Lots of people tend to react with an “eeeeeewwww” when they realize that we have (or SHOULD have) about 100 TRILLION bacteria living in our guts. We are so used to thinking of ALL bacteria as nasty “germs” it took quite a few years before mainstream medicine latched on to the concept that gut bacteria are beneficial—in fact, they are essential to overall health and wellness. Gut microorganisms such as bacteria of the microbiome form a symbiotic relationship with humans—in a symbiotic relationship, both humans and bacteria benefit.
This population of microbes should more accurately be termed the microbiome because along with the bacteria, various viruses, protozoa and fungi live and function quite happily in our digestive system.
Glossary of Terms
- Microbiome: The collection of microorganisms (bacteria, fungi, viruses, protozoa) found within the digestive system.
- Inflammation: A normal and necessary part of the immune response which serves to alert the immune system of an infection or injury. The problem is not inflammation—the problem is when control of inflammation is lost.
- Flora: Describes all the microorganisms in the gut.
- Prebiotics: “Food” for the bacteria in the gut.
- Probiotics: Live organisms that can provide health benefits when they colonize the gut.
- Antioxidants: Substances found commonly in fruit and vegetables that “soak up” free radicals produced by cells as a normal consequence of normal metabolism. When free radicals are not absorbed, they can damage and kill the cells.
- Symbiotic relationship: In biology, this defines a mutually beneficial relationship.
- CFUs: CFUs are Colony Forming Units. CFUs are an estimate of the number of viable bacteria in a supplement. You want to have a product with a reliable and high number
- Functional GI Disorders: These are the most common gastrointestinal (GI) disorders, but among the least poorly understood. They are disorders involving bowel movement, pain/discomfort, altered microbiome and altered functioning.
- Anaerobic bacteria: Bacteria which thrive in oxygen free environments, like that found in most of the gut.
Why is a Healthy Microbiome Essential to YOUR Health?
Under most circumstances, probiotics are safe to use to maintain overall health, to use during antibiotic treatments, to support the immune system and to support bowel regularity and ease of bowel movements. They can also be used to support skin health, reduce vaginal infections, support a healthy digestive system, support healthy gums and reduce periodontal disease and to specifically treat (under a physician’s guidance) several diseases such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), constipation, diarrhea and urinary tract infections.
A recent review article in the British Medical Journal (BMJ), one of the world’s oldest medical research publications, lists various functions of the microbiome that impact health. These include:
- A healthy population of gut bacteria and other microorganisms can aid in digesting and fermenting non-digestible dietary fiber. This process supports other gut bacteria to produce substances known as “Short Chain Fatty Acids” or SCFAs such as butyrate, propionate and acetate.
- Butyrate helps cells in the gut produce oxygen and help control the population of gut bacteria, promoting the growth of a healthy microbiome. It is a primary source of energy for cells in the digestive system. Butyrate can also promote tumor cell death by a process known as apoptosis.
- Propionate moves from the gut to the liver where it helps regulate blood sugar levels and helps regulate hunger signals.
- Acetate helps support the growth of healthy gut microbes and can help regulate hunger—and the metabolism of cholesterol.
- A healthy population of gut microorganisms (gut flora) can reduce and eliminate toxins in foods and improve the absorption of nutrients.
- Bacteria can metabolize plant substances like antioxidants, anti-inflammatory substances, tannins, and lignans and increase their absorption into the body.
- A healthy microbiome can play a critical role in maintaining a healthy weight—obesity is correlated with a lack of diversity in the pattern of bacterial populations.
- A lack of diversity in gut bacteria is also specifically associated with inflammatory bowel disease (IBD), psoriatic arthritis, type 1 and type 2 diabetes, atopic eczema, celiac disease, and arteriosclerosis.
- It is believed that autoimmune diseases and chronic diseases in general are significantly associated with problems in the microbiome.
- A healthy microbiome helps to “train” the immune system to recognize dangerous microbes. It also more generally supports the normal functions of the immune system, reduces allergic responses and reduces the severity of infections.
