Download The Promise of Probiotics

The Promise of Probiotics
You may not know the term “pro­
biotics,” but you’ve probably
already eaten them. Yogurt, aged
cheese, and other cultured and
fermented foods make up this
category of “super foods” now
known world-wide. A probiotic—
literally, “for life” in Greek—is
defined as “a preparation or a
product containing a sufficient
number of live microorganisms
to alter the flora of the host and
bring about beneficial health ef­
fects.” In short, probiotics are
“good bacteria” we import into
our system to hold more danger­
ous microbes in check.
Yogurt, the most popular pro­
biotic, has been around at least
4,000 years, and has been linked
to long life for centuries. In fact,
a Russian immunologist named
Ilya Mech­nikov received a Nobel
prize in the early 1900s for his
studies on the unusual longevity
of Bulgarian peasants. He learned
these peasants ate a diet high in
fermented foods, including yo­
gurt and other foods containing a
bacterium he named Lactobacillus
bulgaricus.
In Japan and Europe, live-culture
dairy products have enjoyed
great popularity for decades.
A growing number of scientific
studies have found that probiotics
can aid both digestive and im­
mune system health. If you watch
US television commercials, you
know the pro­biotics movement
has spread, with mass-market
dairy products promising to help
you “reduce bloating and get
regular” and to “strengthen your
body’s defenses.”
Jumping on the probiotics bandwagon is easy—the foods (or
supplements) are safe and widely
available. Most people find them
both tasty and easy to digest.
But are they really effective? Is
it a “one size fits all” solution,
or should some people seek out
particular types of bacteria? How
can you make sure you’re getting
enough live bacteria to make a
difference?
Oral Cavity
Stomach
Large
Intestine/
Colon
Small
Intestine
Reproductive
Tract
Our “normal flora” is microbes, chiefly
bacteria, which enter through our nose
and mouth, and take up residence in
our digestive system.
To take full advantage of pro­
biotics, you need to begin by
learning a little bit about the place
you want their “good” bacteria
to wind up: your gastro­intestinal
tract.
Welcome Inside
“Microbe City”
The human body contains 100
trillion cells, and 90% of them are
not even our own—they are tiny,
one-celled life forms known as
microorganisms or microflora.
Nearly all of these are bacteria;
the rest are yeasts and parasites.
These bacteria are incredibly
diverse in size, shape, color and
growth rates, and may include as
many as 1,000 different species.
Most of our bacterial guests,
called “normal flora,” reside in
our gastrointestinal tract, primar­
ily in the places shown in the
figure at left, including:
nOral Cavity (mouth, nose,
throat): Millions of bacte­
ria live in a single teaspoon
of saliva, including “bad”
types linked to halitosis and
gingivitis.
nStomach: Few bacteria live
here due to very high acidity,
but one is Heliobacter Pylori,
which can cause ulcers and
stomach cancer. Lactobacil­
lus can help keep H. Pylori in
check.
Continued on Page 2
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nReproductive Tract: A
healthy vagina contains thou­
sands of different types of
bacteria, with the majority be­
ing a type of Lactobacillus.
nSmall Intestine: Millions of
bacteria live in this organ,
where they receive nutrients
in exchange for helping us
digest food, make vitamins,
and stimulate our immune
system. Most of these bacteria
are benign species of Strepto­
coccus and Enterococcus.
nColon: Billions of bacteria,
predominantly Bacteroides,
live in the colon or large
intestine, the final stop in
digestion, where wastes are
stored and excreted in the
stool. The stool contains over
500 different types.
These microbes enter our body
through the air we breathe, and
the food and drink we consume.
Once stuck in the mucous that
lines our oral and nasal cavities,
they are swallowed and propelled
through our digestive system.
In this teeming “inner city,”
microbes compete for food and
space in the mucosal surfaces that
line our digestive tube. The rela­
tion­ship is symbiotic; we give the
bacteria room and board in ex­
change for labor, mainly breaking
down our food. Although there
are widespread “employment
opportunities” in food digestion,
most digestive organs offer lousy
accommodations. All the acid and
churning causes microbes to head
for the choice real estate of the
intestines, with their long coils
of cushy, mucosal folds. Most
gut bacteria actually reside in the
large intestine (colon), the most
hospitable and final stop in di­
gestion, where water is ab­sorbed
from indigestible food matter and
waste is stored and then removed
from the body.
“[Probiotics] actually send signals to the
immune system that reduce destructive overreactions, including inflammation. This means
that insufficiencies affect immune responses—
and therefore every aspect of our health.”
