Olga Gorenyuk
Probiotics
Rena asked about a probiotic company recommendation. I will recommend a couple at the end of this post. But probiotics, like fish oil, have become sooooo popular to supplement and people think its this wonder supplement. Probiotics are the third most common supplement people take currently. While there is a place and time for probiotics, this is part of a much more important issue: GUT HEALTH!
GUT HEALTH AND MICROBIOME are my favorite topics, so there will be lots of talk about this.
Our gut, just like our skin, contains countless numbers of organisms (bacteria, fungi, viruses, protozoa, etc) - collectively they are referred to as our gut microbiome. We also have skin and vaginal microbiomes. The microbiome is in constant interaction with the host cells and there is a symbiotic, codependent relationship between the two. This is a hot topic for research right now and science is changing quickly in this field. One thing we know for sure is that we are learning that a healthy microbiome is VITAL to wellness and life. Evidence will only continue to accumulate in its favor. Some bacteria in our microbiome are pathogenic (bad) while most are beneficial to us and our health.
Probiotics are classified by genus, species and strain (like all living things). Probiotics exert health effects by nonspecific mechanisms, species-specific mechanisms, and strain-specific mechanisms. These mechanisms include inhibition of the growth of bad bacteria in the gastrointestinal tract, production of bioactive metabolites, vitamin synthesis, gut barrier reinforcement, bile salt metabolism, enzymatic activity, toxin neutralization, cytokine production, immunomodulation, and effects on the endocrine and nervous systems. That is a ton of responsibility for our bugs!!! It is believed by many scientists and doctors now that most diseases begin in the gut. I second this theory and whole-heartedly believe that tackling any disease begins with reestablishing gut health.
Probiotics have been shown to be helpful in certain conditions but as a routine health maintenance supplement there is no data to support that. Despite the positive data in some conditions we still don't know which strain of probiotics are most helpful, what dose is optimal.
Probiotics have been shown to help in the following conditions:
antibiotic associated diarrhea, high cholesterol, clostridium difficile infection, constipation, inflammatory bowel disease, irritable bowel syndrome, traveler's diarrhea, infant colic, periodontal disease, dental caries, allergic rhinitis, allergy development.
Inconclusive data exists for diverticular disease, asthma, acne, obesity, and upper respiratory infections.
It is intensively studied in many other autoimmune diseases, cardiovascular diseases, psychiatric diseases, autism and cancer. I suspect positive data will keep coming for all diseases once we nail down the details of dosing, strain, route of administration. This may not be news to some people, but one of the most effective ways to treat C. Difficile infection is via a fecal transplant (also now becoming popular in IBD patients). This is where they literally take the stool of a healthy person and deposit it in the colon of the unhealthy patient and it works miracles, more effective than any antibiotics or biologic treatments!!!
Probiotic genus can be "transient" or "native" which means you either poop it out after a few days(transient) or it colonizes your intestines (native) and are present in much larger numbers than transient probiotics. We get our native probiotics from water, soil and vaginal canal during birth (this is why vaginal births are now being encouraged so much more). We need both types of probiotics. Majority of the probiotics found in supplements are transient; the same goes for fermented foods. Soil-based probiotics (SBO) are a subset of probiotics found in the soil and usually contain 100+ subspecies. Majority of these probiotics are spore-forming which means that once they replicate they reside in a spore which is a protective shield resistant to bile, stomach acids and antibiotics. This is also why some probiotics need to be refrigerated and some not. SBOs are becoming popular now for supplementation.
