EXCELLENThttps://abs.twimg.com/emoji/v2/... draggable="false" alt="🔥" title="Feuer" aria-label="Emoji: Feuer">(and semi-bleak) @AGA_Gastro commentary on probiotics

Probiotics are... https://abs.twimg.com/emoji/v2/... draggable="false" alt="🥁" title="Drum" aria-label="Emoji: Drum">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦠" title="Microbe" aria-label="Emoji: Microbe">Misunderstood
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦠" title="Microbe" aria-label="Emoji: Microbe">Over-hyped
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦠" title="Microbe" aria-label="Emoji: Microbe">Under-studied
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦠" title="Microbe" aria-label="Emoji: Microbe">Mis-regulated

BUT (if done righthttps://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">) have lots of potential

Article highlightshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏻" title="Rückhand Zeigefinger nach unten (heller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (heller Hautton)"> (1/8)
#GItwitter
@rabritton @AmerGastroAssn https://twitter.com/amergastroassn/status/1278394199998685184">https://twitter.com/amergastr...

2/8
Probiotics come with BIG promises

BUT Prob https://abs.twimg.com/emoji/v2/... draggable="false" alt="1️⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1"> Almost ZERO high-quality human trials

Prob https://abs.twimg.com/emoji/v2/... draggable="false" alt="2️⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2"> Strain matters

Some Ecoli are good https://abs.twimg.com/emoji/v2/... draggable="false" alt="🥰" title="Smiling face with 3 hearts" aria-label="Emoji: Smiling face with 3 hearts">
Some Ecoli are bad https://abs.twimg.com/emoji/v2/... draggable="false" alt="👺" title="Japanischer Kobold" aria-label="Emoji: Japanischer Kobold">
Same species not = same function

Strain not always advertised in probioticshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="‼️" title="Doppeltes Ausrufezeichen" aria-label="Emoji: Doppeltes Ausrufezeichen">

Makes systematic reviews V hard

3/8
https://abs.twimg.com/emoji/v2/... draggable="false" alt="3️⃣" title="Tastenkappe Ziffer 3" aria-label="Emoji: Tastenkappe Ziffer 3">Your gut bacteria are a stable little family https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦠" title="Microbe" aria-label="Emoji: Microbe"> https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦠" title="Microbe" aria-label="Emoji: Microbe">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦠" title="Microbe" aria-label="Emoji: Microbe">

They may be toxic like some Thxgiving dinners https://abs.twimg.com/emoji/v2/... draggable="false" alt="🥘" title="Flache Pfanne mit Essen" aria-label="Emoji: Flache Pfanne mit Essen">

But they’re family NONETHELESS and stick together, in their own complicated way

And like some boyfriends you brought home for the holidays, most probiotics WONT LASThttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👋🏻" title="Waving hand (heller Hautton)" aria-label="Emoji: Waving hand (heller Hautton)">

4/8 Prob https://abs.twimg.com/emoji/v2/... draggable="false" alt="4️⃣" title="Tastenkappe Ziffer 4" aria-label="Emoji: Tastenkappe Ziffer 4">

You are a unique little snowflakehttps://abs.twimg.com/emoji/v2/... draggable="false" alt="❄️" title="Schneeflocke" aria-label="Emoji: Schneeflocke">

And so is your gut

You have different flora than your neighbor!

Probiotics interact (prob a lot) with your native bacteriahttps://abs.twimg.com/emoji/v2/... draggable="false" alt="🧫" title="Petri dish" aria-label="Emoji: Petri dish">

So why would it be https://abs.twimg.com/emoji/v2/... draggable="false" alt="☝️" title="Zeigefinger nach oben" aria-label="Emoji: Zeigefinger nach oben"> one size fits all?

5/8
And let me throw some political drama in the mixhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="🇺🇸" title="Flagge der Vereinigten Staaten" aria-label="Emoji: Flagge der Vereinigten Staaten"> (Prob https://abs.twimg.com/emoji/v2/... draggable="false" alt="5️⃣" title="Tastenkappe Ziffer 5" aria-label="Emoji: Tastenkappe Ziffer 5">)

Probiotics are regulated as a FOOD (yum yumhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="😋" title="Face savouring food" aria-label="Emoji: Face savouring food">), not a DRUG

So no need to https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤷‍♀️" title="Achselzuckende Frau" aria-label="Emoji: Achselzuckende Frau">
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">specify strain
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">specify AMOUNT of bacteria per pill
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">submit validation of label claims to FDA
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen">run rigorous clinical trials

6/8
It costs > $2 billion and 10 years to get a drug to market

So why would probiotic makers go thru that?

ESP when, as a food/diet supp, they are allowed to make vague claims like “improves digestion”

7/8
Ok ok ok

Before the probiotic mafia comes to my house and makes me eat yogurt https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤢" title="Angewidertes Gesicht" aria-label="Emoji: Angewidertes Gesicht">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🙅🏻‍♀️" title="Frau gestikuliert „Nicht OK“ (heller Hautton)" aria-label="Emoji: Frau gestikuliert „Nicht OK“ (heller Hautton)">

Great @AGA_Gastro review on probiotics found mod-to-high evidence that certain probiotics prevent necrotizing enterocolitis!https://abs.twimg.com/emoji/v2/... draggable="false" alt="🥳" title="Partying face" aria-label="Emoji: Partying face"> https://twitter.com/trott_nick/status/1290626968392740864">https://twitter.com/trott_nic...

8/8
IF WE CAN

https://abs.twimg.com/emoji/v2/... draggable="false" alt="1️⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1">use fancy tools https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔬" title="Mikroskop" aria-label="Emoji: Mikroskop"> to ID the specific microbial/function deficits of an individual or narrow dz phenotype

https://abs.twimg.com/emoji/v2/... draggable="false" alt="2️⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">create bacterial consortium that play well w the complex environ of your native bugshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👯‍♀️" title="Frauen mit Hasenohren" aria-label="Emoji: Frauen mit Hasenohren">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="3️⃣" title="Tastenkappe Ziffer 3" aria-label="Emoji: Tastenkappe Ziffer 3">actually test them

Probiotics may have ahttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Elektrische Glühbirne" aria-label="Emoji: Elektrische Glühbirne"> future

Fin