KATIE MCCALLUM: Welcome to On Health with Houston Methodist. I’m Katie McCallum. Former researcher, turned health writer, mostly writing for our blogs.

KIM RIVERA HUSTON-WEBER:  I’m Kim Rivera Huston-Weber, and I’m a copywriter with Houston Methodist. 

KATIE: Kim, do you take probiotics? Or have you ever taken probiotics before?

KIM: I think maybe after taking a course of antibiotics but no not really. I mean, ‘cause I stopped taking probiotics with antibiotics ‘cause I never got any of the associated, you know, tummy upset that you’re supposed to get. So, I don’t know, I just never did.

KATIE: It’s funny you mention that first because that’s my most recent experience with probiotics. I had a really bad sinus infection a couple months ago, and my doctor was like, “You know, be sure to take a probiotic with your antibiotic and take it for like a month. Like, take it for a couple weeks after too.” And I was like, “Oh, interesting.” Like, that’s a use I hadn’t considered because I have taken probiotics on and off in my, sort of, health journey. Some of our listeners might remember our digestive health episode where I talked a lot about all my issues and stuff. In no grave detail, but I’ve tried probiotics for things like that, digestive support. It’s interesting, I’ve always wondered how do you know if they’re doing anything?

KIM: Yeah. And you know, I think I’m probably on the opposite end of the spectrum. I tend to think of supplements as, kind of, flushing your money. But different strokes for different folks. So, it was kind of exciting to do this episode to get an understanding of is this a real thing? Because it’s such a huge industry now.

KATIE: Oh yeah, it’s huge. And I think it’s funny you mention that ‘cause I, kind of, am too with supplements. I’m not a big -- like, typically if I wanna fix something in my life, like, I wanna find, like, a quote unquote “natural” way to fix it, and I do not think of supplements as natural. So, when my doctor started recommending, or even when I’m looking online, when you have digestive problems, like, the first thing you read about is, “Are you taking a supplement? Like that’s gonna fix your problems.” It did not fix my problems. But I mean, I don’t think that means they don’t work. But yeah, it’s interesting, you see them everywhere now, or people are always talking about them. There’s like chips that have probiotics in them and, like, all these wild products where you’re like, “Okay what -- Yeah, maybe we do need to talk about this a little bit more. Like, maybe I, kind of -- maybe I missed the boat here.”

KIM: Yeah, and well -- and I think it’s just the proliferation of it because you see it in the news and then also when you’re perusing the snack aisle and it just -- that’s not where I think I’m going to get my health advice, or I’m going to be like, “Oh, this -- Yes, I need to be thinking about probiotics  when I’m choosing snacks to watch a movie.”

KATIE: Yeah. No absolutely. Like, I kinda get it when certain things, again, not processed foods necessarily, but when they’ll call out like, “Ooh, full of antioxidants,” and stuff. It’s a little bit more like okay sure. But yeah, the first time I ran across, like, some chips or something with probiotics, I was like what is -- what is this? So today, we’re talking about probiotics. And who did we talk to?

KIM: We talked to Dr. Eamonn Quigley. He’s a Gastroenterologist here at Houston Methodist.

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KIM: The probiotic dietary supplement industry is extremely profitable, it’s now valued somewhere around 12 billion dollars here in North America. They’re marketing everything from capsules, powders, gummies. All making various claims for everything from gastrointestinal health, weight management, mental health, joint health, diabetes, heart health, and even vaginal health. So, I’d like to get a better understanding of what probiotics actually are, and to just, kinda, sift through the noise that’s out there right now. So, to start, could you tell me what probiotics are?