There is not one that fits all probiotic. Most probiotic formulations have a mix of a couple of strains of bacteria measured in colony forming units (CFUs) per dose; usually 1-50 CFUs (1 CFU is equal to 1^9 organisms). Because its actions are dependent on the strain and species, you need to pick a probiotic that works for you. Some examples are:
Lactobacillis plantarum - helps with antibiotic induced diarrhea
lactobacillus rhamnosus - helps with allergies, asthma, eczema
lactobacillus acidophilus - helps with yeast infections, candida, UTIs
bifidobacterium bifidum - helps with constipation
saccharomyces boulardii - helps with immunity, allergy and asthma
bifidobacterium infantis - helps infants with colic
Another issue is that these organisms have most of their effect in our small and large intestines where the pH is much higher than our gastric (stomach) pH. Since most probiotic supplementation occurs via an oral route; that pill, capsule, liquid or powder has to get through the stomach to the intestines where it will settle, grow in numbers and benefit us. The question is will the probiotic supplement make it through the hostile stomach environment? Depends on the formulation of the capsule, this is where a high quality probiotic company is important.
Since most probiotics are classified by the FDA as supplements they are not subject to the rigorous FDA testing and approval rules. Because of this, just like with other supplements, there is a lot of garbage on the market. Best way to figure out if a company is selling a legit product is to request a certificate of analysis (COA) where a third party organization has done the testing on the product and produces a report.
When it comes to supplementing probiotics, I support supplementation in people with an underlying problem and not for long-term. I believe the goal should be to reestablish healthy gut flora via a multi system approach which includes healing the lining of the gut, stress management, probiotic supplementation, dietary changes, probiotics from food sources and prebiotics. Once gut flora is normalized, probiotic supplementation should be stopped and focus should be on maintaining a good diet, getting lots of probiotics from food sources and lots of prebiotics. Once the good bugs win out they will grow and function on their own assuming you give them good energy source (prebiotics), lots of fiber, and a non hostile environment.
Some of the probiotic brands that are legit are: Silver Fern Brand, Amy Myers MD, Klaire Labs, Truvani, Biobotanical Research. I am sure many others as well.
Whatever probiotic you end up choosing, make sure you check the storage instructions from the manufacturer. Some of them need to be refrigerated while others don't. Also some probiotics contain a prebiotic in them, this is also patient specific and not everyone needs this. Talk to your healthcare provider if you are truly trying to heal a medical problem.
I apologize as this post is very long! I had a very hard time writing it and not going into more detail on gut health. Gut health is paramount to health and writing an answer to "which probiotic should we take?" is not straight forward. I omitted a lot of information cause this would turn into a dissertation and not a blog post. There are many topics to discuss just going from this post and I am sure we will touch upon many of them.
GUT HEALTH AND MICROBIOME are my favorite topics, so there will be lots of talk about this.
Our gut, just like our skin, contains countless numbers of organisms (bacteria, fungi, viruses, protozoa, etc) - collectively they are referred to as our gut microbiome. We also have skin and vaginal microbiomes. The microbiome is in constant interaction with the host cells and there is a symbiotic, codependent relationship between the two. This is a hot topic for research right now and science is changing quickly in this field. One thing we know for sure is that we are learning that a healthy microbiome is VITAL to wellness and life. Evidence will only continue to accumulate in its favor. Some bacteria in our microbiome are pathogenic (bad) while most are beneficial to us and our health.
Probiotics are classified by genus, species and strain (like all living things). Probiotics exert health effects by nonspecific mechanisms, species-specific mechanisms, and strain-specific mechanisms. These mechanisms include inhibition of the growth of bad bacteria in the gastrointestinal tract, production of bioactive metabolites, vitamin synthesis, gut barrier reinforcement, bile salt metabolism, enzymatic activity, toxin neutralization, cytokine production, immunomodulation, and effects on the endocrine and nervous systems. That is a ton of responsibility for our bugs!!! It is believed by many scientists and doctors now that most diseases begin in the gut. I second this theory and whole-heartedly believe that tackling any disease begins with reestablishing gut health.
Probiotics have been shown to be helpful in certain conditions but as a routine health maintenance supplement there is no data to support that. Despite the positive data in some conditions we still don't know which strain of probiotics are most helpful, what dose is optimal.
Probiotics have been shown to help in the following conditions:
antibiotic associated diarrhea, high cholesterol, clostridium difficile infection, constipation, inflammatory bowel disease, irritable bowel syndrome, traveler's diarrhea, infant colic, periodontal disease, dental caries, allergic rhinitis, allergy development.
