Probiotics: yes, no or maybe?

Barts-MS rose-tinted-odometer: ★★ (Black Friday, Friday the 13th #000000)

The meta-analysis below of probiotics suggests they may help people with MS (pwMS). However, when you drill down into the details you will note that there were only four studies included in the meta-analysis with 213 actively treated subjects compared to 107 controls. Far too small to be confident of an effect. The problem with probiotics is not only their definition but trying to work out what they actually do in terms of MS pathology. The rationale for prescribing probiotics to treat MS is based on the potential for gut bacteria to be anti-inflammatory and to stimulate regulatory cells. This hypothesis is based largely on animal studies and I am yet to be convinced it has any relevance to multiple sclerosis. This is why I don’t recommend probiotics to my patients. If your financial resources are limited I would question spending them on unproven therapies such as probiotics.

I would be interested to know how many of you are taking probiotics, who prescribed them and have you noticed any effect? 

Mirashrafi et al. Effect of Probiotics Supplementation on Disease Progression, Depression, General Health and Anthropometric Measurements in Relapsing-Remitting Multiple Sclerosis Patients: A Systematic Review and Meta-analysis of Clinical Trials. Meta-Analysis Int J Clin Pract. 2021 Aug 11;e14724. 

Methods: The English literature search was performed using PubMed, Scopus, Web of Science, and the Central Cochrane Library through January 2021. Random effect models were used to synthesize quantitative data by STATA14 .

Results: From a total of 152 identified entries, four trials were included in quantitative synthesis (n=213; 106 as intervention, 107 as control). An additional six studies with the same structure and different markers were also systematically reviewed. The pooled effect size showed that Expanded Disability Status Scale (EDSS) (WMD=-0.43; 95% CI=-0.65, -0.20; P<0.001), Beck Depression Inventory-Ⅱ (BDI-Ⅱ) (WMD=-3.22; 95% CI=-4.38, -2.06; P<0.001) and General Health Questionnaire (GHQ) (WMD=-4.37; 95% CI=-6.43, -2.31; P<0.001) were improved following probiotics supplementation. However, body weight and body mass index did not statistically change.

Conclusion: Our findings revealed that probiotics supplementation can improve disease progression, suppress depression, and general health in MS patients; although, further investigations may be needed.

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General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice. 

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20 thoughts on “Probiotics: yes, no or maybe?”

  1. A really interesting commentary Prof G, I had recently been considering taking probiotics but wasn’t sure about it – seeing your views has made the decision making easier! Thanks

  2. I went to see an alternative therapist on the back of my CIS diagnosis. I was sceptical but went on the recommendation of a friend. She was sold to me as a fixer and i needed fixing. I liked her but now feel my money would have been best spent on a decent neurologist instead. She recommended probiotics to me alongside a few other bits and bobs. At that point, my MS was fairly invisible but 3 months later i relapsed and that seemed to kick off what are now persistent (sensory) symptoms. I’m not saying it was the probiotics but i did scrap them after that as i also developed very dry hands and mild psoriasis on my knees. At this point i was not on any DMTs so something definitely rocked the apple cart

  3. I eat an insane amount of Greek Yogurt (because I enjoy it and high in protein). Does that count?

    1. I suppose you can claim all fermented food that is live, e.g. yoghurt, cheese, kimchi, artisanal charcuterie, etc., are probiotics. I think what counts is if are you eating these as food or are you taking them for their microorganisms. If the latter it would count as probiotics.

    1. No, I don’t think so. Probiotics and the gut microbiome are not my fields. I am just learning about them. I am just a little bit cynical about the claims being made regarding effects on MS. I am trying to get a feel for how many pwMS are on probiotics, were they prescribed and have they had any effect.

      1. Understood. Unfortunately, it is true, very often something is claimed without a valid scientific basis so it is a real refreshment to see that there are scientists questioning and researching the validity of the claims made. Thank you.

  4. I was diagnosed with MS in ’94 and have lived with the disease from a time of know information to a time now of too much!

    I have always made decisions on a number of factors;
    Faith – trusting a neurologist
    Gut(excuse the pun) – does it feel right alongside what I know of the disease and my pathology
    Instinct – can I imagine that whatever it is I take is in the helpful bracket

    I read a lot about probiotics, I spoke with nutrients and decide to take them.

    Evidentially I cannot demonstrate a marked change but then this ship turns slowly and I have not run into any icebergs recently.

    Supplements are part of my management programme, along with exercise, medical help and mental attitude.

    1. I would imaging most probiotics are safe, but the question is does this justify their use in pwMS without convincing efficacy data?

  5. I have given up dairy (as advocated in many autoimmune diets) and have had non dairy kefir and kombucha. I don’t know if it’s a coincidence but I have felt great on the days these were consumed. It may even be just down to more regular bowel movements who knows?

    1. I guess having regular bowel movements can be positive. Not too many though. But if the fermented foods help reduce constipation, then inturn this might reduce UTI’s ?
      Reducing UTI’s is a good thing.

  6. I started taking them when I was getting lots of UTIs. I’d been on long term abx to sort out the utis, but they my hammered GI tract. A google search said it might help, with the GI stuff and the utis. They weren’t prescribed, but I told my urologist and he humoured with a relatively useful discussion about it. I haven’t had further utis…. Hard to say whether this is due to probiotics or the urology referral… always thought it was the latter but who knows.

  7. I don’t understand why ‘probiotics’ keeps being considered as a single treatment. This is like saying ‘bacteria’. There are good bacteria and bad bacteria. Meta-analysis of this heterogenous group of organisms is very bad science. Somebody needs to assess one organism and if results are positive, say that that bacterium is beneficial. Not that probiotics are good. Clostridia are likely to be bad for pwMS and some lactobacillae may be good for pwMS.

  8. I can not say that the probiotics I take “help” my overall MS. However, when I do not take them, I do feel my MS symptoms are a bit worse (similar to how exercise affects my MS), so I guess they do have some positive benefits.

    My gastroenterologist recommended probiotics (pre-MS, if there is such a thing) to help my gastrointestinal problems. Then once I was diagnosed with MS and started doing crazy amounts of research, I noticed probiotics were a common factor in several of the holistic type approaches to managing MS, so I incorporated them into my approach.

    I am on a DMT, but I also take eight supplements daily, in addition to several pharmaceuticals. Still at about a 6-7 on the pain scale but the Rx allow me to carry out daily functions………MS really sucks!!

  9. I’m cynical about probiotics. They taste far too sweet. What’s the sweetener? Not comfortable with that aspect of them. Then the marketing. Is it not just slick packaging and a modern wellbeing sell for the worried well? It feels like a con to me. Anyway, a Welsh company of my acquaintance suggests Prebiotics are also needed. It seems like too much information….

  10. I use the Clever Guts recipe book (Michael Mosley’s GP wife is the author) which shows you how to improve the microbiome by giving recipes for meals rich in pro- and prebiotics. I’d rather do this than supplement.

  11. Bonjour

    J’ai la sclérose en plaques depuis 1998.
    Edss 5
    J’ai essayé tellement de régîmes « miracles « .
    Vit D
    Vit C (perfusion à haute dose)
    Gluten Free
    No caséine
    Etc Etc
    Aucune amélioration.
    J’espère que le Temelimab (phase 2B actuellement en Suède) arrivera bientôt en France.
    Jérôme 49 ans Paris

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