DR. EAMONN QUIGLEY: That’s the essential question. So, let me be a bit nerdy and start with a very strict definition of a probiotic. Because once you know that, everything else flows from that. So, the most commonly accepted definition of a probiotic, which has actually been around for a while, is that a probiotic is a live microorganism that when ingested in adequate amounts, confers a health benefit on the person who takes it. So, let me go over that with a bit more detail ‘cause it has enormous implications. Number one, it should be live. That means, not only should the bacteria -- the probiotic bacteria be alive when it’s sold, it should remain alive throughout the shelf life of the product, number one. Number two, it should be taken in adequate amounts. That means that whoever has formulated or produced this probiotic has worked out the correct dose for it. Number three, it should confer a health benefit. That means that they’ve actually done proper clinical studies and shown that it helps any one of the things that you already mentioned. What are the problems with that? The problems with this are several. Number one, most probiotics on the market do not have adequate quality control, they have not tested the viability of the product either at the time of sale or for during the shelf life, and they have often not even proven what’s in the probiotic product. That’s an enormous problem. In contrast, there are some probiotics out there which have been subjected to rigorous quality control, they’ve measured the number of live bacteria on day one up to day whatever it is that it should go for. But many do not -- have not done that. Secondly, most kinda seem to, kinda, guess a number and throw that in. Some probiotics actually have been tested to find out what number they need to be effective. But the biggest problem of all, perhaps, maybe it’s not a really big problem is that most of them have not made even an attempt to prove that they actually confer the health benefit that they claim. And it’s gone crazy. There are probiotic mattresses, probiotic jacuzzies. You name it, probiotic has been attached to it. And I would say in the vast majority of those instances, there’s no quality control, there’s no dose-ranging performed, and there’s no evidence of a health benefit. And unfortunately, in some instances where people have taken probiotics off the shelf in a health food store or a pharmacy or whatever, and tested them, they haven't even found that any of the bacteria are alive, or that it even contains the bacteria it’s supposed to contain. And that’s the problem that the consumer has.

KIM: It sounds like probiotics are, kind of, a broad term that you shared there. So, what are the different types and what are some of the benefits of those, and are some more prevalent than others?

DR. QUIGLEY: If you like, the original probiotics came from a group of bacteria called lactic acid bacteria. And the two main families, if you like, within that were bifidobacteria and lactobacilli. And a lot of the probiotics that are still available contain one or other of those. Now, within that, there are a whole lot of different strains, and that’s a very important issue. But there are other probiotics out there in other bacteria classes, and there are even some yeasts which are important probiotics, like Saccharomyces for example. So, there’s a whole variety of bacteria and yeast out there which have probiotic properties as I defined. Now, what do they do? Well, they can do several things. Obviously, if your gut microbiome is in some way deficient or depleted, you can use probiotics to repopulate the intestinal tract. We know from good science, and there’s a lot of good science, that certain bacteria, such as bifidobacteria, engage with the immune system, and they actually have an anti-inflammatory effect. We also know that bacteria produce metabolic products, and that’s why there are claims around weight loss and weight maintenance, etcetera. And of course, they interact with other bacteria, and they, in theory, could suppress bacteria which might be injurious to the host. So, there’s several scientific works out there which show that probiotic bacteria can exert a variety of beneficial effects. The problem is that most of the work is done in animal models, not a lot of it is done in humans. And for a lot of the probiotics out there, there’s been no testing whatsoever. And I’d like to make one additional point, which is a very common issue. And that is that I do experiments, I show that a certain bifidobacteria has beneficial effects, I do a clinical trial that shows beneficial. But that does not apply to all bifidobacteria, it applies only to the specific strain that I tested. But what tends to happen is they -- You know, supposedly I say bifidobacterium longum such and such has an effect, then they claim that every bifidobacterium longum has that effect. You can’t say that.

KIM: So, you’ve shared some of the science backed health benefits that exist for some probiotics, but are they used as treatments for any kind of conditions, or are people looking to use probiotics simply for overall general health?

