[INTERVIEW]
Ronda Nelson: Probiotics are not fixing dysbiosis. They are only managing the symptoms. And the reason that most gut cases don’t work isn’t because of your protocol. It’s because you are asking probiotics to do a job they are biologically incapable of doing. So if your patient has been on a quality probiotic for six months and her gut isn’t better, that’s not the problem. Knowing the difference between what they can do, what they won’t do, and what they should do is going to change every gut case you have from this point forward. Let’s talk about it.
I know, I know. Big shocker. If you’ve never heard this before, I probably just, like, made your ears go, “Wait, what is she talking about?” Yes, we are gonna talk about probiotics today. It is a big, fat lie, most of it. Big, fat bunch of marketing. I haven’t talked about this in a long time. I actually, at one point — oh, I don’t know, about 10 years ago or so — I created a full, like, eight, 12-hour training on the microbiome.
That was kind of back when all the science was new and everyone was discovering. We did the Genome Project, and then we did the Microbiome Project, and everybody was all up in arms about these little tiny critters and what they could do to improve our health. I’m on that page. I’m 100% on that page. However, the problem is, how many times have you given a probiotic and you’re like, “Yeah, wah, wah.” Nothing really happened. And sorry if my voice sounds a little funky. It is. I’m getting over a cold.
What happens when we give these probiotics is that they don’t do what we imagine that they’ll do. And if you’ve never taken the time to look into the research, you’re gonna be surprised at what I’m going to tell you. We have to start asking different questions when it comes to using probiotics in our clinical protocols. The question isn’t as much which probiotic is better necessarily — because there are some exceptions, we’ll talk about that — but also the question is, what is the probiotic doing? What is it actually gonna do? What is it not doing?
We think that when we take a probiotic, that it just magically reinoculates the gut. But the problem is, that’s not how they work. They don’t do that. So let’s talk about what these commercial probiotics are. They do not colonize a gut. I cannot overstate that. This is not a fringe opinion. This is back from 2018, so this is eight years ago. The Weizmann Institute followed people who were taking probiotic supplements, and they found that in most cases, the probiotic strains just passed right on through. They didn’t even stick around.
Where the money matters in this conversation is the mucosal lining, the mucosal microbiome. That is where the microbes live. That’s where it’s the most important — that’s the most important target. That mucosal microbiome, the study found, stayed largely unchanged after the patient had taken these probiotics for a predetermined period of time. So after stopping taking them, they checked the stool and they said, “Hmm, looks like these probiotics were never here.”
So let’s talk first about what they do, okay? What they can do. When probiotics enter the gut, what they do is they can stimulate what are called defensins. Defensins are these little peptides that the gut lining produces that help to manage the microbial balance in the gut. They also provide what’s called transient competitive inhibition. They basically are gonna kinda crowd out — not overtake, they just crowd out — some of the pathogenic activity that might be there while they’re present. Key: while they’re present. If the probiotics aren’t present, then that pathogenic crowding may not last because we’re not getting to the underlying problem, but that’s for another show, another topic.
They also can nudge certain endogenous bacteria towards certain signaling patterns. So the defensins actually help to signal the endogenous bacteria to perform or do different activities. And in specific cases and certain clinical contexts, we know that certain strains of probiotics actually have really solid evidence for helping with things like ulcerative colitis. This is called cold brain right here.
So when your patient says that she does not feel good, or she doesn’t feel better, and she’s been on this protocol and you think that probiotics are part of it — it might be that the probiotics aren’t needed, or it might be that it’s the wrong strain, could absolutely be. But fixing the problem and feeling better and using probiotics are kind of two different conversations.
So the thing we have to remember is, think about it like this: probiotics are like tourists. They’re like tourists in a big city. They’re like tourists in Las Vegas. They’re like a passenger in a moving vehicle. They get in the vehicle, they go to Vegas, they pass through the city, and then they get back on the plane, they leave. They get to their destination, they get out of the car. That’s all. They’ve had an impact on the road, they’ve had an impact on the traffic on the freeway — especially if you have a bad Uber driver. They have an impact on the local economy in the city, but they can’t fix the problems in the city. They can’t fix the potholes in the road. They’re just a driver on the road, and that’s about it.
