Download Probiotics — for life

Probiotics — for life!
by Marcelle Pick, OB/GYN NP
Sometimes a patient will ask me what I consider to be the secrets of good health.
Of course, they already know many of my “secrets” — my patients are very
well-read. But I am surprised by how few women know about the tiny, everbusy microorganisms that inhabit our digestive systems, how vital they are to
wellness, and what can be done to help them flourish.
There are trillions of these microorganisms colonizing the surfaces and cavities
of our bodies — there are ten times as many of them in and on our bodies as
there are human cells! When we’re healthy, it is in large part because they’re healthy. Called
beneficial flora, these small friends help us digest and absorb our food, shore up our immune systems,
detoxify noxious compounds, even contribute to the manufacture of essential vitamins. The term
probiotics, a word you may be hearing more often these days, refers to foods or supplements
containing these live beneficial microbes, primarily bacterial strains and yeast, that can be used to
fortify or rebuild our own natural flora.
By contrast, impaired or imbalanced body flora — including bacteria, viruses, fungi, and protozoans
— are implicated in heart disease, allergies and asthma, skin disorders, obesity, IBS and digestive
problems, urinary tract infections, certain cancers, Alzheimer’s and much more — both acute
conditions and chronic diseases. Since disease-causing bugs in the gut must compete with the
“normal” microbes already in residence, daily probiotic use can be an effective preventative and
therapeutic measure to help us keep the balance of intestinal flora tipped toward the positive side.
The truth is that feeling well depends on keeping your friendly bacteria happy — think how sick you
feel when unfriendly microorganisms get the upper hand with a case of food poisoning, Montezuma’s
revenge, or intestinal flu. You can keep this community thriving with a good diet, good health habits,
and supplementing with probiotics. Many dairy manufacturers and other food industries are now
advertising probiotic-enhanced “functional” foods, and natural food stores carry several varieties of
probiotics. But the choices can be overwhelming when looking for the best probiotic — so let’s talk
about what you need to know.
The flora in your GI tract — it’s a jungle in there!
Imagine that your mouth, large intestines, colon, respiratory system, skin and vagina are all a lush
organic garden, filled with exotic plants. Provided with adequate nutrients, water, beneficial insects
and soil microbes, your garden flourishes. Even when disease or pests present themselves, your garden
gate is strong and the bad guys are easily repelled. But what happens when conditions are suboptimal,
or the ground is razed? Your prized specimens weaken and succumb, pests and weeds take hold, and
the whole delicate ecosystem is overrun. Of course, this is just a metaphor for what happens any time
you get an infection, become ill, take antibiotics, undergo hospitalization or surgery, travel, get rundown, or find you’re just too busy to eat right and take care of yourself.
At last count, scientists estimate that around 750 trillion bacteria, yeast and other microorganisms
inhabit a healthy woman’s body. They make up three to five pounds of your total body weight, and
their genes are estimated to outnumber your own by about a hundredfold! In the buzzing metropolis of
your GI tract, there is ample surface area for these microbes to colonize, but competition for real estate
is high. Through a process of “competitive exclusion,” how you treat your body determines which
bacteria get residence — good, bad or indifferent.
Of the trillions of microbes in your body, researchers have identified some — but by no means all —
of the friendly flora species. Our knowledge about the native microbial inhabitants of our bodies is
beginning to explode, thanks to new tools developed in the branch of molecular biology known as
metagenomics. Scientists estimate we’ve made the acquaintance of a mere 1–2% of our full
complement of microflora! Categorized by microbiologists through a complex process of culturing
and DNA sequencing, essential players in the gut include Escherichia, Lactobacillus, and
Bifidobacterium. Other common gut inhabitants include Bacteroides, Clostridium, Fusobacterium,
Eubacterium, Streptococcusand certain yeast (Candida) strains.
What’s truly amazing, though, is not only how many kinds of these tiny creatures are present, but how
complex the differences among them are. As with all things in the living world, balance is more
fundamental than numbers. Individual species can be both beneficial and detrimental, for example,
depending on a number of factors aside from sheer numbers: life stage; whether they’ve mutated into
a beneficial or harmful strain (antibiotics impact this big time); location in your body; even which
tinier microorganisms might be hyperparasitizing them!