DR. QUIGLEY: It’s important at this stage that we should mention two other classes of product in this arena. One is a prebiotic and the other is postbiotic. Now, what are they? A prebiotic is actually not a bacteria at all. It’s a substance that promotes the growth of beneficial bacteria. It’s usually some form of complex carbohydrates. Some of them are fibrous for example. Another example is inulin, oligosaccharides, etcetera. Post biotics are bacteria -- probiotic bacteria that had been rendered inanimate or they’ve been killed in some way or another. But they can still have biological effects, and even have been shown to have clinical effects. So, when we’re talking about use of any of these in a clinical setting, I think we should differentiate between two situations. One is taking them to treat or prevent a disease, and the other is actually giving them to healthy people. Let me take the last first ‘cause it’s maybe the easiest one. I think it’s fair to say that for people who are absolutely healthy, have no GI problems, have no other problems, there probably is not a lot to gain from taking a probiotic. If it’s a high quality probiotic, it’s probably not gonna do you any harm, but you may not gain a lot from doing so. Now, in terms of the other situation, this is where things get interesting. Because strictly speaking, according to the regulation in the U.S. and elsewhere, you’re actually not allowed to say that you’re treating a disease or curing a disease with a probiotic unless you’ve had it tested in the same way as you would test a drug through the FDA. So, you can make what they call structure function claims, that’s where you can say that it may promote the immune system, or it might promote digestive health. You can use those types of very general terms, but  you can’t go and say they’re going to treat irritable bowel syndrome or treat inflammatory bowel disease, etcetera, etcetera. Or treat depression or anxiety. And that’s why you hear a lot of, kinda, vague claims. ‘Cause that’s the way that area is regulated. ‘Cause very few of these probiotics have actually been tested the same way that you would test a new drug for beating high blood pressure, etcetera. And that’s why the area is so muddy because yes, you’ve got good products out there, which actually do have evidence that they can help in some serious diseases like -- one example is this very serious problem that can occur in preterm infants. It’s called necrotizing enterocolitis, which can be fatal. Probiotics can help to prevent that condition. Now, this is a very important one. Probiotics may also be able to prevent or reduce the likelihood of getting complications if you take an antibiotic. And there’s some evidence that probiotics can actually help people who have symptoms from irritable bowel syndrome. And there’s some other areas out there. Actually, at the outset you mentioned a very interesting area which is the whole thing about the microbiome gut-brain axis. And there is quite a bit of laboratory evidence to suggest that the gut microbiome can influence the function, even the structure of the brain. And there’s actually some evidence from human studies that this may also apply in man. And there is some data, including some research that we did to show that probiotics can actually have an influence on mood and people with irritable bowel syndrome for example, and in other situations. You know, it’s fairly early data, it’s very limited data. But at least there is a suggestion out there that you might be able to modify mood and behavior with using probiotics.

KIM: You had mentioned that, and it really is one of the moments that I’ve always heard about using probiotics is during, or maybe after you’ve done a course of antibiotic treatment. Would you want to use those probiotic gummies on the shelf at the pharmacy or would it be something that you would work with your physician to get something that’s a little bit more high quality?

DR. QUIGLEY: I would certainly get advice from your physician because you may be taking something that’s absolutely worthless. I’m not saying the gummies -- some gummies actually do have effective bacteria, but the important thing is to know that you’re getting a strain of bacteria, or a combination of strains of bacteria that have been shown to be effective in that situation. And there’s lots of data. So, if somebody wants to use probiotic X, they can find out has this been shown to be effective or is it actually probiotic Y?

KIM: Interesting. And does it depend on the antibiotic that you’re using for when you should be supplementing with the probiotics?

DR. QUIGLEY: I think there are two answers to that question. Antibiotics are probably not as important as the patient’s history. Some people seem to be more prone to getting side effects from antibiotics. So, if they have a past history of getting diarrhea or even C. difficile in the past, they’re the group that you should target who are most likely to have problems. All those may not have any difficulty, but any what we call broad spectrum antibiotic, which affects the gut microbiome, could cause these side effects and therefore the patient could benefit from taking a probiotic in that situation.

KIM: So, outside of supplements, where are we usually finding probiotics?

