The probiotic and microbiome hustle. Why you should avoid brands like: Silver Fern Brand, 38Tera, PROMIX, Armra Colustrum, and Emma Relief.

Seaums O'Mahony, an Irish author, retired gastroenterologist, and preeminent author published a wonderful commentary in the journal Gastroenterology titled "How Will the Future Judge Us?"

He has predictions about microbiome research and probitoics that I think are already proving accurate. 

• "The mid-2020s was the heyday of microbiome research. Back then, although there were only a few clinical applications (mostnotably fecal microbiota transplantation for refractory Clostridium difficile infection), microbiome researchers were nevertheless confident that therapies for a huge spectrum of diseases were just around the corner. Unfortunately, that is where they stayed." 

• "Despite the fact that irritable bowel syndrome (IBS) is driven predominantly by psycho-social factors, persistent attemptswere made in the late 20th and early 21st centuries to reframe it variously as a low-grade form of IBD, dysbiosis, and food intolerance. This was because many IBS patients rejected a psycho-social cause and because the potential pharmaceutical market was huge. Even though a systematic review published way back in 2023 concluded that evidence for the efficacy of various probiotics for IBS was “low to very low,” they were still being prescribed for IBS as late as the mid-2030s. A raft of new pharmacologic therapies for IBS in the 2030s and ’40s proved to be equally disappointing."

I challenge anyone to show me a high quality clinical study showing benefit of probiotics and/or various agents to alter the microbiome.

The high prevalence of IBS and other functional GI disorders, combined with limited evidence-based treatments and little incentive for pharmaceutical companies to invest in new therapies, has opened the floodgates for businesses to market expensive products that, in my view, amount to little more than placebo-driven snake oil targeting desperate patients.

Joe Schwarcz wrote a great article summarizing the approach these businesses take: 

"A common scheme is to dredge the scientific literature for some study for some natural substance that has been shown in some way to have some sort of physiological activity. That isn't hard to do because just about anything when tested in the lab or in an animal will have some sort of effect, sometimes positive, sometimes negative. Then cherry pick the positives and plunk those ingredients into a pill or capsule, along with some vitamins and minerals for good measure, and claim the product is "science based." While there may be some evidence for some of the components, although usually not at the dose found in the supplement, there is no evidence for the supplement as a whole since no trials have been run. Therefore the "science-based" claim is bogus. It doesn't mean the supplement cannot work, just that there is no evidence it does. Of course, there will be all sorts of anecdotes from people who claim that their miserable life has been turned around by the doctor’s miraculous discovery, but in terms of science, that doesn't amount to a hill of beans."

Here are some examples of businessess pedeling probiotics that I find particularly egregious (in no particular order). In no way meant to be exhaustive. 

• Silver Fern Brand
• 38Tera
• PROMIX
• Armra Colostrum
• Emma Relief
  

Go through there websites and social media. Is there any evidence for what they are promising or do they just have convincing ads?

Some themes I've noticed 

• Founder talking directly to the camera (Silver Fern Brand). In this case about microbial diversity, microbial balance, and "absolutely improving leaky gut". 
• Using older looking physician to gain credibility (Emma Relief). Blanket statment of "fiber makes constipation worse". 
• Podcast "interview" (Promix). 
• Hiring an influencer (Armra Colustrum).