A Practical Guide to Probiotics

A Practical Guide to Probiotics:

Separating Fact from Fiction

Dr. Bethany Glynn

Lately the word probiotic has become ubiquitous. Everywhere we look there are claims about these supplements, what they can accomplish and how miraculous their effects can be. But how do we separate fact from fiction?

I was asked by the practitioners at Snoqualmie Optimal Health Chiropractic to write this article about probiotics. While this blog post will in no way cover the breadth and depth of the subject, it will summarize the most pertinent facts and ideas to keep in mind when considering probiotic use.  The following are questions consistently asked of me by patients, and my answers based on research and experience.

What is a probiotic?

                A probiotic, in very general terms, is a group of bacteria in a food or supplement that offer benefit to the host. From the time we leave our mothers during birth, we begin to be colonized with bacteria.[i] Over time, these microbes begin to constitute our flora or microbiome, the collective of bacteria completely unique to each of us. No two people have the exact same flora in their digestive tract, even identical twins.  Our bodies are teeming with microbes and this normally doesn’t cause disease. Furthermore, these bacteria have been shown to biosynthesize vitamin K (needed for blood clotting),[ii] provide competition with harmful microbes in the gut for nutrients and binding sites,[iii] and modulate our immune response.[iv] It is when our flora shifts – due to internal or external causes – that an imbalance and symptoms of disease result.

What is a prebiotic?

                Prebiotics are basically food for the bacteria of our digestive tract. Like any organism, our gut flora needs fuel to survive, and these prebiotic foods or food components have been shown in research to cause shifts in the gut microbiome toward health rather than disease. Research has demonstrated that prebiotics can have an effect on immune system function,[v] inflammatory bowel diseases,[vi] and prevention of colon cancer.[vii] It should be noted that some prebiotics – namely fructooligosaccharides or FOS contained in some probiotic formulas – can exacerbate symptoms of irritable and inflammatory bowel diseases and may need be avoided in these populations.

               

Why can’t I get probiotics from my food alone?

                In short, you may be able to. If you’re eating a lot of fermented and unpasteurized foods, you may be able to get some pre- and probiotics that encourage good gut health. Unfortunately, however, widespread use of pesticides, antibiotics, herbicides, chemical sprays, and pasteurization limits the amount of healthy microbes that survive on our food. With mass production of crops over the last century, the above processes are becoming more and more necessary to prevent overgrowth of harmful bacteria on produce. But the consequence is less naturally occurring probiotics in our daily meals. 

How much yogurt would I have to eat per day to get a good dose of probiotics?

                That depends on a lot of factors. First, it depends on what yogurt (or other probiotic food) you’re eating. Second, it depends on your diagnosis or what you’re trying to treat. For general health, a good dose of probiotics is about 10 billion organisms or colony-forming units (CFUs) per day. On average, a cup of yogurt contains probiotic organisms numbering only into the millions. So contrary to the claims of television commercials, yogurt isn’t exactly providing the therapeutic dose needed to deliver health benefits. Does this mean you shouldn’t eat your fair share of organic, cultured dairy products? No. It simply means that in times of imbalance or when trying to achieve a certain health goal, you may need to supplement.

Does the brand of my probiotic really matter?

                Yes. A recent report by ConsumerLab.com found that out of 19 probiotics tested, five contained only 16 percent to 56 percent of the listed amounts of organisms.[viii] In my practice, I often see patients who take discount supplements with no benefit, and then try a high quality brand that ultimately changes their health for the better. It’s so important to find supplement companies that are devoted to producing pure products rather than simply to making profits. These high quality supplements may be more expensive in the short-term, but buying them ensures that you’re getting therapeutic doses of nutrients, vitamins, and – in the case of probiotics – helpful rather than harmful bacteria. Simply put: I don’t want my patients wasting money on products that don’t contain what’s written on the label, and that goes for probiotics as well.

What kind of probiotics should I use after I have taken antibiotics?

                My short answer: a high quality brand probiotic with a wide spectrum of strains. Antibiotics, while necessary in certain situations, are not selective about which bacteria they kill; the result can be a host of health problems from destruction of our healthy gut flora. Make sure that your probiotic contains Lactobacillus and Bifidobacterium, the two most-researched strains for post-antibiotic therapy.

Do strains of probiotics really matter?

                Yes and no. The evidence on this subject is still new and constantly changing. There is evidence that supplementing with a single strain of beneficial bacteria encourage other helpful strains in the gut grow and thrive.[ix] Emerging research is showing that certain strains of bacteria may be able to confer more benefit in people of certain blood types.[x] Research also suggests that certain strains are more beneficial to our psychoemotional sphere than others, even influencing behavior through modulation of calming neurotransmitter receptors in the case of Lactobacillus rhamnosus. [xi] Some strains appear to be more beneficial for treatment of skin conditions such as eczema (atopic dermatitis).[xii] Saccharomyces boulardii, Lactobacillus rhamnosus, and probiotic mixtures have been shown to be of most benefit for reducing recurrence of antibiotic-associated diarrhea.[xiii]

While we do want to pay attention to strains in probiotic supplements, we also have to remember that our bodies are basically made of bacteria. It is estimated that our bodies are made up of less of our own cells than the bacteria contained solely in our digestive tracts. Candida, Streptococcus, Staphylococcus, even Clostridium and E.coli live on and in us all the time. Furthermore, they perform vital functions to the human body until they are allowed to overgrow and cause symptoms. The goal in most cases of probiotic supplementation is to shift the balance of organisms, rather than to effect individual strains of bacteria.

