Are probiotics worth the money?

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诺曼，你觉得你自己是益生菌还是抗生素？

Norman, would you say you're probiotic or antibiotic?

我、我有点倾向于抗生素那边，因为它们不一定总是对你有好处。

I'm I'm sort of equivocating on antibiotics because they're not necessarily always good for you.

你得小心着点它们。

You gotta be careful about them.

至于益生菌嘛，还没定论。

And probiotics, the jury is out.

哦，我还真以为你会在这上面骑墙呢，不过你刚才的回答可比我想的要明确多了。

Oh, I really thought you were gonna be a real fence sitter on that, but that's actually more decisive than I expected.

对。

Yeah.

你以前用过益生菌吗？

Have you been a user of probiotics in the past?

只在天然食品里。

Only in natural foods.

哦，这样。

Ah, okay.

好吧，我觉得这正是我们今天要聊的话题。

Well, I think that's something that we're gonna talk about today.

是吗？

Is it?

是的。

Yes.

因为我们现在是在《这是什么疹子》节目上。

Because here we are on What's That Rash?

我是健康记者泰根·泰勒，我在贾格拉和塔鲁巴土地上为您播报。

I am health reporter Tegan Taylor coming to you from Jagera and Turrbaland.

我是医生兼记者诺曼·斯旺，我在加地加这片土地上，也就是尤拉民族的一部分，为您播报。

And I'm physician and journalist doctor Norman Swan coming to you from Gadigaland, part of the Eora nation.

今天我们聊的是益生菌。

And today we're talking about probiotics.

今天的问题来自苏菲。

Today's question comes from Sophie.

你好。

Hi there.

我就是想问一下，吃抗生素的时候同时吃益生菌有没有用。

I just had a question about taking probiotics with antibiotics.

我最近得了某种胸部感染，吃了两种不同的抗生素，还有一些类固醇。

I recently had a certain chest infection, and I was on two lots of different antibiotics and also some steroids.

药剂师建议我早上和下午各吃一次益生菌。

And the pharmacist suggested that I take a probiotic in the morning and also in the afternoon.

所以，对，我就是想知道这样做到底值不值得。

So, yeah, I was just wondering if it was worthwhile or not.

所以苏菲问的就是吃益生菌到底值不值得花那个钱。

So that's Sophie asking about whether probiotics are worth her money.

我觉得，抗生素的情况比较特殊。

I suppose, like, antibiotics are quite a specific case.

我想聊聊这个，同时也想讨论一下它们到底值不值得吃。

I do wanna talk to that, but also, like, whether they're worth it in general.

对。

Yeah.

这里的理论是，这不仅仅是理论。

So the theory here is well, it's not just theory.

抗生素会杀死细菌，而且它们不仅会杀死目标细菌。

Antibiotics kill bugs, and they don't just kill the bugs that they're intended to kill.

它们实际上会扰乱你肠道里的微生物群。当抗生素进入肠道，尤其是大肠时，会在一定程度上把肠道清理干净，这可能会导致腹泻，因为微生物群有助于让大便成形。

They can actually knock around your microbiome in your bowel so that the when the antibiotics hit your bowel, particularly the large bowel, they clean it out to some extent and it can cause diarrhea because the microbiome helps to really consolidate the poo.

好的。

Okay.

哇。

Wow.

我们才刚说了两句话，就已经提到了腹泻和便便。

We're two minutes in and we've already mentioned diarrhoea and poo.

这真是开了个好头。

This is off to a flying start.

有人可能会说，这是冲刺式的开场。

A running start, some might say.

非常好。

Very good.

所以你看，抗生素引起的腹泻是个广为人知的现象。

So look, there's a well known phenomenon of antibiotic induced diarrhea.

还有抗生素引起的真菌感染，还有一种抗生素诱发的病，好在不太常见，叫做C。

There's also antibiotic induced fungal infections, and there's also an antibiotic induced condition, which thankfully is fairly rare called C.

艰难梭菌，就是艰难梭菌。

Difficile, Clostridium difficile.

