Probiotics

Written in collaboration with Angelica Kada, ND(c), Abrar Negahban, ND(c), Luc Laframboise ND(c), Tal Friedman ND(c), Liam Latouche ND(c), Andrew Krause, ND(c)

Part 1: What Are Probiotics?

Probiotics are live microorganisms that inhabit the respiratory and gastrointestinal tracts and the skin. They are often referred to as “friendly bacteria” as they have a protective role in maintaining health. Probiotics have multiple functions such as: preventing the spread of harmful bacteria and infection; stimulating balance and priming the intestinal immune system; maintaining healthy intestinal and skin function and structure: and aiding in digestion.^{(1, 2)} Probiotics can be found in various foods such as olives, dark chocolate, pickles, yoghurt, kefir, soy milk, tempeh and some other fermented foods. They can also be taken as a supplement when needed. When probiotic levels are insufficient as a result of antibiotic therapy or other causes, many of our body’s functions are compromised.

Supplementing with probiotics may help to restore proper intestinal function, healthy bowel function and even improve overall immune function.⁽²⁾ Probiotics are one of the safest natural health products available and have been extensively studied. They are often considered to be one of the basic building blocks of wellness and disease prevention. You may have also heard of the term ‘Prebiotics’, which are different than probiotics. Prebiotics are simply nondigestable carbohydrates that act as food for probiotics and stimulate their growth. According to Roberfroid, a prebiotic is "a selectively fermented ingredient that allows specific changes, both in the composition and/or activity in the gastrointestinal microflora that confers benefits upon host well-being and health."⁽³⁾ Consuming prebiotics alone can be beneficial to digestion as they feed and increase the population of the friendly probiotic bacteria. Prebiotics can be found in some probiotic supplements as well as in various foods including onions, garlic, chicory root, artichokes, asparagus, bananas and tomatoes. As you can see, there are many healthy foods that can help you obtain both probiotics and prebiotics. However, in the following sections we will discuss whether all probiotics are created equally. Are there some strains that are better than others? For what health conditions should you consider taking probiotics? In addition to common health concerns, probiotics are also extremely useful following antibiotic use. Antibiotics tend to wipe out both infectious ‘bad’ bacteria and the good bacteria along with them. Probiotics allow for the replenishment of the good bacteria and as a result can help reduce any side effects and improve recovery time. Also, we will discuss what dose is appropriate (usually referred to as CFU, or colony forming units) in varying situations.

Probiotics - Wide spectrum of important health benefits
Part II: Different Strains

It is important to note that not all probiotics are alike. Having a professional opinion is useful to ensure you are receiving adequate diagnosis and care for your health issues. Upon completion of a medical assessment, your doctor may recommend probiotic supplementation as part of your treatment plan. Making a distinction among the various strains of probiotics available is key to finding the right remedy for health concerns. Recent research has shown that specific strains may be favoured to address specific concerns. The main reason most people take probiotics is to improve their gastrointestinal health.

As an example, if you have been diagnosed with irritable bowel syndrome (IBS), you may be recommended a probiotic that has a good dose of L. plantarum, L. acidophilus, and B. breve. These three have been shown to reduce symptoms in that condition.⁽¹⁾ Another good all-round strain to look for is Bifidobacterium infantis, which has also shown good effect in IBS treatment(2) Some strains of probiotics have even shown positive results in treating gingivitis and periodontitis. In recent years a number of probiotic fortified foods have been advertised fairly heavily and have been appearing on grocery store shelves. Lets have a look at a few of the widely available choices. Danone (Dannon) markets the subspecies strain DN 173 010 in Canada as B.L. Regularis. In studies, this specific strain has been shown to shorten colonic transit time. In other words, it can help keep you 'regular'.^{(3, 4, 5)} Some research has also shown that it may also help alleviate some of the symptoms of IBS.⁽⁶⁾ Danone also markets a product called DanActive which contains Lactobacillus casei DN-114001. This species has had a variety of research completed that has shown some beneficial effects. Some studies have shown that it may help with immune function during times of stress,⁽⁷⁾ it may help children with diarrhea and allergic rhinitis.⁽⁸⁾ While this strain may not prevent you from catching a cold, it may help reduce the duration of winter infections.⁽⁹⁾ Overall, these few examples should illustrate that one strain may be indicated for one individual, but not for another. In general, there will be one strain or a combination of strains that will be bested suited for each person. More research is continually being conducted on different probiotic strains for different health conditions.

