Are probiotics necessary?

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Are probiotics necessary?

Postby ctv » Sun May 22, 2016 11:04 am

A number of years ago when I suffered from digestive problems my doctor put me on a probiotic supplement because I can't eat fermented foods (inflames my rosacea). My digestion improved, especially as I changed to a whole foods plant-based diet. I'm feeling great. Do I need to continue the probiotic? What does Dr McDougall say about fermented foods? Will my body make its own probiotics? Any clarification is much appreciated.
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Re: Are probiotics necessary?

Postby JeffN » Mon May 23, 2016 11:03 am

ctv wrote:A number of years ago when I suffered from digestive problems my doctor put me on a probiotic supplement because I can't eat fermented foods (inflames my rosacea). My digestion improved, especially as I changed to a whole foods plant-based diet. I'm feeling great. Do I need to continue the probiotic? Will my body make its own probiotics? Any clarification is much appreciated.


No. They are not necessary or required in most cases if someone is following this program as the beneficial bacteria proliferate in the digestive system of someone following this program as they love to live off the by-products of the digestion of fruit, vegetables, whole grains and beans. One does not need to eat fermented foods or raw foods for this to occur.

There are certain medical conditions or situations where they may be recommended on a temporary basis.

ctv wrote: What does Dr McDougall say about fermented foods?


On fermented foods
https://www.drmcdougall.com/forums/view ... 22&t=25898

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Re: Are probiotics necessary?

Postby JeffN » Fri Aug 10, 2018 10:34 am

A follow-up on Probiotics

1) Do Probiotics Really Work? Although certain bacteria help treat some gut disorders, they have no known benefits for healthy people. Scientific American, July 2017

“A closer look at the science underlying microbe-based treatments, however, shows that most of the health claims for probiotics are pure hype. The majority of studies to date have failed to reveal any benefits in individuals who are already healthy. The bacteria seem to help only those people suffering from a few specific intestinal disorders.”

https://www.scientificamerican.com/arti ... ally-work/


2) What do Cochrane systematic reviews say about probiotics as preventive interventions?
Sao Paulo Medical Journal
On-line version ISSN 1806-9460
Sao Paulo Med. J. vol.135 no.6 São Paulo Nov./Dec. 2017

http://dx.doi.org/10.1590/1516-3180.2017.0310241017

ABSTRACT

BACKGROUND:
Probiotics have been used for a range of clinical situations and their use is strongly encouraged by the media worldwide. This study identified and summarized all Cochrane systematic reviews about the preventive effects of probiotics in clinical practice.

DESIGN AND SETTING:
Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp).

METHODS:
We included all Cochrane reviews on any probiotics when they were used as preventive interventions and compared with no intervention, placebo or any other pharmacological or non-pharmacological intervention.

RESULTS:
17 Cochrane systematic reviews fulfilled our inclusion criteria and were summarized in this report. None of the reviews included in the present study provided high-quality evidence for any outcome. The benefits from use of probiotics included decreased incidence of antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea; decreased incidence of upper respiratory tract infections and duration of episodes; decreased need for antibiotics and absences from school due to colds; and decreased incidence of ventilator-associated pneumonia. Probiotics seem to decrease the incidence of gestational diabetes mellitus, birthweight, risk of vaginal infection and incidence of eczema.

CONCLUSION:
Despite the marketing and the benefits associated with probiotics, there is little scientific evidence supporting the use of probiotics. None of the reviews provided any high-quality evidence for prevention of illnesses through use of probiotics. More trials are needed to gain better knowledge of probiotics and to confirm when their use is beneficial and cost-effective.


