Making Sense of Probiotics

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Photo by Lorna DePetrillo, RD

With the growing awareness for healthy living and initiatives to enhance vitality we have seen an huge increase in the usage of probiotics over the last 10 years. The global probiotic market exceeded USD 3.3 billion in sales for 2015 and this trend is expected to continue to grow. 1 Probiotics are gaining popularity in our food and nutrition markets for their ability to overcome and prevent consequences from harmful negative bacteria in the gut.

Gut flora is a topic of interest in healthcare and finding a balance amongst “good  vs bad” bacteria is an ongoing therapeutic challenge . Completely wiping bacteria out through the overuse of antibacterial products and anti-infectious medications is one theory hypothesized for the increased population of allergies. Heavy use of antibiotics can strip our gut of all bacteria, decrease our immune system and furthermore increase our risk for major infections like C. Difficile and antibiotic-resistant organisms.

 What is a probiotic?

Probiotics are healthy bacteria which exist in trillions naturally in our bodies, known as endogenous probiotics, and help to break down our food. On the flip side we are becoming quite familiar with probiotics that are marketed towards foods, in the form of bacteria or yeast. Health Canada adopted the definition of probiotics in 2001, from the World Health Organization (WHO) stating that “probiotics are living microorganisms which upon administration in adequate amounts confer a health benefit on the host. 2  Hill, Guarner et al. suggest probiotics can have a specific health outcome, or they can have a widespread health benefit (2014). Probiotics offering wide spread benefits have been studied for preventing pathogenic bacteria from multiplying, creating normal gut micobiota (a name given to the microbe population in our intestine and helping to produce short chain fatty acids (SCFA’s). SCFA’s are the main source of food for gut bacteria enabling a healthy gut environment. Although research is promising more research is needed for such wide range benefits to make claims.

What does the research say?

Although probiotic research is ongoing, currently the science is only supportive of bowel health. Probiotics have encouraging research linked to: (1) decreased intensity of antibiotic associated diarrhea, and infectious diarrhea3 4 (2) improve symptoms of ulcerative colitis 5, and (3) improve symptoms of irritable bowel syndrome.6 . There is a helpful probiotic chart which allows you to determine different strains of probiotics and what there intention has proven to do through science based research. 7

Unfortunately much of the marketing of probiotics (and consequently public and media understanding) are oversimplified in their approach suggesting that one size fits all. Although we do see health benefits, we need to be more diligent to determine which strains are researched based for having specific health outcomes. Our gut has hundreds of bacterial strains and correcting gut microflora is not as simple as taking any probiotic supplement. For example lactobacillus is one of the most common probiotics used in the food industry however this strain is not prevalent in a healthy gut, so consuming too much of this strain is not necessary.

Personally, many anecdotal reports from my clients over the last 15 years have indicated improved gut stability, digestion and reports of increased energy upon taking a probiotic regimen.  Commonly I see patients with unbalanced diets, high stress, heavy travel, and compromised immune systems that seem to benefit from probiotics. I always get excited when my clients achieve healthy gut activity as this ultimately can promote enhanced absorption of nutrients. Having adequate absorption of micronutrients (vitamins and minerals) as well as macronutrients (carbohydrates, protein and fats) is essential for optimal metabolic functioning. Optimizing the utilization of these nutrients creates a healthy pathway for our neurological, immunological, cardiovascular and endocrine systems to name a few.

Are probiotics a trend?

Despite the increased awareness and marketability of probiotics, we have been living with the concept of “healthy bacteria” since their discovery dating back to the beginning of the 20th century. Interestingly, at this time peasants who consumed yogurt seemed to live longer8. Today there is enough evidence to suggest that probiotics are beneficial for our health and have increasing acceptance in the medical field. It is becoming more common to hear physicians and surgeons recommending probiotics (while patients are taking antibiotics) to take prophylactic measures on gut health. 4

What do we need to know about probiotics? 

