Tag Archives for " GutHealth "

3 Probiotics 101

It’s been a whirlwind the last few months. I’m teaching my last lecture in Endocrine tomorrow.. I’m excited it’s on functional medicine approach to pre-diabetes and obesity! The best part about teaching part-time is getting to teach what I’m passionate about. After this, I just have lots of grading and course coordination items. But the course ends next week then I’m off to Seattle, WA to speak on diabetes cardiovascular outcomes trials. It’s the same presentation from December in Anaheim showcased at a different meeting. It’s nice when you spend a lot of time on something, to be able to do it twice! For this blog post, I had a lot of help from two students working on this probiotic series, so thank you to Vineeta Rao and Ruth Gunti for your hard work. Soon they will be my colleagues! Enjoy!

Dr. Hartzler


Welcome to probiotics 101, a guide to all your FAQs!

What are probiotics?

‘Probiotics are defined as live microorganisms, which when administered in adequate amounts, confer a health benefit on the host.’ 1 The microorganisms are bacteria of different strains that process our food into nutrients that benefit our health. Probiotics come from the Latin preposition pro (“for”) and the Greek adjective (biōtikos) meaning “fit for life, lively.” Put together this means that probiotics are for life.

Why use probiotics?

Using probiotics enhances the gut microbiota to better do its job.  The gut microbiota/microbiome is the conglomerate of bacteria that live in your gut and work together to bolster the immune system, to fight against potential infections, and to make nutrients such as vitamins, fats and other molecules that are needed by the body to function. 1  Furthermore facets of our modern day western lifestyle, such as diet, stress, geography, as well as sleep and travel patterns can negatively affect our gut microbiome meaning we don’t have a healthy gut to begin with. 2 In addition to the poor lifestyle factors, the increasingly prevalent use proton pump inhibitors is correlated with and probably contributes to “decreased bacterial richness” of  gut microbiome, an increased amount of oral bacteria that is potentially pathogenic present in the gut, and an overall greater “microbial alterations” in the gut than those on antibiotics. 3

How do probiotics work?

While probiotics are most commonly associated with replacing flora or colonizing the gut, modifications made to the gut microbiota are not likely permanent and reflect only one of many actions that probiotics have in the body. Among these actions are immune modulation, anti-inflammatory activity, pathogen antagonism, production of short chain fatty acids, repairing and strengthening of the intestinal barrier, metabolism of gut cholesterol, and enhanced antibody secretion.4 While not all probiotics encompass all of these features, depending on the strain, a given probiotic may provide one or several of these protective benefits.5

What is genus, species, and strain?

Bacteria are usually classified to the public by three names much like people who have first, middle and last names. Therefore the first name is a broad name termed genus, followed by a more specific name called a species finally followed by a strain number that is further specifies the exact kind of bacteria.  A labeled example is below!

What is the evidence for probiotic use?

Numerous review studies indicate that probiotics are beneficial overall, especially for gut health.6 However, evidence for treating or preventing specific conditions through probiotics is best established through clinical trials that demonstrate how probiotics produce a specific effect. While the number of controlled trials demonstrating specific effects in humans is still growing, probiotics have also been evaluated in animal experiments and or other in vitro studies that demonstrate efficacy and safety in terms of their use. 1  Fermented foods with probiotics in them have been consumed for centuries for health benefits. Additionally, the modern diet lacks prebiotic fiber that contributes to a diverse gut microbiome.7

What is the difference between Bifidobacterium and Lactobacillus genus of bacteria?

Lactobacillus bacteria is a type of bacteria that produces lactic acid as an end-product of its metabolism. Bifidobacterium bacteria on the other hand produce lactic acid and acetic acid; both these substances are important for the maintenance of the gut microbiome. 8,9

Here are some of the bacteria in each genus considered to be probiotics.8

Microorganisms
  considered as probiotics
Lactobacillus speciesBifidobacterium species
L. acidophilus 
L. casei 
L. crispatus 
L. gallinarum
 L. gasseri 
L. johnsonii 
L. paracasei 
L. plantarum 
L. reuteri 
L. rhamnosus
B. adolescentis 
B. animalis 
B. bifidum 
B. breve 
B. infantis 
B. lactis
 B. longum

How to know you are getting a good product?