- The microbiome can affect mood and mental health
- The gut has sometimes been called “the second brain”. The gut has its own nervous connections—called the enteric nervous system (ENS). The ENS interacts closely with your brain—affecting conditions such as depression and anxiety.
- Most (if not all) chronic diseases have an inflammatory component—a healthy population of gut bacteria can act as an anti-inflammatory “agent” likely mediated by SCFAs acetate, butyrate and propionate.
- The microbiome produces B-vitamins, important for the conversion of food into energy, and Vitamin K, important in the process of blood clotting.
- The healthy bacteria help to limit infections by pathogenic (disease-causing) bacteria by “crowding” them out.9
- A healthy microbiome helps keep your bowels moving and “regular”.9
A healthy microbiome improves blood sugar levels and blood lipid (fat) levels as well as improving overall metabolism. 9
So Then, What are PreBiotics?
Prebiotics are food for bacteria—they are complex carbohydrates that humans don’t digest well, but bacteria and other microorganisms DO digest—and need! Many physicians recommend that if you take a probiotic supplement, the best results will be obtained if you also get prebiotics—either in your diet or as a supplement.
Prebiotics are not all created equally! Some will support the growth of some strains, and some will support the growth of others.
Fiber can be a prebiotic. Physicians often recommend that people increase their intake of fiber—and there are many good reasons for this recommendation:
- Plant fiber contains prebiotics to supply your gut flora with food at the “Microbiome Café”
- Fiber helps you maintain regular and easy bowel movements
- Fiber helps control cholesterol levels
- Fiber helps slow down the absorption of sugars and avoid the spikes in blood sugar.
- Fiber can help improve cardiovascular disease and decrease the risk of cancer, especially bowel cancers.
Prebiotics can be taken as a supplement or as part of your daily diet. Food high in prebiotics include all the good stuff like:
- Fruits (apples, bananas, berries of any kind, and tomatoes (yes, tomatoes are a fruit, not a vegetable!))
- Vegetables (leafy green vegetables like spinach, kale, lettuce, mustard greens, Swiss chard)
- Whole grains (whole wheat, barley, quinoa, brown rice, oats)
- Peas, lentils, and beans
- Onions, garlic
Complex carbohydrates are long strings of different types of sugar molecules—they can be compared to simple sugars like fructose and table sugar which are one or two connected sugar molecules. The simple sugars are easy to digest—but they can raise your blood sugar levels and too much simple sugar can increase the risk of diabetes and other disorders.
Here’s one note of caution—some people have problems with some prebiotics—if you have small intestinal bacterial overgrowth (SIBO) or irritable bowel syndrome (IBS), consult your doctor before taking prebiotic supplements and even before adding lots of prebiotic-containing foods to your diet. Problems with prebiotics are relatively uncommon, but they could increase your chances of bloating, diarrhea, constipation, or increased gassiness—and nobody likes that!
By the way—“synbiotics” are complex mixtures of probiotics, prebiotics and sometimes digestive enzymes. These combinations can be very useful for a variety of digestive problems—and are usually worth at least a try if you have a combination of digestive problems like:
- Constipation + bloating
- Diarrhea + gas
- Indigestion + abdominal discomfort
Abdominal discomfort + irregularity of bowel movements
When and How Can Probiotics be Used to Support Digestion and Overall Health?
The first question has to be: CAN probiotics be used to support digestion and overall health?
The short answer is Yes! Research indicates that probiotics (and prebiotics) can be safely used (as directed) for healthy individuals AND for people with various conditions. ,,
Probiotics can and have been used to benefit children and adults with a variety of conditions including:
- IBS and functional bowel disorders such as constipation, diarrhea, abdominal pain or discomfort and bloating that cannot be determined to have a specific cause.
