Probiotics – Good Bacteria

Last week I got a call from ABC’s Food Coach Lori Corbin, that she wanted me to do a story on probiotics – is it true what the yogurt’s are claiming? I have an expert – but she has a paid interest with a probiotic supplement company – telling me that not all the supplements are the same, that some don’t contain what they say they do – can you help?

Certainly, I said, probiotics are my game, my thing, but the topic is huge so let’s tackle it in parts. Today, I will discuss the foundation information on probiotics and their food sources. Also, full disclosure, I, too, receive compensation for my probiotic work. I consult for Align – maker of a probiotic and for Healing Movements – maker of coconut water kefir and cultured vegetables. I work with these reputable companies because they don’t ask me for exclusivity. They allow and want me to tell the whole story about probiotics; they want me to explain what consumers need to know, what doctors need to know, as they’ve staked their products success on the consumers knowing the whole story.

So here it is.

Probiotics – good bacteria – are meant to inhabit our entire digestive tract at approximately 80:20 ratio with bad bacteria. There will be and we should be okay with there always being some bad bacteria in the digestive tract. But if the balance is upset, we see an increased risk for digestive problems, impaired immune system, skin problems (resulting from digestive disturbances – our skin is our other major excretory organ and remember stuff that’s meant to get out of the body will find a way to get out!), and other potential health issues.

Bacteria are live in the digestive tract. They colonize by replicating quickly and massively – we are talking billions of bacteria in the digestive tract. Different bacteria live in different places based on what they desire as a home environment – think of a native Montanan versus a New York City resident – some like crowds and feed off the energy of the crowd, the noise doesn’t bother them, the pollution isn’t a major deterrent, and they’ve adapted to the types of food available to they whereas others need wide open space, they preferentially choose pure air, hunting for their food, and are ok if they only see a crowd on holidays or if they happen to travel. There are many more (100,000:1) bacteria in the large intestine versus the small intestine as it is significantly less acidic and the small intestine contains more digestive enzymes, has more movement (peristalsis), and generates more antimicrobial chemicals (for example probiotics acting on fiber can create an acidic byproduct that functions like an antibiotic). Thus, because bacteria have different preferences, what we eat and as a result the environment in each area of our digestive tract will either encourage or discourage the bacteria to inhabit and flourish their respective geography.

Outside factors, in addition to what we eat, effect bacteria balance (“Gut Flora”). Antibiotics (“anti” meaning against, and “biotic” meaning bacteria vs. “pro” meaning for or good, “biotic”) get rid of the good with the bad so even one dose of antibiotics can upset the desirable ratio of bacteria. Many of us were given antibiotics frequently as children (Ear and throat infections) or as young adults for skin problems. Its very common for me to see a patient for their digestive issues and as we start back asking about their childhood (no its not mom or dads fault, it was common medical practice for years) we chart out a path of bacteria imbalance – antibiotics for ear / throat infections, skin problems treated with more antibiotics and possibly Accutane, then the onset of digestive problems in their mid to late 20’s, often times exacerbated by the inclusion of birth control pills and / or poor dietary choices in their late teens and early twenties. Thus, the use of antibiotics as well as some other medications is a big factor in potential bacteria imbalances.

Side note: one key side effect of bacteria imbalance is a tendency to bloat around the middle and gain weight or fight abdominal weight despite good dietary and activity practices. I continue to be intrigued by research exploring the link between bacteria imbalance and obesity – there is some compelling evidence that deserves further exploration.

So how do we get the balance back? Probiotics are found in food and in supplement form. Let’s discuss the foods first. Before probiotics became the food trend they are today, reliable food sources of probiotics included fermented foods such as: kimchi, raw sauerkraut, pickles, miso / natto, cultured vegetables, yogurts, aged cheese, and kefir. Today, a rapidly growing number of food products (not fermented foods) are marketing themselves as containing probiotics. This raises two issues a) can / do they support live bacteria in their product and b) should they? It is my opinion that we don’t need to be eating foods that added probiotics to them – there is no danger, and in fact they could do good if the probiotic is viable (live) – but the question is about need and dietary diversity. We don’t need cereals that contain probiotics – our cereals can be our fiber and other nutrient sources and if we want probiotic we can eat some yogurt with the cereal. We can choose from the above list of foods that naturally contain probiotics. If we are allergic to one, don’t like the taste of another, we can move on to a different one on the list.

Some companies are making different versions of naturally containing probiotic foods. Many of these I find worth exploring, especially if dietary preferences or intolerances restrict certain foods (such as dairy), for example – Healing Movement makes both a kefir made from coconut water so it is non-dairy and hydrating and they also make cultured vegetables from a variety of vegetables – not just cabbage – to satisfy different taste buds. But also be a knowledgeable consumer and be wary of marketing or food trends. For example, of the numerous amounts of yogurts being marketed for their probiotics, be cautious of consuming higher than necessary (and than healthy) amounts of sugar in the name of getting in probiotics (which are found naturally in good quality yogurts). Find out how many probiotics are in these specially created probiotic yogurts (many don’t say on the label) as opposed to a regular yogurt as opposed to a frozen yogurt marketed for its probiotic content. Per serving, my resources show them to all be similar, so make your choice based on what your palate desires and skip the sugar-coated probiotic unless you were going for something sugar-coated anyway!

For individuals without the health issues described above and who have never take antibiotics, increasing probiotic consumption through food should be sufficient to maintain bacteria balance. However, for those seeking to address health issues impacted by bacteria imbalance, I recommend a probiotic supplement in addition to dietary modifications which may include probiotic sources as well. Supplements can guarantee that one gets a probiotic dosage sufficient to begin to correct the balance. The necessary quantity ranges with the type and severity of the health issue. A word on supplements – they are not all created equal. The type of probiotic, “strain specificity”, is critical when it comes to the selection of a probiotic supplement to address a health issue. Certain strains demonstrate greater effectiveness than others on symptoms. Additionally, probiotic supplements, absent government oversight of probiotic production may not contain what they say they do, or the bacteria may not be alive at the time you take the supplement despite it being packaged alive (probiotics are very heat sensitive which is why most require refrigeration). In 2003 and 2006, ConsumerLab found that approximately 30% of the probiotics tested failed to provide expected number of live bacteria. In 2005, Consumer Reports found 40% of the probiotics tested contained significantly fewer live microbes than the label promised. So caution with product selection is recommended, ask your healthcare practitioner, and also this book has great information – The Probiotics Revolution by Gary Huffnagle PhD.

Despite the potential downsides, the big upside is that probiotics really make a health difference! Coming up next week, I will present information on the dietary choices that create an optimal environment for good bacteria to flourish thereby controlling the amount of bad bacteria.