所以抗生素确实能搞得你很难受，你应该只在需要的时候吃。

So antibiotics can really mess with you, you and should only take them when you need them.

问题是，益生菌到底有没有用？

The question is, do probiotics help?

我们现在说的是什么？

What are we talking about here?

说的是你在药店买的那种补充剂，里面含有各种细菌。

We're talking about supplements that you buy in the chemist which contain a variety of bacteria.

对，就是药店卖的那些，货架上一排排的，有胶囊的，我记得以前有人给我推荐过，现在还有小球形状的巧克力，还有软糖什么的，广告说得天花乱坠，好像效果很神奇。

Yeah, mean the stuff that you buy in the chemist, there's a shelf and a half of them they're like capsules which is I think kind of what I remember being offered at some stage in my life but there's also like they come in like little chocolate balls you can get gummies and stuff now and the claims that they make are I mean, they're really kind of promising a lot.

他们说的是你的肠道菌群，这个我觉得待会儿得解释一下，但他们还说什么能增强免疫力，甚至能改善情绪。

They're talking about your microbiome, which I suppose we should define in a bit, but they're also sort of saying, you know, it's your immune system and it might even improve your mood.

反正就是说法特别多，有点乱。

Like, there's just a lot flying around here.

确实是。

There is.

而且你看那些文章，讲各种病，我们后面会提到，他们说益生菌肯定有效果，但实际上，证据根本不充分。

And you'll read articles about different conditions, which we'll come to later, where they're confident that probiotics are going to going to make a difference, but in fact, the evidence is not there.

但如果你在货架上看到它，刚吃了抗生素或者心情有点低落，总有一款益生菌适合你。

But if you look at it on the shelf and you've just taken antibiotics or you're feeling a bit low, there's a probiotic for you.

问题是，它到底有没有用？

Question is, does it work?

对。

Yeah.

那我们能不能回到肠道微生物组这个话题？

Well, can we come back to the gut microbiome?

因为这种东西吧，就像是，大家都不知道它，直到某个时候。

Because it's one of those things that, like, no one heard about it until I don't know.

我随便说个年数，感觉肯定不对，差不多十年左右吧。

I'm gonna pick a number of years out of a hat, and it feels like it's gonna be wrong, like ten ish years.

我也不清楚。

I don't know.

然后突然之间，它就到处都是了。

And then all of a sudden, was everywhere.

肠道微生物群，真的太重要了。

Gut microbiome, it's so important.

你得好好养护它。

You gotta support it.

我们说的就是，这些遍布全身的、数以万亿计的细菌群落，包括肠道里的那些，它们对我们有益，而我们对它们的了解其实才刚刚开始。

And what we're talking about is, like, these colonies of, like, trillions of bacteria that live all over your body, including in your gut, that are good for you in ways that we're kind of really only beginning to understand.

那这样吧，Tegan，咱们花一分钟讲讲微生物群，让大家有个概念。

So here, look, Tegan, maybe just a minute on the microbiome and we could get a sense of that.

好。

Alright.

我掐个表。

Setting my stopwatch.

行。

Okay.

开始。

Go.

实际上，肠道里的这些细菌对身体的运作非常重要，从免疫系统到甚至影响大脑的工作方式。

Now, essentially, these bugs in the bowel are really important for the way the body functions, from the immune system to even affecting how the brain works.

而且肠道里的通讯系统和大脑里的通讯系统非常相似。

And the communication systems in the gut are very similar to the communication systems in the brain.

所以，这就说得通了。

So, makes a lot of sense.

而且越来越多的证据表明，通过影响肠道里的情况，你可以影响情绪，比如说抑郁和焦虑。

And there is a growing amount of evidence that by influencing what happens in the gut, you can influence mood, for example, depression and anxiety.

还有，能起到抗抑郁的效果。

There's, and have an antidepressant effect.

它很可能有助于，也可能与肠易激综合征有关。

It may well help, it may well be involved in irritable bowel syndrome.

有一系列病症，微生物群的异常或限制会产生很大影响，但这远远不等于说吃益生菌就能解决问题。

There's a whole series of conditions where abnormalities in the microbiome or restrictions in the microbiome can make a big difference, which is a long way from saying though that taking a probiotic is gonna solve the problem.

