Should I take Probiotics?

People in the pharmacy and my former students would ask me all the time if they should be taking these probiotics that are everywhere. Hopefully my breakdown below helps to make a more informed decision.

There is a plethora of information about probiotics. Here is some basic background, so everyone is on the same page.

Here are four ways the intestinal microflora can be altered:

Administration of antibiotics: For one reason or another, we may have to take an antibiotic for a bacterial infection. An adverse effect of taking an antibiotic is killing the beneficial bacteria in the body, along with the pathogenic bacteria. This is why you may have personal experience with an adverse effect. Sometimes people may get diarrhea and/or a yeast infection (either oral, vaginal or both depending on one’s age) after taking an antibiotic.

Prebiotics: These are foods that promote the growth and metabolic activity of beneficial bacteria. It’s food for the bacteria, your microscopic friends. Some examples include vegetables and, my favorite food, beans. (Another reason to eat more vegetables and beans!) They also make supplement products, however, in my opinion, I think eating the food is tastier; it will also give you other nutrients that the supplements may have.

Probiotics: I will go into more detail about these below. In simple terms, these are beneficial bacteria that have historically been consumed by humans with their food. Some examples include yogurt, sauerkraut, and kimchi. I am a big fan of Sandor Katz. He has written some books, gives talks and has a website dedicated to fermented foods!

Fecal microbial transplant (FMT): Basically, this is where a person with healthy gut microflora donates their feces to a person that has an unhealthy gut microflora. Interestingly this is an old technique. Evidence of this can be found in fourth century Chinese medical literature.

Combinations: A combination of these methods is also possible. You may have seen “synbiotics” available at your local store. The clever name was derived because of the “synergistic” potential relationship between prebiotics and probiotics.

There is an interest in “gut health” that is beyond the clinical sciences. The potential benefit of manipulating your gut microflora has been recognized in alternative and complementary forms of medicine. There are many more claims for the potential benefits of altering gut microflora, but these are not evidence-based and require more formal research.

 

So now for the actual answer.

A more detailed information about probiotics:

Probiotics contain microorganisms have beneficial properties for the person taking them. Most commercial products are derived from food sources, especially cultured milk products.

The list of such microorganisms continues to change as new formulations are made available. Some products you may find at your local health food store include strains of lactic acid bacilli (for example, Lactobacillus and Bifidobacterium), a nonpathogenic strain of Escherichia coli (for example, E. coli Nissle 1917), Clostridium butyricum, Streptococcus salivarius, and Saccharomyces boulardii (a nonpathogenic strain of yeast).

Some of the more commonly available probiotics include:

  • VSL#3 (Bifidobacterium breve, B. longum, B. infantis, Lactobacillus acidophilus, L. plantarum, L. paracasei, L. bulgaricus, Streptococcus thermophilus)
  • Align (B. infantis)
  • Culturelle (L. rhamnosus GG)
  • DanActive (L. casei)
  • Mutaflor (E. coli Nissle 1917)
  • Florastor (S. boulardii)

The specific reason that probiotics are beneficial has not been fully elucidated and further research needs to be done. However, there is evidence-based medicine that supports four general benefits.

  • Suppression of growth or epithelial binding/invasionby pathogenic bacteria
  • Improvement of intestinal barrier function
  • Modulation of the immune system
  • Modulation of pain perception

Fermented foods as “probiotics”

Fermented foods and beverages can be a great source of beneficial bacteria and also are a good way to add other nutrients and fiber to your diet. The majority of cultures in the world have some tradition of fermented food or beverage in some shape or form. As mentioned before, Sandor Katz does a good job of exploring fermented foods and teaching people how to make their own fermented foods and beverages. I would also encourage you to talk to the older members of your family and community to ask them about the “fermented cultural” traditions.

Yogurt is a popular food and can be a good source of beneficial bacteria. Please note that some of the bacteria in the yogurt may not survive the acidic environment of the stomach. In addition, in the United States some of the yogurt in pasteurized! That kills all the bacteria and you will not get any of the beneficial bacteria found in yogurt. If you are going to buy yogurt in the United States, please make sure that it labeled as having “live” bacteria or “live” cultures. The simplest way to know is to read the product label. Or if you are like us—make it yourself.

The fermented dairy beverages a lot of times contain higher concentrations of the beneficial bacteria and there are some that are formulated to survive the acidic environment of the stomach. Again, just make sure you are reading the label to know what you are ingesting.

There are numerous fermented foods and beverages that can be found at your local stores. I would encourage you to check out your local grocery store to see what they offer. We live down the street from a Global Foods Market in Kirkwood, MO and it has fermented food and beverages from all over the world! We like to taste fermented foods from other countries because it makes us feel like we are on vacation.

I hope this helped! If you would like to talk about anything mentioned above in more detail please feel free to contact Dr. Strong or myself.

All the best,

Charles

 

About the author:

Hi everyone! I am married to Pratistha and I have been a licensed pharmacist in Texas since 2007. I have worked in a variety of pharmacy settings over my career and I have about 4 years of teaching experience. I taught for one year UT Austin/UTPA Coop Pharmacy Program and for 3 years at the UTRGV Physician Assistant Program. I enjoy teaching patients and students so I volunteered to help with my wife’s practice.

 

Resources:

 

https://www.ncbi.nlm.nih.gov/pubmed?term=25227293

 

https://www.ncbi.nlm.nih.gov/pubmed?term=24950204

 

https://www.ncbi.nlm.nih.gov/pubmed?term=24560869

 

https://www.ncbi.nlm.nih.gov/pubmed?term=27769810

 

https://www.wildfermentation.com/

 

https://uihc.org/health-topics/ask-expert-does-fecal-transplantation-hold-secret-future-cures

 

https://www.ncbi.nlm.nih.gov/pubmed?term=27743873

 

https://www.uptodate.com/contents/probiotics-for-gastrointestinal-diseases?source=history_widget

 

https://www.ncbi.nlm.nih.gov/pubmed?term=18623173

 

https://www.globalfoodsmarket.com

 

 

 

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