3) Harms Reporting in Randomized Controlled Trials of Interventions Aimed at Modifying Microbiota: A Systematic Review
Background: Probiotics, prebiotics, and synbiotics are used increasingly, although the safety and potential harms of these interventions are poorly understood.
Published: Ann Intern Med. 2018.
DOI: 10.7326/M18-0343
http://annals.org/aim/article-abstract/ ... ystematic#

Conclusion:
Harms reporting in published reports of RCTs assessing probiotics, prebiotics, and synbiotics often is lacking or inadequate. We cannot broadly conclude that these interventions are safe without reporting safety data. Published: Ann Intern Med. 2018.
DOI: 10.7326/M18-0343


4) Probiotic use is a link between brain fogginess, severe bloating

Probiotic use can result in a significant accumulation of bacteria in the small intestine that can result in disorienting brain fogginess as well as rapid, significant belly bloating

https://www.sciencedaily.com/releases/2 ... 095213.htm

Journal Reference:

Brain fogginess, gas and bloating: a link between SIBO, probiotics and metabolic acidosis.
Clinical and Translational Gastroenterology, 2018; 9 (6) Article number: 162 (2018)
DOI: 10.1038/s41424-018-0030-7

https://www.nature.com/articles/s41424-018-0030-7

Abstract
Background
D-lactic acidosis is characterized by brain fogginess (BF) and elevated D-lactate and occurs in short bowel syndrome. Whether it occurs in patients with an intact gut and unexplained gas and bloating is unknown. We aimed to determine if BF, gas and bloating is associated with D-lactic acidosis and small intestinal bacterial overgrowth (SIBO).

Methods
Patients with gas, bloating, BF, intact gut, and negative endoscopic and radiological tests, and those without BF were evaluated. SIBO was assessed with glucose breath test (GBT) and duodenal aspiration/culture. Metabolic assessments included urinary D-lactic acid and blood L-lactic acid, and ammonia levels. Bowel symptoms, and gastrointestinal transit were assessed.

Results
Thirty patients with BF and 8 without BF were evaluated. Abdominal bloating, pain, distension and gas were the most severe symptoms and their prevalence was similar between groups. In BF group, all consumed probiotics. SIBO was more prevalent in BF than non-BF group (68 vs. 28%, p = 0.05). D-lactic acidosis was more prevalent in BF compared to non-BF group (77 vs. 25%, p = 0.006). BF was reproduced in 20/30 (66%) patients. Gastrointestinal transit was slow in 10/30 (33%) patients with BF and 2/8 (25%) without. Other metabolic tests were unremarkable. After discontinuation of probiotics and a course of antibiotics, BF resolved and gastrointestinal symptoms improved significantly (p = 0.005) in 23/30 (77%).

Conclusions
We describe a syndrome of BF, gas and bloating, possibly related to probiotic use, SIBO, and D-lactic acidosis in a cohort without short bowel. Patients with BF exhibited higher prevalence of SIBO and D-lactic acidosis. Symptoms improved with antibiotics and stopping probiotics. Clinicians should recognize and treat this condition.


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PS some confusion exists became several years ago, in two newsletters Dr McDougall recommended probiotics and said there was no known harm. At the time, it was probably true. However, today we know differently and while very few things have changed at all in regard to the core McDougall Program, we do not recommend supplements, except for B12, and that includes Probiotics, unless they are medically indicated in some rare situations. Even then, there are so many strains out there and supplements have their own quality issues so one must always proceed with caution.
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Re: Are probiotics necessary?

Postby f1jim » Fri Aug 10, 2018 2:12 pm

But Jeff! Haven't you seen the commercials? Probiotics cure almost every ill known to man.
HaHa
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Re: Are probiotics necessary?

Postby JeffN » Fri Aug 10, 2018 2:29 pm

f1jim wrote:But Jeff! Haven't you seen the commercials? Probiotics cure almost every ill known to man.
HaHa
f1jim


:)

Most every supplement to date has passed through what I call, the natural life cycle of a supplement.

First, we start hearing news that this new nutrient/supplement looks good.
Then, we start hearing how really good it is looking.
Then, the news gets event better as we find out different details of the nutrient/supplement (types, variations, etc)
This "good news" continues for some time and the supplement hits is peak.
Then we hear of some concerns but sales and use continue
Then more concerns but only in some groups and the peak begins to flatten out
Then we here some concerns in all groups and this flat peaks begins a downturn.
The concerns continue to grow and the trend begins to really take a downturn.
Then we hear about some real harms, especially to certain groups.
The list of potential harm continues to grow and the trend continues to drop.
Eventually the supplement is no longer recommended.