- Antibiotic-associated diarrhea
- Diabetes
- Colic in babies
- Prevention of infections by “crowding out” pathogenic microorganisms (eg. difficile)
- SIBO
- Crohn’s disease
- Ulcerative colitis
Probiotics can also be used preventively to ensure that disease-causing bacteria and microorganisms can’t establish a “foothold” in the gut. Additionally, ingested probiotics can help protect against vaginal, bladder and urinary tract infections (UTIs).
More recent research has indicated that probiotics can be used to support diabetes treatments, cancer treatments, allergies, inflammatory disorders, the immune system, and obesity.
Probiotics and Weight Management
There have been quite a few studies related to the effect of probiotics and weight management. The results have been relatively uniform—and point to the positive effect on weight of a healthy microbiome. ,,
Obesity and being overweight are pretty easily related to the number of calories taken in and the number of calories used up in physical activity. However, if it was “all that simple” all a person would ever need to do to lose weight would be to eat less and be more physically active…and we probably ALL know, it is NOT “all that simple”. Factors like your genetic history, the environment, stress, quality and quantity of sleep, your overall health and medications can all impact your weight.
But—probiotics may be a very useful tool in a quest for maintaining a healthy weight. In mice, for example, a lean body type is associated with the presence of a specific pattern of bacterial species. When microbiomes derived from obese mice were transplanted into lean mice – the skinny mice gained weight! When the “lean bacteria” were added to the obese microbiome and transplanted into the skinny mice—they stayed nice and lean! The same appears to be true in humans!
Probiotics in Healthy Adults
Even after decades of research, we are just beginning to understand the patterns of a healthy microbiome—partly because there are many thousands of different strains of bacteria and fungi, but also because they can change with age, geographic location, diet and health status.
A recent study looked at the effect of probiotic supplements in healthy adults. They concluded that “Results suggest that probiotic supplementation in healthy adults can lead to transient improvement in gut microbiota concentration of supplement-specific bacteria. Evidence also supports the role of probiotics in improving immune system responses, stool consistency, bowel movement, and vaginal lactobacilli concentration. There is insufficient evidence to support the role of probiotics to improve blood lipid profile. Probiotic consumption can improve in the immune, gastrointestinal, and female reproductive health systems in healthy adults. However, this review failed to support the ability of probiotics to cause persistent changes in gut microbiota or improve lipid profile in healthy adults.”
So, a bit typically in scientific reports, there were positive results but some not-so-positive. You already know about the positive results—let’s take a look at the main not-so-positive results. The authors concluded that there was little evidence to show that probiotic supplements were able to induce “persistent changes” in the gut microbiota. Here are some possible reasons why.
- Most studies are relatively short-term, so you wouldn’t necessarily SEE those “persistent changes” in the short-term.
- This particular study was a review of previous studies—so we don’t necessarily know anything about the diet of those involved, the ages of those who were considered “healthy”, or any other medical conditions involved (these studies included “healthy adults” but that definition can vary—you could for example include those with borderline heart conditions, pre-diabetes and could include a number of people with undiagnosed conditions).
- The diets of those taking probiotic supplements are critical in assessing how effective they are! If someone has a diet with a low content of prebiotics (ie. food specifically for the beneficial bacteria), they won’t likely have as good results as those who eat a diet rich in prebiotics! Also—bacteria don’t like junk food as much as some humans do! For one thing, junk food is full of additives and preservatives that are designed to reduce the chance of them getting bacteria growing on them! So, someone taking probiotic supplements along with a diet high in junk food is likely to have poorer results than those taking these supplements and eating a diet supportive of the microbiome! Right?
- Changes from traditional (whole foods) diets to a Western-type diet (more processed and prepared foods higher in fats and simple carbohydrates) are reflected in the microbiome—and that change is associated with increased rates of obesity AND chronic diseases such as diabetes and heart disease.
- Since this study was a review of 45 previous studies, there was a wide variety in the supplements used—a variety in the quality of supplements (this is important!) and in the strains of bacteria used in the supplements.
