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Probiotically Speaking

Probiotics Probiotics
DaVinci Laboratories

Many Americans understand that probiotics are good for their digestive and overall health—and that’s it. Practitioners can help provide more precise therapy.

The field of probiotic research and development has grown so rapidly and expansively in the past decade alone, perhaps more than any other classification of dietary supplements or natural health remedies. Such growth often brings out misconceptions, misunderstandings—and misuse.

Naturopathic physician Steven Sandberg-Lewis, ND, DHANP, of 8 Hearts Health and Wellness and National University of Natural Medicine, Portland (Oregon) observed that many consumers think that by taking a specific probiotic for any duration will ensure it becomes a robust part of their microbiota and thus be able to provide long-term benefits. And although this is possible, it’s likely not true for all. Because our individual microbiota is likely established in fetal development and infancy, “significant changes to the microbial fingerprint later in life by consumption of a short-term probiotic supplement may be rare. More likely, the daily use of probiotic and/or prebiotic-containing foods may have the salient effects that last. The metabolic byproducts of a probiotic microorganism may have the greatest effect on a person’s digestive health or on reduction of health issues than does the intake of a probiotic supplement.”

Eric Yarnell, ND, RH(AHG), professor, Department of Botanical Medicine, Bastyr University and president of Heron Botanicals in Washington, asserted that consumer understanding is “moderate.” He outlines three key misconceptions and their realities:

Misconception: Lactobacillus and bifidobacteria are the main and most important bacteria in the gut.

Reality: By sheer number, these are actually extremely minor members of the gut but can tolerate oxygen and therefore can be ingested via capsules. The most prolific bacteria in the gut by huge margins are obligate anaerobes; these can’t tolerate oxygen and can’t be economically produced in capsules.

Misconception: They should not be taken with food.

Reality: Ostensibly, the stomach acid would kill the bacteria. But many studies support that taking them with food results in more making successful journeys to the colon. “Presumably, this is because that is how bacteria get to the colon in the first place (in food), and that they have adapted to use the food to help protect them from the many antimicrobial defenses in the upper GI (gastrointestinal) tract,” he explained.

Misconception: The dose. People basically don’t seem to know how much to take and the amounts between products vary enormously.

Reality: Most people take significantly less than they need. Minimum doses for most applications, based on positive clinical trials, are 50 billion organisms a day, even for children. Tina Anderson, CEO and co-founder of Illinois-based Just Thrive Probiotic related six additional misconceptions that Americans have about probiotics.

Misconception: A probiotic with 50 billion cells is better than one with four billion cells.

Reality: “In microbiological terms, more is not always better,” she emphasized. “Having 50 billion CFUs in a probiotic is only helpful if you can confirm that 50 billion CFUs are surviving in the digestive tract.”

Unfortunately, she added, survivability studies with several probiotic products (some as high as 250 billion CFUs) have indicated that more than 99 percent of the strains cannot survive digestion. “While lactobacillus or bifidobacteria do reside in our gut, commercially produced strains are shockingly poor stomach survivors and gut colonizers. This explains why so many people find common probiotics ineffective.” Misconception: You need a probiotic with at least 15 different strains.

Reality: Most probiotic studies are done with a single strain and there hasn’t yet been a study demonstrating that more strains create better results. The quality of the strain is significantly more important than quantity, she noted. “When a company creates a ‘kitchen sink’ formulation with dozens of strains, they often have to use cheaper, lower quality strains to keep costs down. Furthermore, the manufacturers of some of these products have no idea if these cocktails will be synergistic or if the bacteria will actually compete with one another, possibly producing a negative result. Instead, seek to recommend a product with only a few strains and whose synergy has been verified.”

Misconception: Probiotics needs to be refrigerated to be considered a “good” probiotic.

Reality: Refrigeration is actually a sign of a weak probiotic. Think about it, Anderson emphasized. “If a probiotic cannot survive at room temperature, how do you think it will survive in a 98-degree body, much less through extremely acidic digestive tract? Short answer: it won’t.” Before recommending, ask for gastric survivability test results proving the probiotic arrives alive in the intestines and a gut model study showing that it colonizes.

Misconception: A probiotic can be improved by being enteric coated or in a special capsule.

