Probiotics are all the rage, or so it seems. They are touted to have benefits from gut health to immune function. We see commercials and often find them added to many ‘foods’, including different types of yogurts, protein and green drinks. They are also present in several vitamin/mineral health supplements and of course, available as isolated dietary supplements. Commercials and marketing seem to make all sorts of promises, when it comes to probiotics, but we have to ask, are they truly necessary and does every person need to have them as part of their daily regimen? Considering the high rate of gut health problems in today’s society, it is wise to take a look.
Most areas of our body are not sterile and microorganism are present in and on our body, in many locations, playing a vital role in our health. This is especially true of areas exposed to the outside environment, including our skin, mouth, ears, nose, digestive tract and even certain areas of the reproductive system. These microorganisms are important, when in balance, as they not only help to maintain a healthy environment, but also impact immune function. When these areas are out of balance, then problems can develop. This raises the question regarding the high use of hand sanitizers, mouthwashes and other cleansing agents. Do they really help or hinder us? Some studies indicate that their high use can actually create more harm, as again, we are impacting normal balance.
A probiotic is a live bacterial organism of certain species, that when taken orally can impart certain health benefits to the consumer, via the digestive tract and gut health. These benefits can range from improved digestion, nutrient absorption, nutrient production, nutrient utilization, alteration of immune and inflammatory status. When it comes to probiotic species, the main two of clinical research interest are Lactobacillus and Bifidobacterium strains, of which there are many.
Probiotic Requirements For Efficacy
First, their intention is to alter or mitigate the microbiome or bacterial population within our gastrointestinal tract. With this in mind, we have to realize that there are likely thousands of different types of bacteria within our gut, outside of protozoa and fungal organisms. In theory, a probiotic can help to shift this population and alter gut health, but again, it can be an uphill battle in some cases given the other populations it is up against, not to mention outside contributors.
Second, in order for a probiotic strain to be effective, it must be able to resist breakdown from acids present in the stomach and also be able to establish itself, growing in number over time. This generally means that the species or strain chosen must not only be ‘tough’ or resistant, but must also be taken in sufficient quantity to allow for replication.
The Microbiome and Impact on Gut Health
The gastrointestinal microbiome is complex and consists of thousands of bacterial, fungal and protozoal species. There is a balance that is required for optimal gut health and digestion, with some species being more prevalent than others. As one population shifts or changes in numbers, other populations are likewise impacted, either to the positive or negative. The microbiome impacts not only digestion and gut health, but also the immune response and inflammatory reaction within our bodies. Thus, when in balance and working properly, we enjoy peaceful digestion and a healthy immune and inflammatory response. When things are out of balance, our health tends to go in an opposite direction.
The microbiome is not completely identical from one person to the next and can vary dependent on many factors ranging from diet to genetic factors, medications and even stress. Those individuals that consume more animal-based protein products and higher fats, tend to have a different microbiome than those that are vegetarian or consume more fruits and/or vegetables. The microbiome of meat eaters tends to be more ‘pro-inflammatory’ while that of a vegetarian tends to be more ‘anti-inflammatory’. This is due to the diet influencing growth of certain strains over another, which then imparts the impact on inflammation. Some bacterial strains, due to byproducts produced, are viewed simply as being more inflammatory in nature than others. This helps us to explain why one group or population of people, tend to be more prone to certain health conditions such as cardiovascular disease and diabetes.
Now, this microbiome is highly variable and there is no specific or ideal state based on research. What research does indicate to us is that in certain disease or health states, there is a shift, when compared to a more healthy population. In many cases, they will note there is a reduction of one group of bacteria, while maybe there is an overgrowth of another. As an example, in many health conditions, researchers note that there is a reduction in Lactobacillus or Bifidobacterium, while there is a concurrent rise in E. coli or maybe Clostridial organisms. Based on this, then, we have recommendations to consume certain probiotic strains, such as Lactobacillus or Bifidobacterium, assuming that by taking them daily, it equates to a higher state of health. But, is that really true?
Variables of the Microbiome and Gut Health
The microbiome is susceptible to almost anything and no two people are alike. Diet is one of the main variables involved, and a diet higher in fruits and vegetables (plant based), equates to a more stable bacterial population due to those foods containing natural prebiotic material and fiber. Thus, if we have health problems, moving to a plant-based diet or one that is predominantly plant based, can actually help us to shift that microbiome naturally, without the need for a probiotic. Our diet is one of the main contributors to overall gut health.
