Food

Are Probiotics Really the Secret to Good Health (Or Just the Latest Crackpot Supplement Fad?)

Proponents claim probiotics can prevent asthma and cure irritable bowel syndrome, colic, yeast infections, acne -- even autism. Have the claims of benefit gone too far?

For some Americans, the world's happiest headline is "You may be entitled to cash." Luckily for them, that sentence crowns a press release that went out this week which also includes the phrase "You could receive up to $100," and describes "a $35,000,000 fund," then boosts its cred with: "A federal court authorized this notice."

And all because a California woman ate yogurt thinking it would regulate her digestion, but -- according to the lawsuit she filed -- it didn't.

A statement released February 16 by the San Diego, California-based law firm Blood, Hurst & O'Reardon announced that the claim period has just opened in a class-action lawsuit against Dannon. Two years in the making, the suit claims the yogurt company "falsely advertised the health benefits of its Activia and DanActive branded products."

Dannon, which promoted these yogurts as being probiotic and digestion-friendly, has pledged to refund every eligible claimant professing to have bought Activia or DanActive since these products were first introduced in 2006 and 2007. If so many forms are filed as to exhaust the initially-agreed-upon $35 million, the fund goes up another $10 million.

"We want as many people as possible to make claims," says Tim Blood, lead counsel in the case. "There's no proof of purchase at all required, just a claim form. Obviously, a lot of people don't keep store receipts," he points out, so claimants can create and sign documents stating under penalty of perjury "that they bought $75 or $100 worth of this stuff."

Ever since Activia and DanActive entered the marketplace, Dannon has promoted them by touting the probiotic microorganisms they contain. They entered the marketplace just about when probiotics (the term was coined in 1965) started becoming very trendy indeed, when the immunity-boosting, infection-preventing, constipation-curing properties probiotics proponents had been praising for decades in the alt-health world went mainstream. Intrigued by the claims and by the apparent promise of regularity, Los Angeles-area caterer Trish Wiener tried Activia, but believed it did nothing for her gut. The suit ensued. Standing by its advertising and its products while maintaining it did nothing wrong, Dannon agreed to settle -- but only because going through the courts "is an extremely expensive and time-consuming process," says Dannon spokesperson Michael Neuwirth. "It requires a tremendous amount of focused attention, which we would rather devote to providing consumers with good products."

Because Dannon is a multibillion-dollar company, the lawsuit has spurred a media hullabaloo. As a result, anyone who hadn't heard about probiotics before last September, when settlement talks began, has now.

Some called the suit frivolous, since for many years it was Dannon's standing policy to offer money-back guarantees on its products. Lamenting the damage done not just to Dannon but to the reputations of yogurt, fermented foods and probiotics in general, some compared the settlement to negotiating with terrorists. Others saw the settlement as proof that probiotics are a scam. This sent still others into mourning as they watched their hopes for wonder cures wither in the wind.

At the heart of it all are microbes with scary names such as Streptococcus thermophilis and Bifidobacterium animalis, which are very much alive and which, with every mouthful of yogurt or other fermented foods, enter the body, where they stay alive, thriving in the warm busy depths of the stomach and bowel and interacting with other bacteria that also live there -- multiplying as fast as they can, because, granted, an individual microbe lives only about 20 minutes.

Our digestive tracts are studded with settlements swarming with little colonists, in us but not of us and, scariest of all, not us. Because probiotics are not regulated by the FDA, their marketing in either food or supplement form can slip through certain legislative cracks; the closest any agency has come to an official definition is the World Health Organization and the Joint Food and Agriculture Organization of the United Nations, which together released a statement calling probiotics "live microorganisms which, when administered in adequate amounts, confer a health benefit on the host."

So do they? Proponents pouring out of the woodwork claim that probiotics can prevent asthma and cure irritable bowel syndrome, colic, yeast infections, acne -- even autism. They point to dozens of studies suggesting that, say, probiotics prevent upper-respiratory infections (Hojsak, Snovak, Abdovic, Szajewska, Misak and Kolacek, 2009), forestall and shorten colds and flu (Leyer, Li, Mubasher, Reifer and Ouwehand, 2009) and enhance immunity against intestinal pathogens (Benson, Pifer, Behrendt, Hooper, Yarovinsky, 2009).