肠道里有数万亿种细菌，种类极其多样。

There are trillions of bugs in the bowel of huge diversity.

你会选哪些呢？

Which ones are you going to choose?

他们通常选的那些，是最容易进入肠道的。

And the ones they tend to choose are the ones which are easiest to get into the bowel.

这正好六十一秒。

That was sixty one seconds.

我印象太深刻了。

I am so impressed.

你看吧。

Look.

我还有四秒钟。

I have four more seconds.

没有了。

No.

你显然在广播行业干了很多年。

You've you've obviously worked in broadcast for a very long time.

顺便说，这可以追溯到二十世纪初。

By the way, it goes back to the early twentieth century.

那位发现巨噬细胞的免疫学家，巨噬细胞是一种白细胞，负责清理体内的垃圾和细菌等等，他就是伊利亚·梅奇尼科夫，他对微生物组非常着迷。

The immunologist who discovered the white blood cell called the macrophage, which is the white blood cell that trumps up rubbish in the body and bacteria and so on, Ilya Mechnikov, he was obsessed with the microbiome.

他认为这对健康极其重要，事实上，他还将酸奶商业化，作为一种治疗产品。

He thought it was incredibly important for health and in fact, he commercialized yogurt as a therapeutic.

他相信，肠道中有害细菌的影响可以通过发酵物质来对抗，而且有可能，你懂的，这真的能延长寿命之类的。

He believed that the harmful effects of bacteria in the gut could be combated by fermented substances and that it was possible, you know, that this could actually extend life, for example.

这和一种说法有关，人们认为住在巴尔干和希腊山区、经常吃酸奶的人都能活到高龄。

And this goes to the fact that there was a belief that people who lived in the mountains in the Balkans and in Greece who drank who ate yogurt all the time lived to ripe old ages.

所以他开创并推广了酸奶的食用。

And so he pioneered and promoted the consumption of yogurt.

真了不起。

Incredible.

我还说了十年。

And I said ten years.

我真是大错特错了。

I was so, so far off.

就是普通的酸奶吗？

What like just normal yogurt?

具体细节我记不清了，但我觉得他可能在酸奶上亏了不少钱。而且他也没活到特别老，活到七十多岁，在当时也算正常寿命了。

I can't remember the story exactly, but I think he might have lost quite a lot of money on the yogurt, And he certainly didn't live to a well, he lived to a reasonable age for the time into his seventies.

他承诺的青春之泉并没有实现啊。

It wasn't the fountain of youth he was promising.

对。

Yeah.

我觉得大家是期望他能活过71岁，结果这可怜的家伙死得太早了。

I think they were expecting him to live much longer than 71, and the poor sod died too soon.

但你要知道，那时候的平均寿命大概也就55岁。

But, you know, life expectancy in those days was probably 55.

他把自己酸奶帝国给毁了。

He undermined his own yogurt empire.

没错。

That's right.

所以梅奇科夫意识到了这一点。

So Mexichov recognized this.

这些细菌能产生一些物质，实际上可以影响并向免疫系统传递信号。而且不仅是对免疫系统，肠道里的化学信使，几乎每一种在肠道里的化学信使，在大脑里也都有。

These bugs produce substances which can actually influence and send messages to the immune system And not only to the immune system, the chemical messengers that are in the bowel, almost every chemical messenger that's in the bowel is there in the brain as well.

所以，微生物组的这种复杂性，以及它与身体其他部分的相互作用，对健康和疾病都非常重要。

So this complexity of the microbiome and the interaction with the rest of the body is very important for health and disease.

那么我想问的是，我在柜台买的益生菌，真的能完成这么复杂的任务吗？

So then I guess the question is, is a probiotic that I'm ordering over the counter, is it actually able to do that really complicated job?

目前来看，答案似乎是否定的。

And the answer at the moment seems to be no.

不是说理论错了，微生物组确实极其重要，但它也极其复杂。

Not that the theory is wrong, so microbiome is incredibly important, but it's incredibly complex.