Probiotics - Wide spectrum of important health benefits
Part III: Dosing

Probiotic dosing can vary based on indication or intention of use. Based on clinical trials demonstrating effectiveness for a wide variety of health concerns, the American Academy of Family Physicians recommends 5 to 10 billion colony forming units (CFUs) per day for children and 10 to 20 billion CFUs per day for adults of Lactobacillus sp., Bifidobacterium sp., and Saccharomyces boulardii.⁽¹⁾ Higher doses have not been found to be unsafe, but the question of cost and necessity can be raised. For general health maintenance, doses ranging from 1 to 15 billion CFUs have been recommended for adults.⁽²⁾ For those who are taking or have taken antibiotics, dose and frequency of use may vary based on the individual case.⁽²⁾ Usually in these instances, health care practitioners may suggest a very high dose of probiotics (upwards of 50 billion CFUs) as a loading dose, then switch after a couple of weeks back to a maintenance dose.

Beyond dosing, an important component of probiotic effectiveness is whether or not they can survive transit through the gastrointestinal tract without being destroyed by stomach acid or intestinal bile salts, and ultimately colonizing the intestinal tract.^{(1, 3, 5)} Colonization refers to probiotics establishing a secure place in the gut and not being eliminated after ingestion. Probiotics can be found in supplements, yogurts, and fermented foods, all of which have different dynamics when it comes to delivery. Some probiotic supplements come in enteric coated capsules to help support this process, while other sources, like powders or whole foods, will not necessarily offer this protection. As a result, yogurt has been criticized for its inconsistent ability to effectively colonize the gut with its probiotics content.^{(6, 7)} However, in a clinical trial where 20 healthy volunteers were fed commercially available yogurt, it was confirmed that the probiotic strains in these yogurts did in fact survive gastrointestinal transit and effectively colonized the gut.⁽⁵⁾ All things considered, it is highly recommended that probiotics be taken with food, or that a supplement be selected that is ‘enteric coated’, meaning it will survive the harsh acidic environment of the stomach and make its way successfully to the intestines. In order to enhance efficacy, probiotics should be stored in accordance with each products recommendations, as some require refrigeration and all have a limited shelf life. A quick review of supplements and whole food probiotic options demonstrates a wide variety of doses and strains, and a quick review of research demonstrates a lack of quality assurance.^{(1, 3)}

Probiotics - Wide spectrum of important health benefits
Part IV: Conclusion

Probiotics have been in the news a lot lately in various foods and in supplemental form, but they’re not the silver bullet that they might have been made out to be. Just like with the management of most aspects of health; a coordinated approach that addresses many different determinants of health (nutrition, exercise, stress management) is going to be far more successful than a single therapy. That being said, probiotics still have an established use in the treatment of digestive concerns, and can be part of a health plan to address other specific health concerns or health conditions.

Should you be taking a probiotic supplement? That’s a decision that your qualified health practitioner is going to have to decide with you. Including foods rich in probiotics is something you can do on your own, and as was mentioned, they are readily available in supermarkets and health food stores. For general health and wellness, adding foods like sauerkraut, kimchi and yogurt is a great way to get some probiotics into your diet. These foods are generally cost effective and easy to find. Similar to a medication though, if you desire to treat a health condition with probiotics, selecting the correct probiotic is about finding the right strain or mix of strains, at the right dose for your specific condition and your overall case. This is something that should be done alongside your health care practitioner, since they are able to ask the right questions and know the strains, doses, and colonization potential that can best affect your gastrointestinal flora in order to get the most effective improvement in symptoms. Aside from speaking with your doctor, we also recommend selecting supplements that have been backed up by research or clinical trials. Although this approach doesn’t guarantee results, it certainly stacks the odds in your favour. It also helps lend credibility that the contents of the selected supplement are standardized and of the correct dose.