Attorney Tim Blood calls this junk science.

"Probiotics is garbage. There's no science behind it. It's a food-industry marketing ploy, called the latest and the greatest when there's really no evidence" supporting the claims. Yes, research papers abound, "but there hasn't been a single properly done study." Companies seeking to sell probiotic products, Blood says, "either conduct their own studies or search the world for some sort of garbage study: If it has some sort of data that they can use, then they say, 'Here's our clinical proof.' Well, if you do a poorly conducted study a hundred times, then sure, you're going to find some favorable data."

"We don't have proper regulation in this country for this stuff," he adds. "If there is something to a health claim, and in this case I don't think there is, then we should encourage companies to use good science, not junk science," as proof.

Dannon's Neuwirth stands firm. Probiotics, he asserts, "can be, and are very helpful to many people." While the labeling for Activia and DanActive will change slightly as a result of the settlement, he says, "The essence of our claims remains intact."

In an era gripped by fear of global epidemics -- swine flu, anyone? -- and in which antibiotics are growing ever more ineffective against ever-smarter pathogens, whatever presents itself as pumping up our immunity takes on an almost numinous glow.

And if you can get that glow from creamy kefir, spunky sauerkraut and tangy tempeh ... that's one reason why this is a boom year for fermented foods, homemade and artisanal and plain old store-bought. Kombucha scobies, kimchee recipes and live, popcornish-looking "kefir grains" are being shared far and wide among foodie networks and alt-health tribes.

It doesn't hurt that these foods and drinks are almost universally yummy. As faddish foods go, it doesn't hurt that many are foreign and might scare your folks. (Exhibit 1: Japanese natt, whole soybeans fermented with Bacillus subtilis so as to smell like feet and, when touched, exude slimy strings.) It doesn't hurt that these items are being billed as not just food but "functional food," a newly surging category including anything fortified or credited with health benefits beyond mere nutrients. It doesn't hurt that they fill an interesting gap between those two states of being into which anthropologist Claude Levi-Strauss lumped everything: the raw and the cooked. Like culinary libertarians, these sour treats that go down so well with nearly everything are boldly, seductively neither/nor.

Even if they aren't wonder cures, it doesn't hurt that they don't hurt.

The field of probiotic studies was founded by Russian microbiologist Ilya Mechnikov, who won the Nobel Prize in medicine in 1908. Theorizing that toxic intestinal bacteria increase the effects of aging, Mechnikov promoted yogurt as a longevity elixir because it contains a beneficial bacteria, the lactic-acid-producing Lactobacillus bulgaricus -- named for yogurt-loving Bulgaria, whose peasants traditionally ate a lot of yogurt and lived extraordinarily long lives. (So do people in the Caucasus Mountains and Pakistan's Hunza Valley.)

Lactobacillus bulgaricus, Mechnikov declared, could battle and replace bad bacteria. Generations of later scientists have continued and broadened his research, but the premise is this: Thousands of teensy-tiny live things will always inhabit your gut. Wanna leave them to it -- that is, give the colonists the run of the place -- or send in some guerrillas instead?

"All probiotic foods are good," says food expert Beatrice Trum Hunter, whose nearly 30 books on nutrition include Probiotic Foods for Good Health (Basic Health Publications, 2008). "The most readily available ones are plain, full-fat yogurt and raw sauerkraut." It amuses Hunter that "many people seem to be obsessed with a desire to maintain a germ-free environment. It may come as a shock for them to learn that the human intestinal tract is home to an estimated 100 trillion bacteria."

Probiotics appear naturally in many, although not all, fermented foods. Since "fermented" is just a nicer way of saying "spoiled," our ancient ancestors couldn't help but "discover" fermentation as a means of food and drink preparation and preservation. Devising ways to control the transformation of sugars and carbohydrates into acids with the help of yeasts, bacteria and molds, they hit upon the formulas for wine about 8,000 years ago, soured milk 5,000 years ago and leavened bread 3,500 years ago. These acids, especially lactic acids, lower food's pH to a point at which disease-causing microbes cannot thrive or multiply.

