Probiotics are good bacteria. They are extremely important to our health and everyone should have an appreciation for what they do for us. In the last few years there has been a growing interest in probiotics, and the use of probiotics in the treatment of medical conditions has increased dramatically. However, there are many misconceptions about how probiotics work and what they do and don’t do. This article will help clear things up. We will discuss what probiotics are, how they work in your digestive tract, how to know if you should take probiotics, and which probiotics to choose.
Your Digestive System
To understand probiotics, you need to understand some basics about the digestive tract. The digestive system is made up of the gastrointestinal tract (also called the GI tract), the liver, pancreas, and gallbladder. The GI tract includes the mouth, esophagus, stomach, small intestine, large intestine, and anus.
The GI tract contains around 100 trillion bacteria, both good and (sometimes) bad kinds. Everyone has good bacteria in their digestive tract, but not everyone has the same kinds of good bacteria, or in the same amounts. The same goes for bad bacteria.
When we are born, there are essentially no bacteria in our digestive tract. But as soon as we are born, bacteria begin to populate the gastrointestinal system. This is not only normal, but it’s imperative to life. Studies have shown that without bacteria, animals do not develop properly and cannot live very long.
The human digestive tract is an ecosystem. The various forms of life in this ecosystem compete for space and for resources like water and nutrients. They are vital for helping to break down food, they create some vitamins, produce fatty acids critical to our health, decrease inflammation, and they produce waste materials and other chemicals. The things we ingest (food, drink, and other things that make it into our digestive system) feed the organisms in this ecosystem. And our intestinal wall provides both a place for these microorganisms to grow and a barrier to prevent invasion into the rest of our body.
Another important aspect of this ecosystem is our immune system. Our immune system is exceptionally active in the digestive tract, allowing needed nutrients to pass into our bodies, while working to prevent unwelcome guests. When the ecosystem in our gut gets out of balance, we often develop digestive symptoms and can also develop other health problems. Digestive symptoms can be caused by both the presence of an unwanted microorganism (bad bacteria, yeast, or parasites) and the absence of or a deficiency of needed microorganisms (good bacteria).
Our digestion depends on the presence of a complex soup of trillions of individual microorganisms that help us digest the food we eat. Without them, we would die.
Modern medical science still has much to learn about this “soup” of microorganisms that live inside us. But we do know some of the problems that can develop in this ecosystem that interfere with good digestion.
What are Probiotics?
In simple terms, probiotics are good bacteria in our digestive system. However, today the term probiotics has taken on a new meaning and generally refers to probiotic supplements available in capsule form.
Probiotic products are becoming increasingly popular and vary widely in quality, quantity, and effectiveness.
Although there are thousands of different bacteria, the best-known friendly bacteria are Lactobacillus acidophilus and Bifidobacterium. Lactobacilli are also the bacteria that change milk into yogurt, and they are present in acidophilus milk.
Bifidobacterium have been shown to provide many health benefits. A healthy intestinal system has more of both these friendly bacteria than other unfriendly bacteria.
However, the fact is that only a tiny fraction of the number of species of good bacteria found in the digestive tract are even available in supplement form. There are dozens of probiotics that exist in the GI tract that we cannot get in pill form, even though the current approach to probiotics is to treat them like a drug. Take these particular probiotics and they will work magic. Sometimes that happens, but more often it doesn’t.
What are Antibiotics and What Do They Have to Do with Probiotics?
Antibiotics kill bacteria and are the opposite of probiotics. For the last few decades, we have seen the rise of the use of antibiotics, considered wonder drugs because of the lives that they saved. Unfortunately, we have also seen that too much of a good thing can be harmful.
The overuse of antibiotics has directly contributed to the development of antibiotic resistant bad bacteria, such as MRSA, also known as methicillin-resistant Staphylococcus aureus, which is an infection caused by staph bacteria. We are only beginning to appreciate that there is another downside to taking antibiotics, they kill good bacteria.
In response to this, we are now seeing a rise in the popularity of probiotic supplements.
Why We Need Good Bacteria
Healthy people live in harmony with their “good” bacteria, or normal intestinal flora. This is called symbiosis. We provide the bacteria with a home and food, and in return, they do some great things for us.
One of the most important services good bacteria provide is preserving the correct balance of bacterial populations within the body. By their very presence, they prevent the establishment and spread of “bad” bacteria and yeast because harmful bacteria and yeast generally have no place to grow if friendly bacteria are thriving.