There are many overarching reviews that conclude that probiotics as a whole class are effective, suggesting that many strains share the similar levels of effectiveness. Additionally, there are number of factors that contribute to how probiotics act in our bodies such as genetics, diet and host microbiome that makes it difficult to isolate the effects of one strain over another. However, it is important that the product contains the live bacteria in large doses that will survive the harsh environments of the stomach.6

How much does the specific strain matter when ensuring that you have a good product? As more studies for probiotic use emerge, there is an ongoing controversy about the importance of the strain. On one side of the debate, larger studies that examine multiple clinical trials suggest that probiotics have benefit even when grouping similar strains together in one class. The theory behind this position is that similar strains of probiotics will have actions causing similar effects in the body.6 One the other side of the debate, some clinicians compare strain selection to choosing a particular antibiotic to attack a specific disease-causing microbe.4 Advocates of this position point to the fact that Lactobacillus plantarum DSM 9843 reduces irritable bowel syndrome while Lactobacillus plantarum MF 1298 aggravates the condition and thus conclude that when supporting a specific condition, one should only use a strain that has demonstrated efficacy for that specific condition.10-12

In summary, data for use of probiotics is exploding on a daily basis. Probiotics are useful to promote healthy gut transit and repair and for a myriad of immune benefits.  In addition, data suggests significant changes to the gut microbiome is most easily stimulated by ingestion of prebiotics, which are non-digestible foods that promote and stimulate the growth of bacteria in the gut.13 Prebiotics are often combined with probiotic supplements.  Sometimes they may not be well tolerated by certain individuals especially those that have an imbalance in bacteria. Certain non-gas producing prebiotics may be helpful for some patients. We will talk more about these situations in my next post!

If you are looking for quality probiotics. Please check out my Fullscript store and click on the probiotics category! I’m happy to help with simple questions on products via email or if you are interested in a 1:1 personal GI health consults with my team, please let me know. We are launching tele-health services soon!

SOURCES:

  1. Fijan S. Microorganisms with claimed probiotic properties: an overview of recent literature. Int J Environ Res Public Health. 2014;11(5):4745-67.
  2. Conlon MA, Bird AR. The impact of diet and lifestyle on gut microbiota and human health. Nutrients. 2014;7(1):17-44.
  3. Imhann F, Bonder MJ, Vich vila A, et al. Proton pump inhibitors affect the gut microbiome. Gut. 2016;65(5):740-8.
  4. Probiotic Advisor. The Importance of Strain. https://www.probioticadvisor.com/probiotic-essentials-1/the-importance-of-strain/#.XC-EEPZFxPZ. Accessed January 21, 2019.
  5. Hill, C., et al., Expert consensus document: The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol, 2014. 11(8): p. 506-514.
  6. California Dairy Research Foundation. Is it time to consider generic probiotic effects? http://cdrf.org/2013/03/01/is-it-time-to-consider-generic-probiotic-effects/. Updated March 1, 2013. Accessed August 20, 2018.
  7. Holscher HD. Dietary fiber and prebiotics and the gastrointestinal microbiota. Gut Microbes. 2017;8(2):172-184.
  8. Kechagia M, Basoulis D, Konstantopoulou S, et al. Health benefits of probiotics: a review. ISRN Nutr. 2013;2013:481651.
  9. Bifidobacteria Institute. Difference between bifidobacteria and lactobacillus. http://bb536.jp/english/basic/basic03.html. Accessed August 20, 2018.
  10. Ducrotte, P., P. Sawant, and V. Jayanthi, Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome. World J Gastroenterol, 2012. 18(30): p. 4012-8.
  11. Niedzielin, K., H. Kordecki, and B. Birkenfeld, A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol, 2001. 13: p. 1143-1147.
  12. Ligaarden, S.C., et al., A candidate probiotic with unfavourable effects in subjects with irritable bowel syndrome: a randomised controlled trial. BMC Gastroenterol, 2010. 10: p. 16.
  13. Cashman K. Prebiotics and calcium bioavailability. Curr Issues Intest
    Microbiol. 2003 Mar;4(1):21-32. Review.

