In our last alternative health newsletter, we talked about what probiotics are and what the benefits of probiotic supplementation might be. In this issue, we conclude our examination of probiotics by exploring:
- Those situations you need to watch out for when supplementing with probiotics.
- Why subtle differences in probiotic strains matter -- hugely.
- What to look for when choosing probiotic supplements.
- And some final thoughts on lifestyle choices you might be making that could compromise the probiotic benefits you expect to see when using supplementation.
Issues concerning probiotics
Ecclesiastes 3, verse 1 says, "To everything there is a season, and a time to every purpose under heaven." When talking about probiotics, this would seem to be particularly apt. While it is true that in an overwhelming number of cases supplemental probiotics are beneficial, there are indeed a handful of circumstances where they may not be recommended. Incidentally, these are things you probably haven't heard much about since they run counter to the probiotic hype currently sweeping the functional food market.
Probiotics and obesity
A study published last year in Nature rippled through the media. In summary, it said that "good" bacteria (from Phyla Firmicutes, which includes most of the bacteria found in a probiotic formula such as acidophilus) make people fat, whereas "bad" bacteria (Phyla Bacteroidetes) make people lean. To put it in simpler terms: according to the study, when it comes to losing weight, the bacteria that we normally call "good" (L. acidophilus, L. salivarius, L. bulgaricus, L. plantarum, etc) are "bad." And the bacteria that we used to think of as "bad" are in fact "good." Isn't that a head spinner?
But it gets even more interesting. In a companion study, they found that the ability to lose weight seems to be transferable -- at least in mice -- as evidenced by the results seen when transferring "bad" bacteria from the bowels of lean mice into fat mice. Based on this study, some medical authorities in the media were predicting a whole new way to treat obesity by transferring "bad " bacteria into the colons of overweight people. (Don't think about that too much. It can conjure up some rather unpleasant images.)
On the other hand, don't panic. These studies are not necessarily what they seem at first blush -- although they most assuredly give one pause. The simple truth of the matter is that beneficial bacteria can cause you to gain weight because they help you digest your food better. Only in America could getting more nutrition from your food be labeled a "contributing factor to the pathophysiology of obesity." (Check out that phrase. It actually makes better nutrition sound like a disease! That's pretty twisted.)
Probiotics and pancreatitis
According to a study published in Lancet in Feb 2008, in patients with severe acute pancreatitis, the use of probiotic supplements did not reduce the risk for infectious complications and was associated with an increased risk for mortality. Although the difference in infectious complications was not large, 30% in the probiotics group versus 28% in the placebo group, the difference in mortality rate was a notable 16% in the probiotics group versus 6% in the placebo group.
"Whether other (combinations of) strains might have resulted in different results is debatable, but, until the underlying mechanism is actually revealed, administration of probiotics in patients with predicted severe acute pancreatitis must be regarded as unsafe," the study authors concluded. "Most importantly, probiotics can no longer be considered to be harmless adjuncts to enteral nutrition, especially in critically ill patients or patients at risk for non-occlusive mesenteric ischaemia." [Translation: We don't recommend feeding probiotics directly into the stomach with a plastic tube in cases where someone has inflammation of areas associated with the small intestine.]
It should be noted that only one particular multi-species probiotic preparation was tested -- one, incidentally, provided by a company hoping to market that mix specifically to help with pancreatitis…theoretically. This fact alone (along with other limitations acknowledged by the study's authors) limits the usefulness of the study in terms of making conclusions about probiotics in general, but at the very least it brings to mind Ecclesiastes, as I cited earlier. "To everything there is a season."
Probiotics can cause infection
Lactobacillus species are a rare but well-recognized cause of infection of the heart lining in adults (and other forms of infection in children). Several reports have directly linked cases of bacterial sepsis to the ingestion of probiotic supplements. Specifically, people with weak immune systems may be at risk of developing a serious infection when taking Lactobacillus acidophilus. People who have had an injury or illness of the intestinal wall; who have had illness that makes them prone to getting infections; who take prescription drugs, such as corticosteroids (prednisone), that may make them vulnerable to infections; who have had surgery to replace a heart valve; or who have a heart murmur should speak with a health care professional before taking acidophilus.
