Diet, travel, stress, illness, aging and the use of antibiotics all contribute to an imbalance or “dysbiosis” of the intestinal tract leading to digestive problems. These problems cause some two million people to visit the doctor each year. It’s no wonder that the heartburn medication Nexium, with sales of almost $6.0 billion, was the number two selling drug in the U.S. in 2009.
Probiotics – the beneficial bacteria in our intestinal tract – can help relieve gastrointestinal problems like constipation, diarrhea, bloating and gas. Consumers are increasingly interested in more natural approaches to solve digestive problems.
Non-profit websites such as US Probiotics were designed to educate consumers and medical professionals about the health benefits of probiotics for women and men and the latest research and development. Recently, The International Scientific Association for Probiotics and Prebiotics (ISAPP) unveiled new guidelines to help consumers make informed decisions about prebiotic and probiotic products.
If you’re looking to incorporate these beneficial organisms into your diet, here’s some information to help you better understand the role, benefits and what to look for when selecting a probiotic.
As a Greek word, probiotic means “for life.” In 2001, the World Health Organization (WHO) defined probiotics as “live microorganisms, which when administered in adequate amounts, confer health benefits on the host.” Probiotics balance and restore intestinal microbiota or protect against an upset in the equilibrium of the intestinal tract.
The microflora of the intestinal tract is dominated by four types of bacteria: Bacteroides, Bifidobacterium, Eubacterium and Peptostreptoccus. Of the four, Bifidobacterium is thought to be the most important in the digestive environment.
Although the benefits of consuming a probiotic depends on the type of probiotic bacteria used and the amount consumed, most experts agree that daily consumption is beneficial.
With a balanced level of healthy bacteria in the intestinal tract, digestive function can be enhanced. For this reason, probiotics can play a beneficial role for a number of intestinal problems including constipation, diarrhea, inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS).
Fermented milk products like yogurt, can help decrease the symptoms of lactose intolerance including nausea, cramps, bloating and gas. Individuals with lactose intolerance do not product enough lactase, the enzyme needed to digest lactose, the natural sugar found in milk and dairy products. Probiotics that contain Lactobacillus reduce lactose content by predigesting some of the lactose and metabolizing it into lactic acid thereby decreasing the symptoms of lactose intolerance.
A healthy intestinal microflora may also help to strengthen the body’s immune system. About 70% of the immune system is located in the digestive tract where specialized cells help to defend the body. The bacteria that line the intestinal tract help to defend against pathogens. Regular consumption of probiotics helps to strengthen this barrier.
Some specific strains of bacteria provide condition-specific benefits. A recent study showed that children in daycare given L. reuteri suffered less from fever, stomach infection and common colds than other children in the daycare setting. The strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 have both been shown to support vaginal health in women. Clinical studies using UAS Laboratories’ Lactobacillus acidophilus DDS-1 suggests that this probiotic can be effective in the prevention and recurrence of urinary tract infections (UTIs).
A probiotic is defined by its genus (e.g., Lactobacillus), species (e.g, rhamnosus) and strain designation (often a combination of letters and numbers). Different strains of the same species do not necessarily have the same effect or impart a desired health benefit. Therefore, it is important to differentiate among products based on clinical research that supports a specific strain’s claims. It is especially important that probiotics that make claims of health benefits be studied in well-controlled clinical trials in humans.
In addition to containing the specific strain(s) of bacteria, a probiotic should also have the same levels as those used in published research. Probiotics are measured in colony forming units or CFUs, which is the measure of live microbes in the product. Importantly, more CFUs do not necessarily mean that the product is better or more effective. Different probiotics have shown to be effective at different levels. Scientific literature has documented health benefits for products ranging from 50 million to more than 1 trillion CFUs per day.
A trusted manufacturer will indicate the CFUs and strain information on consumer packaging and literature. For example, the bacterial strain used in Dannon’s Activia product is trademarked as Bifidus Regularis. Information on the company’s website provides references to the scientific literature associated with the specific strain used in Activia which is Bifidobacterium animalis DN-173 010.
A key area of concern with probiotics is quality control. Recent reviews have found many probiotic supplements do not contain what they claim. To ensure the purity and quality of its Align probiotic supplement, P&G has developed bacterial bar coding which can identify the specific Bifantis strain of Bifidobacterium between 30 other very closely related strains.
What are Prebiotics?