Allergic Rhinitis & The Gut..Is it time for Probiotics?

Despite summer being in full swing here in Ohio, there are a lot of people here and across the country are who are still suffering from seasonal allergies and what the medical community refers to as allergic rhinitis (AR). AR is one of the most common diseases that effects nearly 1 in every 6 Americans. AR is an inflammatory condition often leading to symptoms such as congestion, runny nose, sneezing, nasal itching, and watery/itching eyes.1 

Some experience seasonal allergies that are temporary due to triggers being pollens that come and go depending on the season. Others experience year-round or perennial allergies due to dust mites and continued triggers. Some patients could experience what is referred to as episodic allergies from triggers they encounter outside of their typical environment such as family members’ pets.1

Guidelines recommend avoiding allergic triggers as a first step in treatment such as removal of pets, using air filtration systems, and bed covers (to avoid dust mites). 1 Nasal saline rinses can be very helpful to clear out the pollens from the nasal passage before sleeping, this is my favorite one that is easy to use! Washing your hair before sleeping can also help reduce the pollens that attach to our hair follicles. From a western medicine standpoint, during serious allergy flare ups, I need to use a topical nasal steroid such as fluticasone. 1 The great part is they are now available over the counter. This can help calm down the inflammation short term as you consider other ways to address allergies more naturally. Budesonide  is the nasal steroid of choice for pregnant women, using the lowest effective dose and duration is recommended.2,3

An interesting discussion recently has been the connection between the gut and the lack of diverse healthy microbes to the development of allergies. Multiple studies indicate that the increased incidence of autoimmune and allergic diseases in developed countries may be associated with reduced diversity in bacteria exposure and changes of bacteria in various body tissue. AR and atopic eczema have been shown to be related to changes in gut microbial composition.4

“Leaky gut” is a term for an impaired intestinal barrier or an increase in gut permeability, which may also play a role in the development of asthma and allergies. The intestine should play a role as the gatekeeper of immunity and when this is broken the body can start to have a reaction to typical proteins called antigens it would not normally react to. This can include food reactions, or reactions in the nasal passageways or lungs. AR is considered by some to be an early form of an autoimmune disease.4

Thus an important part of treating seasonal allergies is making sure the gut is healthy, this is a whole post in itself that will be coming soon, but for now starting with a high quality probiotic and avoiding allergic triggers including foods that further trigger allergy symptoms is a start. For me I have a reaction to ragweed in the fall and I have found that sunflower seeds trigger my allergic rhinitis because they are similar plants. Paying attention to food triggers can be very helpful! In regards to probiotics, Vliagoftis et al performed a meta-analysis of 16 clinical trials on the treatment of AR and Asthma and found that 9 of 12 studies that elevated clinical outcomes of AR showed improvement due to the use of probiotics. They determined that probiotics may have a beneficial effect by reducing symptom severity and medication use. Most of these studies reported used some form of Lactobacillus species such as Lactobacillus casei, Lactobacillus acidophilus, Lactobacillus paracasei, Lactobacillus rhamnosus, some included a combination with Bifidobacterium strains.5

My favorite probiotic for adults right now is OrthoBiotic from OrthoMolecular. This is a high quality mix of the strains discussed above.  It also includes Saccharomyces boulardii which is a beneficial non-pathogenic yeast that works to balance intestinal flora.  The only patients who should not take Saccharomyces would be those with compromised immune systems. Each OrthoBiotic capsule provides seven proven probiotic strains chosen for their ability to withstand the harsh gastrointestinal (GI) environment and adhere to the intestinal tract. The specific strains found in this product have be shown to increase Secretory IgA which provides enhanced gut Immunity.