关于在服用抗生素时服用这些益生菌补充剂能否预防腹泻，已经有很多研究和试验。

There's been a lot of research and a lot of trials into whether taking one of these probiotic supplements when you're on antibiotics will prevent the onset of diarrhea.

有些试验说有效，有些说没用。

And some trials say yes, some trials say no.

其中很多试验是在儿童身上做的。

A lot of them have been done in children.

综合证据来看，它可能对抗生素后腹泻的风险有一点小作用，但作用不大。

And the balance of evidence is it maybe has a small effect on the risk of diarrhea after antibiotics, but it's not a big effect.

问题是，回到梅契尼科夫的理论，康普茶或者新鲜酸奶会不会效果更好呢？

The question is, would kombucha or fresh yogurt, going back to Metchnikov, do a better job?

这个也还不太清楚。

And that's not entirely clear either.

不过，像酸奶或康普茶里的菌种范围，可能比胶囊里的要广得多。

Although the range of bugs in something like yogurt or kombucha may well be wider than you get in a capsule.

我觉得关于胶囊，有一点值得指出的是，它是一种高价的专利产品，所以他们得让自己的产品跟别家的有点不一样，还得能培养，能规模化生产，能运输，还要装进塑料瓶里给你。那些符合这些条件的肠道菌群，未必就是对你身体最有用的那些。

I think the thing about the capsules that's important to kind of call out is that it's a premium patented product and so they've kind of got to have something different to what their mates have and they've got to be able to grow it and they've got to be able to grow it at scale and they've got to be able to transport it and put it in a plastic bottle for you to have like the gut bugs that tick those boxes might not necessarily be the same gut bugs that are doing you the most good inside you.

其实，这个问题你可以自己回答，Tegan，因为你去过南澳的一个中心，那里的理念就是，益生菌胶囊里那点有限的菌种，根本不够。

I mean, you can answer this question, Tegan, for yourself because you went to actually a center in in South Australia based on the premise that a small range of bacteria in a probiotic capsule is just not enough.

对，确实如此。

Oh, exactly.

所以我去了那个地方，它在阿德莱德，算是一个商业机构。他们 basically 是想从粪便移植那种模式出发——这其实挺像献血的，找个供体，再找个患者，通常是病情特别重的病人，然后给他们做类似移植或者输血的治疗。但这又有点像去药店买量身定制的产品。他们试图大规模培养那些最重要的肠道菌群，找出哪些最关键，然后把它们配成一种混合制剂给到人用，里面包含多种不同的菌株。

So I did go to this it's sort of a commercial facility in Adelaide that's trying to basically kind of get from poo transplants, which is very much like a it's almost like blood donation thing, you get a donor and you get a patient, usually someone who's like really really sick, and you give them basically a transplant or a transfusion to something where it is more like going to your pharmacy and buying something that's tailored and they're trying to sort of brew up big vats of the most important gut bacteria and kind of identify which ones are the most important and then give a cocktail of those so like many different types of that that they would give to a person.

但问题来了。

But here's the thing.

我觉得我知道你要说什么了。

I think I know what you're about to say.

怎么把它弄到屁股那儿去？

How do you get it to the butt?

怎么把它弄到屁股那儿去？

How do you get it to the butt?

那要么是用结肠镜，要么是插导管，或者是灌肠。

Well, it's either a colonoscope or a catheter or an enema.

因为你不希望这东西被吞下去后，还没到该去的地方就散开了。

Because you don't want to be swallowing this stuff and it breaking free before it gets to where it needs to be.

不，那可能只是口臭严重了五百倍。

No, it could be just halitosis times 500.

说真的，益生菌的问题就在于你得吞下去。

Seriously, the problem with the probiotics is you're swallowing them.

而且它还得穿过胃酸的考验。

And it's got to get through the acid of the stomach.

接着还要经过小肠里的酶，才能到达它该去的地方，也就是微生物群主要存在的大肠，结肠那里。

You've got it through the enzymes of the small bowel before it gets to where it needs to be, which is where the microbiome mostly is in the bowel, which is in the large bowel, the colon.