So when you have these patients on long-term protocols, or even the patient that comes in and says, “Oh, I’ve been taking a probiotic, and I feel amazing when I’m taking it.” Okay, is that fixing the problem? Because when does a patient feel good? When they’re taking the probiotic. And when do they not feel good? When they’re not taking it. Does that mean we solved the problem? No, it does not mean we solved the problem. In fact, the probiotic isn’t solving the problem at all. It didn’t fix the road, and it didn’t fix the crime in Las Vegas. It’s just covering it up. That’s all that it’s doing.
So there are some companies that do what are called DNA-based probiotics, and the philosophy is — and I, I don’t know, I was kinda out on this in the very beginning, but I could be wrong, and I am often wrong, and I’m okay to admit when I’m wrong or when I don’t understand something fully and I need to understand it more. But I just kinda had this, like, spidey sense that something didn’t feel right to me about these DNA-based probiotic strains.
The theory is that they’re gonna take your genetic profile, and they’re gonna match your genetic profile and/or your microbiome, and then they’re gonna use your DNA to create these targeted microbial probiotics that are gonna match your specific need. And it sounds more rigorous, I would agree, and it sounds more personalized and more customized. But here’s my argument, and I think it stands up to heat. If it doesn’t, let me know because I’m open.
Your microbiome isn’t static. And if we’re using a stool test on one day plus your DNA to determine what your perfect microbiome is — how does that factor in diet? How does one-day stool plus your DNA factor in stress? How does that factor in food poisoning or other things that are going to affect the microbiome — sometimes as quickly as within 24 to 48 hours?
In 2022, they did a review in “Nature Reviews Microbiology,” and they confirmed that the microbiome can shift significantly based on short-term environmental changes, and those shifts can persist. So I’m not getting this whole customized DNA microbiome thing. I’m just not. It doesn’t make any sense to me. This is the simple Ronda brain. I just know how to take something. I understand the concept. But it doesn’t make any sense.
When they run your stool, they run a DNA and they say, “Oh, your microbiome based on your DNA needs more of X strain.” Okay, that’s fine for like last Tuesday when I collected the stool. But if I eat less veggies or more veggies, if I’m under more stress or not as much stress, if I ate undercooked chicken and I’m sick versus not — now how customized are those probiotics for me? They’re not. So I think we’re conflating our DNA profile, our genetics, with microbiome composition. Does it factor in an antibiotic that I had to take? Now it’s not customized anymore. How does that even work?
So the microbiome is fluid, and I think that’s the thing. Why would we think that giving a probiotic supplement that has X number of strains in it, supposedly customized for me, is going to work long term if the microbiome is fluid? And then the other thing you have to consider: if there are 20 trillion different types of bugs in the body, have you ever looked at the back of a probiotic bottle? I mean, really looked at it, like with your eyeballs. It says Lactobacillus blank, and whatever Lactobacillus. And then it has Bifidobacterium blank, and whatever strain of Bifidobacterium. And let’s say they proudly boast on the label that there are 20 billion in this bottle.
Okay, wonderful. Well, the 20 billion may or may not have been there at the time of manufacture. That’s number one. Number two, depending on the manufacturing process — where do you think they got those bugs? Did they go scrape out somebody’s intestines and filter them? No, they grew them, my friends. They grew them. These are not bacteria from carrots and dirt. These are made in a lab. They have to be scalable.
No probiotic lab has a bazillion-acre farm that they’re growing probiotics. I mean, there are soil-based organisms, I get that. Those I’m probably a little bit more okay with, but I need to understand what the manufacturing process is. How have they filtered it? How have they treated it? Was it exposed to heat? Is it heat labile? Can it be altered by being in plastic? How fast does it degrade if it’s not under the right controlled temperature? Those are all the questions that my little analytical brain just keeps asking.
So when we look at a probiotic bottle and we say, “Oh, it has 20 billion,” the poor patients — I feel bad for them, because they’re subject to the TikTok influencers. And they’re subject to opinions on TikTok and the next Instagram influencer, and what their neighbor’s taking. Well, who says their neighbor’s body is like their body? Why does that probiotic make you poop and then person B takes it and it makes them constipated? Bingo. That’s my point. There isn’t one probiotic external that’s gonna be good for every single person internal.