Reality: “This is simply marketing,” Anderson declared. “If a probiotic needs a special enteric or seaweed coating or special technology in order to survive digestion, then it will most likely be too weak to compete with the other 80 trillion bacteria already residing in the gut.”

Misconception: You need to rotate probiotics to create diversity and maintain efficacy.

Reality: According to Anderson, the idea of rotating probiotics originated from the realization that many probiotics stop working after a month or two of use because many probiotics are too weak to cause any lasting change in the gut.

A truly effective probiotic, she underscored, will not stop working over time. A quality probiotic will continue to cleanse and heal the gut from daily assaults with every dose. “Its effect multiplies; it does not go away,” she said.

Thankfully, related Natural Practitioner Editorial Advisory Board member Amber Lynn Vitale, there is a gradual yet definitive shift in consumer mindset, from thinking that a probiotic is only for either digestive support or after antibiotic treatment, to the understanding that probiotics are useful for maintaining nearly all aspects of health. However, she still hears certain misconceptions, such as: “Won’t all the strains compete in the capsule? Won’t they fight for resources in my body? How can these strains make it to my small intestine alive if they aren’t enteric coated? How do I know these are human strains? What if these bacteria mutate and make some super bug that cannot be killed by antibiotics?”

She added that NIH’s (National Institutes of Health) Human Microbiome Project has created a new definition of what a probiotic is, and it is much more specific than the former WHO (World Health Organization) definition that says a probiotic must be:

1) A species that can normally be found in a healthy human microbiome
2) Supplemented in an amount significantly greater than it occurs in the human microbiome in order to stimulate a boost in healthy immune response
3) Must be able to tolerate the natural environment of the human microbiome.

Natalie Lamb, technical advisor for Protexin (Bio-Kult), Florida, observed that the media has played a significant role in increasing public awareness of the “fascinating life of our gut microbes” and in relating new research showing use of probiotics in specific conditions and results. For example, TV advertising by numerous yogurt brands has grown the awareness of ingesting probiotics to improve digestive health. Additionally, said Lamb, “many bloggers are sharing their positive experiences of using commercial probiotic supplements for digestive health issues as well as many conditions throughout the body, including popular use for children in allergies, food intolerances, skin conditions and behavior issues.”

A Rapidly Evolving Category

With probiotics, seemingly, breakthroughs and innovation occur at a pretty rapid clip.

One such ingredient is a compound that mimics a probiotic—Saccharomyces boulardii is a non-pathogenic yeast that functions like a probiotic, according to Kathy McIntee, vice president of Patient One Formulas, New York. She explained that S. boulardii acts as a temporary flora that quickly achieves high concentrations in the GI tract. It also remains unaffected by antibiotics that don’t discriminate in killing both good and bad bacteria. As a result, co-administration with antibiotic treatment is recommended to protect and promote recovery of healthy gut flora. What’s more, it helps prevent antibiotic-associated diarrhea as a secondary benefit.

Further, she said, “S. boulardii effectively competes against the bacterium C. difficile, which is known to flourish during antibiotic use and is often the cause of GI disturbances following antibiotic therapy. S. boulardii has also been shown to compete against candida colonization. In addition to preventing antibiotic-related diarrhea, it helps prevent recurrent C. difficile-related diarrhea and colitis, traveler’s diarrhea, acute bacterial and viral diarrhea, inflammatory bowels and irritable bowel syndrome (IBS).”

Vitale pointed out that Lactobacillus GG is now off patent and available for use by other companies; it boasts numerous compelling studies showing benefits in neurological balance for children and adults alike, making for “exciting possibilities.” Also, she said, Lactobacillus rhamnosus strains like HN001 for balancing immune function show great promise.

New research Anderson is excited about is the first double-blind, human clinical trial on leaky gut (metabolic endotoxemia) that was published in the World Journal of Gastrointestinal Pathophysiology in August 2017 showing that a group of bacillus spore-forming bacteria can heal leaky gut in only 30 days. “Spore-forming bacteria (bacillus endospores) is where the probiotic marketplace is heading because of their history of safety and efficacy for over 60 years,” she stated, adding that while these strains have been used in Asia and Europe for decades, they are new to the U.S. supplement market.