现在大家做粪便移植，都是直接把东西灌进结肠里，因为那里才是它该去的地方。

And what people are doing with fecal transplants is putting it directly into the colon, which is where it needs to be.

所以对于病情特别严重的人来说，这确实非常有用。

So that's like really, really useful for people who are very, very sick.

就像我刚才提到的那个地方，他们开发的疗法主要是用来治疗艰难梭菌感染的。但这可不是那种普通人随便走进药店就能买来自行使用的东西。这些非处方产品用起来方便多了。所以回到苏菲的问题：对于普通老百姓来说，这东西到底有没有价值？

Like the place that I went, the therapy that they've developed is used for C difficile infections like you were saying but it's not something that you know every person can wander into their pharmacy and buy and self administer like there's something very convenient about these over the counter products so like coming back to Sophie's question is there value in it for the everyday person?

我看了一下相关文献，我的观点是它的适用范围非常有限。

My view looking at the literature is very limited.

省省你的钱吧。

Save your money.

康普茶、酸奶都能给你提供不少益生菌。

Kombucha, yogurt give you a good dose of probiotics.

有些啤酒其实也行，不过我不是建议你去喝啤酒。

Some beers even actually do, not that I'm suggesting you go on beer.

但丰富的饮食，会让你肠道里的细菌更丰富、更多样化。

But a rich diet, is going to force the bugs in your bowel to be richer and more diverse.

所以你说的丰富饮食，是指营养丰富、纤维丰富的饮食吗？

So when you're saying a rich diet, you mean like a nutrient rich, fiber rich diet?

对。

That's right.

谢谢你帮我纠正。

Thank you for correcting me here.

但确实是这样。

But that's right.

营养丰富的饮食，搭配各种蔬菜，少吃肉，换句话说，地中海式饮食能让你的肠道菌群非常多样化，这有助于抗炎，能让身体稳定下来，免疫系统也更有条理。

A nutrient rich diet with a wide variety of vegetables, not a lot of meat, in other words, Mediterranean style diet gives you a very diverse microbiome, which is anti inflammatory, which really just settles things down and gets the immune system in order.

所以这就是益生元的方法。

So this is the prebiotic approach.

你吃什么，效果真的不一样。

What you eat makes a difference.

当然，也可以加点发酵食品，比如酸奶、康普茶之类的，但关键还是你吃的食物种类要丰富。

Sure, throw in fermented foods like yogurt and kombucha and things like that, but it's the range of foods that you eat.

至于抗生素引起的腹泻，预防它的话，你不如保持饮食多样化，让肠道菌群保持健康状态。

And with antibiotic induced diarrhea and preventing that, you might as well just have a diverse diet and have the microbiome in good enough shape.

实际上，有一些证据表明，服用益生菌反而会延缓肠道菌群的恢复。

In fact, there's a little bit of evidence that taking probiotics delays the recovery of the microbiome.

所以我觉得顺其自然就好。

So I would just be natural.

诺曼，自然就好。

Norman, Natural Swan.

在我们彻底结束这个话题之前，你觉得益生菌未来会不会真的变得非常有用？

Before we close this off completely, do you see probiotics, like, getting to this point sometime in the future where they really are very worthwhile?

对。

Yeah.

答案是的。

The answer is yes.

加拿大已故教授约翰·比嫩斯托克做过一项有趣的研究，他发现肠道菌群中有一种特定微生物居然有抗抑郁的效果。

Interesting work in Canada by the late professor John Bienenstock found a very specific organism in the microbiome that actually had an antidepressant effect.

这开启了一个全新的领域，叫做营养精神病学。

And that's launched a whole area which is called nutritional psychiatry.

这个领域的领军人物是墨尔本迪肯大学的费利斯·杰克，关于肠道和大脑之间联系的研究做得很好，而且肯定会有所成效。

We've got a leader in this field, Felice Jacka at Deakin University in Melbourne, And there's really good research going on into this link between the gut and the brain, and that will bear fruit, so to speak.