Vitamin D and Omega 3’s, which seemed to hold favor for a long time, are now experiencing the same life cycle.

We are seeing the same with Probiotics.

But don’t worry, soon as the next newest supplement comes along, everyone will jump on board thinking, this is the one.

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Re: Are probiotics necessary?

Postby JeffN » Thu Sep 06, 2018 2:48 pm

Article

Probiotics labelled 'quite useless'
By James Gallagher
BBC News

A group of scientists in Israel claim foods that are packed with good bacteria - called probiotics - are almost useless.

Their study is among the most detailed analyses of what happens when we consume probiotics.
They are seen as healthy and good for the gut, but the results found they had little or no effect inside the body.

The researchers said probiotics of the future would need tailoring to the needs of each individual.
The team at the Weizmann Institute of Science made their own probiotic cocktail using 11 common good bacteria including strains of Lactobacillus and Bifidobacteria.

Read more...
https://www.bbc.com/news/health-45434753#



Study
Personalized Gut Mucosal Colonization Resistance to Empiric Probiotics Is Associated with Unique Host and Microbiome Features. Cell ARTICLE| VOLUME 174, ISSUE 6, P1388-1405.E21, SEPTEMBER 06, 2018

https://www.cell.com/cell/fulltext/S0092-8674(18)31102-4

Summary

Empiric probiotics are commonly consumed by healthy individuals as means of life quality improvement and disease prevention. However, evidence of probiotic gut mucosal colonization efficacy remains sparse and controversial. We metagenomically characterized the murine and human mucosal-associated gastrointestinal microbiome and found it to only partially correlate with stool microbiome. A sequential invasive multi-omics measurement at baseline and during consumption of an 11-strain probiotic combination or placebo demonstrated that probiotics remain viable upon gastrointestinal passage. In colonized, but not germ-free mice, probiotics encountered a marked mucosal colonization resistance. In contrast, humans featured person-, region- and strain-specific mucosal colonization patterns, hallmarked by predictive baseline host and microbiome features, but indistinguishable by probiotics presence in stool. Consequently, probiotics induced a transient, individualized impact on mucosal community structure and gut transcriptome. Collectively, empiric probiotics supplementation may be limited in universally and persistently impacting the gut mucosa, meriting development of new personalized probiotic approaches.
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Re: Are probiotics necessary?

Postby JeffN » Mon Feb 04, 2019 9:56 am

Are Probiotics Money Down the Toilet? Or Worse? | Complementary and Alternative Medicine | JAMA | JAMA Network

"With interest growing in natural therapies, the popularity of probiotics is on the rise. ... Two recent studies by researchers in Israel, however, are raising questions about the widespread use of probiotics to impart general wellness and restore intestinal flora after the use of antibiotics, 2 common indication"

https://jamanetwork.com/journals/jama/f ... le/2723633

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Re: Are probiotics necessary?

Postby JeffN » Tue Mar 26, 2019 5:35 am

Narrative reviews: The Unregulated Probiotic Market
Clinical Gastroenterology and Hepatology
Volume 17, Issue 5, April 2019, Pages 809-817

https://doi.org/10.1016/j.cgh.2018.01.018

Background & Aims
This narrative review provides an overview of the current regulation of probiotics, with a focus on those used for the dietary management of medical conditions (Medical Foods).