Bifidobacterium lactis (B. lactis), one of the probiotics in the above formula, is predominantly found in the colon. A double-blind, randomized placebo-controlled trial on subjects receiving B. lactis or placebo for eight weeks found that B. lactis supported a balanced immune response in individuals hypersensitive to environmental allergens.6 Flora Boost can be a great option for toddlers and kiddos that don’t swallow pills yet.

Ther-Biotic Complete is another great probiotic I recommend by Klaire Labs. They also have a Women’s Formula as well that supports healthy colonization in the vaginal tract as well as provides the probiotic strains above shown to be beneficial in allergic conditions. Klaire Labs formulas do need to be refrigerated upon arrival.

You can find all of these high quality probiotics in my Supplement Store on FullScript. If you have questions, feel free to reach out! Don’t forget to contact me & sign up for blog updates if you want 15% off your first order.

Stayed tuned for my next post which will discuss my favorite supplements (Quercetin, Stinging Nettles) and nutrients (Vitamin C, Bromelain, N-Acetyl-L-Cysteine) and their useful role in supporting allergic conditions. And if you need recommendations for probiotics for babies, head over to this post.

 

References:

  1. Seidman et al. Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology–Head and Neck Surgery 2015, Vol. 152(1S) S1–S43.
  2. Wallace DV, Dykewicz MS, Bernstein DI, et al, “The Diagnosis and Management of Rhinitis: An Updated Practice Parameter,”J Allergy Clin Immunol, 2008, 122(2 Suppl):1-84.[PubMed 18662584]
  3. NAEPP Working Group Report on “Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment,” National Institutes of Health, National Heart, Lung, and Blood Institute, NIH Publication No. 05-5236, March 2005. Available athttp://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg/astpreg_full.pdf
  4. Hormannsperger G, et al. Gut matters: Microbe-host interactions in allergic diseases. J Allergy Clin Immunol 2012;129:1452-9.
  5. Vliagoftis et al. Probiotics for the treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials. Ann Allergy Asthma Immunol. 2008;101:570–579
  6. Singh A, Hacini-Rachinel F, Gosoniu ML, Bourdeau T, Holvoet S, Doucet-Ladeveze R, Beaumont M, Mercenier A, Nutten S. Immune-modulatory effect of probiotic Bifidobacterium lactis NCC2818 in individuals suffering from seasonal allergic rhinitis to grass pollen: an exploratory, randomized, placebo-controlled clinical trial. Eur J Clin Nut. 2013 Feb;67(2):161-7.

5 Babies and Probiotics

Over recent years the connection between the gut microbiome (the bacteria in our gut, also know as our gut flora!) and chronic diseases has been stronger than ever.  There are a large number of publications linking less diverse flora to a myriad of conditions especially those in the asthma, allergy, and autoimmune realm.

The bacteria in our gut play several roles including:1

  • Critical role in regulation of the immune system
  • Provide protection against pathogen (bad bugs!) overgrowth
  • Influence host-cell growth and blood vessel growth
  • Regulate intestinal endocrine functions, neurologic signaling, and bone density
  • Provide a source of energy (5 to 10% of daily host energy requirements);
  • Biosynthesize vitamins, neurotransmitters, and multiple other compounds
  • Metabolize bile salts
  • React to or modify specific drugs
  • Eliminate exogenous toxins

Currently researchers are even studying how to implant drug peptides into the bacteria in our gut for certain conditions. One particularly interesting one is for the treatment of inflammatory Bowel disease, which often severe cases come with injectable agents that weaken the immune system all over. Wouldn’t it be great if we had targeted therapy just in the gut!