So it’s not about the bacteria that are missing. I think it’s about the terrain. And yes, these DNA genetic probiotics — okay, fine, they’re looking at my genetic terrain, if we could call it that. But they’re not looking at the fluidity of my own personal microbiome. You cannot seed broken soil. You cannot influence a dysbiotic gut unless you’re dealing with the dysbiosis specifically. Because if I just throw in a bunch of good lab-made probiotics — and who’s to say that even the ones on the back of the bottle are even right? Maybe they’re not even right.
And then on top of that, there are 2,400 — last I checked — 2,400 different types, high-level species of microorganisms in the gut. 2,400. How many are on the back of that bottle? There might be five or six different strains, different species. Oh yeah, that’s right. Let me remind myself. You hear my sarcasm. But if I have 2,400 different species in my gut, oh yeah, I’m for sure gonna remodel all of those 2,400 with these seven or 10 that are in this probiotic bottle. Yeah. Of course it’s not gonna work.
The goal here is to create the terrain that allows the endogenous bacteria to do what they need to do. So probiotics are not the answer. We have to maintain and correct the terrain. It’s the only way to do it. And how do we do that? Well, no matter what supplement company you’re using, everybody’s got a protocol for weed, seed, feed. The five Rs: replace, restore, reinoculate, all the things. Whatever method you subscribe to, fine. Do you, my friend. You got this. You know how to do this. I don’t need to tell you how to do the reinoculation.
But I can tell you this: if there are parasites — truly gut parasites — I get kind of frustrated, I think, when people talk about parasites all the time, although I think they’re more common than we think, and I am shifting my perspective on that a little bit. But if there’s something frankly wrong or going on in the gut that you know about — like they had food poisoning or something more obnoxious like ulcerative colitis, or they’re celiac, SIBO, some gut thing — you have to deal with that. How are you going to re-seed or re-feed or reinoculate a dysbiotic, altered terrain in the gut with a simple probiotic? It’s just not gonna happen.
So there’s that. But I want you to really consider the role of upper digestion. And I think, you know, I have several soapboxes or hills that I will die on, as I like to say, and this is one of them: that we cannot overlook the importance of solid upper digestive function. And that includes stomach acid, bile production, and digestive enzymes.
Now, I don’t talk much about digestive enzymes because — not that I don’t believe in them, I think they’re important — but the pancreas does a pretty good job of making those digestive enzymes, unless the person has been on a really crappy diet for a really long time, like high sugar, and the pancreas is kinda worn out, or used up its digestive enzyme capacity, we’ll call it, its bank or available allowance of digestive enzymes. In which case you may want to supplement with them, or use something like bovine pancreas, some pancreatic tissue, bovine tissue, to help to put some juice back in that exocrine pancreas function with bicarb enzymes, et cetera.
But that all has to be working before the microbiome can stabilize. Because when hydrochloric acid is sufficient, the proteins pass through properly. When there’s not enough, the proteins pass through the stomach only partially digested, and that becomes fermentation substrate for opportunistic bacteria. Well, why would we wanna give the opportunistic bacteria more food to feed on? We do not want that. So we wanna make sure that everything possible gets broken down in the upper digestion.
When bile is sluggish, fat emulsification breaks down, doesn’t work well, and the literal environment of the small intestine shifts. It becomes more favorable towards dysbiosis, less favorable for absorption, just because of poor bile flow. And then when the enzymes are compromised, you get a different microbial response in the large intestine — which is the last stage, and where the largest composition of the gut microbes are — and you get this shift in the large intestine different than you would if you had had proper upper digestion.
So if you have a patient and you’ve been treating SIBO, treating SIBO, treating SIBO — but you’ve never, ever said, “Before we do that, we have to make sure that stomach acid, bile, and enzymes are working well” — then you’re wasting money, their money, and their time, and your time too. Don’t do that. The downstream work that you’re doing was sitting on top of a broken foundation, and no one stopped long enough to answer the question, “Hmm, is the upstream digestion really working?”
Now, there are certain scenarios where it could actually make it worse. People with SIBO, they don’t tolerate probiotics well at all because of the nature of SIBO, and I get that. But you have to remember that the upper digestion piece is so, so important.