- There was also a wide variation in how often and for how long the supplements were taken. People often tend to think of supplements as drugs—you take them for “x” number of days and you are done! This is often not the case! Bacteria in a microbiome need time to “settle in” and get “comfortable”. This may take 4-6 weeks and maybe longer, and many of the studies included in this review lasted less than that.
How about the authors’ statement that lipid (blood fat) profiles were unchanged? Well, as is commonly the case in research—other studies have found that lipid profiles ARE significantly changed for the better with probiotic supplementation! This study (also a review) had some significant differences with the one that didn’t find any positive changes in lipid profiles—for one thing, they only included studies that included Lactobacillus strains of bacteria. Also—very importantly—this study controlled for the number of Colony Forming Units (CFUs).
So—which bacteria should be included in a quality probiotic? And what makes a quality probiotic?
Quality Probiotics
So far, the scientific consensus is that there are over 30 different genera (the capitalized “first name” of bacteria) and at least 500 different species (the uncapitalized “last name” of bacteria) in our guts., It can be a lot to keep track of, so here are some of the basics!
Bacteria and Yeast Used in Probiotics.
The most commonly used probiotics include various strains and species from:
- Lactobacillus
- Lactobacilli are rod-shaped anaerobic bacteria (but which can tolerate some oxygen) and are found in the digestive system and the female urogenital tract—babies delivered vaginally naturally pick up lactobacilli during delivery. Lactobacilli can be very important by limiting the growth of disease-causing bacteria. The lactobacilli tend to populate the small intestines and may help to reduce inflammation throughout the body, deal more effectively with stress and help improve digestion while decreasing gas and bloating. 25, 26, 27
- Strains used in probiotics include: acidophilus, L. helveticus, L. johnsonii, L. gasseri, L. jensenii, L. plantarum, L. paracasei, L. casei, L. rhamnosus, L. bulgaricus, L. lactis, L. delbrueckii, L. brevis, L. reuteri and others.
- Bifidobacterium
- Bifidobacteria are non-motile anaerobic bacteria and are thought to be among the first bacteria to colonize the gut even before birth. Bifidobacteria are commonly found in the digestive system, the mouth, and the female urogenital tract. The Bifidobacteria have been used in probiotics to treat a variety of digestive disorders, can help digest food and “crowd out” other disease-causing bacteria. The bifidobacterial appear to be effective in maintaining healthy and regular bowel movement.24
- Strains commonly used in probiotics include: lactis, B. animalis, B. longum, B. breve, B. adolescentis, B. bifidum, and B. infantis.
- Saccharomyces
- Saccharomyces is a form of yeast that has been found to be beneficial for health. It has been used for centuries for brewing and baking breads. boulardii was first found in mangosteen and appears to be useful in cases of diarrhea. S. cervisiae is baker’s and brewer’s yeast and is believed to support the immune system and to reduce inflammation.
- Two strains are commonly used are boulardii and S. cerevisiae
- Bacillus
- Bacillus is a strain of bacteria commonly found in soil. These bacteria are often thought to colonize the gut as a result of eating raw plants.
- coagulans and B. subtilis are the strains most commonly found in probiotics.
- Bacillus strains form stable spores that survive the high acid content of the stomach and can be “delivered” to the gut. Bacillus is thought to support the immune system, to regulate the bowels (in cases of diarrhea or constipation). Bacillus may also produce cancer-fighting substances.
- More research needs to be done on the use of soil-based organisms (SBOs) like Bacillus strains. While they were ingested regularly before the development of processed foods, they do not usually form part of the microbiome—and the potential for adverse effects is not well understood.
- Other strains of bacteria can be used including:
- Some strains of Streptococcus (the non-disease-causing strains like Streptococcus thermophilus and Streptococcus salivarius)
- Pediococcus pentosaceus and Pediococcus acidilactici
- Strains of Lactococcus
Quality Matters
Bacteria and yeast are living organisms but they should be stored as directed. Some probiotics may require refrigeration to maintain their stability and the number of Colony Forming Units (CFUs), an important concept we will talk about a bit later.