Findings
The probiotic market has grown rapidly, both for foods and supplements intended to enhance wellness in healthy individuals, and for preparations for the dietary management of disease. Regulation of probiotics varies between regions. Unless they make specific disease-related health claims, probiotics are regulated as food supplements and regulation is focused on the legitimacy of any claims, rather than efficacy, safety and quality. Many properties of probiotics are strain-specific, and safety and efficacy findings associated to specific formulations should not be generalized to other probiotic products. Manufacturing processes, conditions and ingredients are important determinants of product characteristics and changes to manufacturing are likely to give rise to a product not identical to the “original” in efficacy and safety if proper measures and controls are not taken. Current trademark law and the lack of stringent regulation of probiotic manufacturing mean that the trademark owner can commercialize any formulation under the same brand, even if significantly different from the original. These regulatory deficits may have serious consequences for patients where probiotics are used as part of clinical guideline-recommended management of serious conditions such as inflammatory bowel diseases, and may make doctors liable for prescribing a formulation not previously tested for safety and efficacy.

Conclusions
Current regulation of probiotics is inadequate to protect consumers and doctors, especially when probiotics are aimed at the dietary management of serious conditions.
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Re: Are probiotics necessary?

Postby f1jim » Wed Mar 27, 2019 7:31 pm

Jeff, why are you holding back?
Please tell us how you really feel!
Haha.
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While adopting this diet and lifestyle program I have reversed my heart disease, high cholesterol, hypertension, and lost 54 lbs. You can follow my story at https://www.drmcdougall.com/james-brown/
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Re: Are probiotics necessary?

Postby JeffN » Wed Mar 27, 2019 7:36 pm

:)

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Re: Are probiotics necessary?

Postby JeffN » Thu Jan 16, 2020 10:42 am

This is true for most all supplements, not just probiotics
(Thanks Jim for the heads up)

Online Information on Probiotics: Does It Match Scientific Evidence?
ORIGINAL RESEARCH ARTICLE
Front. Med., 15 January 2020 | https://doi.org/10.3389/fmed.2019.00296

https://www.frontiersin.org/articles/10 ... 00296/full

Probiotics are over-the-counter products marketed for enhancing human health. Online information has been key in promoting probiotics worldwide. However, only few rigorous clinical studies have met the stringent criteria required to establish the efficacy and safety of probiotics. The present study was undertaken to assess the information quality of webpages referring to probiotics and to compare the recommendations available online with the information collected from trusted scientific sources. We evaluated 150 webpages returned by Google searching “probiotics” in terms of typology of website, health information quality based on the JAMA score and the HONcode certification, as well as completeness of the information based on the presence of four criteria: (1) links to scientific references supporting health claims, (2) cautionary notes about level of evidence for alleged benefits, (3) safety considerations, and (4) regulatory status. We then enumerated the health claims mentioned online and the corresponding clinical trials and reviews registered in the Cochrane library. Finally, the conclusions of Cochrane reviews were used to assess the level of scientific evidence of the information available through Google search. HON-certified websites were significantly more frequent in the top 10 websites than in the remaining websites. In terms of completeness of information, only 10% of webpages met all four criteria, 40% had a cautionary note on benefits, 35% referred to scientific literature, and only 25% mentioned potential side effects. The results of the content analysis led us to conclude that: (1) the most frequent typologies of webpages returned by Google are commercial and news, (2) commercial websites on average provide the least reliable information, and (3) significant numbers of claimed benefits of probiotics are not supported by scientific evidence. This study highlights important biases in the probiotics information available online, underlining the need to improve the quality and objectivity of information provided to the public.

Conclusion: We conclude that the high level of uncertainty for most health claims found online hinders the rational use of probiotics, leaving the field open to unsubstantiated allegations and misuse. With the growing interest in therapeutic interventions targeting the microbiome, there is a clear need for a new regulatory framework and new policies regarding communication on the benefits and risks of probiotics.
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Re: Are probiotics necessary?