Benefits of Probiotics
The goal of treatment with probiotics is to increase the good bacterial in the digestive tract and is done for three main reasons:
- Having the right kind of bacteria in the digestive tract helps you properly digest your food and can reduce the amount of gas that you produce.
- Having healthy colonies of good bacteria helps to prevent overgrowth of the digestive tract by other bacteria and yeast, which can cause diarrhea, constipation, gas, bloating and abdominal pain.
- Good bacteria produce some vitamins that are essential to health.
How to Know if you Need Probiotics
Taking probiotics might seem like a no brainer. It is certainly worth trying if you are suffering from digestive problems, but there are hundreds of probiotic products on the market and they vary widely in quality, quantity, and effectiveness.
Equally important, the ecosystem of the digestive tract is a very complex area that is often affected by numerous other variables. People with digestive problems often find that probiotics are of no benefit, or only help a little. Sometimes they even make symptoms worse. This is not rare, and it occurs for a variety of reasons.
If a patient has an infection, they may need more than just probiotics. If the patient is deficient because they have another issue (inflammation, etc.) then treating that issue first will be necessary before adding probiotics to the diet. Probiotics will be helpful when they are needed, but will not be if they are not needed, or if you have a bacterial or yeast overgrowth that needs to be treated first.
Testing is necessary to help you gain a better understanding of your unique bacterial environment and what is causing your symptoms. The tests, most commonly done by stool testing, or more specifically a DNA analysis of your stool, can measure both the good and the bad microorganisms present in the digestive tract.
By measuring and evaluating the ecosystem in the digestive tract, the doctor can determine if you need probiotics. The situation is fairly complex and requires that the doctor be familiar with the appropriate kinds of testing, the types of results, and the ways the particular labs conduct their analyses and provide their reports.
The testing will also indicate whether or not it will be necessary to add other dietary supplements, such as natural anti-fungals, anti-parasitics, or antibiotics to kill off harmful microorganisms and thus increase the effectiveness of the probiotics colonizing the digestive tract. By doing so, the ecosystem of the intestines can be more quickly and effectively restored to a healthy state.
What Can Probiotics Treat?
Although evidence is still being gathered, researchers say there is enough data to rate the effectiveness of probiotics for several specific illnesses. An expert panel made recommendations in 2014 and concluded that probiotics can be effective for:
- Diarrhea in adults and children
- Necrotizing enterocolitis, a disease impacting the intestine of premature infants
- Inflammatory bowel disorders (Crohn’s disease and ulcerative colitis)
- Irritable bowel syndrome (IBS)
- Allergic disorders
- Radiation enteritis, inflammation of small and/or large intestine from radiation treatments
- Acute childhood diarrhea
- Preventing antibiotic-associated diarrhea
- Preventing pouchitis, an intestinal inflammation that can follow serious intestinal surgery
- Regulating immune response
- Treating and preventing eczema
- Improving alcohol-induced liver injury and non-alcoholic fatty liver disease
- Kidney disease
Probiotics may also be useful in other unexpected ways. Medical studies have suggested that probiotics may decrease the risk of common childhood problems such as ear infections, strep throat, and colds.
The amount of information about the role of the bacteria in our digestive tract is growing daily. This ecosystem relates to the health of our entire body, not just our digestive tract, and their importance cannot be overstated.
Choosing a Probiotic Supplement
Choosing a quality probiotic is essential and can be a challenge. The quality of the product has a dramatic impact on whether or not it will solve your digestive problems.
There are four major issues that determine the effectiveness of probiotics:
- Viability: The first issue is the viability of the bacteria. Basically, are they still alive and will they remain alive in your gut? Unfortunately, in many cases, there are little if any viable bacteria in many products on the market. If they aren’t alive, then they aren’t going to do you any good.To try to avoid this problem, at the very minimum, generally it is prudent to select a product that is refrigerated. Hopefully, it was refrigerated in transit and in storage as well. Even if it is freeze-dried, which helps, it should also be refrigerated to help maintain viability. There are also some shelf stable products now available, but it’s very difficult for the average person to tell the difference from the shelf stable products and the imposters.
- Quantity: A good probiotic product will guarantee that you get at least 25 billion live bacteria. Many products only have 1-10 billion or so organisms, or don’t even tell you how many they have. These probably aren’t worth taking, even if they are viable.The digestive tract contains trillions of bacteria. So a billion may sound like a lot, but it may not have much impact if you are particularly deficient in good bacteria. In fact, even a high-quality product with 25 billion bacteria may not have much impact on improving your situation.You may need to supplement with hundreds of billions of bacteria over a period of weeks. There are very few supplements capable of providing you this much good bacteria.