Based on local resources, each culture and region developed its own fermented specialties, from Hawaiian taro-starch poi to Indian lentil-rice idli to Chinese soy sauce to Ethiopian teff-flour injera bread. Shrimp paste, quark, lutefisk, tea, coffee, salami, chocolate, cheese: All are the products of fermentation, gifts from a pre-refrigerated age. While for our ancestors these were stretchy, stringy, sludgy, salty, smelly staples, time-tested safeguards against starvation and food-borne sickness -- and, if Mechnikov was right, other sickness as well -- for us they've become pretty much optional.

"Most Americans are not eating adequate amounts of fermented foods such as yogurt, kefir, kombucha, miso, sauerkraut, kimchee and real pickles (not the jarred kind that are pasteurized and so are 'dead') and are missing out on the benefits of the friendly bacteria found in these foods," laments registered dietician Karen Scheuner. "The health benefits from eating fermented foods are like taking a pill to boost or protect your immune system. Most Americans do not eat these foods on a regular daily basis, and yet we as a nation tend to be reaching for more pills and potions to treat many ailments without addressing the underlying health [of] the gut where these bacteria live. ... Seventy percent of immune function takes place in your gut. The gut is where most of the pathogens -- the bad bacteria that make us sick -- live, and if there is an infection of anykind," anywhere in the body, "the fighting of it will take place in the gut."

U.S. Centers for Disease Control nutritionist Joel Kimmons agrees. The cooperation between our bodies and those countless foreign microorganisms inside us, on us, and around us -- minuscule and living foreign objects permeating our internal tissue, our skin, our hair, even our eyes -- is evolving still.

"We are constantly educating our immune systems and our digestive systems, establishing which bacteria have a symbiosis with us. Yet many people still have this very draconian slash-and-burn attitude toward any life on our bodies that is not 'our' life. With this attitude, the only way to deal with these other life forms is: kill, kill, kill.

"But think about your body as an ecology," Kimmons says. "It's not creepy that things are living all over you. They're there, and they're either good or bad: There's not a third choice. There's no sterile option. We spend a lot of time fighting microorganisms, but they're not the enemy. A sea change has to happen where we start relating to the world in an inclusive, compassionate way."

This compassion must extend to bacteria.

"If the friendly ones aren't living in you, the bad ones will be."

For over 25 years, Sadie Kendall has been bacterially souring Holstein cream to produce creme fraiche. Originally produced in Normandy and used in classic French sauces, it's one of the world's multitudinous fermented dairy products -- a huge category that also includes Swedish langfil, aka "ropy milk," and shubat: fermented camel's milk, the national drink of Kazakhstan. Made in Atascadero, California, award-winning Kendall Farms creme fraiche is a probiotic product because it contains live lactobacilli, although the name of the exact strain Kendall uses is a closely guarded trade secret.

"When you work with fermentation, the important thing is understanding what characteristics you want in your end product," Kendall says, "then finding out which microorganisms are out there. Find out what they produce and what temperatures they like. See what they like to eat and how they want to live. Then when you find the right ones for you, give them whatever they want."

After earning a university degree in philosophy, she was about to start law school when, interested in cheese, she took a food-science course for fun. Enthralled, she gave up law for lactic acid.

"When you start learning about lactic-acid organisms, you realize that without them we would all be dead," Kendall says. "They make food safe. Without them, we would have died out long ago from food poisoning. To lactic-acid bacteria, we should genuflect every day."

Like Kimmons, she wishes our species would just lie back and accept being occupied territory.

"We are walking sausage casings for microorganisms. The majority of our body weight is made up of microorganisms." They aren't us, precisely, yet largely "they are who we are. We're never alone."

The probiotics business is booming. Sales of refrigerated yogurt climbed nearly 5 percent in December, according to the trade journal Supermarket News. New products are streaming onto the market, such as EvoraPlus probiotic mints from Florida's Oragenics, Inc. -- to be sold, beginning next month, in all 7,000 Walgreen's stores -- and sugar-free vanilla-flavored Probiotic Yogurt Bears from Israel's Anlit Advanced Nutrition. Both were announced this week.

Meanwhile, Tim Blood is pursuing another case, this time against General Mills, for its Yoplait Yo-Plus.

Anneli Rufus is the author of several books, most recently The Scavenger's Manifesto (Tarcher Press, 2009). Read more of Anneli's writings on scavenging at scavenging.wordpress.com.