I’ve always said that everything is connected, and that couldn’t be more true when considering probiotics. Think of it – throughout the environment there are symbiotic relationships where different organisms co-exist to each other’s benefits. We ourselves are teeming with bacteria, in and outside of us, and for the most part, we get along just fine. In our gut, we have over 500 strains of bacteria and yeasts, with trillions of individual microorganisms – more than we have cells in our body – and weighing more than any of our individual organs.
What ARE probiotics, exactly?
Probiotics are defined by the World Health Organization as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host”. They are bacteria and yeasts that we acquire from birth and as we consume foods and interact with our environment. They can be taken as a supplement, in fact, the term “probiotic” refers to microbes added to food or taken as a supplement. They take up residence in our GI tract where they are nourished by our food intake. IN order to be called a probiotic, they must also be isolated from human bodies.
Where do we get these probiotics?
Our first contact with probiotics occurs during our birth. Those of us born vaginally are first exposed as we are push through our mother’s birth canal. Then we pick them up as we are handled by our parents and family and nurses. We acquire them as we suckle at the breast, and as we are kissed, by mom and dad and Aunt Martha and our new big brother. Later, we ingest them as we are introduced to food. One benefit of an organic diet is a greater diversity of microbes in food.
Natural sources of probiotics are found in fruits and vegetables, especially organic. Peeling and washing them does reduce the amount. Another source are cultured or fermented foods, such as fermented vegetables, kefir, and yogurt. Sourdough is cultured, but the heat of baking kills the lactobacillus that give it its tangy flavor. Sauerkraut and other fermented veggies like beets are simply muddled with salt. This builds up a brine and the natural lactobacillus species in them ferments the carbohydrates in them, producing lactic acid that gives them their sour or tangy flavor. My homemade sauerkraut tingles my tongue a bit!
How else can I get probiotics?
As mentioned above, they are also available as supplements. Single-strain formulas are available, such as lactobacillus acidophilus or saccharomyces boulardii. Most probiotic supplements are broad spectrum, containing a range of different genera and species of bacteria and possibly a strain of yeast. They can be taken as pills, powders, gummies, shots, and more. I take a psyllium fiber in my tea that contains bacillus coagulans, a spore-forming bacteria. I also take a broad-spectrum probiotic with 16 strains of bacteria and a separate saccharomyces boulardii capsule. Some supplements are refrigerated.
Wait, they need refrigeration?
It totally depends upon the product you buy and its formulation. Look on the label – a product requiring refrigeration will say so. Many supplements are formulated in a way that the product does not need refrigeration. Some strains are more fragile than others. Probably a good idea to keep in a cool, dry place, at any rate. Your moist humid bathroom is not a good place to store your probiotics – or you medications, either!
If a probiotic is bacteria or yeast, what is a pre-biotic?
Well, your gut flora need to eat, too. Prebiotics are soluble fibers found naturally in foods that nourish the gut flora. Eating a diet rich in fiber, i.e. a plant-based diet, helps to feed the bacteria and yeasts in your gut, promoting their best function. Prebiotics are also added to foods and are sold as supplements. Examples of these include:
- Inulin, a fiber from chicory
- Fructooligosaccharides
- Psyllium husks (also known as Metamucil©)
- Larch tree arabinogalactan, acacia gum and other soluble fibers
Because I am trying to restore and maintain a healthy microbiome, I am consuming as much fiber as I can tolerate. That means whole grains, fruits and vegetables. I sauté chopped veggies and scramble with eggs for breakfast. I make sourdough bread rich with nuts and seeds. My go-to snack is a trail mix I make with nuts and dried fruits. And just a wee bit of chocolate. ‘Cuz, you know. We all need chocolate.
What do probiotics DO for me?
While there are many strain-specific benefits, in general probiotics are associated with boosting immunity by various mechanisms. They improve symptoms associated with irritable bowel syndrome like cramping and diarrhea. They help manufacture vitamins like vitamin K. They break down indigestible fibers and sucrose. They decrease pH which inhibits the growth of pathogens in the gut as well as the vagina and skin. Probiotics can prevent traveler’s diarrhea, and are used to treat pouchitis, a condition associated with ulcerative colitis. Some gut bacteria produce short-chain fatty acids that help to inhibit infections. (These are important in preventing recurrence of c diff). Probiotics may help prevent the inflammation associated with conditions such as Alzheimer’s disease and Parkinson’s disease, may influence autism, and may moderate your mood. Some strains may improve symptoms of anxiety and depression.
So what conditions are probiotics used for?
Preliminary research shows probiotics may have some benefit in the following conditions:
- Traveler’s diarrhea
- Clostridioides difficile
- Eczema
- Irritable bowel syndrome
- Vaginal yeast infection
- Urinary tract infection
Probiotics are often used for other conditions as well, including skin health (they are being added to cosmetics now), mood conditions like depression and anxiety, weight management and lactose intolerance.
Why doesn’t my doctor recommend probiotics?
As probiotics are generally considered a supplement, they do not require the type of clinical trials that drugs are subjected to. I did a little research so I could present this clearly and it is really complicated (for my nerdy friends, see the link below). It comes down to the intended use. If a probiotic manufacturer wants to make a specific claim that their strain is intended to treat a certain condition, then it needs to be studied in a clinical trial. Clinical trials are expensive and take many years to conduct. If there is no money to be made in bringing a product to market, studies don’t get done.
Supplements cannot make specific claims about treating a condition, although they can make a general health claim, like “improves the gut flora”. So, there are some studies out there about specific probiotic strains, but many claims have not been well-studied. For that reason, many guidelines, including those for treating c diff do NOT recommend probiotics to treat or prevent disease. Most medical providers have not received training about using supplements and therefore do not recommend them.
If an altered microbiome is associated with c diff, then why aren’t probiotics considered a treatment?
Good question, that. Since there are only a few studies of limited quality, they are not recommended. There is one review of fours studies of saccharomyces boulardii, a probiotic yeast, which shows it may prevent or treat c diff. It is thought to bind to toxin A that is produced by c diff and may also secrete IgA antibodies. I belong to a support group on Facebook and most of us are taking some kinds of probiotics and especially s. boulardii. There are products in development as drugs, meaning they are in clinical trials now, that are microbiome-based therapies. Chances are, as they are being clinically tested and marketed as biologic drugs and not supplements, they will be very costly, and maybe not accessible to all.
OK then – next chat will be about your microbiome. We’ll delve into more specifics about how it works. I have a link to a cool video that you’ll like. See you next time!
Probiotics – Health Professional Fact Sheet (nih.gov)
Probiotics: What is it, Benefits, Side Effects, Food & Types (clevelandclinic.org)
So informative! Thank you once again – look forward to the next installment
Thanks, Roz. I just dropped my next post.