The benefits of probiotics (+Week 4)
The takeaway
Microbiome Diet is going well; meal preparation saved me during a rough week.
Probiotics are beneficial microorganisms that can improve outcomes for certain diseases, including Irritable Bowel Syndrome, acute infectious diarrhea, antibiotic-associated diarrhea, diabetes, eczema and necrotizing enterocolitis
Most studies use probiotics doses between 1 and 50 billion bacteria, 20 billion is the average.
Most studies found benefit when probiotics containing multiple bacterial strains was used.
Some studies stressed that using probiotics for a minimum of 8 weeks is required to see benefit.
Read on for more details!
Meal prep for the win. Last week, Izak was out of town for 4 days, so I simplified lunches and dinners. On top of that, Lana and I endured back-to-back minor stomach bugs, so I was grateful to have some healthy food on hand and the Microbiome Diet recipe booklet. Three meals consisted of leftover oven-roasted chicken, microwaved or baked sweet potatoes and steamed broccoli, and I cooked one big batch of chicken, turnip, and kale soup (modified from the Microbiome Diet handbook) that lasted for quite a few meals. I supplemented with simple salads as needed. I don’t really mind eating the same thing multiple times a week—for me, it easily outweighs cooking multiple times. Alternatively, doubling or tripling recipes and freezing portions works better for people who prefer more variety. Heathy eating requires planning, preparation and TIME, but we’re seeing the benefits extend into many aspects of our lives, with improved overall health, energy and mood.
Pregnancy/general health update. My blood sugar and weight gain are still in check, although being sick definitely caused increased fasting blood sugar for a few days. My energy levels are pretty well sustained, although I sometimes still lull in the afternoon sometimes. I think eating more in the morning definitely helps keep energy high and cravings low throughout the day. I’m really enjoying the veggie-meat skillet breakfast that I posted about a couple weeks ago—a high-protein veggie-rich breakfast seems to be just what my body needs. Since I’ve added eggs back in, scrambles with spinach, mushroom and onion with a side of fruit or sweet potato is another go-to.
Next week I’ll discuss a few natural approaches I’ve taken to prevent gestational diabetes, but for now, I’m going to dive in to this week’s topic: probiotics.
What are probiotics?
Probiotics are defined as a live microorganisms, that when taken in a sufficient quantity, confer a health benefit to the host. We typically think of probiotics as the capsule form, but they probiotic bacteria are also found in fermented foods such as sauerkraut, kimchi, yogurt, kefir, kombucha, miso and tempeh.
What type of bacteria do probiotics contain?
Most probiotics contain strains of lactic acid-producing bacteria, including Lactobacillus, Bifidobacterium, and Streptococcus. Sometimes the yeast Saccharomyces is used.
Common organisms I see in studies and commercial probiotics are: Lactobacillus acidophilus, L. rhamnosus, L. casei, L. bulgaricus, L. plantarum, L. reuteri, L. gasseri, L. salivarus, L. paracasei, L. delbrueckii, and L. brevis. In the genus Bifidobacterium, B. breve, B. bifidum, B. infantis, B. longum, B. animalis subspecies lactis (B. lactis). Streptococcus thermophilus is another lactic acid bacterium found in probiotic formulations. The yeast Saccharomyces boulardii, which is related to S. cerevisiae (brewer’s yeast), is seen less often.
What is the proper dose?
I analyzed the dose used in 57 studies and found a wide range between 4 million to 7.5 trillion, but most studies used between 1 and 50 billion bacteria with an average of about 20 billion. However, dose is not directly related to effectiveness; plenty of studies that showed efficacy used low doses and plenty used high. Although I don’t know for sure, I assume the probiotics used in the studies are fresher than store-bought; therefore, they likely contain more live bacteria.
Most probiotics guarantee the number of bacteria at manufacturing, not at time of consumption. The stability and livelihood depends on the formulation of the pill, storage conditions and time on the shelf. Thus, I tend to go for higher numbers of bacteria, 20-50 billion for everyday maintenance and 100 billion if I have to go on antibiotics. Recent calculations estimate that the human colon (of a 70 kg “reference male”) contain 380 billion bacteria [1] so 20 billion bacteria would make up about 5% of our total gut bacteria.
My go-to probiotics. Yes, even my 2-year old gets a daily probiotic!