所以长话短说，货架上那些东西可能不值得花钱，多样化的饮食对你有好处，而且诺曼可是粪便移植的超级铁杆粉丝。

So the long and the short of it is the stuff that's on the shelf, probably not worth your money, a varied diet is good for you, and Norman's a massive, massive fan of faecal transplants.

我看到它们就忍不住夹紧屁股。

I'm just clenching my buttocks as I see them.

哦，看来这个问题已经解答了。

Oh, well, Sophie, I think that answers your question.

我们还想特别感谢那些发来问题的朋友。

And we did wanna say a huge thanks to those of you who sent in questions.

有人质疑说，运动到底能不能让人开心起来。

We've had people querying whether it's even possible to enjoy exercise at all.

格雷格对任何能带来乐趣的运动形式都持怀疑态度。

Greg's a bit dim on the idea of enjoying any form of exercise.

诺曼，对此你有什么回应吗？

Any response to that, Norman?

嗯，你看。

Well, look.

作为一个自虐的苏格兰人、澳籍苏格兰人，你知道的，我

As a masochistic Scotsman, Scottish Australian, you know, I

我同意这个说法。

go with that.

你就是得折磨自己。

You just gotta punish yourself.

生活就不是用来享受的。

Why life is not for enjoyment.

你和格雷格，显然是一路人。

You and Greg, obviously, birds of a feather.

帕特里克来信说，他小时候其实挺爱踢足球的，但后来发现膝盖已经踢不了了。

And Patrick wrote in to say he actually loved playing soccer as a young'un, but discovered that his knees didn't like playing soccer anymore.

他还发现了匹克球，我觉得那好像是美国的玩意儿。

And he's discovered pickleball, which I mainly know about from I think it's an American thing.

对。

Yeah.

对。

Yeah.

在美国特别火。

It's huge in The United States.

但帕特里克靠打匹克球减了五公斤。

But Patrick's lost five kilos doing pickleball.

他非常喜欢这种社交氛围。

He loves the social aspects.

而且，我们都应该直接拿起球拍打起来。

And, you know, we should all just pick up a paddle and get on with it.

你以前打过匹克球吗？

Have you had a golf pickleball before?

没有。

No.

没有。

No.

我对它一窍不通。

It's opaque to me.

而且我在冒险。

And then I'm taking the risk

我可能会喜欢，那为什么不试试呢？

I might enjoy it, so why won't we?

好吧，那最好别这样。

Well, we'd better not have that.

不不。

No, no.

还有一个来自玛吉的问题，问的是如果有高血压，做高强度间歇训练合适吗。

And one more question from Margie asking whether high intensity interval training is appropriate if you have high blood pressure.

我们先记下来，等讨论高强度间歇训练的时候再回复玛吉。

We'll take that on notice, and we'll come back to Margie when we deal with HIT.

好的，你知道把问题发到哪里，如果忘了，我现在提醒你一下。

Well, you know where to send your questions, but if you've forgotten, I will remind you right now.

你可以通过ABCHealth的Instagram账号给我们发私信，或者

You can send us a DM at the ABCHealth Instagram account or

你也可以发邮件到 thatrash@abc.net.au，那我们下次见。

You can email us at thatrash@abc.net.au, and we will see you next time.

到时候见。

See you then.

这个播客对古怪自然话题的痴迷，就像磁铁吸冰箱一样。

What the duck is the podcast attracted to weird nature, like magnets to a fridge.

我是安妮·琼斯，我控制不住自己。

I'm Anne Jones, and I can't help it.

鸽子会产奶。

Pigeons make milk.

有人形容那种奶的质地像淡黄色的农家奶酪。

Some people describe it as a yellow kind of cottage cheese consistency.

鸽子有著名的亲戚。

Pigeons have famous relatives.

鸽子和渡渡鸟是一个家族的。

The pigeon and the dodo are in the same family.

而且鸽子对法国大革命也有部分责任。

And pigeons were partially responsible for the French revolution.

让他们吃吧。

Let them eat squaw.

这档播客怎么又出新季了？

What the duck has a new season out right now.

去ABC Listen应用上看看吧。

Check it out on the ABC Listen app.