Do my probiotics really need to be refrigerated?

                Possibly. Many probiotic labels say that the bottles should be refrigerated. In requiring refrigeration, companies hope to maintain close to the number of CFUs of bacteria that were originally placed in the bottle at the packing date. In other words, these companies are trying to keep the number of living microbes as close to the number on the label over time. For this reason, I always tell my patients to find a probiotic supplement that lists the number of CFUs or organisms on the bottle; it’s a sign that the company operates under quality practices. If you’d like to take this a step further, you can call the supplement company you’re interested in and ask them about CFUs in their probiotics at expiration. So at minimum, you’ll be receiving that many living organisms per capsule up until expiration. Many companies will not give you this information; my advice would be to avoid products from these companies.

While CFU and refrigeration labeling can be a sign of a quality supplement, research isn’t as clear as to the reasoning behind this recommendation. There is evidence that non-living and even components of probiotic strains may offer health benefits to the host.[xiv] If refrigeration is a big enough problem for patients that it would prevent consistent supplementation, I don’t require that they refrigerate their probiotic.

Does gut health really have an effect on overall health?

                We now know that gut bacteria do impact our overall health, but we aren’t yet sure how to accurately study the entire microbiome of one’s digestive system. In order to learn about varying strains of beneficial and harmful bacteria, researchers either have to isolate single strains and implant them into animals born and raised in germ-free environments, or try strains of probiotics in groups of people with certain conditions. The problem with the former animal study scenario is generalizability; in other words, the results of these studies in animals may not be useful or applicable to humans and may not indicate the true effect of a bacterial strain in a normal, flora-colonized human intestine. The problem with the latter, human studies is that of individuality; as stated previously, each and every person has their own unique microbiome as a product of environmental effects, diet, and genetics. These human subjects, although sharing a diagnosis with one another, may or may not benefit from certain probiotic strains due to individual variability of their intestinal flora.

Despite the hurdles to be overcome in research design, there is emerging evidence of a gut-brain axis. In medical school, we learn that the gut has its own nervous system called the enteric nervous system. This branch of the nervous system is much more intertwined with the overall (central and autonomic) nervous system than we had previously thought, necessitating a new branch of specialized medicine called neurogastroenterology. This field studies the connection between the brain and the gut; we are finding that the same neurotransmitters (chemicals our brain and nerves use to communicate) we target in drug therapies for depression and anxiety also have effects in the intestines. Not surprisingly, the health of the gut can also lead to effects on the brain and, hence, our behavior and emotions.[xv]  It has been shown that the gut microbiome effects brain development from birth.[xvi]

Who needs probiotics?

According to research, you could need supplementation of probiotics if you experience the following:

·         Antibiotic use[xvii]

·         Multiple sclerosis[xviii]

·         Autism spectrum disorders[xix]

·         Asthma and atopic conditions (like eczema)[xx]

·         Anxiety[xxi]

·         Depression[xxii]

·         Crohn’s disease[xxiii]

·         Ulcerative colitis[xxiv]

·         Celiac disease[xxv]

·         Problems concentrating and behavioral issues (ADHD)[xxvi]

·         Vaginal or urinary tract infections[xxvii]

·         Reflux or ulcer associated with H. pylori infection[xxviii]

So when can I start taking probiotics?

As always, make sure to consult a qualified professional before starting any new supplement or diet.  Side effects, which are rare, tend to be very mild and temporary. For people who experience gas and bloating when beginning a probiotic supplementation protocol, it can be important to start with a low dose and increase over the course of several weeks. Probiotics should be avoided in immunocompromised individuals without the guidance of a licensed physician.

A probiotic supplement can be of great benefit to many people. I personally believe (and have seen in practice) that quite often there exists an emotional component to physical illness and/or imbalance. Probiotics, according to recent research, seem to be able to address both. As the field of neurogastroenterology continues to grow, I am sure we will continue to find more uses for these organisms and further unravel the intricacies of their impact our health and happiness.

About the Author

Dr. Bethany Glynn is a naturopathic primary care physician along with Dr. Bizzy Riley at Naturopathic Clinic of Issaquah and Thrive Supplements. While she specializes in pediatric and adolescent care, she especially enjoys helping families living with autism, anxiety, and ADHD. Dr. Glynn is passionate about the connection between the body and mind, not stopping at a diagnosis but determining the underlying physiological or emotional cause of one’s imbalance. In practice, she accomplishes this process with patients through a combination of lab assessment of nutrient deficiencies, genetic testing, nutritional and diet therapy, biofeedback, counseling, and homeopathy. For more information on her practice or to make an appointment visit www.IssaquahHealth.com. To order high quality natural products from Thrive Supplements, call (425)391-1080 or stop in at 48 Front Street N in Issaquah.

DISCLAIMER: The information included in this post is for educational purposes only and is the opinion of writer. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not constitute a physician-patient relationship.

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