Among our body’s microbes, you
can find the “good” (probiotics
like Lactobacillus, a common bac­
teria in yogurt), the “bad” and
the “risky.” In this final group
are several bacterial species
that benefit us when they are in
the right place, and in the right
numbers. For example Klebsiella
make vitamins B12 and K when
they’re inside our small intestine
but, in our lungs, they can cause
pneumonia.
In a healthy gut, friendly bacte­
ria are plentiful enough to keep
the dangerous and potentially
harmful bacteria under control.
Un­fortunately, many of us find
their numbers lacking, says Gary
B. Huffnagle, PhD, a professor of
internal medicine, microbiology
and immunology at the Univer­
sity of Michigan Medical Center.
“New research is revealing that
the [probiotic] population often
isn’t large enough for optimal
health,” writes Dr. Huffnagle in
his book The Probiotics Revolution.
Aside from their role in proper
digestion, Dr. Huffnagle main­
tains that probiotics are also
vital to our immune system.
“They actually send signals to
the immune system that reduce
destructive overreactions, includ­
ing inflammation. This means
that insufficiencies affect immune
responses—and therefore every
aspect of our health.”
The chart on page 3 identifies
some of the autoimmune disor­
ders suspected to be associated
with a bacterial overgrowth.
In addition to affecting our im­
mune system, the microbial
im­balance in our gut can affect
other systems in our body, in­
cluding our hormonal system.
As you may know, the digestive
system plays an important role in
the proper disposal of estrogens
from the body. When the flora in
our intestines is disturbed, estro­
gen that should be excreted can
be recycled and reabsorbed into
the bloodstream, creating hor­
mone imbalance.
The Gut as an
Immune Organ
According to Kelly Dowhower
Karpa, PhD, RPh, the gastrointes­
tinal tract is the largest immune
organ in the body. In her book
Bacteria for Breakfast, Dr. Karpa
describes how gut bacteria com­
municate with immune system
cells within the walls of our
intestines. This “instant mes­
saging” helps ensure immune
cells act appropriately to fight
disease-causing substances, while
tolerating normal foods and nor­
mal flora. As we grow up, this
“oral tolerance” becomes the
cornerstone of a mature immune
system. “Normal gut bacteria
Continued on Page 3
2
acquired in infancy are likely to
be the most important determi­
nants of allergies and diseases
of chronic inflammation later in
life,” Dr. Karpa writes.
Allergies
Dr. Karpa says that since the late
1950s, the incidence of immunerelated conditions, from allergies
to inflammatory diseases, has
exploded in Western societies.
Many researchers believe envi­
ronmental changes are involved,
in particular, increased hygiene
practices and unbalanced, pro­
cessed-food diets. “This indicates
that exposure to various types of
bacteria—through dietary sources
and by actually getting sick and
letting the immune system do its
job—makes a dramatic impact on
the development of allergic dis­
eases,” Dr. Karpa explains.
The widespread use of antibiotics
over the same period must also
be considered, stresses S.K. Dash,
PhD, founder and president of
UAS Laboratories, a leading pro­
biotic company. “Antibiotics can
be the biggest culprits in destroy­
ing our friendly bacteria,” writes
Dash in The Consumer’s Guide to
Probiotics. “At high dosages, they
can wipe out all bacteria inside
your body, the good along with
the bad. Once that happens, the
race is on to as to which micro­
organisms, the good guys or the
bad guys, set up shop.”
Even if you don’t take antibiotic
medications, Dash points out that
meat eaters still consume them,
since most US cattle, pigs and
poultry receive antibiotic feed.
He strongly urges those taking
prescription antibiotics to use
probiotics at the same time to
replenish their stock of beneficial
bacteria.
According to Dr. Karpa, the
presence of bacteria in the gut
stimulates production of cyto­
kines, which are signals to the
immune system to trigger inflam­
mation and allergies. Different
species of bacteria stimulate the
release of different cytokines.
We know that allergic reac­
tions happen when the immune
system overreacts to harmless
substances. Some studies show
taking probiotics during preg­
nancy can help prevent babies
from developing eczema, notes
Dr. Huffnagle, who adds that
probiotics are “under intense
investigation as an allergy treat­
ment.” Autoimmune diseases
may also be helped by probiotics
someday, he believes, “because
they signal the immune system to
show restraint.”