This is the case with E. coli, Candida and strep. Regarding location in the body, for example, the fecal
coliform E. coli “behaves itself” when it’s in your intestines and colon, but causes infection once it
gets into your urinary tract. (That’s why it’s so important to wipe front-to-back when using the
bathroom!) Everyone needs a “little” yeast, too — Candida is common in most women’s bodies, but
as long as a neighboring yeast called Saccharomyces keeps residence too, it generally doesn’t get out
of hand. As for hyperparasites, a colony of E. coli itself can contract a tiny virus (called a bacteriophage = “eats bacteria”) and get wiped out. We are only just beginning to comprehend how complex
the life within us can be!
Over the millennia, we’ve evolved a mutually beneficial, symbiotic relationship with our microflora.
As long as we provide a hospitable environment, they remain as paying guests, helping digestion,
metabolism, detoxification, and maintaining a balanced immunological response to potential allergens.
As infants, our intestinal tract cannot mature efficiently without them. Many researchers believe that
some allergies are rooted in a deficiency of friendly flora in childhood, resulting in an underdeveloped
GI tract and compromised immune response.
Like most microbes, beneficial bacteria can be inhaled or acquired by touch, but more often than not
they find their way into the body with what we eat. Fermented foods like sauerkraut, kefir, kim chee,
tempeh and yogurt contain active cultures of beneficial bacteria. The first beneficial microbe in our gut
(Bifidobacterium infantis) is introduced through our mother’s breast milk during the initial days of life,
helping us digest milk sugars. As we mature, other species, like Lactobacillus, colonize the intestines,
colon and vagina.
All these microorganisms are sensitive to acidity (pH) levels, and prefer their environments warm and
dark. They flourish when they get the right food and languish when they do not. What you eat early on
in life influences which strains colonize your GI tract. Evidence suggests that a kind of unique
microbial fingerprint is established in the early years of life that may reflect an individual’s initial diet
and birth culture. This begs the question of whether inherited food sensitivities, like gluten intolerance,
are more the product of primary gut flora or genetics. Perhaps research will tell us more in the future.
Gut flora are also susceptible to sudden changes in their environment, and will die off in the millions
when conditions aren’t right. Illness, stress, and medication use affect the balance of microorganisms,
as well as the speed of peristalsis (the wave-like action of the digestive system). But because gut flora
get their food by breaking down what we eat, diet is the most important factor.
Beneficial bacteria, digestion and nutrition — a dynamic
partnership
Within the gut community and beyond, each type of flora has a specific DNA code that defines its
mechanisms of action. Individual strains inhabit certain sections of the GI tract and target certain
sugars, proteins or fats for digestion. Scientists have only decoded about 10% of friendly gut flora, but
even these preliminary data prove how dependent we are on them.
Many species of beneficial bacteria — such as Lactobacillus bulgaricus and L. thermophilus, which
are used in fermenting yogurt, as well as the near-ubiquitous E. coli — manufacture B vitamins and
vitamin K. They also break otherwise indigestible carbohydrates down into short-chain fatty acids,
providing us with energy and nutrients. Other forms of bacteria digest proteins, freeing up their amino
acids for absorption. And some target the digestion and storage of fat, helping us normalize our
cholesterol and triglyceride levels. Acidophilus and Bifidobacterium strains increase the bioavailability
of minerals that need short-chain fatty acids for optimal absorption, such as magnesium, iron, copper
and manganese.
Good intestinal flora help prevent bloating, gas, and yeast overgrowth by controlling the pH (acidity
versus alkalinity) level of the intestines through production of lactic acid. The main bacterial phyla in
the colon, Bacteroides and Firmicutes, and the ancient, single-celled organisms called Archaea, all
consume hydrogen, generate methane, and regulate bowel movements. In babies, these helpful
organisms stem diaper rash, diarrhea, and colic, as well as preventing allergies.
Gut flora and immunity
Beneficial bacteria reinforce the mucosal barrier of the intestines, which is associated with the gutassociated lymph tissue (GALT), helping to prevent pathogens, toxins and allergens from gaining
access to the rest of the body. In this way, their presence “teaches” the immune system which allergens
and toxins are tolerable and which need to be disposed of.
Some bacteria have a stimulating effect on the immune system, by increasing T–cell counts, for
example. In a recent study reported by the Annals of Nutrition and Metabolism, the number of certain
T–lymphocytes that target cytotoxins (T2, T3 and T4) jumped by more than 28% in healthy young
female test subjects after they ate conventional yogurt daily for one month.
Other good bacteria produce natural antibiotics and antifungals; for instance, Streptococcus salivarius
manufactures an antiseptic that neutralizes the sulfur compounds responsible for bad breath (halitosis).
Friendly flora also keep unfriendly bacteria in check by depriving them of nutrients and secreting acids
(acetic, lactic, and formic) that create a hostile environment for pathogens.