So when the patient comes in and says, “Oh, well, I’ve been on a probiotic. I take probiotics with every meal, and I’m not bloated.” Okay, great. It probably did help competitively inhibit some of the dysbiotic bacteria, crowded out some of that bacterial activity. Maybe it stimulated some defensins, and that short-term improved the gut environment, and maybe it reduced the pH enough that it created a less hostile environment, maybe more tolerant of poorly digested food coming down the tube. I don’t know, and all of that could be true or none of it could be true.
The point is, is the probiotic really fixing anything? Because as soon as she stops, as I mentioned earlier, the symptoms come back. So she’s not fixed, friend. The patient is not better. We’re looking at the probiotic as the savior when it’s really not. It’s just an add-on. The fix is get upper digestion working and then address what’s actually going on in the gut. If it’s SIBO, fine. If it’s dysbiosis, fix it. If it’s ulcerative colitis, if it’s some kind of an IBD-type thing, diverticula — fix the problem. Fix that. But you have to make sure that upper digestion is working. We can’t hang our hat on the effectiveness of a probiotic.
So here’s what I would recommend that you do this week. First, don’t ask the question: what probiotics should I add? The better question is: what are the conditions that caused this imbalance, and how can I fix them? When you choose to use a probiotic as part of a larger protocol, you definitely can, and I’m never saying don’t do that. But don’t rely on the probiotic — even if it’s a DNA one, a special one — thinking that it’s gonna be an end-all be-all, because it’s not.
Here’s what I want you to do this week. I want you to think back, and I want you to look at — pull the chart notes and your records for two to three patients that you’ve had, either they’ve come in already on probiotics or you’ve put them on a probiotic, and just look at their progress over time. If they’re making progress, good job. Way to go. Nicely done. If they haven’t, I want you to look for specific symptoms. If they’re like, “Yeah, I’m still not better,” and you’re thinking, “Oh, well, the probiotic’s probably fine” — I want you to look for their specific symptoms.
I want you to look for bloating within 30 minutes of eating. What does that signal? Bile. I want you to look at low ferritin for no reason. I want you to look at their history of maybe reflux, or even just fat intolerance or food sensitivities. See how many of those symptoms are showing up, because those are telling you right there that there’s an upper digestive problem, not a probiotic problem.
Second thing I want you to do: the next time your patients say something like, “Oh yeah, my symptoms came back when I stopped my probiotic,” I want you to practice now so that you know how to talk about it. I want you to reframe it with them and say something like, “Okay, well, that just means that the probiotics haven’t really fixed the symptom.” This is not a big stretch for you guys. What you have to do is fix the terrain first. And before you reach for another stool test or a DNA microbiome test, just do me a favor. Just start with upper digestion. Just start there. Start with adequate hydrochloric acid, so breakdown in the stomach, good bile, good digestive enzymes, and just see what happens.
See if their poop changes. See if they start eliminating more frequently or regularly. See if some of those meal-based digestive symptoms go away, because that’s why the patient — or you, maybe — reached for the probiotic in the first place, right? Because there’s a digestive complaint. So let’s go back to the basics. Let’s not build a gut reconditioning protocol with the five Rs or your weed and feed, whatever you wanna call it, on top of a foundation that is leaking and in bad shape all over the place. Let’s not do that. Let’s go back to the upper digestion and start there.
So the probiotics are really not the enemy. We’re just asking them to do something that they were never intended to do. We’re asking them to repair the terrain, to improve an environment that’s under stress. But they can’t. They’re not supposed to, and they never will. So I think this is a big, huge marketing ploy. Shocker, I know. I think the probiotics get overbilled a lot of times, and we put more stock in them than what they really are.
[CLOSING]
Ronda Nelson: If you wanna know what my five foundational aspects are for every single clinical case, go get my free resource. It’s at rondanelson.com/nonnegotiables. These are my five foundational non-negotiables that I do with every single patient, every single one, and I make sure that all of these work. I absolutely believe these are foundational, and you should too.
I think if you are practicing functional medicine with your patients, you’re making recommendations in the way of supplement protocols, lifestyle modifications — if you start chasing symptoms and you don’t address the underlying issue, you’re going to miss the most important part, and that is making sure that their foundation is in really good shape. So just go to rondanelson.com/nonnegotiables and you’ll be able to download it.
So there you go, my friend. That’s all I got for you this week. Have an amazing week. I’ll see you next week.
[END]