Suspected Associations Between
Autoimmune Disorders & Bacterial Overgrowth
Disorder
Type of Bacteria
Ankylosing spondylitis
Graves’ disease and Hashimoto’s disease
Guillain-Barre syndrome
Multiple sclerosis
Rheumatic fever
Rheumatoid arthritis
Autoimmunity, in general
Kiebsiella
Yerainia
Campylobacter
Chlamydia
Streptococcus Pyogenes
Citrobacter, Kiebsiells,
Proteus, Porphyromones
Escherichia coli, Proteus
Inflammatory Bowel
Disease, Crohn’s Disease
and Irritable Bowel
Syndrome
Sometimes, a malfunctioning
of the immune system leads to
chronic inflammation of the intes­
tines, resulting in inflammatory
bowel disease (IBD), which af­
fects 60 to 70 million Americans.
Specific forms of this disease
range from the relatively mild
Irritable Bowel Syndrome (IBS)
to the most severe form, Crohn’s
Disease. Studies show that people
with IBD have lower levels of
probiotics in their gastrointestinal
tracts than do healthy people.
IBS is characterized by bowel
pain, bloating, either diarrhea
or constipation, and gas. IBS is
a frustrating disease because it
has no known cause, and doesn’t
coincide with any visible dam­
age to digestive organs, so it is
diagnosed only after the other
forms of IBD have been ruled
out. It affects three times as many
women as men. As many as 20%
of US women are believed to suf­
fer from IBS at some point in their
lives. Probiotics have had mixed
results in treating IBS. However,
one Irish clinical study showed
significant improvement when
IBS patients took a daily drink of
Bifido­bacterium infantis.
In Crohn’s Disease, deep inflam­
matory lesions affect the lower
part of the small intestine and
the colon. (A similar condition,
ulcerative colitis, is characterized
by smaller lesions plaguing only
the colon.) The resulting thicken­
ing and swelling of the bowel
wall can cause deep intestinal ob­
struction, which can become life
threatening. Patients frequently
endure cycles of extreme pain
and weight loss with periods of
remission. Treatment usually in­
cludes anti-inflammatory drugs
Continued on Page 4
3
injected into the intestinal
tract. For some, medications
fail and surgery is required.
Even when the immune
system is not implicated, a
number of very common
gastrointestinal illnesses—
ranging in severity from mild
stomach upset to life-threat­
ening, chronic ailments—do
occur when there is an imbal­
ance in gas­­tro­intestinal flora.
Diarrhea
Nearly everyone has struggled
with diarrhea, often the result
of viral gastroenteritis (usually
caused by rotavirus or noro­
virus) or Traveler’s diarrhea
(following ingestion of water
contaminated by fecal bacteria
such as E. coli). Some people
develop severe diarrhea after
exposure to an antibioticresistant strain of bacteria
known as C. difficile. This often
occurs in a hospital or other
institutional setting, following
a course of antibiotics.
Acute diarrhea, whatever its
cause, remains the world’s
leading cause of illness and
death, as dehydration quickly
proves deadly where treat­
ment is unavailable. Yet, even
with modern medical care,
those who suffer from C. dif­
ficile often endure painful,
recurring bouts with diarrhea
whose symptoms may include
a life-threatening form of
colitis.
While probiotics are generally
advised for preventing but
not actually treating disease,
in the case of diarrhea, some
studies show probiotics can
actually heal. “Lactobacillus
CG at high doses for 7-10 days
after antibiotics has cured
patients with relapsing C.
difficile,” says Dr. Karpa. In
“You may have to search for the right
probiotic, the appropriate number of
microorganisms, or the necessary combination of probiotics until you find the
right mix to successfully fill the bacterial
niche missing in your gastrointestinal
tract.”
addition, studies show Lacto­
bacilli can treat and prevent
rotaviral diarrhea, shortening
the duration of diarrhea and
speeding healing.
In general, probiotics are
a boon to good digestion.
Probiotics in the intestines
make shortchain fatty acids
(needed for GI tract health),
antioxidants, amino acids
and vitamin K. Nutrients in
fermented foods are more
readily absorbed than the
nutrients in non-fermented
foods. Fermented foods are
those in which an agent such
as a yeast, bacterium, mold
or enzyme is used to break a
substance down into simpler
substances; examples include
converting milk to yogurt
or cheese, fermenting soy to
make miso, and fermenting
cabbage to make kimchi or
sauerkraut.
component of our digestive
system. However, when the
pH balance is tipped, often
by antibiotics or a diet high in
sugar and starches, a candida
overgrowth may occur, result­
ing in candidiasis (commonly
called a yeast infection). In
the intestines, this can cause a
wide range of chronic diges­
tive problems, such as bloating
and heartburn. Sometimes, the
Can­dida organism bores into
the gut wall, releasing power­
ful toxins and incompletely
digested dietary proteins into
the bloodstream. The immune
system then produces antibod­
ies, causing allergic reactions
which can trigger a host of
problems, including chronic
fatigue, headache, and depres­
sion, as well as an avalanche
of food allergies.