Oral probiotics must survive the acid environment of the stomach before they are able to reach the small and large intestines (where they can begin to grow and provide the benefits of helpful bacteria). Quality probiotics will have some form of a delayed release coating—protecting the probiotics from stomach acid and delivering them at high CFUs to the intestines.
Even with the best technology and recommended storage, probiotics won’t last forever—nothing does! A general rule of thumb is to use the probiotics as soon as possible and within 1 year of purchase.
Colony Forming Units
The term “Colony Forming Unit” or CFU is used in probiotics to give an estimate of the number of viable bacterial or yeast cells in a dose of those probiotics. The CFU is not necessarily a “quality indicator” but you need to know that there has to be a sufficiently high number of CFUs so that enough bacteria and yeast survive the rather harsh environment of the digestive system—remember, the digestive system is designed to break down foods into small, absorbable molecules and it can break down and destroy the bacteria and yeast in probiotics.
You need to have a high CFU number along with a variety of organisms to really make a difference. This number should be—at an absolute minimum—greater than 10-30 billion CFUs. More is not necessarily always better—a high CFU number should be “attached” to a good variety of clinically proven probiotic strains (see list above) and some form of “delayed” release so that the bacteria and yeast arrive in large numbers where they can do the most good!
Possible Adverse Effects of Probiotics
As mentioned, for the majority of people, probiotics are very safe. If you have any digestive or other medical condition and are using probiotics for relief, we strongly recommend you work with a knowledgeable healthcare provider.
Most adverse effects with probiotics are relatively mild and temporary, usually lasting a few days. These effects can include:
- Increased gassiness
- A sense of bloating
- Constipation or diarrhea
There are some rare adverse events related to some substances naturally produced by probiotics—these include reactions to bacterial amines like histamine and others—these may cause headaches in some people, but these tend to be temporary.
In very rare cases in individuals with a suppressed immune system or with significant digestive conditions, the bacteria in the gut can “escape” and sometimes cause infections—this is why we recommend that if you are using probiotics to provide relief for a specific medical problem, you should closely work with a healthcare professional.
In general, those people with a suppressed immune system, recent surgery, pancreatic disease or with a diagnosed digestive condition should consult their personal healthcare provider for guidance in probiotic use.
How Should Probiotics be Taken?
Probiotics should generally be taken once a day on an empty stomach. Some healthcare professionals recommend that they should be taken in the morning, and some recommend they be taken at night. Follow the directions given on your probiotic supplement—but if you experience any gassiness or bloating, consider taking them at another time.
Probiotics and COVID
Currently, there is NO evidence that probiotics can help prevent COVID. On the other hand, there IS evidence that probiotics can support the immune system. While there is no good way to predict who might get sick from COVID, it is hard to think that supporting the immune system is a bad idea. Just don’t think of it as a preventive—instead, think of probiotics as a healthy approach to life!
What are Digestive Enzymes?
Humans normally make all sorts of enzymes—these are complex protein molecules that accelerate chemical reactions without being used up—enzymes are naturally “recycled”! There are literally thousands of different enzymes –and the digestive enzymes are just one class that digest or break up complex food molecules into smaller and smaller bits that can be more easily absorbed by the digestive system. Digestive enzymes can make it easier for you to more fully digest your food and more fully ABSORB the nutrients in the food because it breaks up food into small, absorbable “pieces”.
Each enzyme is specific to a substrate of a particular type—you can usually recognize when something is an enzyme because it ends in “ase”. Some of the earliest-discovered enzymes don’t always end in “ase” though—use of that ending for enzymes is a relatively recent development. The following is a list of digestive enzymes and the substrates they break down into smaller fragments.
| Enzyme | Normally Produced by: | Substrate |
|---|---|---|
|
Amylases |
Salivary glands
Pancreas |
Complex carbohydrates, starches |
|
|
Starches |
|
Lipases |
Pancreas |
Fats (ie. Lipids) |
|
Proteases |
Glands of the stomach, pancreas, and small intestine |
Proteins |
|
(Derived from papaya) |
|
|
Nucleases |
Pancreas |
Nucleic acids (DNA) |
|
|
|
|
Other Digestive Enzymes |
|
|
|
|
Phytic acid found in grains and oils |
And….do YOU Need Digestive Enzymes?
