-more of distinct bacterial species are transferred from a healthy donor to the patient.

    It's quite hard to package all those sensitive, beneficial, adapted-just-to-the-human-gut strains for reproducible evaluation & administration – so FMT is hard to fit into standard medical studies & FDA approval processes.

    But sometimes a mere dot's worth of a healthy person's feces can be a miracle cure for someone else! So, a company has driven an approval of their particular $10k-per-treatment shit-pill through FDA processes, and partially as a consequence, the FDA has been cracking down on people arranging FMTs in less-formal & far-cheaper ways – despite a great record of safety and effectiveness.

    A well-informed & highly-opinionated rant on this topic: "A Monopoly on Poop" https://stephenskolnick.substack.com/p/a-monopoly-on-poop

  • sgc 272 days ago
    Apparently almost any strain of lactobacillus should be able to make some type of yogurt (each one with a distinct flavor). I have taken relatively expensive probiotic supplements sold in a very famous supermarket in the US known for this type of thing (yes, that one), which claim to have close to a dozen strains of lactobacillus. It was utterly incapable of even beginning to make yogurt. It was just plain milk at the end of the process, not even a discernible yogurty taste to it. On the other hand, we had great success using a cheap yogurt starter we found sitting around that had expired 5 years ago. I would love to have a full spectrum of probiotics, but can't spend the money to actually find one that works, so I have to stick to homemade yogurt.
  • frereubu 272 days ago
    After getting really annoyed with the pseudoscientific naming around this I built a whole site about it a couple of decades ago to get to the top of search results and got threatened with a lawsuit by Danone...

    https://whatisbifidusregularis.org/

  • guilhas 272 days ago
    More specifically "probiotic X didn't work for Chinese people with constipation"

    But that's a typical arstechnica title

  • hnpolicestate 272 days ago
    The thing that has treated acute IBS episodes for me is ib guard. The green box. Though I'm pretty sure the primary ingredient is just peppermint oil.
  • giardini 272 days ago
    Maybe they need to move upstream.

    My wife is all-enthusiastic about oral probiotics (as a cure-all). She's been watching some Chinese medical experts yak about that.

  • PorterBHall 271 days ago
    “Popular gut probiotic craps out…”

    My hat’s off to the copy editor who wrote that headline.

  • Havoc 272 days ago
    How does one actually go about procuring good probiotics? Short of doctor I mean
  • zdw 273 days ago
    The headline is some of the best output I've recently seen.
    • itronitron 273 days ago
      It's a solid and well-formed contribution.
      • hedora 273 days ago
        Yeah, but the register is more regular. This one’s been ripening for a decade and is as fresh as the day it was produced:

        https://www.theregister.com/2014/01/20/haribo_gummy_bears_im...

      • hanniabu 273 days ago
        Both of you sound like bots
        • projektfu 273 days ago
          That was the wrong criticism and your model will need to be retrained. The correct response is "this isn't Reddit".
          • exe34 273 days ago
            good bot
        • Ekaros 272 days ago
          I prefer these bots to those that prose profusely generating larger than human piles of crap...
        • zdw 273 days ago
          Ah, I'm not definitely not todsacerdoti , who automated reposting all of lobste.rs to HN.

          My pithy comment was actually inspired by Sir Patrick Stewart's interview about his role in the Emoji movie: https://youtu.be/CgAIqP6hNlQ?t=215

    • morkalork 273 days ago
      Beth Mole is as consistent as ever
    • ramesh31 273 days ago
      Every so often you get the chance to make something perfect. Must have been a good day.
  • AlbertCory 273 days ago
    Whenever some theme gets broad advertising, I get suspicious. "Helps boost the immune system!" -- WTF does that mean?

    "Probiotics for gut health!" -- yeah, right. Get back to me in 10 years when you have some actual evidence.

  • manoweb 273 days ago
    [flagged]
    • Texasian 273 days ago
      Did… you really just use the term Chinamen in 2024?
      • ramesh31 273 days ago
        >Did… you really just use the term Chinamen in 2024?

        Yeah it's really not the preferred nomenclature.

      • surgical_fire 273 days ago
        Would chinaperson be better?
      • secondcoming 273 days ago
        Almost as bad as using ellipses in a sentence for dramatic effect...
    • spondylosaurus 273 days ago
      Lactose tolerance is a fluke, not the norm. Unless you're of European (+ non-Jewish) descent, you probably won't be able to digest most dairy products as an adult.
      • gojomo 272 days ago
        I know that's the conventional wisdom, but as an adult of European descent who usually handles lactose/dairy well, I sometimes have periods of reduced tolerance, perhaps due to changes in my gut biome.

        And there's evidence even lactose-intolerant ("lactase nonpersistent") demographics can tolerate ever-larger amounts of lactose with a gradual ramp-up of consumption that shifts their gut biomes in a different direction:

        https://pubmed.ncbi.nlm.nih.gov/38159728/

        There's a chance the conventional view overweights human genetics and underweights biome, which could create a self-fulfilling diagnosis of "lactose intolerance".