Candidiasis
Vaginal and Urinary
Tract Infections
The presence of probiotics
in the gut also inhibits the
growth of yeasts by pro­
ducing pH-lowering lactic
acid (and sometimes other
acidic substances). A strain of
yeast called Candida albicans
(candida for short) is a normal
Candida overgrowth also oc­
curs in other organs, notably
the vagina. The use of oral
contraceptives, standard hor­
mone replacement therapies,
and especially antibiotics
increases a woman’s risk for
vaginal candidiasis.
Continued on Page 5
4
Antifungal medications are pre­
scribed to treat the symptoms,
but they typically recur unless
the GI tract can be recultivated
with friendly bacteria. Probi­
otics have been conclusively
shown to help restore the nor­
mal yeast-bacteria balance in
the body. “Products that stimu­
late L. acidophilus or B. bifidum
can help immensely as part of
a comprehensive program that
addresses the whole person,”
says Dr. Dash.
Other imbalances in the vagina
and the urinary tract may also
benefit from increased use of
probiotics. For example, prob­
lems associated with vaginitis
(inflammation of the vagina)
can affect women of all ages,
causing vaginal discharge and
pain. In younger women, the
discharge and pain are usually
the result of an imbalance of
harmful bacteria. This can be
very serious when it occurs to
pregnant women, since it can
cause premature labor.
Postmenopausal women often
get atrophic vaginitis—inflam­
mation resulting when estrogen
levels drop. This scenario caus­
es increased vaginal pH and
pre­disposes these women to
vaginal pain and discharge,
and also to urinary tract infec­
tions (UTIs). While UTIs are
easily treated, they often come
back.
Clinical evidence shows that
probiotics may help prevent
and even treat urogenital tract
problems. In their chapter on
these conditions in The Power
of Probiotics, the authors cite
a clinical study showing that
women who took freeze-dried
L. rhamnosus GR-1 and L. fer­
mentum RC-14 were much less
likely to get bacterial vagi­
nosis, and that their levels of
Prebiotics
In order to boost the effectiveness of probiotics, adding dietary fiber
or prebiotics to your diet is highly recommended. Prebiotics, says Dr.
Dash, are “carbohydrates that selectively feed beneficial bacteria in
the intestinal tract and stimulate their growth.” He explains that prebiotics may be thought of as “fertilizer” for the good bacteria in the
GI tract. Examples include polydextrose, inulin, and fructooligosaccharides (FOS), also sometimes called oligofructose or oligofructan.
Prebiotic foods include whole grains, fruits, vegetables, red wine and
dark chocolate. In addition, some of these foods also contribute to
a fiber-rich diet, which helps relieve constipation—yet another benefit realized from probiotic use. Although it’s best to get fiber from
whole foods, fiber supplements can be valuable, particularly if they
include soluble fiber sources and are taken with lots of water.
protective Lactobacilli bacteria
were also higher, indicat­
ing protection from yeast
overgrowth.
Yet, getting a beneficial effect
for any individual’s specific
health needs depends on sev­
eral factors, including:
Value of Probiotics
nthe strain of bacteria se­
lected and how your body
is able to utilize it
With growing alarm over the
spread of virulent strains of
antibiotic-resistant bacteria,
many people are eager to try
approaches to illness preven­
tion and treatment that do not
require the use of antibiotics.
In his book, Dr. Huffnagle
remarks at how prescient
Chinese doctors were cen­
turies ago: “They somehow
knew that the intestines were
not merely a digestive organ,
but the center of health and
well-being.” To­day, he adds,
modern medicine is confirm­
ing their wisdom with clinical
studies and laboratory tests,
which add knowledge on the
effects of various bacterial
strains. For example, he says
the value of probiotics in sup­
porting overall health can be
seen in a recent German clini­
cal trial that showed healthy
work­ing adults taking Lacto­
bacillus and Bifidobacterium
supplements have fewer, less
severe colds and higher white
cell counts.
nthe numbers of live bac­
teria in the purchased
product, and whether
they are stored and taken
properly.