DR. QUIGLEY: Probiotics can be found in a whole variety of products. You know, as you know, some yogurts contain probiotic organisms. They can be formulated in a liquid form, you can get them as tablets, etcetera, etcetera. And that’s an important point because one of the things that the person who’s selling the probiotics should be able to tell you is whether that form, you know, when they make it into a gummy or when they make it into a liquid, or whatever it is,  that has not affected the viability of the organism. So, they should have shown, not only that there were live bacteria as it was originally produced, but that also this viability was preserved in whatever form they're going to sell it in the future.

KIM: You mentioned yogurt. That’s the thing that comes to top of mind for me is where one person may find some probiotics, and I think about fermented foods also like kimchi, sauerkraut. Is it better to try to get probiotics from dietary sources like that versus taking them in a different form?

DR. QUIGLEY: There really is no good answer to that because the only way you could answer that is by doing a comparative study, and unfortunately, they’re just not there. To a lot of people, that sounds more attractive because you’re not taking anything additional, but in effect, if the yogurt contains liable bacteria and they're the right type of strain, it should be just as effective as a pill or a liquid or what other form it should be. But there are a lot of “Ifs” there, and I think the critical thing is, you know, we need more studies. We need high quality studies. Fortunately, that's happening.

KIM: Earlier on, you kind of mentioned jacuzzies and other things that, kind of, are invoking probiotics and benefits. One of the places that we see, kind of, emerging in this field are processed food companies. So, there’s sodas, and snacks. If someone is wanting the gastrointestinal benefits or any of the host of benefits that can come with probiotics, is it worth purchasing a soda or a snack, or should they just a supplement if they wanna do that?

DR. QUIGLEY: They should -- and it’s easier for me they should, but in fact this is very difficult for the consumer ‘cause it assumes almost that they have the same knowledge of the probiotic arena as somebody who’s an expert in the area. Ideally, they should know or be advised by their physician or their health care provider what type of probiotic to take. In general, I would steer clear of these, kinda, more exotic preparations, and I would stick to, you know, the ones that you find that have been around for a while, that have been tested in clinical trials, and that, you know, they may be in, kind of, traditional formats. Like, they could be in capsule form, or tablet form, or they could be in a liquid form. They are the ones that I would stick with.

[Music to signal a brief interjection in the interview]

KATIE: Interested in probiotics, but not ready for the research of finding a high quality, effective probiotic supplement? There are plenty of approaches to add live microbes and the food they eat to your diet. Consuming live microbes may help your immune system develop properly and can help sustain a robust microbiota as you age. Include, as part of your healthy diet, probiotic containing foods such as fermented foods that contain live microbes, including yogurt, kefir, most cheese, miso, kimchi, sauerkraut, fermented vegetables, most kombuchas, and tempeh. For yogurt and dairy products, make sure you see “Live and active cultures” on the label. To ensure the fermented foods you choose contain probiotics look for the words “Naturally fermented” on the label, and when you open the jar look for telltale bubbles in the liquid which signal that live organisms are present. Prebiotics and fiber, which can feed your microbes include plenty of foods rich in insoluble fiber, which tend to contain the most prebiotics. You'll find them in whole grain products such as oatmeal, and whole grain breads, as well as vegetables like asparagus, leeks, onions, and garlic, as well as starchy vegetables like sweet potatoes and corn. Beans, lentils, and peas are also good sources. And try to eat whole foods as much as possible while limiting sugar, saturated fat, and processed foods as they can deplete the good bacteria in your gut.

[Music]

KIM: Up after the break, Dr. Quigley talks about some of the next generation probiotics and what they’re seeing in the research.

[Music]

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KIM: We’ve talked a lot about the benefits, and you mentioned that it probably wouldn’t hurt someone who’s otherwise healthy to use probiotics. But are there any risks associated?