Gut flora, hormones, and metabolism
Beneficial flora metabolize and recycle hormones, including estrogen, thyroid hormones, and
phytoestrogens from food sources, which can help offset symptoms of menopause, PMS and
perimenopause. In this way, they help maintain proper hormonal balance, and may protect bone and
breast health as well. They also detoxify drugs and other potentially harmful compounds we put into
our systems on purpose or by accident. There is evidence that some probiotics may have anti-tumor,
anticancer effects by helping us metabolize specific food components (like antioxidants and
flavonoids) into useable forms.
Vaginal yeast infections and systemic yeast (Candida) — an
example
Candida albicans is a type of yeast organism that normally helps us digest carbohydrates. Candidiasis,
or yeast overgrowth, is an example of what happens when there is an imbalance in the body
environment. Like weeds in the garden, once the balance has been shifted toward the negative, it can
take a lot of work to regain a desirable floral balance. Without proper and consistent attention, weeds
will grow back and run riot, as in cases of chronic vaginitis or systemic yeast overgrowth.
While conventional doctors accept and treat the reality of vaginitis, there is still a lot of resistance in
Western medicine to the concept of systemic yeast. But the truth is, the causes and effects of bacterial
and yeast overgrowth, and thus the treatment protocol, are similar. The basic idea is this: weed out the
bad guys through deprivation and antimicrobials, then repopulate with beneficial species.
Conventional medicine excels at the first step. There are scores of prescription antifungals and
antibiotics that will knock out the invasive species. But not much is done about the second — and
most important — phase: repopulation with good bacteria.
Using vaginitis as an example, we understand that when the good microbes are in the majority, they
keep the vaginal environment slightly acidic and hostile to infectious agents. If the environment
changes in pH from antibiotic use, illness, or poor dietary choices, the immune system is weakened. If
infectious bacteria are then introduced from the rectum or other sources, the tables are quickly turned
and infection established, marked by increased discharge, itching, burning, and odor.
At Women to Women, we tackle yeast vaginitis with a three-step approach. First we starve Candida of
sugar, their favorite food, by recommending a sugar-free and yeast-free diet. Then we use an
antimicrobial supplement, such as Candex, to decrease the number of yeast. Many women feel worse
for a while as huge numbers of yeast die off, producing toxic by-products. Third, we counteract this
“die-off effect” by inoculating the vagina and intestines with a probiotic supplement containing the
highly beneficial yeast organism known as Saccharomyces boulardii.
In fact, it is not uncommon for a woman suffering from chronic vaginitis to take an antimicrobial two
hours before a meal and then a probiotic with her meals. This yin-yang approach helps the good
bacteria more quickly reestablish balance. We often tell patients with less severe yeast vaginitis to dip
a tampon into plain, active-culture yogurt and insert it into the vagina for an hour or so, twice daily, to
achieve a similar result. Be sure the yogurt is fresh, unsweetened, and contains live lactobacilli.
Alternatively, you can try inserting a quality probiotic gelcap containing Lactobacillus acidophilus for
a few nights in a row. For more information on yeast overgrowth, read our full article on Candida.
For such an easy fix, it’s remarkable to me that more doctors don’t talk to women about probiotics,
especially when antibiotics are prescribed so routinely — particularly for children.
Antibiotic use and intestinal flora — don’t throw baby out with the bathwater...
Antibiotics have changed the course of human history. They have prolonged our lifespan by wiping
out many of the infectious diseases that were the scourge of humanity for centuries. They are lifesaving and absolutely essential — when used judiciously.
Broad-spectrum antibiotics work by wiping out most of the bacteria in your system. Other forms of
antibiotics target certain strains of bacteria. Either way, it’s imperative that the right kinds of bacteria
grow back once the bad strains have been decimated, or the bad guys will be back soon enough.
Depending on your overall health, stress levels and diet, this repopulation often doesn’t take place, and
other problems can develop as a result.
What’s more, bacteria are living, evolving organisms that can become resistant to chronic or improper
antibiotic use and increasingly virulent. This is especially worrisome in children and the elderly,
whose health can rapidly decline with antibiotic-associated diarrhea or antibiotic-resistant diarrhea. I
think we are seeing now that treating every ear infection with antibiotics actually has a diminishing
return.
