America has a weight problem. And it’s not just America. Around the world, even in many developing countries, obesity rates have, no pun intended, ballooned over the last five decades. On one level, the answer seems simple enough—too many crappy calories made from too much processed sugar and artificial ingredients. Pair that with too many desk-bound and house-bound activities as most people’s work life turns to something that happens with a keyboard, and leisure activities turn to something that happens on a screen. These problems can be even more exacerbated by “food deserts” where there are few good diet choices, even in the midst of American cities, and “activity dead zones” where kids simply don’t have the option of safe and open places to play.
But there are also indicators that there’s something more going on than just all of the above. For some people, no effort to overcome the issue seems to be enough, and the distribution of obesity can seem remarkable uneven—and unfair—with some people people experiencing health-threatening problems even when their diet is relatively “good” and others chowing down on regular Little Debbie-based intake without apparently suffering consequences. And of course that can be genetics. Or simply chance. However, when health researchers look at the way obesity has spread over those decades, the pattern looks familiar—it looks like an disease. It looks like a disease that starts as an epidemic, and then becomes endemic; settling in as a regular, constant infestation.
Is it possible that, under the cover of bad food and decreased exercise, there’s also something else at work? Something that has directly affected the way that people metabolize their diets, good and bad? Researchers have certainly seen hints of such an issue. In particular, there has been intriguing information about gut biota—those comensal organisms, mostly bacteria, which share our bodies and perform critical roles in turning the food we eat into energy and nutrients we need.
It’s an area of health science that was very slow to develop, in large part because human beings have been very reluctant to think of themselves as cooperate colonies, where bacteria aren’t always the enemy, but form integral parts of the system. Antibiotics for fighting disease-causing organisms have been developed and deployed with little, or no, thought given to how they would affect the bacteria that are vital to good health. The same is true of foodstuffs, especially processed materials that may be actively damaging to vital bacteria.
This past week, The New York Times ran an article about a possible treatment for obesity involving changes to the gut biota. That article illustrates two problems: how the issue is treated, and how it is reported.
The Times article looked at work on the bacterium Akkermansia muciniphila. It’s a bacteria that’s common in the guts of healthy people, but one that seems to be found in much smaller quantities in the digestive systems of people with type-2 diabetes, pre-diabetes, or at some other rung on the ladder of “metabolic syndrome.” When people in the study were regularly given supplements of A. muciniphia, they showed what seem to be dramatic improvements—better response to insulin, better liver functions, and a drop in body mass.
That seems pretty hopeful. But it’s also pretty indicative of where things stand when it comes to probiotics. The actual study published on July 1 in Nature, demonstrates a number of problems. One, the study group is indeed very small. Two, the losses in weight and fat are so small they’re within the realm of statistical noise. Three, the effect was seen in patients who were given supplements of dead bacteria, but not those who were given supplement of live bacteria. That would seem to be a big issue if this was pointing toward any kind of “probiotic” solution.
Rather than indicating an issue with the living gut biota of the people in the study, this result seems to indicate … honestly, it’s not clear what it indicates, if anything. The Nature study records a small-scale experiment, one that produces some mildly-interesting results, the biggest of which barely peeks into the realm of statistically significant. Maybe it’s a key finding. Maybe it’s nothing at all.
And unfortunately, the study in Nature and the article in the Times are both reflective of where much of probiotic research still stands. There are very good reasons to think that there is a connection between the extent and variety of bacteria found in the gut biota and good health. But it’s completely unclear which direction the arrow points—do people with good health have extensive gut biota because they’re healthy, or are they healthy, at least in part, because they have the right gut biota? Researchers still do not know.
Right now the evidence that any bacteria-laced product—that’s pills, food supplements, yogurts, cheeses, and anything else someone has thought to stamp with the word “probiotic”—is making a significant contribution to the fight against obesity is pure speculation. That doesn’t mean there’s nothing to probiotics. There absolutely is. And it’s not just weight. Research has shown a connection between gut biota an other aspects of health, including how the body fights off infections of genuinely bad bacteria. Even how it handles cancers.
We’re just not there yet. The science on probiotics and related issues is decades behind some other areas of health research, and that marketing campaigns for people trying to sell a solution in a pill are not. The same food companies, and drug companies, that pushed all those crappy calories and gut-wrecking products on the public in the first place, are now trying to turn a second profit by pushing more manufactured items that hint at cures for the problems they helped to create. It isn’t clear they’re improving health in the process.
America has become a nation where dialysis centers are an all-too-common feature of strip malls in towns and cities across the country. Obesity has replaced cigarettes as not just a primary cause of death, but a primary factor behind many forms of cancer. This is a epidemic that represents a greater health threat than opioids, by far. Poor diets and decreased exercise are part of the problem, but they’re not the whole problem, and untangling this issue is of huge importance. But it’s definitely a work in progress … frustratingly difficult and slow progress.
This isn’t a condemnation of the whole probiotic movement or industry. Many of the people using probiotics, selling probiotics, and pushing probiotics are well-meaning. And some people taking pro-biotics, in any form may experience health benefits. But right now, there is no miracle pill, or magic mixture of bacteria, or super yogurt that will melt away pounds or stop the need for supplemental insulin. And no matter what you read in the news, that solution isn’t right on the horizon.