Some people don’t produce the normal digestive enzymes—and they must take replacement enzymes, usually as a prescription. This is often a condition known as exocrine pancreatic insufficiency or EPI. EPI can be associated with diabetes, cystic fibrosis and pancreatic diseases such as acute or chronic pancreatitis. However, there are other many much more common causes of functional digestive enzyme deficiencies—these include:
- Gallstones
- Anatomical problems such as a poorly functioning pancreatic sphincter that controls the flow of pancreatic enzymes into the small intestine
- Alcoholism or heavy drinking
- Protein deficiency
- Malnutrition or micronutrient deficiency
- High caloric diet
- Poor exercise habits
- Poor dietary or lifestyle habits (too much coffee, sugar, tobacco use, junk foods)
- Infection with a bacteria known as pylori
- Stress
- Pregnancy
- Possible decrease in enzyme activity with aging
- Repeated use of antibiotics
However, many more people just don’t produce enough of one or more digestive enzymes, or those enzymes need a bit of a “boost”—and many more people could benefit from adding digestive enzymes to their daily routine.
Lactose intolerance is one example—lots of people don’t have lactase, the enzyme that breaks down milk sugar. Taking the digestive enzyme lactase can help people with lactose intolerance safely and comfortably eat various dairy-based foods.
One idea is that as we age, we lose some of the ability to make digestive enzymes—this has not yet been proven, however. It is possible that as we age, we begin to develop sensitivities to foods and digestive enzymes may help, especially if there are foods that tend to give you indigestion, stomach aches, gas or if you feel bloated after a meal.
Ideally, you would want to supplement with a particular digestive enzyme for your particular digestive problem. In reality though, it can be very difficult to figure out exactly which enzyme you need—and so most digestive enzyme supplements use the whole “kitchen sink” approach and supply all the enzymes you MIGHT need.
The good news about this approach is that it is safe and often very effective.
As an added sort of “bonus”—digestive enzymes appear to be as effective as NSAIDs (non-steroidal anti-inflammatory drugs) at relieving arthritis pain.
When Should You Consider Digestive Enzymes along with your Probiotics?
We already have a good idea that the use of probiotics to replenish and support the microbiome is an important and effective way to support your health. Digestive enzymes can be a very useful additional approach in helping you get the most nutrients from your diet while also supporting the microbiome—because digestive enzymes CAN support the microbiome as well as increase the efficiency of your digestive process. But, how can you tell if you may benefit from digestive enzymes? Here is a list of possible reasons to try digestive enzymes:
- Bloating
- Increased gassiness (flatulence or excessive “farting”)
- Abdominal pain or discomfort
- Diarrhea or constipation that occurs frequently
- A sense of fullness after only a few bites of food
- A suspicion that you have one or more food intolerances.
A word or two about enzyme activity—there are lots of different units used to represent how active an enzyme is—and a long treatise about it would likely put most of you to sleep! Only buy products where the activity is provided—you might see units like “DU”, “HCU”, “FTU” etc. These units measure different things with different enzymes, but they do provide you with some “goalposts” for comparison. Ultimately, if you buy from a quality-conscious and reputable company, you will provide yourself with the best chance of success!
Takeaways
Including probiotics can be a very effective approach to “self-care”. In naturopathic medicine, a healthy digestive system is considered the key to overall health and probiotics, along with a good source of prebiotics, either in a healthy diet or as a supplement can prove to be beneficial in many cases. Some people might benefit by the addition of digestive enzymes as well.
Knowledge is always a good thing—and we hope this article has provided you with a solid knowledge base allowing you to make informed decisions. We always also recommend that you talk to your healthcare provider to get the best advice for YOU!