Inconclusive data exists for diverticular disease, asthma, acne, obesity, and upper respiratory infections.
It is intensively studied in many other autoimmune diseases, cardiovascular diseases, psychiatric diseases, autism and cancer. I suspect positive data will keep coming for all diseases once we nail down the details of dosing, strain, route of administration. This may not be news to some people, but one of the most effective ways to treat C. Difficile infection is via a fecal transplant (also now becoming popular in IBD patients). This is where they literally take the stool of a healthy person and deposit it in the colon of the unhealthy patient and it works miracles, more effective than any antibiotics or biologic treatments!!!
Probiotic genus can be "transient" or "native" which means you either poop it out after a few days(transient) or it colonizes your intestines (native) and are present in much larger numbers than transient probiotics. We get our native probiotics from water, soil and vaginal canal during birth (this is why vaginal births are now being encouraged so much more). We need both types of probiotics. Majority of the probiotics found in supplements are transient; the same goes for fermented foods. Soil-based probiotics (SBO) are a subset of probiotics found in the soil and usually contain 100+ subspecies. Majority of these probiotics are spore-forming which means that once they replicate they reside in a spore which is a protective shield resistant to bile, stomach acids and antibiotics. This is also why some probiotics need to be refrigerated and some not. SBOs are becoming popular now for supplementation.
There is not one that fits all probiotic. Most probiotic formulations have a mix of a couple of strains of bacteria measured in colony forming units (CFUs) per dose; usually 1-50 CFUs (1 CFU is equal to 1^9 organisms). Because its actions are dependent on the strain and species, you need to pick a probiotic that works for you. Some examples are:
Lactobacillis plantarum - helps with antibiotic induced diarrhea
lactobacillus rhamnosus - helps with allergies, asthma, eczema
lactobacillus acidophilus - helps with yeast infections, candida, UTIs
bifidobacterium bifidum - helps with constipation
saccharomyces boulardii - helps with immunity, allergy and asthma
bifidobacterium infantis - helps infants with colic
Another issue is that these organisms have most of their effect in our small and large intestines where the pH is much higher than our gastric (stomach) pH. Since most probiotic supplementation occurs via an oral route; that pill, capsule, liquid or powder has to get through the stomach to the intestines where it will settle, grow in numbers and benefit us. The question is will the probiotic supplement make it through the hostile stomach environment? Depends on the formulation of the capsule, this is where a high quality probiotic company is important.
Since most probiotics are classified by the FDA as supplements they are not subject to the rigorous FDA testing and approval rules. Because of this, just like with other supplements, there is a lot of garbage on the market. Best way to figure out if a company is selling a legit product is to request a certificate of analysis (COA) where a third party organization has done the testing on the product and produces a report.
When it comes to supplementing probiotics, I support supplementation in people with an underlying problem and not for long-term. I believe the goal should be to reestablish healthy gut flora via a multi system approach which includes healing the lining of the gut, stress management, probiotic supplementation, dietary changes, probiotics from food sources and prebiotics. Once gut flora is normalized, probiotic supplementation should be stopped and focus should be on maintaining a good diet, getting lots of probiotics from food sources and lots of prebiotics. Once the good bugs win out they will grow and function on their own assuming you give them good energy source (prebiotics), lots of fiber, and a non hostile environment.
Some of the probiotic brands that are legit are: Silver Fern Brand, Amy Myers MD, Klaire Labs, Truvani, Biobotanical Research. I am sure many others as well.
Whatever probiotic you end up choosing, make sure you check the storage instructions from the manufacturer. Some of them need to be refrigerated while others don't. Also some probiotics contain a prebiotic in them, this is also patient specific and not everyone needs this. Talk to your healthcare provider if you are truly trying to heal a medical problem.
I apologize as this post is very long! I had a very hard time writing it and not going into more detail on gut health. Gut health is paramount to health and writing an answer to "which probiotic should we take?" is not straight forward. I omitted a lot of information cause this would turn into a dissertation and not a blog post. There are many topics to discuss just going from this post and I am sure we will touch upon many of them.