DR. QUIGLEY: That’s a very important question. Safety is always to be considered. There have been problems with probiotics. They’re very rare actually. The problems mostly arise because of poor quality control. And as you probably know, there have been instances where actually pathogenic bacteria have ended up being in a probiotic and have actually killed children. So, that’s not saying that the probiotic -- it’s saying that the manufacturer had no quality control, and they allowed their probiotic product to be contaminated. What I would say is this, is that if you are taking a high-quality product that has been manufactured to a high standard, that has been tested adequately in humans, and that has a rigorous quality control standard, a probiotic is generally safe. Now, there are some exceptions, perhaps. For example, if the individual is very immune deficient for whatever reason, maybe you should avoid a probiotic in that situation. But in general, if you’re dealing with a high-quality product, the risks are low. Beyond that, we know what we’re doing.

KIM: Interesting. Can you overdo it with probiotics and maybe take it too often or -- And what would be the ramifications of something like that?

DR. QUIGLEY: It’s very difficult to do that because if you think of the math. Like if you have -- when you look at the number of bacteria that you normally have in your GI tract, the numbers that you take with a probiotic are way smaller. So, to have a significant impact on changing the overall numbers of bacteria, it’s almost physically impossible. So, you can’t overdose -- well, I suppose in theory you could, but it would be really be hard to do it. But that’s not an issue. The issues are more related to poor quality and contamination.

KIM: So, you’ve talked about rigorous quality control. And with so many claims out there and so many different types of companies, you know, selling probiotic supplements, how could a consumer go about choosing one and, kind of, sifting all of the claims around them?

DR. QUIGLEY: Well, there are a number of things you could do. There actually is something that they can look up. The definition that I provided right at the outset was produced by the International Scientific Association for Probiotics and Prebiotics, ISAP. And I would highly recommend going on to the ISAP website, just Google ISAP, you’ll find it. And they have a lot of materials there which are designed, some for scientists, but a lot of them are designed for the lay public. And they have these infographics which are excellent, which will take you through the definition.  But they will also give you some guidance as to how you can go to the supermarket or the health food store, and take something off the shelf, and ask yourself some critical questions which will help you to go some way towards getting a product that might actually be effective. And I highly recommend that to everybody. I have to disclose, of course, that I am actually on the board of ISAP, but it is an independent scientific organization, which is not linked directly to any company.

KIM: You talked about some of the specific strains that are being studied, what does, sort of, the next -- this is probably not the best way to phrase it, but what are some of the, like, next generation -- what are -- what’s -- what are you hoping the research will show in the future about probiotics?

DR. QUIGLEY: Well, you’ve used a very distinct term there, which is one that’s like a hot topic in this area at the moment, which is “Next generation.” And there are a number of things that people are looking at there. They’re looking at postbiotics because as I mentioned earlier, even when some of these organisms are dead, and this is very specific organisms, they can retain some of the biological effects of live organisms. And obviously, if you can show that dead organisms are effective, that would be very attractive because whatever risk there may be with the live organisms, they shouldn’t exist with the dead organism. So, that’s one area. People are also looking at and studying in great detail the metabolic effects of bacteria and the products that they produce. For example, it has recently been discovered that some of these bacteria, which could be used as probiotics, actually produce neurotransmitters like we normally produce in the body, which could modulate the nervous system in the gut, or even the nervous system in the brain could operate. So, a lot of exciting stuff like that. I mentioned the immune system. Again, there are very interesting ways that the probiotics can interact with the immune system and suppress inflammation. And we’ve also touched on this idea of modulating the central nervous system, and there’s again, research going on to show that perhaps you can do this through the vagus nerve, though modifying the inflammatory response, through producing neurotransmitters, neuromodulators, etcetera. So, there is a -- I think there’s quite a lot of work going on to show how we can modulate the human body with probiotics and probiotic effects. There’s quite a lot of work going on, and looking at next generation probiotics. And of course, there are more clinical trials, high quality clinical trials being done with probiotics in important areas. So, I think there’s quite a lot to be excited about. And, you know, the range of possibilities continues to increase. Now, the other area that’s very interesting, which is not a probiotic, but is the fecal microbiota transplantation. Now, fecal microbiota transplantation is where you take a whole stool and you process it, and you give it to a donor, and that’s been shown to be very effective in the treatment and prevention of C. difficile infection, but from that has come the idea of can we go one step further and find out exactly what it is in these stool products that is effective? And people look here at the consortia, in other words, picking out the bacteria which are effective in a particular situation and getting those combinations. That’s at a very early stage, but it’s a very exciting possibility that you might -- ‘cause there is suggestions that C. difficile seems to be you know, a big winner, but in other areas, it’s been tested and it’s been very interesting. So, for example, in inflammatory bowel disease, some studies have worked great, some of them have been hopeless. In irritable bowel syndrome, some have made people worse, and some people have been dramatically. Which suggests that there’s something about what you get from the donor that makes all the difference. And if you could figure out what it is exactly that makes a stool sample from one individual cure one of these conditions, and from another individual do nothing or make it worse, there’s -- that’s a very exciting possibility. That’s not probiotics strictly speaking, but it is talking about what I called microbiome modulation in the most general sense.