Moreover, conventional medicine’s complete silence on the topic of probiotics doesn’t help matters. I
am amazed by how many people are put on a course of antibiotics with no mention of what to do once
they’re through. The good news is that for the most part, using probiotics is easy and safe, even for
children on antibiotics and the elderly. And they may just help ward off further complications. A
probiotic containing the yeast Saccharomyces can be especially helpful in preventing both antibioticassociated diarrhea and antibiotic-resistant diarrhea. And they may just help ward off further
complications. (People with compromised immune systems can also benefit, but should work with a
healthcare provider well-versed in the use of probiotics.)
Who needs probiotics?
In my experience, everyone in our modern, industrialized culture could benefit from daily
supplementation with probiotics. Our Western diet, filled with sugar, fatty meat and chemicals, along
with our use of antibiotics, give unfriendly flora the advantage.
How do you know if you have an imbalance, or could otherwise benefit from probiotics? Chances are
if you’ve been sick or taken antibiotics recently, you need to repopulate the good bacteria in your
system. Indications for probiotic use include symptoms of floral imbalance, as well as many other
conditions:
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GI sensitivity (cramps, diarrhea/constipation)
Bloating or foul-smelling gas
Dysbiosis, including IBS or partially-digested stools
Yeast infections, thrush, cold sores, diaper rash
Headaches and migraines
Joint aches
Chronic bad breath (halitosis)
Rosacea, acne
Fatigue, irritability
Anorexia and/or bulimia
Stuffy nose, increased mucus production
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Increased symptoms of PMS, perimenopause, or menopause
Worsening sensitivity to sugar and fermented products
Urinary tract infections, whether once in a while, recurrent or chronic
Worsening symptoms of inflammatory conditions, like asthma
(Although many of the above symptoms can indicate floral imbalance, they can also indicate more
serious conditions. See your healthcare provider with any ongoing concerns.) A digestive stool
analysis and an allergy panel can both be useful tools in determining the state of the flora in your gut.
Genova Diagnostics provides several good options. Testing for yeast sensitivity and parasites may also
be helpful. See our article on diagnosis for more information.
Any woman taking antibiotics or anti-fungal agents should supplement with probiotics during and for
at least two weeks afterwards. I also recommend supplementing with probiotics during cold and flu
season, and to help ward off food poisoning and parasites while traveling. Several probiotic organisms
have been shown effective in the prevention and treatment of traveler’s diarrhea. If you’ve got a trip
coming up, look for a well-balanced probiotic containing the yeast Saccharomyces boulardii plus a
mixture of Lactobacillus acidophilus and Bifidobacterium bifidum.
Supporting probiotics with diet
It’s important to support probiotic use and your existing friendly flora through optimal nutrition,
especially by minimizing refined sugar and processed foods in your diet. For more information refer to
our Nutritional and Lifestyle Guidelines.
Good bacteria feast on fiber. The bad guys love refined sugar and animal fat. Given a ready supply of
vegetables, legumes and whole grains, good bacteria live long and prosper. Polyphenols, found in
foods like garlic, green tea and ginseng, are also helpful in fostering friendly flora.
Fermented foods such as miso, tempeh, soy sauce and yogurt are renowned for their health-boosting
qualities. They introduce active probiotic cultures that help wedge out unfriendly bacteria by
competing directly with two main food poisoners: the toxic strains of E. coli and Staphylococcus
aureus. Many longevity experts have extolled the health benefits of eating fermented foods — now
you know why!
A few nutrients called prebiotics have been isolated that set the stage for probiotic survival. These
include fructooligosaccharides (FOS), and inulin, which are natural sugars found in bananas, chicory
root, onions, leeks, fruit, soybeans, sweet potatoes, asparagus and some whole grains. Prebiotics help
probiotics survive passage through the acidity of the stomach and small intestine, and foster their
growth in the intestines and colon. Recognizing the value added by a prebiotic to a probiotic
supplement, we included one in our own Balanced Biotic formulation.
We are only just beginning to understand how these prebiotic saccharides work in the gut to impact
our health and longevity. Foods high in inulin and fructooligosaccharides have been shown to lower
cholesterol levels, stabilize blood sugar, and improve calcium absorption.
The mechanism proposed for the latter benefit is that prebiotics decrease the pH in the colon, making
it more hospitable for certain beneficial gut flora, which in turn do the job of absorbing any calcium
remaining in the food by the time it gets to the colon. Though we don’t understand all the steps in this
process or whether the effects hold true across a lifetime, we do see a positive association between a
diet high in these foods and higher bone density, with the expected decreased risk for osteoporosis.
It’s interesting to note that archaeologists studying prebiotics in our ancestors’ diets believe that the
earth ovens used to slow-roast root vegetables helped preserve inulin molecules through the cooking
process. When it comes to an optimal diet, there really is something to be said for “slow food!”