Medications are another variable and a high percentage of our human population are on at least one medication per day for various reasons. Antibiotics are one of the biggest problems, as they directly impact the bacterial population within our gastrointestinal tract. We may take them for a throat or ear infection, but are also negatively impacting our gut microbiome. This is why many get diarrhea or upset stomach with some medications, which quickly rebounds back to normal when they are discontinued. However, more problems come with long term use of these medications.
Stress, which includes our emotions, is another huge area that creates vulnerability for gut health, digestion and the microbiome. The stress response by the body directly impacts the gut, by altering the pH and also motility rates. Through this, bacterial populations are then impacted negatively, which then creates not only digestive disturbances but also contributes to the many health ailments that a chronically stressed individual encounters.
As we can see, these are just a few of likely many variables that interplay with our gut health daily. Given this, a person could take a probiotic, but it may not provide benefits for a few reasons:
- The probiotic strain chosen is not ideal or not in a high enough dose
- The probiotic is not able to establish itself in the gut due to other variables being present
As an example, a person that is a heavy meat eater or junk food eater likely cannot overcome the detrimental effects of that diet by consuming a probiotic. This is mainly due to the local environment within the gut being unfavorable for the ‘good’ bacteria to establish. This is also due to the fact that the diet itself, is not providing necessary elements for overall health.
Another example would be a person that is heavily stressed, daily. That stress response is creating an unfavorable environment not just in the gut, but in the entire body. Consuming a daily probiotic likely is not going to be of major benefit overall, because the environment is not favorable.
If we can improve the ‘microenvironment’ of the gut, then we can likewise usually shift bacterial populations more in our favor. Ideally, we do this through modification of our diet and/or stress. In many cases, due to stress or dietary choices, we have marked inflammation present, which then alters pH and even creates permeability issues. Any means of altering this inflammatory response is beneficial and includes herbs such as Curcumin or even amino acids like Glutamine. The Ayurvedic formula, Triphala, has also demonstrated benefits to the microbiome due to ability to mitigate the inflammatory response and fiber present within the blend. When it comes to stress and emotions, specifically, we can reduce their negative consequence on our health through the use of adaptogens, which include Ashwaghanda, Bacopa, Eleutherococcus and Ganoderma.
Benefits of Probiotics
Probiotics are helpful, but I do believe that dose and strain chosen are huge factors. Many experts in the field note that the use of probiotics should ideally be for the short term, to help a person get over a hump. If we are reliant upon them long term, then this implies that a variable is present that needs to be improved upon, whether if that be diet, stress or otherwise. If all things are in play, we shouldn’t need that probiotic, as our gut should balance itself out.
Now, when it comes to specific strains or species, as mentioned, Lactobacillus and Bifidobacteria appear to be the most prominent in current research. When we look at data, Lactobacillus and Bifidobacterium species tend to be more in use with specific gastrointestinal disorders, while Bifidobacteria also tends to show benefits in other areas of health including mentation and immune function. This is not always the case, of course, as both have research in all areas.
Many probiotic supplements offer several strains of bacteria within their formulas, but often the doses of each are sub-optimal. We have to be aware of this and realize that dose and strain can dramatically impact effectiveness, and one dose may impart some benefits, while another dose provides additional gains. This is evident with Bifidobacterium strains, particular BB536, which at lower doses of 5 billion cfu, there are positive gains in gut health or digestion, while at higher doses of 20 billion cfu, we then begin to note improvements in immune function. When it comes to using multiple species or strains, the jury appears to be out and undecided, as to whether it is better or not. In some studies, combinations are beneficial, while in others, use of a single isolated species, such as Bifidobacterium BB536, we still see moderate benefits. It does appear that in many cases, even the use of a single species at proper dosage, can actually help us to shift other beneficial bacterial populations. In some studies using Bifidobacteria, they also note an increase in Lactobacillus species secondarily. This is likely due to indirect changes in the microenvironment, which then allows for replication of those other species.
In the End
To use a probiotic or not is a complex topic, but overall, there do appear to be benefits when the right one is chosen. However, we do need to remember that there are many players in the game. Our gut may be deficient in ‘good’ bacteria, but there is a reason for that and that reason is what we need to figure out. If we think that supplementing will negate all of our worries, then we need to think again. There are many variables, and the more we can correct or improve, then the better off our health will be in the end.
Author: Tom Schell, D.V.M., CVCH, CHN