Probiotics have become mainstream. Numerous studies have documented their beneficial effects, and a growing number of healthcare providers are recommending probiotics for various gut-related conditions. A simple keyword search for “probiotic therapy” on PubMed produces almost 7,500 studies and more than 300. A study published in The Canadian Journal of Infectious Diseases & Medical Microbiology in 2004 greatly contributed to clinical understanding of probiotic therapy because it outlined the ability of probiotics to repopulate gut flora after antibiotic therapy and to manage gut-related issues such as diarrhea.
What Are Probiotics?
In the human body, bacteria outnumber cells by a margin of 10 to 1. The small intestine contains billions of bacteria, and the colon houses trillions of bacteria. Of the approximately 500 strains of bacteria, 20 make up about 75% of gut bacteria. Some of these strains are probiotics, or naturally occurring friendly bacteria. Most probiotics live in the small and large intestines. The most important strain, Lactobacillus, populates the small intestine. The colon houses another strain, Bifidobacterium. These strains work symbiotically to benefit gut
health. Probiotics contribute to numerous body functions. They assist food and nutrient assimilation, inhibit harmful bacteria and boost immune system function. They also help manufacture many B vitamins as well as vitamin K, help digest lactose, help normalize cholesterol and triglyceride levels, and help break down and rebuild hormones. Whether patients eat a bad diet, experience frequent stress or develop diarrhea or constipation, most can benefit from ingesting probiotics. Friendly flora can also have beneficial effects on recurrent bladder infections, vaginal infections, lactose intolerance, high blood pressure, cancer, immune system regulation, kidney stones, cholesterol and allergies. Sugar, white flour, fried foods and caffeine are common culprits in low levels of friendly flora. Such substances reduce vitamin and mineral absorption, often leading to cravings and nutrient insufficiency. While they cannot compensate for a bad diet, probiotics can help repopulate gut flora, increase nutrient absorption and stop this vicious cycle. Psychological stress, on the other hand, can trigger or exacerbate intestinal inflammation, destroying friendly gut flora and weakening the immune system. Probiotics can repopulate beneficial bacteria to enhance the immune system, reduce inflammation and prevent GI effects of stress. A study published in Proceedings of the National Academy of Sciences showed that mice who were fed Lactobacillus rhamnosus experienced less stress and anxiety and lower levels of corticosterone (a stress hormone) than mice who did not receive the probiotic. Scientists have observed a connection between low erotonin levels and irritable bowel syndrome (IBS). A study published in the American Journal of Health-system Pharmacy in 2005 showed that serotonin aids in motility, pain sensitivity and fluid secretion, all of which play a part in IBS and other gut-related problems. A probiotic could provide the missing link to ameliorate gut health. In fact, the gut produces about 95% of the body’s serotonin. So consider recommending probiotics for a depressed patient before a drug such as fluoxetine, since probiotics can increase serotonin and bridge gut–brain communication.
Fermented foods such as cottage cheese, yogurt, sauerkraut and kefir help normalize intestinal flora in general. Traditional Japanese foods, such as miso and tempeh, also contain probiotics. To receive therapeutic effects from any foods, however, supplementation with a high-quality, high-count probiotic is necessary. Before advising patients to rush to the nearest vitamin or drug store, consider some limitations of commercial probiotic supplements. For one, many supplements contain just one strain of probiotic bacteria. Friendly flora work synergistically, so receiving just one strain (like acidophilus) provides limited gut health benefits. Even more limiting, most commercial brands contain millions of bacteria — hardly enough to therapeutically repopulate a patient’s gut flora.20 Billions of species are needed to repopulate gut flora. Many commercial probiotics also fail in one or more of three critical areas. The first problem is strain crossover. Many commercial manufacturers lack the technology to properly identify strain count and prevent strain crossover. The second common problem is short shelf life. Probiotics are living organisms. Over time, they die and moisture builds within the capsules, resulting in inefficacy. Even products with a sell-by date on the label may have lingered on drugstore shelves for too long. The third problem is gut survival. Many commercial probiotics lack the type of encapsulation that would permit them to survive the stomach’s incredibly acidic pH, so they never make it to the small intestine.
So how can patients find a probiotic that effectively repopulates friendly gut flora? Recommend a professionals-only brand with guaranteed potency that offers billions of a combination of strains. Most of these require refrigeration. The average patient benefits from a supplement that contains about 5 billion mixed-strain probiotics. To achieve specific therapeutic benefits, such as treating disease or quieting the gut after antibiotic therapy, patients might need to ingest supplements containing 25 billion organisms up to three times a day.
This study was written by Marcelle Pick, RNC, MSN, OB/GYN NP and printed in the March issue of Advance for NPs & PAs