Safety, Storage and Use
Probiotics are very safe for the
majority of people, with the
exception of those at very high
risk for infections of all types,
such as those with HIV/AIDS
or cancer, or those taking ste­
roids. It is always advisable to
check with your practitioner
before taking any new supple­
ments, as probiotics do have
the po­tential to interact with
some medications.
Moreover, your practitio­
ner can help you select the
probiotic that is best suited
to treating your particular
condition, notes Dr. Karpa.
“You may have to search
for the right probiotic, the
appropriate number of micro­
organisms, or the necessary
Continued on Page 6
5
combination of probiotics until you find the right
mix to successfully fill the bacterial niche missing
in your gastro­intestinal tract.”
How should you take your bacteria: pill or plate?
Either form will work, as long as you follow the
proper procedure. Foods containing live cultures
must be kept refrigerated, and storage dates must
be strictly followed. Although it might seem
that pill supplements would be required for the
lactose-intolerant among us, you may be surprised
to learn that is not necessarily the case. Probiotics
have actually been shown to help break down lac­
tose (milk sugar), reducing symptoms of the illness
and allowing sufferers to reintroduce dairy into
their diet—at least in the form of yogurt and other
fermented products.
Care must be taken when pur­chasing a probiotic—
in any form—to help ensure you are receiving the
promised bacterial strain and number of live bacte­
ria, properly stored. All too often, Dr. Karpa notes,
the bacterial strains listed on a label are not the
actual strains in the product.
This leads some observers to suggest cutting out
the middleman. Frank Murray provides a recipe
for making your own yogurt in his book Acidophi­
lus and Your Health. He also includes this advice
for purchasing yogurts: Always purchase yogurt
with “live, active cultures” including Lactobacillus
acidophilus, and avoid frozen yogurt and puddingstyle yogurt which add stabilizing chemicals and
artificial sweeteners.
Quite frequently, probiotic foods (unless very care­
fully made or purchased) just don’t supply enough
active bacteria to alter the gut flora. In order to
give your probiotics a better chance of success,
make sure to take them on an empty stomach and to
add more dietary fiber, or prebiotics (see box on page
5) to your meals.
Recommendations from your healthcare practi­
tioner may help guide you to reliable products
from proven manufacturers. “By selecting quality
products, using appropriate storage conditions and
ingesting pro­biotics on an empty stomach, you can
obtain maximal benefits from taking probiotics,”
sums up Dr. Karpa.
References
nThe Probiotics Revolution by Gary B. Huffnagle,
PhD and Sarah Wernick, Bantom Dell; New
York, NY; 2007.
n“Autoimmune Disease: A Modern Epidemic?”
by David M. Brady, ND, DC, CCN, DACBN;
Townsend Letter; June 2012.
nBacteria For Breakfast: Probiotics for Good Health
by Kelly Dowhower Karpa, PhD, RPh, Trafford
Publishing; Victoria, BC, Canada; 2003.
nThe Consumer’s Guide to Probiotics by S.K. Dash,
PhD, Freedom Press; Topanga, CA; 2006.
nThe Power of Probiotics: Improving Your Health
with Beneficial Microbes by Gary W. Elmer, PhD,
Lynne V. McFarland, PhD and Marc McFarland;
The Haworth Press; New York, NY; 2007.
nAcidophilus and Your Health by Frank Murray,
Keats Publishing Inc.; New Canaan, CT; 1998.
nSee also the newsletters Digesting It All! (April
2012) and A Connection With Yeast (October
2012) by Women’s Inter­national Pharmacy.
Connections is a publication of Women’s International Pharmacy, which is dedicated to the education and management of PMS, menopause, infertility, postpartum depression, and other hormone-related conditions and therapies.
This publication is distributed with the understanding that it does not constitute medical advice for individual problems.
Although material is intended to be accurate, please seek proper medical advice from a competent healthcare professional.
Publisher: Constance Kindschi Hegerfeld, Executive VP, Women’s International Pharmacy
Co-Editors: Julie Johnson and Carol Petersen, RPh, CNP; Women’s International Pharmacy
Writer: Kathleen McCormick, McCormick Communications Illustrator: Amelia Janes, Midwest Educational Graphics
Copyright © November 2012, Women’s International Pharmacy. This newsletter may not be reproduced or distributed
without the permission of Women’s International Pharmacy.
®
For more information, please visit www.womensinternational.com or call (800) 279-5708.
Women’s International Pharmacy | Madison, WI 53718 | Youngtown, AZ 85363
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