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Probiotics – Are they good digestive health? | Arshad Malik, MD

Which Probiotic is Best for My Gut?

As a gastroenterologist in Plano, TX I receive a lot of questions from my patients regarding bacteria in our digestive system. With the emergence of probiotics, many people are wondering how much good/bad bacteria they should have and whether they need to supplement the number of bacteria their body naturally produces.  

While there is not a definitive answer to those questions, I felt it was important to provide a brief background on probiotics and give the perspective of a gastroenterologist in regards to the potential benefits of probiotics. Hopefully, the information in this article will help to educate those interested in probiotics and in their evaluation of which probiotic may be best for them. 

How Do Probiotics Work?

The National Center for Biotechnology Information notes that normal intestinal flora aids in digestion, fights off harmful bacteria & viruses, and produces vitamins. The intestinal floral can be damaged or lessened by a variety of things such as illness, hereditary diseases, radiation, chemotherapy, and antibiotics. That’s where probiotics come into play. Probiotics are live, friendly microorganisms that can improve the native flora within the digestive and respiratory systems. These microorganisms help break down food, assist in the absorption of nutrients, and can help fight off the harmful organisms that cause illnesses such as diarrhea, bowel diseases, and infections. 

Probiotic Bacterial Strains – What’s the difference?

The two most commonly used groups of probiotics are Lactobacillus & Bifidobacterium. Lactobacillus organisms metabolize sugar to produce lactic acid. Bifidobacteria are the predominant bacteria in our intestinal flora. They produce acetic acid in addition to lactic acid, both of which are beneficial to our health. 

There are many strains of bacteria within these two groups. Here are some of the strains used most often today.

  • L. acidophilus – Occurs naturally in the mouth and gastrointestinal tract and aids in the fermentation of sugar.
  • L. brevis – Normally found in the human intestines and excrement. L. brevis is also in many fermented foods.
  • B. lactis – Breaks down body waste and helps with vitamin and mineral absorption. B. lactis has been found to improve digestion. 
  • B. infantis – Important for infant health. Can be passed along from mother to baby during pregnancy. B. infantis lives in our bodies our whole lives and improves digestion. Produces acid within the digestive tract making it more difficult for harmful bacteria and parasites to colonize.
  • L. reuteri – Has been found to inhibit the growth of harmful bacteria, yeasts, fungi, and protozoa. 

What is a Probiotic Delivery System?

A probiotic delivery system is the method by which probiotics are delivered into the body as usable, functional bacteria in large enough numbers to survive the harsh effects of the digestive system while still remaining effective. 

There are two primary systems for which probiotics are delivered: 

  • Non-Conventional Commercial Products – Consists mainly of food products produced with probiotic strains. Yogurt, cheeses, cream, chocolate, milk, and even meat. These are good delivery systems that are readily available, convenient, and beneficial to those who use them.
  • Conventional Pharmaceutical Formulations – These delivery systems tend to be the most effective formulations for the delivery of probiotics and come in the form of capsules, beads, and tablets. Pharmaceutical formulations tend to be more effective overall than the food-based systems.

Which Probiotic is Best for Me?

Each probiotic is different and which strains you take should largely depend on what ails you. Listed below are some of the most common digestive conditions and which probiotic may work best to treat and prevent them. However, keep in mind that it is recommended to discuss with your doctor before taking probiotics or other supplements to treat specific conditions.

  • Diarrhea – Lactobacillus bacteria are considered the most effective in the prevention and treatment of diarrhea (especially in children when diarrhea is caused by rotavirus).  L. reuteri has been found to reduce diarrhea for both rotavirus and non-rotavirus cases.
  • Lactose Intolerance – L. acidophilus helps support the digestion of lactose. 
  • Irritable Bowel Syndrome (IBS) – Probiotic combinations that include bifidobacteria strains are suggested as working best to limit IBS symptoms. In particular, B. infantis has shown in some instances to reduce the pain, bloating, and constipation that are associated with IBS.  
  • Inflammatory Bowel Diseases
    • Ulcerative Colitis – Studies have shown that there is a benefit to using probiotics to manage ulcerative colitis.  Probiotics should be multiple strains of Lactobacillus and Bifidobacterium (particularly including B. infantis) as clinical trials did not show the efficacy of single strain probiotics. VSL#3 has been demonstrated to be of benefit in maintenance of remission in mild UC
    • Pouchitis – VSL #3 which contains four strains of Lactobacillus and three strains of Bifidobacterium has helped some with relieving the symptoms associated with pouchitis
  • Constipation – The Bifidobacterium are noted as the most effective in relieving constipation and the bloating associated with it. B. lactis has been found to be the most successful for relieving adult constipation but was not as successful in constipated children. Eating yogurt and fermented food, such as sauerkraut and pickles, can help alleviate constipation systems. 

Probiotic Benefits – A Gastroenterologist’s Perspective

Probiotics certainly have a place in the management of GI symptoms but it is important to keep in mind that probiotic supplement efficacy is typically moderate as compared to traditional pharmaceuticals. As such, they are often better as a supplement to, rather than replacement for, traditional pharmaceuticals. Probiotic strain(s), quantity and preparation make a difference. Multi-strain or even dual-strain probiotics are not necessarily better.

I often get asked if routinely taking a probiotic or a probiotic yogurt is good for “general digestive health.” Product labels often indicate that their probiotic “improves digestive health” or “strengthens the immune system.” The FDA has not approved any health claims for probiotics. I suggest patient’s monitor if their own symptoms respond to taking the probiotic for a month. If not, your money is probably better spent elsewhere.

At present patient interest in “first-generation” probiotics is at an all-time high but “next-generation” probiotics and probiotic derived products are being worked on. Many questions remain to be answered.

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