KIM: That all sounds very exciting. And I think this is an area where, I think again, because the supplement industry, the food industries are really latching on to it. ‘Cause you mentioned the prebiotics and postbiotics. Are there supplements out there right now that are, kind of, purporting any of those benefits, and are they worth any time?

DR. QUIGLEY: The prebiotics certainly are very interesting. And because the prebiotics will come mostly in the form of foods. And as I mentioned, they work by boosting the good bacteria, but they have other – like fiber obviously, there’s other benefits as well. So, prebiotics -- a lot of prebiotics have fairly well-defined benefits, and they’re being refined also because people are getting very precise. They’re saying, you know, “We’re gonna produce this prebiotic, which is going to particularly stimulate this type of bacteria, which is going to have this effect.” Now, one advantage that prebiotics have, ‘cause they’re really foods, they really have -- they’re very low risk. And so, their safety will not really be an issue, and they -- and you know from the consumer’s point of view, they will also be attractive because it’s a food and you know, you’re not taking live organisms, etcetera. So, I think the prebiotic, yeah it will continue to grow and develop, I think it’s an important one, but again same rules should apply. Your prebiotic must be produced with high quality control, it must be shown to have the effects that a prebiotic should have, and it should be shown to be effective in whatever condition you’re treating.

KIM: So, say we’re taking a quality probiotic, we’re taking our daily fiber, how are we going to know it’s working?

DR. QUIGLEY: Unless you have symptoms before you start treating it, I’m not sure how you can judge.  For example, a probiotic lowered your cholesterol or improved your blood sugar control, that’s obviously something you could measure. I don’t know a lot of evidence for those, but there will be things you could measure. So, unless you had symptoms, or unless you had a biological abnormality that could be modified and that you could measure if you’re healthy, I’m not sure how we would know that they’re helping you.

KIM: I think that’s important for those who are inclined to take supplements just for general health if, you know.

DR. QUIGLEY: Yeah. But the same applies to -- most people don’t need vitamins, but they take multivitamins, or they take a lot of other stuff that they don’t need.

KIM: It’s a good reminder that, you know, sometimes we might be burning our money in that way sometimes.

DR. QUIGLEY: Oh yeah.

KIM: Is there anything that -- on the topic that you feel like we haven’t touched on that you would want to make sure that people understood?

DR. QUIGLEY: I think I would go back to where I started, and I would remind people of what is a probiotic and what isn’t a probiotic. Unless it fulfils those criteria that I mentioned at the outset: being live, being taken in an adequate amount, and having a health benefit, then it’s not a probiotic. And that will eliminate a lot of the stuff out there. We’ll also allow the good products to be highlighted and to be shown for what they’re worth.

KIM: So, we should always be making sure that we’re seeing that live and active on any packaging that we’re buying?

DR. QUIGLEY: Correct. Not only like and active when you buy it, but they should tell you that -- or for whatever the shelf life. Is it six weeks or six months that the bacteria will remain live in an adequate amount.