So the question is if our gut is so important, how do we help our children start out on the right track with solid gut flora.  The answer….you guessed it..probiotics!  Probiotics are “Live microbes that confer health benefits when administered in adequate amounts in the host.”1The key with infants though is to get them probiotics early in the first few days when their gut is designed to multiply those good bugs! The in utero environment was once considered sterile. However recently, DNA studies of the micro biome have found bacterial species in the placentas of healthy mothers, in amniotic fluid of preterm infants, and in meconium.1

Ideally babies born vaginally shouldn’t need this right, they swallow fluid during delivery through the vaginal canal that should seed their gut? While that is true, most of us Mommas have taken antibiotics in our lifetime, if not multiple courses, been under stress (which has been proven to change gut flora!)2, and often times are eating or have eaten a diet previously that was not friendly towards growing and multiplying good bacteria.  We also live in an environment where traces of antibiotics are in our water supply and food chain. So I recommend every baby whether born vaginally or c-section get probiotics during the first week of life. I also recommend Mommas take probiotics throughout their pregnancy.

Another way to help the flora grow is with breastmilk. Studies3,4 have shown that the guts of breast fed babies vs formula fed babies are different compositions of bacteria. Breastfed babies have more beneficial bifidobacteriam species.  Exclusive and partial formula-feeding have been shown to alter the gut bacteria toward adult patterns, increase pro-inflammatory bacterial species, increase gut permeability (leaky gut) and result in lower concentrations of fecal short-chain fatty acids compared with exclusive breastfeeding.4 While I realize this isn’t possible for every women, from my experience it’s hard, especially during those first few months.  Believe me lots of tears were shed in the process of making it work for us with my first child. Then of course pumping if you are working out of the home is hard too. But I promise it’s worth the attempt at least. The IGG in the breastmilk also helps seal the gut lining which makes your babies less susceptible to gut damage and autoimmune conditions such as type 1 diabetes5, and allergies, asthma, and airway disease.6

Studies have shown infant gut flora diversity and healthy guts have been linked to less risk of asthma/wheezing, food allergies, and many other autoimmune conditions.5-9 Some data is even suggesting good flora can modulate behavioral and neurodevelopmental disorders.10

Ther-Biotic Women’s Formula

Ther-Biotic for Infants

It’s pretty simple, babies don’t need a large amount of probiotics just a little bit to get their gut started and if you get it early, you don’t may not have to supplement daily later on. Most functional medicine providers and myself recommend either using a Women’s Formula like Ther-biotic® Women’s Formula  by Klaire Labs or their Ther-biotic® Infant Powder.  With the capsules, you can open the capsule and place a small amount of the powder on the breast or the tongue of the infant before feeding, then mom can close the capsule and swallow the rest.

After a few days of that you can also use the infant powder or continue to share yours. They are similar formulas.  The Women’s formula is designed to be the flora that are found in the vaginal canal so it’s just want baby should have swallowed in an ideal world. If baby becomes too gassy after a week or so of the powders, you can start to decrease the dose to 1-2 times per week.

UltraFlora® Baby

OrthoMolecular Saccaromyces product

Metagenics also makes an infant drop called UltraFlora® Baby  that has been easily to use with my son.  If gas becomes an issue with the baby again only give a few times a week after that initial week and consider using a strain called Saccaromyces Boulardii which is a healthy yeast that balances the gut flora and is well known for it’s beneficial effects in acute and chronic GI conditions.11  I is not a gas producing organism.I personally like the OrthoMolecular Saccaromyces product that doesn’t have to be stored in the fridge but Klaire Labs makes one too. There have been case reports of Saccharomyces Boulardii blood stream infections in immunocompromised patients, so I would not recommend use for those patients or premature infants.11

I wish I would have known to give probiotics earlier with my daughter, we started them at about 5 weeks after she was colicky and had reflux. Along with an elimination diet for me, she was lots better!  So it’s not too late even if you are reading this and your child is older they may benefit from replacing gut flora, depending on age, they may need a different formula. Our daughter was allergic to tree nuts, eggs, and a few other things early on, verified by skin prick testing, after a few years of vitamin D and probiotics and eating a gut friendly diet for the most part. The most recent skin test was negative for everything tested! Praise the Lord! She enjoyed splitting a Cashew LaraBar with mom today no problems! Feel free to reach out if you need specific recommendations on probiotics for you or your loved one!

