By Dr. Nina Radcliff
Perhaps a friend or family member has talked with you about probiotics? Or you may have walked by the dairy case or health food section – and you see shakes, milk, yogurt, energy bars, ice cream (along with an array of other items) with added probiotics claiming that the product will improve your overall health. But that may not necessarily be fact. As today’s consumer knows, we need to ask – are these claims based on real science, or are they just another food fad to squeeze money with trendy marketing? Let’s dig deeper.
Bacteria outnumbers cells in our body ten to one, leading some to say that our bodies are literally more bacteria than human. While that may “gross” some of us out, it is important to understand that not all bacteria are bad, yucky, or harmful. In fact, some bacteria perform invaluable acts– balancing and keeping harmful bacteria at bay, digesting food in our gut, educating our immune system, and producing vitamins that are necessary for bodily functions.
And each and every one of us has a unique collection of bacteria, known as a microbiome, that stems from our mothers at the time of birth, lifestyle, medications we consume, and treatments we may have undergone. So, why is this important? Recent technological advancements and learning have shown that this germ fingerprint plays a role in our health, and, too, disease. Microbiome studies are still relatively young and it is very important to note that there is a tremendous amount we need to learn.
And, probiotics have become somewhat of a craze – meaning it has outpaced the science. Quite frankly, most experts agree, there are huge information gaps and the missing information makes the research studies hard to translate into practice. Let’s take a look at key information with respect to general understandings of probiotics.
Dr. Nina’s What You Need To Know: About Probiotics
What are probiotics? The term means “for life” or “promoting life.” It is an umbrella term for living microorganisms, typically bacteria, but also includes yeast, that have the potential to provide a beneficial health effect. And the theory is that by consuming “the right” bacteria, we can:
- Maintain a desirable community of microorganisms. Our gut hosts between 500 to 2,000 different species of bacteria, yeast, parasites, and virus. And there is research to support that a “diverse” microbiome is linked to improved health—yet, we do not have a clear picture as to what that ideal, healthy gut microbiome looks like.
- Help the digestive tract return to normal after being disturbed—in other words, rebalance it. This typically occurs after a course of antibiotics wipes out pathological, or harmful, bacteria, but, too, takes out our beneficial ones. It can also occur from radiation and chemotherapy.
- Absorb nutrients. Certain bacteria in our gut help to break down complex carbohydrates, fat, and protein into smaller components that facilitate absorption into our body. Also, the digestion of lactose, the sugar in milk, can become problematic to some of us and increases in prevalence with age. This can cause uncomfortable diarrhea, bloating, and gas.
- Stimulate the immune response and help fight off infections. It is estimated that between 60 to 80 percent of our immune tissue is located in our digestive tract and there is interaction with our gut bacteria that impacts normal, healthy immune cell development. Additionally, research shows that our microbiome can influence whether a vaccine has an effect in our body. And, too, “bad” bacteria can lead to inflammation in the lining of our gut, thereby, allowing bacterial cells to enter our bloodstream.
What are specific health problems that probiotics may help with?
Facts are that benefits have not been conclusively demonstrated with large research studies, and not all probiotics have the same effects. Additionally, we do not know how much needs to be taken, or who would most likely benefit (are there differences based on gender, ethnicity, or genetics). That being said, there are some controlled trials showing that probiotics confer the following health benefits:
- Bowel/gut: irritable bowel syndrome; inflammatory bowel disease; infectious bacteria caused by viruses, bacteria, parasites; antibiotic-related diarrhea; and prevention of necrotizing enterocolitis in very low birth weight infants.
- Other body parts: Skin conditions such as eczema; urinary and vaginal health; allergic rhinitis; common cold; oral health such as tooth decay and periodontal disease; and liver disease.
What are the different types of probiotics?
There are literally hundreds of them. Based on our current understanding, the most noteworthy are Lactobacillus and Bifidobacterium. However, at this time, recommendations for a specific strain to treat a specific disease or condition is premature.
Where are probiotics found? In certain foods and supplements.
- Yogurt contains probiotics that are added after heat processing (pasteurization) and will state on the label “live and active cultures.” Kefir is a fermented product—similar to yogurt but thinner and more like a buttermilk—that contains a diverse blend of bacteria and yeast.
- Sauerkraut, kimchi, pickles, tempeh, and miso are fermented veggies
I am a strong proponent that the best way to attain necessary vitamins, nutrients, antioxidants, and probiotics are from the foods and drinks we consume. When we “tease out” a particular component (or chemically compound it) to put it in a pill or capsule, we lose out on many beneficial effects of the food item, such as fiber, or other antioxidants, vitamins, and nutrients.
However, in some cases, attaining probiotics from food may be challenging: intolerance to dairy, and, hence yogurt or kefir; food allergies; gastrointestinal illness that makes consumption of probiotic-rich foods not possible; or not readily available. And it is important to underscore that at this time, there are no probiotics that have been approved by the Food and Drug Administration (FDA) to prevent or treat any health problem. As a dietary supplement, there is no guarantee that they are effective, or safe—because they have not undergone the rigorous clinical trials that prescription drugs have. We also do not know the most beneficial dose or strain diversity.
What are some safety concerns about probiotic supplements?
For most healthy people, they are considered safe (which begs the question, if you are healthy, why add probiotics?). However, critically-ill patients—those in the intensive care unit, sick infants, postsurgical and hospitalized patients, and those with immune-compromised conditions—are at-risk for adverse events. These include sepsis (overwhelming infection followed by a maladaptive immune system response that attacks the body’s own tissues and organs), fungemia (yeast or fungus present in the bloodstream), and ischemia (insufficient oxygen delivery to tissues or organs).
And, too, allergic reactions have been reported and some common mild side effects include diarrhea, gas, and bloating that often subsides after a few days.
The best way to maintain your unique healthy gut microbiome is to get enough sleep and exercise, eat healthy meals that include lots of fruits and vegetables, avoid chronic and excessive stress and not to drink too much. It is also important to remember not to replace scientifically proven treatments with unproven products and practices.
It is important to consult your health care provider first if you are considering a probiotic regime. And, too, to understand that not all probiotics are created equal. Different probiotics have different strains and concentrations of bacteria with different properties. Only a minority of them have been properly tested in clinical trials to find if they were indeed effective.
Yes, it is complicated as each one of us has a unique composition of intestinal flora. All of these nuances are going back to basic science before moving further to the clinical arena. When the health care world talks about personalized medicine, we are really talking about the microbiome: how to understand all the subtle interactions with our human host, and how to achieve this for our best health.
Stay tuned—there’s more to come! In the meantime, be cautious about claims that probiotics can help solve everything. Keep in mind that much more is needed to be known and it is important to talk to your physician about probiotics.
Dr. Nina Radcliff is dedicated to her profession, her patients and her community, at large. She is passionate about sharing truths for healthy, balanced living as well as wise preventive health measures.
She completed medical school and residency training at UCLA and has served on the medical faculty at The University of Pennsylvania. She is a Board Certified Anesthesiologist and a member of the American Society of Anesthesiologists where she serves on committees for Young Physicians and Communications. Author of more than 200 textbook chapters, research articles, medical opinions and reviews; she is often called upon by media to speak on medical, fitness, nutrition, and healthy lifestyle topics impacting our lives, today.