How many strains are optimal? Why do you need different strains?
I take probiotics that have at least 12-15 different strains of bacteria to support diversity in my gut. Across the human subjects tested, over 1000 species of bacteria have been identified in the gut [2], with at least 160 species found in each European individual tested [3]. A gut microbiome containing high levels of diversity (many different species that are all well-represented) is associated with improved health [4].
“Most of the Human diseases affecting westernized countries are associated with dysbiosis and loss of microbial diversity in the gut microbiota” [4].
Gut microbial dysbiosis (imbalance) is associated with intestinal disorders, including inflammatory bowel disease, colon cancer, and irritable bowel syndrome and extraintestinal disorders including allergy, asthma, metabolic syndrome and cardiovascular disease [5].
Gut bacteria perform various processes in our body, like digesting food, supplying vitamins, synthesizing neurotransmitters, producing anti-inflammatory compounds, training the immune system, and providing a barrier to protecting from invading pathogens. So a well-rounded team of workers is more likely to offer health advantages. Some bacterial species are more beneficial than others and certain bacteria may thrive differently in different hosts. Thus, taking a variety offers a better chance that you will establish a more diverse gut microbiome and gain more benefits from taking the probiotics.
What diseases can probiotics prevent or treat?
“Whether a disease-prone microbiota pattern can be remodeled to a more robust, resilient and disease-free state by probiotic administration remains a key unanswered question” [6].
Fortunately, more and more studies are evaluating probiotics in randomized, blinded clinical trials and beginning to answer this question. Below I provide a brief summary of the findings from many studies, including review articles that compile the results of meta-analyses, each of which evaluates the results of several individual trials. Analyzing several studies is important to see if the effect is consistent across various researchers and test subjects, with slightly different experimental approaches.
It is important to remember that each study uses different probiotics, so it is difficult to recommend a specific strain or combination of strains. The general takeaway that I gathered is that better results are observed when multiple strains are used, and when the probiotic is used for at least 8 weeks. Personally, I take probiotics daily and have been for years. Probiotics are considered safe for the general public, with few adverse effects reported, except in highly immunocompromised patients or sick preterm infants [7].
Disclaimer: I am not qualified to provide medical advice; you should discuss specific concerns and questions with your doctor.
Diseases for which probiotics have been tested (this list is not exhaustive).
Disorders of the gastrointestinal (GI) tract
Irritable Bowel Syndrome: probiotics have been shown to reduce pain and severity of symptoms in IBS [6, 8, 9].
Antibiotic-associated diarrhea: meta-analysis showed that probiotics may prevent antibiotic-associated diarrhea in pediatric patients [6, 8].
Helicobacter pylori infection: H. pylori infection in the gut contributes to ulcers. When used in conjunction with standard H. pylori eradication therapy (i.e, antibiotics), probiotics have been shown to significantly prevent diarrhea or reduce the duration and intensity of diarrhea [8,9].
Inflammatory Bowel Disease (IBD): Overall, the data show that probiotics are not very effective in treating symptoms of IBD [6].
IBD with constipation: probiotics could be considered to help treat overall symptoms, but the data are not very strong [8, 9].
IBD with diarrhea: probiotics could be tried to treat overall symptoms of IBD-D, but again the data are not very favorable [8].
Crohn’s disease: Insufficient evidence [8].
Ulcerative colitis: Conflicting data; probiotics may support therapies of patients in the maintenance phase [6, 8].
Bowel habits: probiotics help improve consistency of stools and frequency of evacuation [9].
Clostridium difficle-associated diarrhea (CDAD): Probiotics reduce the risk of diarrhea following C. difficile (“C. diff”) infection [6, 8].
Infectious diarrhea: treatment with probiotics can reduce duration of infectious diarrhea in both developed and developing areas. Also, probiotics reduced the rate of hospital-acquired diarrhea in children and adults [6].
Metabolic disease
Diabetes: probiotics can significantly reduce fasting blood glucose and average blood sugar levels (measured by hemoglobin A1C test, which estimates the blood sugar level over previous 3 months) [8]. However, there is inconsistent evidence regarding reduced insulin levels. (See my previous post on probiotics and gestational diabetes.)
Cholesterol/triglyceride levels: probiotics can significantly lower total cholesterol and LDL cholesterol, but not increase HDL cholesterol [8].