Lamb has observed “some very interesting work expanding this year (2017) on the microbiota-gut-brain axis, raising the possibility that treatment with probiotics could be an effective therapeutic strategy for managing neurodegenerative disorders.”

For example, the first human trial in Alzheimer’s disease (AD) was published; researchers found that supplementing with Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum and Lactobacillus fermentum positively affected cognitive function and some metabolic statuses in the only human trial in AD patients. “This is particularly interesting to me as AD is a chronic neurodegenerative disorder affecting millions of people worldwide, for which there is currently no pharmaceutical treatment that can successfully reverse its progression, and available drugs appear to only ameliorate some symptoms once the pathology is diagnosed. As the population ages, cognitive behavior including learning and memory is of growing concern,” she added.

This brings the fact that probiotics are becoming more condition-specific. For example, noted Jared Paulson, MTCM, sales and education manager, Washington-based Ayush Herbs, dermatologists are starting to prescribe topical probiotics that are formulated with slightly different microbes or microbial ratios than oral probiotics, and are seeing successful results.

Further, “emerging research is showing auto-immune disorders may be alleviated with the improvement of the human microbiome. Cancer researchers have noticed better clinical outcomes with the administration of probiotics in those being treated with chemotherapy or radiation therapy,” he said.

Dr. Yarnell commented that he has seen Renadyl show specifically to help patients with chronic kidney disease. “I think we will see more of this in the future. If someone could figure out a cheaper way to make oxygen-impermeable capsules, we would likely see an explosion of specific organisms for specific conditions, most obviously right away Oxalobacter formigenes for people with oxalate-containing kidney stones and Faecalibacterium prausnitzii for people with IBD (irritable bowel disease).

Lamb revealed that 2018 is when the largest IBS probiotic trial to date using the multi-strain probiotic Bio-Kult 14-strain will be published. The randomized, double-blind, placebo-controlled trial in 360 moderate-to-severe symptomatic diarrhea-predominant IBS adults was associated with a statistically significant consistent improvement in overall symptom severity in patients with IBS-D, and was well tolerated. “I foresee both single and multi-strain probiotic formulations continuing to be published in an ever-widening range of specific conditions and being considered alongside conventional pharmaceuticals as research grows,” she predicted.

Products to Consider

According to Anderson, Just Thrive Probiotic & Antioxidant contains pharmaceutical-grade bacillus strains (not with lactobacillus and bifidobacteria strains found in other probiotics). The company’s bacillus spore-forming bacterial strains are licensed exclusively from the Royal Holloway University of London, from probiotic expert, Dr. Simon Cutting.

Just Thrive, she stated, has the only published study showing that these strains are healing leaky gut within 30 days of use, and nine human clinical trials on the product are currently underway. “Just Thrive Probiotic’s hardy strains have been shown by gastric survivability studies to pass through all digestive acids to reach the intestines completely alive and to actually colonize the gut as shown through a gut model study. All four proprietary strains are pharmaceutical-grade and DNA-verified by an independent third-party lab.”

Patient One’s Flora Maintenance probiotic is described by McIntee as a multi-strain, identity-confirmed probiotic with a potency of 25 billion live bacteria per capsule. “Ten compatible, well-researched strains (seven found in the small intestine and three found in the large intestine) are combined with the prebiotic fructo-oligosaccharide. The combination of a prebiotic and a probiotic has been clinically proven to promote enhanced effectiveness,” she said.

McIntee added that as strain identity is necessary to link a culture to a specific health effect; the strains in Flora Maintenance are genetically identified by a the RiboPrinter microbial characterization system. Patient One’s bacteria cultures, she said, are produced with a proprietary system that promotes increased viability over an extended shelf life and are provided in an acid-resistant, delayed release capsule to survive stomach acids for effective delivery to the intestinal tract, where the organisms can colonize and replicate.

New York-based NÜD’s Bare Biotic helps support healthy digestion and well-being, according to COO Naomi Ostrove. It features the company’s Probiotic Blend Complex that includes maltodextrin, Lactobacillus acidophilus, Lactobacillus Lactis, Bidfidobacterium longum, Bidfidobacterium bifidum, Lactobacillus bulgaricus and fructooligosaccharides.

