How many of you have consumed probiotic supplements for health benefits? I was at CVS yesterday and saw gummy probiotics. To be honest, I’m not sure that should even be a thing. I’ve got nothing against probiotics and make a solid effort to eat some at every meal. For example: yogurt for breakfast; sauerkraut with salad at lunch; and, kimchi as a side with dinner. If I eat bread it’s sourdough and I make my own Kombucha.. You could say I’m a huge fan of probiotics (and prebiotics). They keep my gut healthy, my immune system strong and even my mood upbeat (90%+ of all serotonin is manufactured in the gut). So why am I skeptical about probiotic supplements? Read on my friends.
Probiotics, Prebiotics & Something called Synbiotics
People who take probiotic supplements are attempting to manipulate their intestinal microbiota for health. Given that studies have linked a healthy gut with everything from a trimer waistline to reduced cancer risk, who wouldn’t want to take supplements that are “designed” to do just that? In addition to probiotics, there are two other closely related products: prebiotics and synbiotics. Here are definitions and examples of all three:
- Probiotics: “Live microorganisms that confer a health benefit on the host when administered in appropriate amounts.” (WebMd definition) In addition to the examples I listed above, kefir, miso soup and even dark chocolate are probiotics. There are four major classes and within these classes, hundreds (if not thousands) of varieties.
- Lactobacillus and Bifidobacterium: Among the most commonly used probiotic supplements, these are naturally found in cultured milk based products (yogurt, kefir, etc.) and fermented foods such as sauerkraut.
- Saccharomyces boulardii: Yeast or fungus based probiotics.
- Soil based bacterial probiotics: also known as spore-forming bacteria, you’ll see “Bacillus” in the name.
- e coli 1917: The non-deadly E-coli. This particular E. coli strain was isolated in 1917 based on its potential to protect from presumably infectious gastroenteritis.
- Prebiotics: These are the things that probiotics feed upon. They are soluble fiber, not alive, and include foods such as onions, Jerusalem artichokes and garlic.
- Synbiotics: These are products that contain both probiotics and prebiotics. I believe this term was coined by the supplement industry, when it created pills that combined both pro and pre-biotics. This should be a warning that it might not be the best idea J. That said, there are examples of traditional foods that are synbiotics. For example, Europeans often mix yogurt (probiotic) with oats (prebiotic).
What is the Gut Microbiota and Why is it Important to my Health?
To say that the gut microbiota is a complex organism is a gross oversimplification. Here are some pertinent facts about the gut microbiota from the European Society for Neurogastroenterology
- Our gut microbiota contains tens of trillions of microorganisms.
- This includes at least 1000 different species of know bacteria.
- One third of our gut microbiota is common to most people, while two thirds are specific to each one of us. (Yes, your gut microbiota is a unique fingerprint!)
- It is now well established that a healthy gut microbiota is largely responsible for the overall health of the host.
What happens If the Gut Microbiota Is Unbalanced?
In addition to obvious gastro-intestinal issues such as diarrhea, bloating, gas and burping; studies have linked unbalanced gut microbiota to auto-immune disorders, depression, skin problems, weight gain and myriad of other problems. The term often thrown around for unexplained gut issues is “leaky gut”. In talking with my clients, I’ve realize there is a lot of confusion concerning this condition. Here’s a high level explanation:
Mainstream practitioners generally don’t use the term “leaky gut”. Though they do recognize a condition called “intestinal permeability”, which is veiwed as a symptom of a disease such as Crohn’s or Celiac. However, most functional medicine practitioners consider leaky gut a legitimate and prevalent reason for illness related to your gut microbiota. Either way, the process looks like this: If you imagine a healthy intestinal track as a very tightly meshed kitchen strainer, someone with leaky gut would have a kitchen strainer that became “inflamed” and their mesh would be looser, allowing items to pass through the intestines into the bloodstream that don’t belong there. If you’re suffering from “leaky gut” and testing negative for Crohn’s and Celiac, traditional doctors can be frustrating as they might negate your symptoms. However, functional medicine practitioners can also be disheartening as they might try to sell your supplements that are totally unnecessary.