- Strain: Beneficial bacteria come in many different strains and different species. For example, there are different Lactobacilli bacteria, as well as different strains of Lactobacillus acidophilus. The companies that sell these products often make claims about the effectiveness of their particular specie or strain of bacteria. The species and strains of good bacteria found in the supplements may not match the species or strains that your intestines need to reach healthy and appropriate levels. By identifying the microbial ratios in the gut via a DNA stool analysis test, specific levels of different types of good bacteria can be measured and identified as deficient. By replacing specific bacterial species (instead of guessing), healthy levels of good gut bugs can be replenished to maintain a healthier intestinal environment. Some species and strains of probiotics are much more anti-inflammatory than others. These help to reduce distress in your intestinal immune system, while others may have a potentially pro-inflammatory effect or no effect at all. Research shows that certain strains of good intestinal bacteria are exceptionally strong regulators of intestinal inflammation.The key issues are the ability of the bacteria to survive digestion, adhere to the intestinal wall, fight off opposing bacteria, flourish in the intestine, and promote good digestion. A quality probiotic will do all of these things.
- Contaminants: Another important issue in the production of probiotic products is the intentional or accidental inclusion of additives or contaminants into the supplement. Some probiotics add a number of various species and strains of bacteria to their product with the idea that more is better. Others, due to poor quality control, contain types of bacteria that were never meant to be included in the product and can actually make your problem worse. Many probiotic products contain unnecessary additives or food allergens such as dairy or soy. Dairy is especially common because it is often used to grow the good bacteria. This is particularly problematic for people who have a dairy allergy or intolerance. They need to be aware of this issue and seek out a dairy-free probiotic.
As you can see, there are several issues to consider when selecting and using probiotics. And although probiotics can be very helpful for digestive problems, they can also be capable of causing digestive problems when used incorrectly.
Natural Probiotics in Foods
While probiotics are available in supplement form, they are also in and on many foods.
Many fruits and vegetables are naturally covered in good bacteria. That natural wax on your organic apple is a film of Lactobacillus.
Eating a plant-based diet can help to support the good bacteria in your digestive tract. In adults, diets that have a high proportion of fruit and vegetables and a low consumption of meat are associated with a good ratio of good bacteria to bad bacteria in the digestive tract. The reverse is true for a diet high in meat and low in plant-based foods.
Some processed foods, such as yogurt and acidophilus milk, contain good bacteria. It is now becoming fashionable to put probiotics into all sorts of processed food products in an effort to come up with new and creative ways to give people these good bacteria. Most yogurt brands do contain probiotic strains of Bifidobacteria and Lactobacillus, which are said to restore the balance of good bacteria in the gut.
However, eating yogurt, drinking acidophilus milk, or taking acidophilus supplements does not guarantee that you will have adequate colonies of good bacteria. Many people are so deficient in good bacteria that only larger doses will replenish the digestive tract, and often the presence of another bacteria or yeast/Candida must be treated first before good bacteria will be able to colonize and take hold.
How IBS Treatment Center Can Help
At the IBS Treatment Center, we have seen first-hand the significant difference in effectiveness between various probiotic products. In our practice, it is common to hear from patients who have tried probiotics that the supplements offered no improvement or even made them feel worse.
We have also been able to test our patients to determine whether or not the probiotic actually took hold and flourished in their digestive tract.
The results of stool testing can reveal infection, imbalance, and/or a deficit of microorganisms (bacteria). When a problem is discovered, a treatment can be designed that will address any of these situations. That treatment most often involves probiotics.
Effectively utilizing probiotics is one key to properly treating IBS. This is a science. Please contact our clinic if you have questions about probiotics or would like to schedule an appointment with one of our physicians.
Our treatment involves experience, personal attention, and creating a unique wellness plan just for you. There is no one-size-fits-all treatment for IBS. Our team of doctors and nutrition experts will use advanced resources to diagnose your IBS triggers and create a personalized treatment protocol to cure your IBS for good.
Dr. Wangen is the founder and medical director of the IBS Treatment Center, the award winning author of two books, and a nationally recognized speaker on digestive disorders. He has been on ABC, NBC, and Fox as well as public radio, and was named one of Seattle’s Top Doctors by Seattle Magazine.