Be informed when shopping for probiotics. I recommend reading the food label to be certain your product contains an actual probiotic. Products are measured in CFU’s (Colony Forming Units). You want to look for CFU’s between 3-50 billion that suits your specific digestion. They are categorized respectively to their genus, species and strain. For example:  THE GENUS – Lactobacillus; THE SPECIES – Acidophilus;  THE STRAIN – SD5212. The strain number needs to be present and allows you to look for the research study on each particular probiotic. To determine what strains are used for which health outcomes you can visit http://www.probioticschart.ca7.

Probiotics are not necessarily something to take all of the time. Endogenous probiotics are showing to be much more beneficial than probiotics in foods. Once your digestive system is working, a maintenance plan may be as simple as adequate fibre in your diet to allow your body to make its own sources. There is no one regimen- so be sure to inform yourself or consult with a professional to find your balance.

What about Fermented Products? 

There are so many fermented foods that can be prepared from cultures including sauerkraut, kefir, kimichi, kombucha, and yogurt. Although these wonderful foods contain healthy bacteria and are thought to have health benefits, they are not necessarily considered a probiotic. Some fermented foods loose their healthy bacteria through the process of pasturization. If live cultures are added back into the product like you will find with yogurts, kefirs and some (not all) Kombucha it will read, ‘contains live cultures’ or raw. You will see the probiotic strain on the food label if it indeed contains a probiotic.

The Future of Probiotics 

As rapidly emerging scientific discoveries of these micororganisms emerge, we may expect to see positive outcomes from specific strains of healthy bacteria on type II diabetes, heart disease, colitis, Crohn’s disease, and even cancer. There are an infinite number of strains yet to be discovered and their roles in health will be the focus of continuous research. To determine which strain is best for your health you should connect with your RD or health care professional.

 

REFERENCES:

1. Probiotics Dietary Supplements Market Size Worth $7.0 Billion 2025  (2017, February) Grandview Research. Retrieved on Aug 3 , 2017, from http://www.grandresearch.com/industry-analysis/probiotics-market

2. Health Canada. Questions and Answers on Probiotics. Retrieved on May 3 2017 from http://www.hc-sc.gc.ca/fn-an/label-etiquet/claims-reclam/probiotics_qa-qr_probiotiques-eng.php.

3.Cochrane Database Syst Rev. 2010 Nov 10;(11) Probiotics for treating acute infectious diarrhea. Retrieved on August 1, 2017 from https://www.ncbi.nlm.nih.gov/pubmed/21069673

4. Rogers, B et al. Prescribing an antibiotic? Pair it with probiotics. The Journal of Family Practice. Retrieved on July 14, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601687/

5. Fedorak R. Probiotics in the Management of Ulcerative Colitis. Gastroenterol Hepatol (NY). 2010 Nov; 6(11): 688–690.

6. Cong Dai et al. Probiotics and Irritable Bowel Syndrome. World J Gastroenterol. 2013 Sep 28; 19(36): 5973–5980.

7. Dragana, Skokovic-Sunjic. (2017) Clinical Guide to Probiotic Products Available in Canada 2017. Retrieved Aug 1 2017 from http://www.probioticchart.ca/

8. Mohsin, Ali (May 2014) Copy of Probiotics Timeline. Retrieved on July 23, 2017 from https://prezi.com/5join3oac-ig/copy-of-probiotics-timeline/

9. Marco ML, Heeney D, Binda S, CJ Cotter PD, Foligne B, et al. Health benefits of fermented foods: microbiota and beyond. Curr Opin Biotechnol 2017; 94-102.

10. Doron S, Snydman DR. Risk and safety of probiotics. Clin Infec Dis. 2015. May 15;60 Suppl 2:S129-34. doi: 10.1093/cid/civ085.

11. Hill C , Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B et al. Expert consensus document. International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and aporopriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014 Aug; 11(8): 506-14


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