Probiotics are one of the most common self-prescribed supplements I see in patients. When I ask them why they are taking them, I often get the standard “I heard they were good for me,” followed by “I’m not sure if they are helping.”
Without understanding why a probiotic can be good for you, it is hard to gauge if it is working for you. Probiotics also come in a variety of types that are specific to different needs. Blindly taking a probiotic is like walking into your health food store and asking for “vitamins” because you heard they were helpful.
To understand probiotics, you must be introduced to your amazing microbiome.
The microbiome consists of the trillions of microorganisms (bacteria, fungi, viruses, etc) that live in and on our bodies. The microbiome exists primarily in our digestive tract but we can also find subsystems on our skin, in our lungs, in our bladders, and our vaginas. We have evolved to live symbiotically with our microbiome, meaning that we rely on one another for survival.
The health of our microbiome is crucial for our overall health.
Digestion, Nutrition, & the Microbiome
The majority of our microbiome exists in our digestive tract, particularly the large intestine. It supports the break-down of a variety of foods, in particular more fibrous foods such as vegetables and legumes. The microbiome also turns indigestible foods into short chain fatty acids (SCFA) which are anti-inflammatory for our system.
A healthy microbiome also plays a role in our metabolic health, aiding in both blood sugar regulation and fat digestion and storage. In animal research, mice without a microbiome are more prone to obesity and diabetes. In humans, we see a similar effect. Those with a healthy balanced microbiome tend to be leaner versus those with “unbalanced” or unhealthy microbiomes tend to be overweight.
The microbiome is considered healthy when there is a good balance between the various species that we know are beneficial to our health, also called commensal organisms. When there is too much of one species or if there are harmful (pathogenic) species present in the microbiome, then it is considered unhealthy.
The food choices that we make have a huge impact on the health of our microbiome. Eating an abundance of vegetables, particularly non-starchy vegetables, fruits, and whole grains has a positive effect on the health of our microbiome. In contrast, diets that are high in refined sugars, sugar alternatives, and preservatives (found in packaged foods) have a profoundly negative effect on our microbiome.
The use of anti-biotics and frequent laxatives also harm our microbiome because they flush out and kill our good bacteria and organisms.
An unhealthy microbiome leads to unhealthy digestion, causing bloating, gas, heartburn, constipation, and diarrhea. It has also been linked to a variety of digestive conditions including irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Research has shown that probiotics can have a positive effect on these conditions by returning the microbiome to a more balanced state.
Immunity, Inflammation, & the Microbiome
A healthy microbiome is also essential for the health of our immune system. Our microbiome is an active part of our immune system and our commensal organisms (good bacteria) will attack outside germs to prevent them from infecting us.
The microbiome also plays a major role in educating our immune system. An unhealthy microbiome tends to be a poor teacher and promotes a more inflammatory immune system. This leads to wide-spread inflammation in your body which has been linked to arthritis, psoriasis, eczema, diabetes, depression, and anxiety.
It also leads to a weaker immune system overall, meaning you are more likely to get sick.
Using probiotics in these conditions can help shift the microbiome to educate a less inflammatory and stronger immune system.
It is also important to note that antibiotics, pain killers, and corticosteroids, which are all used to treat the above conditions, have a negative impact on our microbiome health.
Using probiotics after rounds of these medications is a great practice for supporting your microbiome health.
What Makes a Good Probiotic?
It is always helpful to consult a knowledgeable health care professional when picking a probiotic, especially when it comes to treating specific conditions.
There are specific strains that have been shown to be beneficial for specific conditions. They can also recommend better quality brands to ensure that you are actually getting the probiotics stated on a label.
That said, there are general rules that everyone should know when picking probiotics.
To start, you want a minimum of 10 billion CFU (colony forming units). This is the number of organisms present in the probiotics. Our microbiome organisms vastly outweigh the cells in our body. If you are getting a probiotic with a lower number than 10 billion, the probiotic is likely not making it all the way through your digestive tract and thus won’t be as effective.
You also want to look for a variety of species on the ingredient list, usually 10 -15 total. Most should be lactobacillus species or Bifidobacterium species as these make up the bulk of our microbiome. In specific conditions, you may only want 1-2 species in your probiotic but for general health, a variety is more appropriate.
Most probiotics must be kept in the fridge as they are living organisms. To see noticeable changes, I recommend a minimum of 4 weeks of consistent dosing, although some conditions require up to 3 months of dosing.
The last point I want to make on probiotics is that they are not meant to be taken for a lifetime (really there are very few supplements that would even fall into that category). They should be used strategically and temporarily to shift and balance your microbiome back into its healthiest state.
On a daily basis you should be supporting your microbiome through diet & lifestyle. Aim for 7-9 servings of vegetables per day, drink lots of water, and avoid artificial sweeteners and refined sugar. Consider adding fermented foods in your diet to give your body small doses of probiotics for maintenance. Kimchi, kombucha, sauerkraut, and plain yogurt are all great options to incorporate into your diet.