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
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
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
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
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]
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.
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
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.
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?
to research, you could need supplementation of probiotics if you experience the
·Reflux or ulcer
associated with H. pylori infection[xxviii]
So when can I start taking probiotics?
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
[i]Giacomo, Biasucci et
al. Cesarean Delivery May Affect the
Early Biodiversity of Intestinal Bacteria.J.
Nutr. 2008;138(9): 1796S-1800S.
[ii]Bentley R., Meganathan R. Biosynthesis of vitamin K
(menaquinone) in bacteria. MicrobiolRev.
[iii]Candela M. et al. Interaction of probiotic Lactobacillus and Bifidobacterium strains with human
intestinal epithelial cells: Adhesion properties, competition against
enteropathogens and modulation of IL-8 production. Int.
J. Food Microbiol.2008;125:286–292.
[iv]Mazmanian S.K. et al. An immunomodulatory molecule of
symbiotic bacteria directs maturation of the host immune system. Cell. 2005;122:107–118.
AR, Calder PC. Prebiotics, immune function, infection and inflammation: a
review of the evidence. Br J Nutr. 2009;101(5): 633–658.
C, Whelan K, Lindsay JO. "Evidence for the use of probiotics and
prebiotics in inflammatory bowel disease: a review of clinical trials". Proc
Nutr Soc. 2007;66(3):
MS, Butler RN, Howarth GS (Oct 2006). Probiotics, prebiotics and synbiotics: a
role in chemoprevention for colorectal cancer?. Cancer Biol Ther. 2006;5(10):
[viii] ConsumerLab.com: Many Probiotics Fall Short.Engredea News & Analysis. Website. http://newhope360.com/business/consumerlabcom-many-probiotics-fall-short. 2013. Accessed February 06,
[ix] Phillips, ML. Gut Reaction: Environmenal Effects on
the Human Microbiota. Environmental
Health Perspectives. 2009; 117(5): A198-A205.
[x]Watanabe M, et al. Identification of a new adhesin-like protein from
Lactobacillus mucosae ME-340 with specific affinity to the human blood group A
and B antigens.
J. Appl. Microbiol. 2010;109:927–935.
[xi]Bravo JA et al. Ingestion of Lactobacillus strain regulates emotional
behavior and central GABA receptor expression in a mouse via the vagus nerve. Proc
Natl Acad Sci.
[xii] Rosenfeldt V et al. Effect of probiotics on gastrointestinal
symptoms and small intestinal permeability in children with atopic dermatitis. J
[xiii] Hookman, Perry and Barkin, Jamie S. Clostridium difficile associated
infection, diarrhea and colitis. World
J Gastroenterol. 2009; 15(13): 1554–1580.
[xiv]Kataria J, Li N, Wynn JL, Neu J. Probiotic microbes: do they
need to be alive to be beneficial? Nutr Rev. 2009;67:546–550.
[xv] Saulnier DM et al. The intestinal microbiome,
probiotics and prebiotics in neurogastroenterology. Gut microbes. 2013; 4(1): 17-27.
[xvi]Douglas-Escobar M, Elliott E, Neu J. Effect of intestinal microbial ecology
on the developing brain. JAMA Pediatr. 2013;167: 374–379
[xvii]Dethlefsen L., Huse S., Sogin ML., Relman DA. The pervasive
effects of an antibiotic on the human gut microbiota, as revealed by deep 16S
rRNA sequencing. PLoS Biol.2008;6:e280.
[xviii]Ochoa-Repáraz J., Mielcarz D.W., Wang Y., Begum-Haque S.,
Dasgupta S., Kasper D.L., Kasper L.H. A polysaccharide from the human commensal
Bacteroides fragilis protects against CNS
demyelinating disease. Mucosal Immunol.2010;3:487–495.
[xix]de Magistris L,
Familiari V, Pascotto A, et al. Alterations of the intestinal barrier in
patients with autism spectrum disorders and in their first-degree relatives. J Pediatr Gastroenterol Nutr.
[xxi]Cryan JF, O’Mahony SM. The microbiome-gut-brain axis: from bowel to
behavior. Neurogastroenterol Motil. 2011;9:187–192.
[xxii]Mayer EA. Gut feelings: the emerging biology of gut–brain
communication. Nat Rev Neurosci. 2011;9:453–466.
[xxiii]Influence of Saccharomyces boulardii on the intestinal permeability of
patients with Crohn's disease in remission. Scand
J Gastroenterol. 2008;43(7):842-8.
[xxiv] Furrie E et al. Synbiotic therapy (Bifidobacterium longum/Synergy
1) initiates resolution of inflammation in patients with active ulcerative
colitis: a randomised controlled pilot trial. Gut. 2005 Feb;54(2):242-9.
[xxv]Collado MC, Donat E, Ribes-Koninckx C, et al. Specific
duodenal and faecal bacterial groups associated with paediatric coeliac
disease. J Clin Pathol 2009;62:264-
[xxvi] Blum K. et al. Attention-deficit-hyperactivity
disorder and reward deficiency syndrome. Neuropsychiatr
Dis Treat. 2008 October 4(5): 893-918.