For many of us, however, diet alone is not adequate when we need to repopulate our systems with
good bacteria. Remember, we are talking trillions of bacteria here! And age, poor diet, stress, disease,
and drugs all take their toll on our intestines’ little helpers. You need a steady, consistent supply of
probiotics to redress these issues. For example, you’d need to eat highly active functional foods like
yogurt and kefir every day. If you’re not experiencing any intestinal distress, that is probably enough.
But if you’re like most Americans, it’s just a drop in the bucket. In order to make a noticeable
difference, we recommend probiotic supplements.
The lowdown on probiotic supplements
At Women to Women, we’ve found that many of our patients, members and readers understand the
benefits of probiotics and are interested in trying one, but aren’t sure where to begin. Probiotics come
in a wide range of formulations, from encapsulated beads and powders to enteric-coated capsules and
liquid functional foods, their labels listing scores of lengthy scientific names and number in miniscule
print. I’d like to help make that choice easier by offering some guidance on what to zero in on.
But first a word of encouragement: probiotics are generally very safe and easy to use, so if you don’t
have success with one after a month or so, you can always try another one for a few more weeks, and
so on until you find one that works perfectly for you. Each of our bodies has its own unique soil and
weather patterns and hence, its own ideal microfloral garden.
That said, there are definite criteria that a good all-round probiotic should meet. The first thing to take
into consideration is form. We’ve found at our practice that many women are too busy to fuss with a
lot of individual powders or liquids and special storage requirements, and prefer powdered probiotics
in capsules. In the past most probiotics had to be kept refrigerated to maintain viability, and oftentimes
the bottle got left behind in the fridge of today’s busy, on-the-go woman. Thankfully, researchers
solved the shelf stability questions, so for convenience sake, we suggest you choose one that does not
require refrigeration. Even the best probiotics do lose potency with age, however, so buying smaller
quantities more frequently will help guarantee the most active cultures. And if it’s convenient for you,
go ahead and keep it in the refrigerator to prolong shelf life.
The second important consideration is content — what it contains, how much, and what it doesn’t. The
best general purpose probiotic supplements combine several beneficial bacteria with yeast. Look for
supplements that contain Saccharomyces, Lactobacillus acidophilus and bifidobacteria in the billions.
There is some controversy as to whether it is better to take each strain separately, but we think a
combination works beautifully for most individuals. Certain products feature every probiotic organism
ever described, or tout zillions of CFU’s (colony-forming units) per dose. The concern here is that too
many active organisms can produce the very symptoms we seek to alleviate. We haven’t seen any
science backing up the notion that more is better, and we’re consistent in our belief that balance is
more effective than quantity.
You also want to make sure the product you choose includes a prebiotic, such as FOS or inulin, to help
the flora survive the acidic environment of the upper GI tract. We prefer inulin, as it’s a precursor to
FOS and may have a less “sugary” effect on women prone to yeast infection, who sometimes do better
to avoid supplements and foods containing FOS. As we outline above, inulin may offer the added
bonus of increasing calcium absorption, and possibly magnesium absorption as well. Some probiotics
are enteric-coated, but we don’t consider this feature necessary as long as a prebiotic has been
included in the formulation to safeguard delivery of live organisms to the intestines.
One additional concern is how the probiotic has been manufactured. To be sure you’re buying what’s
stated on the label, look for a product has that comes from an NSF-Certified, GMP-compliant facility.
The NSF is an independent, non-profit certification company that evaluates, certifies, and works with
regulatory officials to ensure the purity, safety and quality of consumer products internationally.
Naturally, the bottom line for a probiotic is how well it works. You should begin to feel a difference
within a week or two if your probiotic supplements are effective. If not, try a different variety,
combination or brand the next month. These supplements are remarkably safe, so it’s okay to
experiment. If you buy a smaller quantity, you won’t waste your money — but be sure to give it a
couple of weeks to show benefits.
Good things come in small packages
Like any supplement, even the best probiotics are no substitute for good overall health practices. But
they do work extremely well as part of a balanced approach, combined with a healthy diet and
lifestyle. In that context, consumption of probiotics can make a real, sustained difference in your longterm health. The old adage, “You are what you eat” could be reworded: “You are what your intestinal
flora eat!”
Each commitment we make to positive change is an important one. Many of us get discouraged when
we fail to live up to major resolutions, so take a tip from the microscopic organisms in your own body
and begin by paying attention to the little things. Sometimes they turn out to be the most important of
all.