The DNA of probiotics
As we discussed in the last alternative health newsletter, our intestinal tracts are sterile when we're born, but even as we pass through the birth canal we begin swallowing bacteria and populating our intestinal tracts with colonies of bacteria. When we eat food, put our hands in our mouths, kiss someone, or eat fermented food, we are allowing new bacteria to enter our intestinal tracts and begin forming colonies. And this was even more true 100 years ago before modern supermarkets and the mass sanitation of our food supplies. We got beneficial bacteria from our raw dairy products delivered straight from the farm -- before pasteurization. We got bacteria from our fruits and vegetables plucked straight from the ground or off the vine. And once inside, these bacteria multiplied inside us by the trillions until they outnumbered the cells in our body.
The interesting thing, though, is that each person has a unique array of bacterial cultures in their gut -- influenced by whose hand you shook, the food you ate, and where your food was grown. A person who grows up in Kenya, Africa is going to have an entirely different probiotic system than a person who grows up in Wasilla, Alaska. Not necessarily better or worse, just different -- by virtue of exposure to different bacteria during the course of their lives. And even in those cases where the bacteria may be of the same species, Lactobacillus acidophilus for example, the strains are likely to be entirely different -- as is the DNA of that bacteria.
What this means is that the intestinal tract in Kenya is likely to be better at digesting ugali, a thick, polenta-style cornmeal porridge eaten by almost everyone in Kenya, whereas the Alaskan digestive tract is likely to be better at digesting moose and elk. This can affect everything from susceptibility to weight gain, allergies, and even many diseases. It has become increasingly clear that different bacteria provide people with different advantages and disadvantages. Certain bacteria (H. pylori) have been linked to the incidence of stomach ulcers, but take away those bacteria with antibiotics, and you are likely to see a higher incidence of asthma, hay fever, allergies, and eczema. (One of the key reasons I prefer mastic gum for dealing with ulcers.)
The bottom line is that subtle differences in bacteria -- or even differing genes in similar strains of bacteria can play a major role in terms of which bacteria can help us or hurt us.
Perspective on probiotics
All in all, the potential benefits of probiotics far outweigh any negative potential -- with that potential being either theoretical or specific to people with excessively weakened immune systems or who are already suffering from particular infections such as pancreatitis. That means that if you are not under a doctor's care for any specific condition, then probiotic supplementation should be part of your regular health maintenance program. And if you are under a doctor's care, it doesn't mean that you shouldn't use probiotics -- just that you should check with your doctor first.
The bottom line is that for the vast majority of people, there can be no true health or recovery from disease unless you have colonies of over 100 trillion beneficial microorganisms flourishing throughout your intestinal tract, aiding in digestion, absorption, the production of significant amounts of vitamins and enzymes, augmenting your immune system, and working to crowd out all harmful bacteria -- allowing them no place to gain a foothold. Supplementation with a good probiotic is mandatory to raise your baseline of health.
A good probiotic formula is absolutely essential for long-term intestinal health and long-term parasite control. When choosing a probiotic, look for the following characteristics:
- As we've discussed above, not all strains of beneficial bacteria are created equal. For each type of bacteria, there are recognized super strains. (See below.) Choose a formula that uses only recognized super strains of beneficial bacteria. They will be identified as such on the label or in the company literature. If the strains are not identified, don't buy it.
Make sure the formula you choose was developed using full-culture processing so that the beneficial bacteria and its powerful supernatant are kept together. The supernatant, which is the medium the culture was grown in, contains a multitude of beneficial byproducts of the growth process, including vitamins, enzymes, antioxidants, and immune stimulators.
Then there's the question of how many live microorganisms are left in your formula when you actually use it. Pick up any probiotic formula, look at the label, and you'll see something like: "Contains 13 billion live organisms per capsule at time of manufacture." And that's the problem: "at time of manufacture." The die-off rate can be astounding. Most formulas will experience a die-off approaching log -3 (or down to a paltry 13 million) within just 60 days of manufacture. Heat and moisture accelerate the process, which is why most manufacturers recommend that both you and the store from which you bought your formula keep your probiotic supply refrigerated. An alternative is to look for formulations that use tableting and encapsulation techniques that seal the bacteria from moisture. But even then, refrigeration is recommended.