Postby JeffN » Mon Jul 06, 2020 5:05 am

And the hits keep coming

Evidence for probiotics falls short of the hype

Based on a comprehensive technical review, the American Gastroenterological Association (AGA) has released new clinical guidelines which note that for most digestive conditions there is not enough evidence to support the use of probiotics—live microorganisms found in some foods and dietary supplements that are often touted as beneficial. [AGA does not recommend the use of probiotics for most digestive conditions. AGA press release. June 9, 2020

Journal Pre-proof
AGA Technical Review on the Role of Probiotics in the Management of Gastrointestinal Disorders
S0016-5085(20)34732-6
https://doi.org/10.1053/j.gastro.2020.05.060
Gastroenterology
https://www.gastrojournal.org/action/sh ... %2934732-6

AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders5085(20)34729-6
S0016-5085(20)34729-6
https://doi.org/10.1053/j.gastro.2020.05.059
https://www.gastrojournal.org/action/sh ... %2934729-6

AGA does not recommend the use of probiotics for most digestive conditions
June 9, 2020
https://gastro.org/press-releases/aga-d ... onditions/
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Re: Are probiotics necessary?

Postby JeffN » Mon Jul 06, 2020 5:35 am

Do probiotics actually do anything? –
60 Minutes
CBS News

Dr. Patricia Hibberd is an infectious disease specialist and a professor of medicine at boston university.

Dr. Hibberd has reviewed hundreds of studies in the medical literature about probiotics. She has also done her own studies and told us there's not enough high quality research to recommend off-the-shelf probiotics for the medical problems for which they're commonly used.

Dr. Patricia Hibberd: The whole idea that maybe throwing in good bacteria that we would take by mouth that hopefully would land in the right places in the GI tract and work with the immune system. We just don't know how to do any of that.

Dr. Jon LaPook: But right now, there is a multi-billion dollar industry that's growing.

Dr. Patricia Hibberd: Yes.

Dr. Jon LaPook: And people are out there buying this stuff.

Dr. Patricia Hibberd: Right.

Dr. Jon LaPook: So, is there convincing evidence that commercially available probiotics have been found to be beneficial for reducing diarrhea from antibiotics?

Dr. Patricia Hibberd: No.

Dr. Jon LaPook: Treating irritable bowel syndrome?

Dr. Patricia Hibberd: No.

Dr. Jon LaPook: Decreasing allergies?

Dr. Patricia Hibberd: No.

But probiotics are suggested as a remedy for all those things… and more.

One cause of confusion may be the placebo effect: some people using probiotics may feel better because they expect to feel better. And figuring out what probiotics do inside the gut is complicated. One reason is that each person's microbiome is unique, so the same probiotic may have different effects on different people. That's exactly what professors Eran Elinav and Eran Segal found at Israel's Weizmann Institute of Science.

Eran Elinav: We wanted to directly assess what the probiotics were doing and how they interact with what's already inside in our gut.

The researchers collected thousands of samples from a small group of adult volunteers who were given probiotics.

Eran Segal: We've actually looked across the entire gastrointestinal tract at places where nobody has looked before.

The volunteers all underwent multiple endoscopies and colonoscopies.

Dr. Jon LaPook: So you're going down the swallowing tube, into the stomach, and into the first part of the small intestine. And then colonoscopy, you're coming from below.

Eran Elinav: Exactly. And then we gave some of these volunteers a very large combination of probiotics that are out there in your supermarket. And half of the individuals were given what we call placebo, which is an empty pill.

Eran Segal: so the results were actually very striking so what we're seeing is that half the people take the probiotics and the probiotics, as they go in, they just go out and they don't populate the gut.

Dr. Jon LaPook: Was that surprising to you?

Eran Elinav: That was highly surprising to us, most of us or all of us, are under the assumption-- these probiotics would settle in at least temporarily in our gut, and would do the good things that we expect them to do.

The researchers also studied a treatment commonly recommended by doctors, giving probiotics to help restore the balance of gut bacteria wiped out by antibiotics.

Eran Segal: We found that the probiotics actually delayed the restoration of the bacteria of those individuals to what they had before as compared to individuals who took antibiotics and then did nothing.

Dr. Jon LaPook: So here a lot of us have been taking probiotics with antibiotics because we think maybe that'll help us get back to normal more quickly. And this is showing the opposite.

Eran Segal: Exactly.

Eran Elinav: Exactly.