        That is: a person notices a bad reaction, and is told (influenced by demographic tendencies) "oh, as an adult you'll inevitably be lactose-intolerant". They avoid dairy, further thinning (or completely eliminating) the bacteria that could help from their gut, ensuring a more-noticeable negative reaction upon further consumption.

        OTOH, if the right bacterial mix was maintained, or reintroduced then maintained if necessary, many considering themselves lactose-intolerant might not persistently be.

        (Separate from the bacteria themselves assisting in lactose digestion, there's even some chance that the positive or negative shock of a wildly-changed biome might epigenetically affect the beyond-childhood activation of the human genome's own lactase genes – a possibility mentioned in the middle of this microbiologist's writeup: https://www.cnn.com/2019/04/17/health/lactose-intolerance-mi... )

        • spondylosaurus 272 days ago
          My gastroenterologist says that intestinal illness can render you temporarily lactose intolerant for a few weeks after the fact. That might be what's happening to you, or some version of it!
      • lotsofpulp 272 days ago
        There are a billion plus South Asians that eat a ton of dairy. Cows are even sacred.

        Lactose tolerance is a very wide scale, from zero tolerance to even cheese to being able to drink multiple glasses of milk without getting diarrhea.

        Based on anecdotal evidence and the seeming popularity of pizza, a lactose intolerance so great that cheese is an issue seems to be rare.

        • spondylosaurus 272 days ago
          Many cheeses contain little to no lactose, which may be a factor :) But yes, being raised in a dairy-heavy culinary culture is one predictor of continued lactose tolerance into adulthood.
      • pfdietz 272 days ago
        Lactase persistence is also common in many parts of Africa.
    • permo-w 272 days ago
      I would be surprised if they eat any cheese whatsoever. most eastern asians are lactose intolerant
  • spants 273 days ago
    [flagged]
    • homebrewer 273 days ago
      Just wondering, have you ever managed to convert or convince a single person by acting like a stereotypical vegan?
      • kstenerud 273 days ago
        If you're not going to judge people, then why bother at all?
        • hinkley 272 days ago
          How do you know if someone is a vegan?
          • cwbriscoe 272 days ago
            Don't worry, they will tell you.
    • loeg 273 days ago
      There's absolutely no evidence that a vegan diet provides a benefit for gut health relative to a diet including meat.
    • wusher 273 days ago
      I had the exact opposite experience. when I stopped eating meat I got worse. When I stopped eating vegetables I got better. I’m not saying you shouldn’t eat vegetables, I’m saying your claim isn’t as strong as you think it is and peoples gut issues are different.
      • lepus 273 days ago
        A lot of people go all in on increasing dietary fiber and then experience gut issues and think it must be the plants when they didn't work into it slowly enough. It's like going to the gym and and feeling sore all over all the time or even getting injured and then concluding that going to the gym is bad when no one told you that you should start easy. In my opinion there's harm in how people fail to communicate how to get started on plant based diets when they miss important issues like this that can permanently put people off from it.
      • dpassens 273 days ago
        Am I misunderstanding or do you really not eat any vegetables at all, not even in a dish with meat?
        • BenjiWiebe 272 days ago
          Some friends of mine tried the carnivore diet for a while. From what I understood they did not eat meat dishes that included vegetables.
    • bryant 273 days ago
      If the concern is just meat, why not go vegetarian instead?
      • CapitalistCartr 273 days ago
        Wearing this leather belt is what's causing my constipation.
        • hinkley 272 days ago
          Get a bigger belt, friend.
      • 2OEH8eoCRo0 273 days ago
        Because it's more about being an absolutist snob than anything. Vegans don't eat honey. If I have a pet hen I can't eat the eggs? Ridiculous.
      • SoftTalker 273 days ago
        What kind of vegetarian? Some allow eating eggs and dairy. Some allow fish or even birds.
    • BenjiWiebe 272 days ago
      Some friends of mine tried the carnivore diet. One thing they noticed was improved gut health.
    • hanniabu 273 days ago
      Some people have dysbiosis which makes it impossible to have most vegetables
      • shermantanktop 273 days ago
        People who have things which are exotic, rare, or complicated don’t present some kind of existence proof against advice directed at a general population which doesn’t have those conditions.
        • hanniabu 272 days ago
          People that are healthy don't need probiotics either, sooo ....
  • rbattula 272 days ago
    im over ars
    • ptsneves 272 days ago
      It also became a site I rarely visit compared to some years back when I did several times a day and even subscribed. They have some good writers in house but otherwise it has descended into politics and pop culture movies and gadgets, with the odd ode to violence like monkey torture stories or Viking eviscerations. The space news are maybe the best online.