On the Shelf
Mickie Cathers
Patients concerned about antibiotic use affecting their gut health may turn to probiotics for aid. Probiotics are widely known to promote a healthy balance of microbes in the body’s gut microbiome, leading to improved digestion and boosting immune function, potentially benefiting mental health and well-being.
Background
Probiotics and prebiotics are essential components of a healthy gut microbiome, yet they are sometimes confused with each other. Probiotics are trillions of live microorganisms in the body aiding nutrient absorption, immune regulation, and neurotransmitter production. Prebiotics, found in high-fiber foods such as whole grains and vegetables, serve as fuel for probiotics.
An imbalance of microflora in the gut is linked to various health issues beyond GI problems. Factors such as stress, antibiotic use, and poor diet can disrupt the gut microbiome, which has been linked to chronic disease, immune dysfunction, and infections.
Taking a dietary supplement or consuming fermented foods rich in probiotics, such as kombucha, kefir, sauerkraut, and yogurt, helps increase the population of beneficial microorganisms in the gut. A higher count of friendly microorganisms supports a healthy microbiome community by limiting the room for and growth of harmful, disease-causing microorganisms.
Is there a benefit?
The literature goes back decades in support of the potential of probiotics, highlighting their impact on reducing risks of diseases and improving health outcomes. A comprehensive narrative review by Gul and Durante-Mangoni published in the March 2024 issue of the Journal of Clinical Medicine explores the health advantages and mode of action of most popular probiotics, Lactobacillus, Bifidobacterium, and Acidophilus (Lactobacillus acidophilus).
The authors cited several epidemiological studies supporting the association of fermented foods and beverages. They covered a range of health benefits that probiotics afford including a reduced prevalence of atopic dermatitis and a reduced risk of high BP and CVD. The review authors also showed benefits of probiotic consumption for patients with T2D. The group who consumed probiotic yogurt containing L. acidophilus and Bifidobacterium lactis improved their fasting glucose levels and antioxidant capacity.
Studies showed that probiotics produced beneficial effects across multiple health domains including oral health and immune and intestinal health. The authors also noted anti-obesity actions of Lactobacillus, Bifidobacterium, and other probiotics supplements in relation to lowering low-density lipoprotein and total cholesterol levels, assisting in normal weight maintenance with low leptin levels. Clinical trials noted in the review revealed probiotic efficacy in managing CKD, diabetes, and wound healing.
Probiotics’ effect starts as they produce vitamins and short-chain fatty acids that nourish gut cells and improve digestion. They also play a crucial role in energy regulation, neurotransmitter production, and suppressing proinflammatory cytokines like IFN-γ, TNF-α, IL-4, and IL-13. Probiotics improve gut barrier function by preserving the epithelial barrier, encouraging cell survival, boosting the synthesis of antibacterial agents and proteins that protect cells, and bolstering protective immune responses, contributing to overall well-being.
Dosage and availability
Foods naturally rich in probiotics include dairy products such as kefir, unpasteurized cheese, traditional buttermilk, and yogurt. Nondairy fermented products that provide probiotics include kimchi, kombucha, miso, pickles (fermented, not vinegar-pickled), natto, kvass, and sauerkraut.
Probiotic supplements are available online and on store shelves in capsules, tablets, chews, liquids, and powders, either alone or often in combination with prebiotics. Probiotic supplements are often labeled with a colony-forming unit (CFU) of 1 billion or higher. This count indicates the number of live microorganisms and is the general recommendation of dosage.
Some probiotics are available as topical applications for the skin or other body areas where beneficial microbes thrive.
Probiotics aren’t just for humans; they’re available for pets as well, to restore normal intestinal flora in animals.
What to tell your patients
Probiotics are generally safe but may cause mild digestive issues such as bloating, constipation, or intestinal gas. There’s a small risk of adverse effects for patients with weaker immune systems, including those on immunosuppressant drugs. Selecting the right product may make the difference.
It’s important to follow package instructions and pay close attention to expiration dates as CFUs decline over time.
Probiotics don’t stay in the system long term; discontinuing them returns the microbiome to its baseline.
Advise patients to choose probiotic products with at least 1 billion CFUs of well-researched strains such as Lactobacillus, Bifidobacterium, Bacillus, or Saccharomyces boulardii.
Be aware that the two starter bacterial cultures (Streptococcus thermophilus and Lactobacillus bulgaricus) found in many yogurts are destroyed by stomach acid, offering no probiotic benefits.
Refrigeration is key to maintaining probiotic viability as heat can kill off beneficial microorganisms if not stored correctly.
When possible, choose a probiotic encapsulated with a prebiotic, such as inulin, ensuring the probiotic has a food source to thrive and remain effective. ■