Some manufacturers claim that you need to use enterically coated capsules to protect the bacteria from stomach acid, which kills the bacteria; but this makes no sense. If stomach acid universally killed beneficial bacteria, then no one who ate fermented foods over the centuries would have received any benefit from the bacteria they contained since all of the bacteria in those foods would have been destroyed by stomach acid. Nonsense! And in fact, those same manufacturers, in an astounding self-contradiction, usually cite the long lives of Russian peasants who eat these probiotic rich foods as proof of the value of their own formulas. Bottom line: beneficial bacteria do not need to be enterically coated. As long as you choose strains that have been specifically developed (or have naturally evolved) to survive stomach acid, they will indeed survive stomach acid quite nicely.
On the other hand, some modern strains of bacteria used in dairy products have been custom bred to optimize the fermenting of the dairy products -- in terms of speed and taste, for example, not to survive stomach acid. Think of commercial tomatoes as a comparison. The modern tomato has been bred for enhanced eye appeal, to resist cold temperatures in the field, and to have a thick skin so that it does not bruise when transported by the hundreds of thousands in giant bin trucks. In other words, the modern tomato is not bred for taste. So that's what you end up with -- rugged, red, tasteless tomatoes. And what does that have to do with probiotics? Quite simply, many strains have been bred to optimize the production of a product -- not to survive intact in the varying pH environments of the human stomach and gut. On the other hand, the DDS Acidophilus strain, for example, was specifically researched and developed to survive stomach acid, not to mention have better retention, multiply rapidly, and combat yeast and fungi. In summary, if you stick to recognized super strains that have been bred for use in supplements, you will have no problem.
What species and strains of probiotics do you want in your supplement?
At one time, this was a fairly easy question to answer. Not anymore. Thanks to the "buzz" surrounding probiotics, new strains are appearing almost daily. (Engineering new strains is fairly easy to do.)
Why so many new strains? It's because manufacturers are trying to isolate new beneficial features that can be used to provide a marketing advantage over the competition. For example:
- Dannon's Activa with Bifidus regularis was specifically created to "help naturally regulate your digestive system."
- Yakult, with L. casei Shirota was created to optimize the health of the intestinal tract and boost your immune system.
Are they good? Are they bad? Do they work?
The answer is somewhat mixed. Some work better than others. The biggest problem is that often the virtues of the new strains are promoted based on limited studies or short term observation. They don't necessarily have the long term track record that some of the more established species and strains have. That doesn't make them bad or useless -- just less proven. For example, although initial studies indicated that Activa was indeed helpful, subsequent reevaluation of those same studies were less positive and resulted in a class action lawsuit against Dannon for making false claims. As for Yakult, several million users attest to its probiotic benefits, but subsequent studies have not necessarily supported that anecdotal evidence -- at least as it pertains to boosting the immune system.
The bottom line on new strains is that they are unproven. Some may be highly beneficial -- often even better than their predecessors -- but they have not yet stood the test of time. For my part, when choosing a probiotic formula, or designing my own for that matter, I prefer to stick with the tried and true. Once a new strain has stood the test of time and demonstrated its benefits with no unexpected side effects, I'll then consider it to be one of the tried and true.
With that in mind, there are many beneficial bacteria that can be contained in a good probiotic, but two are preeminent. Look for a formula based on these two:
- L. acidophilus resides primarily in the small intestine and produces a number of powerful antimicrobial compounds in the gut (including acidolin, acidophilin, lactocidin, and bacteriocin). These compounds can inhibit the growth and toxin producing capabilities of some 23 known disease-causing pathogens (including campylobacter, listeria, and staphylococci), as well as reduce tumor growth and effectively neutralize or inhibit carcinogenic substances. There are three recognized super strains of acidophilus: DDS, NAS, and BT1386. It's also important to note that L. acidophilus is the primary beneficial bacteria in the vaginal tract. When the presence of the acidophilus is compromised, this allows the bad guys such as Gardnerella vaginalis or E. coli or Chlamydia to take over. This is particularly important to women to help prevent a whole range of vaginal infections.
- Many researchers believe that declining levels of bifidobacteria in the large intestine actually mark the eventual onset of chronic degenerative disease. Bifidobacteria benefit the body in a number of ways. They:
- Consume old fecal matter.
- Have the ability to remove cancer-forming elements, or the enzymes which lead to their formation.
- Protect against the formation of liver, colon, and mammary gland tumors.
- And in addition to all of that, bifidobacteria are substantial producers of a range of important B vitamins.
More is not always better. Too many beneficial bacteria in one formula may find the bacteria competing with each other before they can establish themselves in separate areas of the intestinal tract. On the other hand, there are several other bacteria that are extremely beneficial in any probiotic formula.
