Probiotics: Useful or Not?

In the wake of a recent settlement agreement in the class action lawsuit against Dannon's Activia and DanActive lines of yogurt, the New York Times has decided to dip into the discussion on "neutraceuticals" in the most non-committal tones.  The article cites information both in favor of and against the usefulness of probiotics in mass market grocery store products.  I think it behooves us to look a little more closely at the issue.

Michael Pollan among others is well known for mocking "nutraceuticals," and I can understand where he is coming from. It seems ridiculous - and so perfectly American - to expect a scientific food additive to fix a health issue. Eat your way to health! Nevertheless, yogurt has long been known to be a valuable source of helpful bacteria.  

The classic "use case" for yogurt is after a round of antibiotics, to help replenish your intestinal flora.  Yogurt can also be helpful to women suffering from yeast infections.  Farther down the dairy case, acidophilus milk is helpful both to people with lactose intolerance, and to help "regulate the digestive system," as the euphemism goes.

So in a certain sense, regular old yogurt is itself a nutraceutical.  But of course, no company in the country would be happy with "it's fine the way it is." We always have to develop bigger better faster shinier foods, in order to catch the consumer's attention, justify expensive ad campaigns, and shoulder aside shelf space from unchanged (i.e. lesser) brands.  And so the probiotic movement in yogurt, which started sticking all kinds of strains of bacteria in there.  

I think most people accept that supplemental bacteria in yogurt could help with conditions like diarrhea and irritable bowel syndrome. The real source of skepticism is with some of the "fringe-ier" claims, such as preventing cancer or lowering cholesterol levels. As the National Institute of Health drily observes, "in studies of probiotics as cures, any beneficial effect was usually low; a strong placebo effect often occurs."

There are no known adverse effects to taking probiotics, either as a supplement or as an addition to yogurt.  However, there also isn't a whole lot of rigorous scientific work on whether or not these supplements are as helpful as advertised.  Most of the evidence in favor of probiotics comes from animal studies or laboratory tests, and results from large scale real world "actual human intestinal activity" tests are notably absent.  

Furthermore, as a researcher pithily points out in the New York Times article,

"To say a product contains Lactobacillus is like saying you're bringing George Clooney to a party. It may be the actor, or it may be an 85-year-old guy from Atlanta who just happens to be named George Clooney. With probiotics, there are strain-to-strain differences."

Granted it's not going to hurt you to choose Activia over the regular yogurt.  But considering that Activia costs a premium, particularly compared to buying a big tub of plain yogurt, it can have quite an effect on your pocket book!