Probiotics are one of the most common self-prescribed supplements I see for both gut health and for general health. 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.
Why we care about the microbiome?
A healthy microbiome is an ecosystem that helps us not only digest our food but also regulate our metabolism, our mood, and our immune function.
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.
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 healthy microbiome?
We consider a healthy microbiome to be balanced and an unhealthy microbiome to be unbalanced. The term for an unbalanced microbiome is dysbiosis and we tend to see poor ratios between different species in this state.
Often we get hung up on the idea of good bacteria and bad bacteria as well as the fear of overgrowth and the presence of organism that should not be there. I find it more helpful to focus on = balance. A balanced and strong ecosystem won't allow for invaders.
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. Stress and poor sleep also tend to suppress our microbiome
An unhealthy microbiome or dysbiosis leads to unhealthy digestion, causing bloating, gas, heartburn, constipation, and diarrhea. We see dysbiosis in a variety of conditions but particularly IBS, IBD, and chronic constipation.
How do probiotics fit into the microbiome conversation?
Probiotics are live organisms that are generally meant to mimic or provide healthy bacteria to our microbiome. There are different probiotics for different conditions because the helpful strains vary depending on what you are trying to achieve.
Probiotics don't necessarily change our microbiome but rather contribute to it's overall
function. Often times when we stop probiotics their benefits will stop shortly after.
This is why its important to also consider prebiotics and fermented foods.
Timing of probiotics is really important and often when we don't see results it's because we added them in at the wrong time
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.
Picking a probiotic that helps with constipation might not help you if you're struggling with diarrhea. This is why it's helpful to have guidance.
Most good probiotics have 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, especially if you're targeting the large intestine.
This is not a universal rule and if you're picking a single strain probiotic this doesn't necessarily apply. Nor does it necessarily apply if you're trying to target the mouth, stomach, or small intestine.
For general health you 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.
For conditions like IBS, we tend to favor Bifidobacterium species.
For constipation and heartburn, a species called Lactobacillus Reuteri has been shown to be pretty helpful.
For diarrhea, stomach bugs, and antibiotics, Saccharomyces Boulardii is a strong contender.
Again, everyone is different and a probiotic chosen specifically for your needs is going to work best.
Finally, probiotics take time to start to have an impact on your health. To see noticeable changes, I recommend a minimum of 4 weeks of consistent dosing, although most conditions require up to 3 months of dosing before we can evaluate if they are helping.
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.
Looking for more?
The world of gut health can feel overwhelming. There is so much information out there and it's hard to know what you should be following. It can also feel difficult knowing how to start.
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