- L. salivarius is one of my favorites. It helps digest foods in the intestinal tract and makes vital nutrients more assimilable. It also works to eat away encrusted fecal matter throughout the entire colon; it helps repair the intestinal tract by providing needed enzymes and essential nutrients; and it adheres to the intestinal wall, thereby forming a living matrix that helps protect the mucosal lining.
- L. plantarum has the ability to eliminate thousands of species of pathogenic bacteria. It also has extremely high adherence potential for epithelial tissue and seems to favor colonizing the same areas of the intestinal tract that E. coli prefers -- in effect, serving to crowd E. coli out of the body. At one time, plantarum was a major part of our diets (found in sourdough bread, sauerkraut, etc.), but is now virtually nowhere to be found.
- L. salivarius and L. plantarum work well in tandem. They both flourish in the digestive tract and function as scavengers, working to eat up the hardened, "sludge" that has built up on the lining of the intestinal wall. They also work down in the bowel to loosen encrustations of fecal matter off of the colon walls. In addition, they destroy much of the E. coli bacteria found in the colon. Their partnership extends to the fact that L. Salivarius primarily targets bad bacteria, while L. plantarum targets viruses.
- L. rhamnosus is a powerful immune stimulator. It inhibits the growth of most harmful bacteria in the intestine. It can increase the natural killing activity of spleen cells, which may help to prevent tumor formation. It boosts the ability of the body to destroy foreign invaders and other harmful matter by three times normal activity; and has been shown to increase circulating antibody levels by six to eight times. L. rhamnosus supplementation has been associated with the prevention or alleviation of everything from lactose intolerance, diarrhea, constipation, inflammatory bowel disease, and food allergies. And finally, in animal studies, L. rhamnosus has been shown to inhibit the growth of colon tumors.
- Other important friendly bacteria you might find in a good formula include: Streptococcus thermophilus, L. bulgaricus, B. longum, and L. casei.
- Much has been written about the properties of the soil-based bacteria such as: Bacillus subtilis, L. sporogenes, and B. laterosporus. For many people, they can produce a powerful boost to the immune system, and I am not opposed to their use. But, in certain circumstances, they may become toxic. It's hard to argue with the great results that many people have had using formulations that contain these cultures. On the other hand, it's possible to get all of the same results using only the cultures that I've mentioned above.
- Note: a good probiotic formulation will usually contain fructo-oligosaccharides (FOS) which help promote the growth of beneficial bacteria. For some of these bacteria, such as Bifidus, FOS can increase their effectiveness by a factor of 1,000 times or more!!
Other things to consider when supplementing with probiotics include:
- Start slowly. When you first start using a probiotic supplement, there is a good chance that you will precipitate a die-off of bad bacteria in your intestinal tract. This can lead to excessive gas and stomach rumblings and cramping for 10-21 days. Start with one capsule (or even half) for several days. Build up slowly to the recommended dosage for your particular supplement.
- One final note: eating yogurt (unless you make your own) does not really help. First, the bacteria used to make most yogurt (L. bulgaricus and S. thermophilus) are not the key beneficial bacteria, although they are indeed helpful. (Some brands throw a small amount of acidophilus in after the fact -- just so they can put it on the label). Even more important, though, much of the yogurt that you buy in the store is now pasteurized after it is made. Pasteurization before the yogurt culture is introduced is essential to the making of yogurt; but pasteurization after the culture has been allowed to grow is done merely to increase shelf life and totally destroys all the benefits inherent in the yogurt.When choosing yogurt in the store, make sure that the cultures are still living. If it doesn't say "live, active cultures" on the label, don't buy it.
- A diet high in complex carbohydrates such as fruits, whole grains, and vegetables promotes the growth of bifidobacteria in the large intestine. Heavy meat consumption does just the opposite, and in fact promotes the growth of E. coli. If you eat meat, keep consumption to 3 ounces a day or less.
- Avoid antibiotics when possible. And if circumstances necessitate that you do undergo a round of antibiotics, always make sure to replenish your beneficial bacteria immediately upon completion of the antibiotics. Recolonize the good guys before the bad guys have a chance to take their place. Remember, nature abhors a vacuum. If you don't supplement with good bacteria, bad bacteria will move in, and you will suffer from dysbiosis.
- And of course, drinking chlorinated water, or eating meats or dairy produced with antibiotics, totally defeats any program you're on.