Another area of interest to me is the relationship between mood and gut health. As noted in my opening paragraph, 90% of all serotonin (that feel good chemical that the pharmaceutical industry tries to upregulate with drugs such as Prozac) is created in the GI tract. I believe that “gut feeling” might be more factual than metaphorical. There have been some studies on mice where changes in gut microbiota have resulted in altered behavior. From an empirical standpoint, I have noticed that people who eat crap are generally more anxious than those who eat healthy. Even if their weight is fine, they are more likely to have autoimmune issues such as eczema. I’m currently getting my esthetician license and my textbook says food has no bearing on skin conditions such as acne, but I think that’s a load of crap. Enough said.
So What’s a Healthy Gut?
A healthy gut has a diverse microbiota. Studies show people with a diverse gut flora are healthier: they are less likely to be overweight, have autoimmune issues or be depressed. The standard recommendation for building a healthy gut is to eat a diet high in fruits and vegetables and consume low-fat dairy (I consume raw,full-fat dairy, but that’s an issue for another blog.) What might be surprising to some readers is that exercise helps your gut microbiota. Dr. Deanna L. Gibson from the Department of Biology at the University of British Columbia (Canada), has found that cardiorespiratory fitness is correlated with increased microbial diversity in healthy humans.
The tricky part, as mentioned above: there is no one-size fits all gut flora. If you have a healthy gut and eat well studies show there is little benefit to taking probiotics as supplements don’t live long in the body.
Also, a probiotic that helps one person can hurt another. Even what is considered a healthy diet, can differ from one person to the next. For example, people with Crohn’s or IBS are often put on a low FODMAP diet. FODAMAPs are a collection of short chain carbohydrates and sugar alcohols found in foods naturally or as food additives. FODMAP is an acronym that stands for:
Fermentable – meaning they are broken down (fermented) by bacteria in the large bowel
Oligosaccharides – “oligo” means “few” and “saccharide” means sugar. These molecules made up of individual sugars joined together in a chain
Disaccharides – “di” means two. This is a double sugar molecule.
Monosaccharides – “mono” means single. This is a single-sugar molecule.
Polyols – these are sugar alcohols (however don’t lead to intoxication!)
As you can see from this chart, many high FODMAP foods are healthy for the average person:
Many studies have shown that there are regional differences in gut flora. People closer to the equator tend to eat more plants and vegetables, i.e. carbs, while those closer to the artic would eat more animal protein, i.e. protein and fats. Your heritage might determine how well you do with high carb diet and what type of pro and prebiotics are good for you.
Have I confused you?
If I’ve confused you, I’m sorry. Unfortunately, the topic is rather complicated and research is breaking new ground on a daily basis. On a thirty thousand level view, here are some practical tips:
If you think your gut is healthy:
- Avoid taking anitbiotics unless absolutely necessary. If you have to take antibiotics, studies suggest taking a diverse, high-count probiotic can help keep your gut microbiota healthy. These are usually found in the refrigerated section of a health food store.
- Eat a wide variety of foods, including fermented.
- Avoid processed foods.
- You will probably not benefit from taking pro-biotics.
- Make sure the following are properly managed: stress, sleep and exercise.
If you think your gut is “off”:
Assuming standard tests, such as a colonoscopy, haven’t revealed anything, here are some things to try:
- Hydrogen Breath Test: If you’ve been eating a diet super high in processed foods you could have SIBO, small intestinal bacterial overgrowth. You might need to take an antibiotic to “trim the bad bacteria”. From there you can repopulate the gut with healthy specimen. SIBO is generally diagnosed via a hydrogen breath test.
- Stool Sample: A comprehensive stool sample (CSA) will show the good, bad and ugly of your gut. I’ve never had a CSA, but with a name like Yoshida, I eat Sushi which is a common trigger for parasites. If something would ever feel off, including a prolonged depressed state, I would definitely check for parasites via a CSA and properly supplement to rectify the situation.
- Fast: Obviously check with your doctor to make sure you are healthy enough to sustain yourself on only water for 24-48 hours, but it might be the vacation your gut needs to regulate itself.
- Take Probiotics: However, be granular in your approach. Try classes of probiotics separately, e.g. take Lactobacillus and Bifidobacterium only and see how you do. Don’t take a supplement with a pre-biotic. Though it seems better, if the probiotic you are taking isn’t right for you, it will exacerbate the effect. Also, note you can be a probiotic non-responder.
- Exercise (check out my previous blogs on how to motivate yourself)
- Manage stress
- Get enough sleep
The gut is so important to our health and wellbeing. According to Hippocrates, “All disease begins in the gut.” So does your health my friends. Let’s nurture that ecosystem and pinky swear to never take gummy probiotics.