Hypertension: Probiotics improved systolic and diastolic blood pressure, especially if baseline exceeds 130/85 mmHg [8].
Obesity: inconsistent results in whether probiotics provide benefit.
Allergic disease
Eczema: probiotics administered to infants persistently and significantly reduced rates of eczema in children up to 7 years [6,8,10]. (See my previous post on eczema.)
Allergic rhinitis: Conflicting data, but probiotics may reduce overall nasal symptoms and treat allergic rhinitis [8].
Atopic sensitization (development of eczema, hay fever, or asthma) and food sensitization: The risk of atopic and food sensitization was lower only when probiotics were taken both prenatally and postnatally, but not if they were taken only prenatally or only taken postnatally [11].
Other diseases
Necrotizing enterocolitis (NEC) in premature birth: There is strong evidence to support that probiotics reduce the incidence and mortality of necrotizing enterocolitis in infants [6,8,12].
Sepsis in premature birth: probiotics can help reduce sepsis in premature birth [8].
Respiratory tract infection: The data are conflicting, but probiotics may reduce the severity and duration of upper respiratory tract infections [6], although there is insufficient data to recommend them as routine therapy for patients hospitalized in intensive care with ventilator-associated pneumonia [8].
Influenza: probiotics reduced the duration and severity of influenza-like symptoms in children [6].
Liver disease: probiotics have been associated with reduced levels of liver enzymes and improvement in insulin resistance [8].
Depression: One meta-analysis showed improvement in mood [13].
Post-trauma morbidity: probiotics can reduce incidence of hospital-acquired infections, ventilator-associated pneumonia and time spent in intensive care, but did not reduce the mortality rate [8].
There is insufficient evidence to show effect on treating acute pancreatitis, bacterial vaginosis, or urinary tract infections [8].
How should you feed your beneficial gut bacteria?
Bacteria feed on the undigested starch, or prebiotic fiber, in the lower intestine. Prebiotics come in 3 forms, including resistant starch, non-starch carbohydrates and soluble fiber.
Do you take probiotics daily? Which brand do you like? Have you taken them to treat something specific? I’d love to hear, so leave me a comment!
References
Sender, R., S. Fuchs, and R. Milo, Revised Estimates for the Number of Human and Bacteria Cells in the Body. PLoS Biol, 2016. 14(8): p. e1002533.
Sommer, F. and F. Backhed, The gut microbiota--masters of host development and physiology. Nat Rev Microbiol, 2013. 11(4): p. 227-38.
Qin, J., et al., A human gut microbial gene catalogue established by metagenomic sequencing. Nature, 2010. 464(7285): p. 59-65.
Mosca, A., M. Leclerc, and J.P. Hugot, Gut Microbiota Diversity and Human Diseases: Should We Reintroduce Key Predators in Our Ecosystem? Front Microbiol, 2016. 7: p. 455.
Carding, S., et al., Dysbiosis of the gut microbiota in disease. Microb Ecol Health Dis, 2015. 26: p. 26191.
Sanders, M.E., et al., An update on the use and investigation of probiotics in health and disease. Gut, 2013. 62(5): p. 787-96.
Doron, S. and D.R. Snydman, Risk and safety of probiotics. Clin Infect Dis, 2015. 60 Suppl 2: p. S129-34.
Rondanelli, M., et al., Using probiotics in clinical practice: Where are we now? A review of existing meta-analyses. Gut Microbes, 2017. 8(6): p. 521-543.
Hungin, A.P.S., et al., Systematic review: probiotics in the management of lower gastrointestinal symptoms - an updated evidence-based international consensus. Aliment Pharmacol Ther, 2018. 47(8): p. 1054-1070.
Zuccotti, G., et al., Probiotics for prevention of atopic diseases in infants: systematic review and meta-analysis. Allergy, 2015. 70(11): p. 1356-71.
Zhang, G.Q., et al., Probiotics for Prevention of Atopy and Food Hypersensitivity in Early Childhood: A PRISMA-Compliant Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicine (Baltimore), 2016. 95(8): p. e2562.
AlFaleh, K. and J. Anabrees, Probiotics for prevention of necrotizing enterocolitis in preterm infants. Evid Based Child Health, 2014. 9(3): p. 584-671.
Huang, R., K. Wang, and J. Hu, Effect of Probiotics on Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 2016. 8(8).