Prebiotics act as a food source for the bacteria with beneficial consequences for the host. With a ready available food source, beneficial bacteria can replicate in the intestinal tract. Probiotics directly repopulate the intestinal tract with the beneficial bacteria whereas prebiotics provide an environment which is hospitable to the beneficial bacteria.
Prebiotics and fiber are similar in that they are both non-digestible carbohydrates and are fermented by the gut. Prebiotics differ from fiber in that they must be selectively used by only the beneficial bacteria to confer certain health benefits.
Prebiotics occur naturally in foods such as leek, asparagus, chicory, Jerusalem artichoke, garlic, artichoke, onion, wheat, oat and soybean. Prebiotic compounds are also added to many prepared foods such as yogurt, cereal, bread, biscuit, milk desserts, ice cream, spreads, drinks and infant formula.
Certain prebiotics, when used in adequate amounts, have been shown to provide health benefits including improved digestive function and intestinal environment, positive modulation of immunity and metabolism, improved lipid metabolism and improved absorption of dietary minerals. Not surprisingly, prebiotics complement probiotic functions.
A branded prebiotic called Beneo which is made from inulin and oligofructose (natural food ingredients extracted from the chicory root), has shown in clinical studies to enhance satiety as well as lower energy and food intake. With over two-thirds of the population overweight or obese, expect to see this food ingredient in an increasing array of functional foods.
In order for a prebiotic to provide benefit to the host, it must resist degradation by stomach acids. Once in the intestine, the prebiotic must be broken down or fermented by beneficial organisms in the gut. Good prebiotics are stable under heat when dried and can be stored at room temperature for months. The most reliable prebiotics have been tested on humans and are available in sufficient amounts to confer a benefit.
Types of Prebiotics
The most widely accepted prebiotics are inulin – a type of fructooligosaccharides (FOS) derived from chicory – and oligofructose because human studies indicate their ingestion directly increases levels of Bifidobacteria in the colon. A daily dose of 5-8 grams of fructooligosaccharides (FOS) or galactoooligosaccharides (GOS) has a prebiotic effect in adults.
One of the challenges of delivering a quality product is the ability of the probiotic to survive passage through the stomach. If the probiotic survives the stomach and bile acids, it then must adhere to intestinal cells and colonize within the human intestine. The probiotic also must be antagonistic toward pathogenic bacteria.
Supplementing with Probiotics
A wide array of dairy products, functional foods and nutritional supplements are formulated with probiotics or a combination of prebiotics/probiotics.
Cultured Dairy. Cultured dairy foods result from the fermentation of milk products under controlled conditions by lactic acid producing probiotic cultures (i.e., selected specific microorganisms). Dairy is a ideal choice for obtaining probiotic bacteria because dairy helps to neutralize stomach acids thereby increasing the chance that the bacteria make it intact to the intestine.
Dairy product forms are ideal because the short shelf-life and refrigeration allows the living microorganisms to remain as active living cultures. Fermented dairy products like yogurt are beneficial because they are a source of calcium, riboflavin, vitamin B12, potassium and certain amino acids. A few brands offering dairy and non-dairy probiotics include Horizon Organic, Dannon (Activia), Bio-K and Yakult.
Functional Foods. Probiotics are increasingly being added to a wide array of foods. New technologies based on microencapsulation of the dried live bacteria, provide increased resistance to the temperatures and pressure environments typically found of many food processes.
To enhance the beneficial effects of each other, some companies are combining a prebiotic with a probiotic to create a synbiotic (“syn” for together and “biotic” an ecosystem made up of a naturally occurring organisms) functional food. Two brands offering functional foods that contain probiotics include Attune Foods and Good Belly.
Nutritional Supplements. While delivering probiotics in a supplement is more appealing to some consumers, this product delivery form can be challenging. Probiotic bacteria are damaged by heat, moisture, light and exposure to air. Dried probiotic organisms, like those used in supplements, are activated when hydrated. Once activated, they quickly expire, so shelf life and viability through time of consumption are critical to an effective product.
This month, VitaMedica is proud to introduce Probiotic-8. This supplement contains 8 different species of beneficial bacteria. Each 8 billion serving of live beneficial bacteria favorably alters intestinal balance, promotes healthy digestion and supports immune system function. The addition of the prebiotic FOS assists in the healthy growth of beneficial organisms. Our enteric coated capsules deliver microflora directly to the intestine, bypassing the harsh acidic conditions of the stomach. VitaMedica’s Probiotic-8 is ideally suited for daily use or after antibiotics. Be on the lookout later this month for this exciting new product introduction!
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.