Elinav and Segal's findings contradict much of the conventional wisdom about probiotics. Other scientists are now building on their work.

Eran Segal: To be clear we're not against the concept of probiotics in general. We actually think that probiotics may have huge benefits.

Eran Elinav: But, we need to be very cautious in generally prescribing these microbes without knowing enough of what they do.
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Re: Are probiotics necessary?

Postby JeffN » Thu Jul 09, 2020 2:43 pm

Effect of Probiotic Use on Antibiotic Administration Among Care Home Residents
Author: Butler, Christopher C.; Lau, Mandy
Publication: JAMA
Publisher: American Medical Association
Date: Jul 7, 2020

Key Points
Question Does a dose of a daily oral probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 reduce cumulative systemic antibiotic administration days for all-cause, acute infections in care home residents?

Findings In this randomized clinical trial that included 310 participants, this daily probiotic combination, compared with placebo, did not significantly reduce antibiotic administration over 1 year (mean cumulative antibiotic administration days, 12.9 vs 12.0).

Meaning The findings do not support the use of probiotics for reducing antibiotic administration in older adults living in care homes.

Abstract

Importance Probiotics are frequently used by residents in care homes (residential homes or nursing homes that provide residents with 24-hour support for personal care or nursing care), although the evidence on whether probiotics prevent infections and reduce antibiotic use in these settings is limited.

Objective To determine whether a daily oral probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 compared with placebo reduces antibiotic administration in care home residents.

Design, Setting, and Participants Placebo-controlled randomized clinical trial of 310 care home residents, aged 65 years and older, recruited from 23 care homes in the United Kingdom between December 2016 and May 2018, with last follow-up on October 31, 2018.

Interventions Study participants were randomized to receive a daily capsule containing a probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 (total cell count per capsule, 1.3 × 1010 to 1.6 × 1010) (n = 155), or daily matched placebo (n = 155), for up to 1 year.

Main Outcomes and Measures The primary outcome was cumulative antibiotic administration days for all-cause infections measured from randomization for up to 1 year.

Results Among 310 randomized care home residents (mean age, 85.3 years; 66.8% women), 195 (62.9%) remained alive and completed the trial. Participant diary data (daily data including study product use, antibiotic administration, and signs of infection) were available for 98.7% randomized to the probiotic group and 97.4% randomized to placebo. Care home residents randomized to the probiotic group had a mean of 12.9 cumulative systemic antibiotic administration days (95% CI, 0 to 18.05), and residents randomized to placebo had a mean of 12.0 days (95% CI, 0 to 16.95) (absolute difference, 0.9 days [95% CI, –3.25 to 5.05]; adjusted incidence rate ratio, 1.13 [95% CI, 0.79 to 1.63]; P = .50). A total of 120 care home residents experienced 283 adverse events (150 adverse events in the probiotic group and 133 in the placebo group). Hospitalizations accounted for 94 of the events in probiotic group and 78 events in the placebo group, and deaths accounted for 33 of the events in the probiotic group and 32 of the events in the placebo group.

Conclusions and Relevance Among care home residents in the United Kingdom, a daily dose of a probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 did not significantly reduce antibiotic administration for all-cause infections. These findings do not support the use of probiotics in this setting.
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Re: Are probiotics necessary?

Postby JeffN » Fri May 05, 2023 8:31 am

I thought this would fit in here....

Impact of the gut microbiota and associated metabolites on cardiometabolic traits, chronic diseases and human longevity: a Mendelian randomization study. J Transl Med 21, 60 (2023). https://doi.org/10.1186/s12967-022-03799-5

https://translational-medicine.biomedce ... 22-03799-5

"these results do not support large causal effects of the human gut microbiota and microbial metabolites on human chronic diseases and longevity."

and ....

"Altogether, results of this study suggest that previously reported associations between the human gut microbiome and human disease might have been due to biases such as reverse causality or confounding and that the impact of the gut microbiota on cardiometabolic traits, chronic diseases and human longevity may not be as prominent as previously suggested."
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