KIM: And that’s interesting to think because we don’t always know how long things sit on shelves either. So, to be able to keep that in mind when we’re making our purchase. Thank you so much for being with us today, Dr. Quigley. It’s been a wonderful conversation.

DR. QUIGLEY: Thank you. I’ve enjoyed it very much also.

[Sound effect signaling end of interview]

KATIE: So, it sounds like those vague claims on the front of all these probiotic boxes that I see when I walk through the aisles are exactly that, vague, and they’re vague for a reason.

KIM: Yeah. They don’t mean much. Extremely vague. And I was surprised at just the wide variety of industries that are getting in on this probiotic trend. So, mattresses?

KATIE: Oh yeah, that was funny. And jacuzzies are also --

KIM: Jacuzzies, yeah. I was like --

KATIE: What does that even mean?

KIM: Are you boiling yourself with probiotics?

KATIE: Going into thermal vents and we're like --  the ocean holds all the secrets, let’s bring them into your backyard. It’s so weird.

[Laughter]

I had not heard of those. I mean I thought when we talked about how they’re in chips now, we were kind of like entering the wild space of probiotics, but clearly, we were not.

KIM: Yes. So, there are apparently lots of exotic marketing claims out there, even more so than just chips.  But I think that stands to prove that there is a lot of nuance in this space and you, kind of, have to do a little bit of your own research to get the benefits that you want out of using probiotics.

KATIE: Yeah, definitely. I think -- when I first heard about probiotics, I thought of -- I mean, I guess I knew they were supplements, but I thought of them less like supplements than some other things, but certainly seems like a supplement. You -- there’s a lot of criteria that you need to check before you go put something in your shopping cart and buy it. And you know, I, on the way here, was like, “Ah, I’m just gonna go run by the drug store and like see what’s there.” And you know, Dr. Quigley mentioned that website we can go to and use it as a resource. And I did, and I pulled up the list, and I was, like, walking through the store and was like, “Alright, are any of these even here?” And, you know, Kim, there were some there. So, there’s good news out there, there’s quality products at your doorstep, but there were a lot not on the list sitting on the shelves. I would say 90% of what was on the shelf was not a quality product per that website.

KIM: Which I would like to say that I’m -- I don’t know. I’m not surprised, but I think that stands to prove that it’s so difficult for people to sift through all of this because there’s just so much of it.

KATIE: Mhm.

KIM: And you have to be a little bit more discerning than just, like, putting it in your cart.

KATIE: Yeah absolutely. And I think -- we’ll drop that link that he mentioned in the show notes for you guys because I will pretty much be bookmarking it. Like, so when I walk through the store next time I need probiotics, or if I wanna try ‘em again. You know, like I said, I tried them in the past and they didn’t really help me a ton, but probably because I was just picking a random box that looked the most legit and, you know, taking a pill every day, rather than like -- now I have a list, and I can go fact check. And there were two options for me there in the store that’s right by my house. So, I did really like that. As much as there seems to be a lot unknown, I left y’all’s conversation with some actual options out there for myself. So, I’ll probably try ‘em.

KIM: Yeah. And I think I, as a person, who hasn’t really thought to use them, I think I would definitely consider because it now seems less like hope in a bottle, which is, you know, usually how I feel about most supplements, but it seems like there’s a lot of science backed evidence with some of these strains that it might be worth it just to see if it boosts my overall gastrointestinal health.

KATIE: Yeah, for sure. I mean, I think really interesting conversation, and that’s why I like that we do these things. You even kinda mentioned it. You expected to, kind of, hear something different than what we actually heard, which ended up being a bit more skeptical information so that you can be a consumer out there making science driven choices, which I love. So, I think that was really cool. I like that’s what came out of this.

KIM: Yeah, definitely. I didn’t know a whole lot about probiotics going in and I certainly know a lot more coming out.

KATIE: Awesome. Well, that’s gonna do it for us today with this episode of On Health with Houston Methodist. Be sure to share, like, and subscribe wherever you get your podcasts. We drop new episodes on Tuesday mornings. Until then, stay tuned and stay healthy.