More on gut healing in adults and kiddos to come! Also a post to come on metabolic disease and the gut, early life exposure to antibiotics can influence risk of diabetes and other metabolic conditions like obesity and allergies!12,13

*this post contains affiliate links to products I recommend, all the probiotics recommended in this post can be found in my FullScript Store You do have to set-up a quick account to use. Thanks for supporting the blog, remember 10% goes to support various ministries! Check out My Favorite Things for more details.

References

  1. Lynch S, Pederson O. The human intestinal microbiome in health and disease. N Engl J Med 2016;375:2369-79.DOI: 10.1056/NEJMra1600266.
  2. Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011 Dec;62(6):591-9.
  3. Madan JC, Hoen AG, Lundgren SN, Farzan SF, Cottingham KL, Morrison HG, Sogin ML, Li H, Moore JH, Karagas MR. Association of Cesarean Delivery and Formula Supplementation With the Intestinal Microbiome of 6-Week-Old Infants. JAMA Pediatr. 2016;170(3):212-219. doi:10.1001/jamapediatrics.2015.3732
  4. O’Sullivan A, Farver M, Smilowitz JT. The Influence of Early Infant-Feeding Practices on the Intestinal Microbiome and Body Composition in Infants. Nutrition and Metabolic Insights. 2015;8(Suppl 1):1-9. doi:10.4137/NMI.S29530.
  5. Endesfelder D, Engel M, Zu Castell W. Gut Immunity and Type 1 Diabetes: a Mélange of Microbes, Diet, and Host Interactions?. Current Diabetes Reports [serial online]. July 2016;16(7):60. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017 doi:10.1007/s11892-016-0753-3.
  6. Huang et al. Breastfeeding and timing of first dietary introduction in relation to childhood asthma, allergies, and airway diseases: A cross-sectional study. Journal of Asthma. 2016; Published on-line 07 Sept 2016. P 1-10. http://dx.doi.org/10.1080/02770903.2016.1231203
  7. Uusitalo U, Liu X, Virtanen S, et al. Association of Early Exposure of Probiotics and Islet Autoimmunity in the TEDDY Study. JAMA Pediatrics [serial online]. January 2016;170(1):20-28. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017.
  8. Arrieta M, Stiemsma L, Finlay B, et al. Early infancy microbial and metabolic alterations affect risk of childhood asthma. Science Translational Medicine [serial online]. September 30, 2015;7(307):307ra152. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017.
  9. Fujimura K, Sitarik A, Lynch S, et al. Neonatal gut microbiota associates with childhood multisensitized atopy and T cell differentiation. Nature Medicine [serial online]. October 2016;22(10):1187-1191. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017.
  10. Hsiao E, McBride S, Mazmanian S, et al. Microbiota modulate behavioral and physiological abnormalities associated with neurodevelopmental disorders. Cell [serial online]. December 19, 2013;155(7):1451-1463. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017.
  11. Kelesidis T, Pothoulakis C. Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders. Therapeutic Advances in Gastroenterology. 2012;5(2):111-125. doi:10.1177/1756283X11428502
  12. Yallapragada S, Nash C, Robinson D. Early-Life Exposure to Antibiotics, Alterations in the Intestinal Microbiome, and Risk of Metabolic Disease in Children and Adults. Pediatric Annals [serial online]. November 2015;44(11):e265-e269. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017
  13. Johnson C, Ownby D, Joseph C, et al. Antibiotic exposure in early infancy and risk for childhood atopy. The Journal Of Allergy And Clinical Immunology [serial online]. June 2005;115(6):1218-1224. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed February 19, 2017.