Ayush Probiotics 100B contains seven strains of bacteria, and all the strains are from human origins, which makes them well suited to adapt to the human body as they are naturally bile- and acid-resistant, according to Paulson. The cultures are manufactured through a fermentation process. The bacteria are then freeze-dried and nitrogen-packed into vegetarian capsules, producing a room-temperature stable product good for two years (longer if refrigerated). Ayush Probiotics 100B is also free of common allergens. In addition, Ayush Probiotics 100B can be activated with food or on an empty stomach.

Bio-Kult Advanced Multi-strain contains 14 probiotic strains, according to Lamb. She explained that the formula delivers high concentrations of beneficial bacteria to the colonization sites in the gut, and is thus able to help a more diverse range of GI issues. The Bio-Kult strains have shown significant antimicrobial activity, good colonisation properties and an ability to stimulate the innate immune system. She noted that several clinical trials have been conducted using some of the Bio-Kult strains that have addressed support in areas of constipation, intestinal inflammation, abdominal cramps, non-alcoholic fatty liver disease and non-alcoholic stretohepatitis.

Bio-Kult also offers Candéa, a multi-strain probiotic supplement with added garlic and grapefruit extract to bolster the body’s natural defenses against Candida overgrowth and may help to prevent it changing from its yeast-like form to the invasive filamentous fungus form by helping to prevent candida from finding sites in the gut to grow, according to Lamb.

Addressing urinary tract health is the goal of Bio-Kult’s Pro-Cyan, which contains cranberry extract standardized to give a minimum of 36 mg proanthocyanidins (PACs containing A-type), known to restrict the adhesion ability of bad (pathogenic) bacteria and two probiotic strains as well as vitamin A, which contributes to the normal function of the immune system and the maintenance of mucous membranes.

Nevada-based Hyperbiotics has developed probiotic products that focus on oral health, as research shows that the health of the oral microbiome is closely associated with both digestive and overall health, emphasized Jamie Morea, co-founder. “This is in large part because the mouth is the gateway to the gut, and any bacteria living in the oral microbiome can make their way deep into the intestinal tract, where up to 80 percent of the immune system resides. Additionally, undesirable oral bacteria can escape into the bloodstream via the gums, leading to issues with heart health, blood glucose regulation and brain function.”

To keep the oral microbiome balanced with plenty of beneficial bacteria, Hyperbiotics developed PRO-Dental, an oral probiotic with strains chosen for their ability to combat the inhospitable bacteria that can lead to dental, upper respiratory and systemic issues. In the recent clinical study, Morea pointed out, subjects who took PRO-Dental daily for four months experienced significant reductions in levels of harmful oral bacteria that can cause gum-related health issues.

A companion product is Hyperbiotics’ Activated Charcoal Probiotic Toothpaste, which, according to Morea, contains xylitol to fight pathogenic bacteria, activated coconut charcoal to whiten teeth and balance pH, and probiotic L. paracasei to support a healthy oral microbiome. “In fact, research shows that the L. paracasei in Dental-Lac can help maintain healthy teeth and gums by directly increasing the number of probiotic bacteria and reducing the number of Streptococcus mutans (undesirable bacteria) in the mouth.”

Of course, there are many probiotic products and probiotic-fortified foods such as yogurts that you can recommend to your clients/patients. But keeping these guidelines in mind will help you recommend the most qualitative and effective ones that will encourage your patient/client to assert that he/she feels much better.

Healthy Take Aways

• The metabolic byproducts of a probiotic microorganism may have the greatest effect on a person’s digestive health or on reduction of health issues than does the intake of a probiotic supplement.
• Researchers found that supplementing with Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum and Lactobacillus fermentum positively affected cognitive function and some metabolic statuses in the only human trial in AD patients.
• Dermatologists are starting to prescribe topical probiotics that are formulated with slightly different microbes or microbial ratios than oral probiotics, and are seeing successful results.
• Emerging research is showing auto-immune disorders may be alleviated with the improvement of the human microbiome.

For More Information:

Ayush Herbs, www.ayushherbs.com
Bio-Kult, www.bio-kult.com
Hyperbiotics, www.hyperbiotics.com
Just Thrive Probiotic, www.thriveprobiotic.com
NÜD, www.nudtrition.com
Patient One, www.patientoneformulas.com