Probiotics are one of, if not the most, talked about and prescribed supplements for gut health as well as general health and well-being.
Probiotics can be taken in a variety of ways and with a wide range of options on the market, there can be confusion and questions about which is the best and most well-studied.
In this article we’ll explore the role probiotics play in health, how they work and the ones that can be considered in certain situations. In particular, how they can help with digestive issues such as bloating, IBS and IBD. [1]
What are Probiotics and how do they work?
Probiotics are defined as “Live microorganisms, that when administered in adequate amounts, confer a health benefit on the host”. This is generally applied to probiotic supplements but also more loosely refers to fermented food as well.
One of the most common misconceptions is that probiotics simply add more “good bacteria” to the gut. This may be described as filling up a jar with more marbles. However, this is not the case with probiotics.
Probiotics are described as transient organisms. This refers to the fact that they travel through the gut but do not reside there. However, as they travel through the gut they interact with the body which then leads to health benefits.
Probiotics can therefore be considered ‘signalling molecules’ as when they adhere or stick to the gut lining for a brief period of time, they send a signal to the immune system along the gut lining. This is carried about based on the biological pattern of protein structure on the surface of the probiotic bacteria.
Depending on this biological pattern (which varies between different strains of bacteria) a different biological response may result.
These responses can include reducing inflammation or activating the body’s own antimicrobial response to kill less beneficial bacteria. [2]
Types of probiotics used for gut health
More and more research is being carried out for the role the gut plays in non-digstive conditions. For example, there are certain strains of probiotic bacteria that can support mental health or skin health.
The vast majority of probiotics on the market are focused on supporting the gut and digestive health issues.
There are views that probiotics for gut health can be separated into 3 categories.
These are:
- Lactobacillus and Bifidobacteria strains
- Saccharomyces Boualrri (a beneficial yeast probiotic)
- Spore-forming bacteria (for example Bacillus Coagulans)
The category of these bacteria, which has the widest range of strains, is the Lactobacillus and bifidobacteria category. Often, this is the category contained in most probiotic products on the market.
It can also be that those with IBS symptoms may only try probiotics from the first category without exploring options outside of this.
However, another school of thought (which is more science-based) indicates probiotics should be selected based on their strain and the research behind this. For example, two different strains of Lactobacillus probiotic bacteria may have two different applications for gut health.
These can be found in single-strain products (which just contain 1 strain of bacteria) or as multi-stain formulas. These contain several strains of bacteria.
Research also indicates that probiotics do not have to be alive when they’re taken. This can be due to the protein structure on the surface of the bacteria (which contains the information required to trigger a positive response from the body) remaining intact, even when bacteria are no longer technically alive. [3]
Benefits of Probiotics for Gut Health
As described, rather than seeing probiotics as a way to add more bacteria to the gut, the concept of these being ‘signalling molecules’ can be a better way to understand their benefits.
Depending on the strain of bacteria, different benefits may be seen.
This can be due to actions in the gut such as:
- Reducing inflammation
- Triggering the body’s own release of antimicrobial compounds (which help to balance the gut bacteria)
- Supporting the health of the gut lining
- Regulating the immune response
Individual response to probiotics can depend on factors such as:
- The balance of the gut microbiome
- Degree of inflammation
- Genetics [4]
Digestive Health
The most common implication of probiotics is their role in supporting digestive health and gut issues. They can be used to help with a wide range of gut-related issues such as:
- Bloating
- Abdominal pain
- Diarrhoea
- Constipation
- SIBO
- Heartburn
Immune System Support – Boosting the immune response through gut health
Probiotics can support the immune response in the gut as well as overall immune health. This may in part be that a healthy gut microbiome supports the entire immune system.
This is reinforced by research indicating that probiotics help to improve immune health and reduce the risk and duration of illnesses.
A 2014 study found that probiotics significantly reduced”
- the average duration of respiratory illness episodes
- the number of days of illness per person
- the number of days absent from daycare/ work/school [5]
Probiotics for gut–specific conditions
Probiotics are used in a way that is mostly based on symptoms rather than test results. This relates to how probiotics are administered and tested in clinical trials.
During the trials for probiotics, strains are administered to patients with a range of digestive issues. Following a period of time on the probiotics, if specific symptoms improve, this strain of bacteria is then considered to be helped for those symptoms.
For example, suppose a significant percentage of patients have an improvement in their bloating while taking a specific strain of probiotic bacteria. In that case, this bacteria can then be considered a treatment consideration for this symptom.
IBS
For IBS, a range of probiotics have been used and found to be helpful for the associated symptoms.
The common symptoms of IBS include:
- Bloating
- Distention
- Abdominal pain
- Food intolerances
- Constipation
- Diarrhoea
- Flatulence
The common underlying factors involved with IBS include changes in the gut bacteria, low-grade inflammation and activation of the immune response, probiotics can be considered.
The most common and well-studied probiotics for IBS include:
- Lactobacillus Rhamnosus GG
- Lactobacillus Plantarum 299V
- Lactobacillus Acidophilus NCFM
- Bifidobacterium Lactis Bi-07
These can often be found as single probiotic strains of included in multi-strain formulas.
While each strain has been researched individually, this does not mean each patient will respond in the same way to each of them. Therefore, it can be helpful to rotate through these strains to find a specific strain that is most helpful. [6]
Inflammatory Bowel Disease
Probiotics can also be considered in inflammatory bowel conditions such as Crohn’s disease and Ulcerative colitis.
While this is a distinctly different condition from IBS, some of the same strains have been found to be beneficial in addressing this condition, in particular L Rhamnosus GG.
Additionally, higher-strength multi-strain probiotic formulas have also been found to be clinically helpful in inflammatory bowel conditions. One of the main and most well-researched multi-strain formulations is VSL3.
This formula has been found to have potent anti-inflammatory benefits which may be required if there is a more severe inflammation. [7]
SIBO
As explored, probiotics are transited organisms and do not work in a way that fills the gut with more bacteria. This may be a common misunderstanding of the way in which probiotics work and lead to online concern about their use in SIBO treatment.
Since probiotic bacteria travel through the gut as transient organisms, they do not colonise the small intestine. But if they’re viewed in a way where their action is to trigger the production of natural antimicrobials from the small intestine, this is a way that probiotics can actually reduce the bacterial load in the small intestine.
Understanding probiotics in this way can lead to more confidence in their use in SIBO treatment. [6]
Best sources of probiotics
Probiotics can be administered in capsule, powder or liquid form. From a clinical perspective, understanding which strain of bacteria is being used and the benefits it provides.
A good rule of thumb is to select probiotics supplements that state the specific strain. For example, it would be best to see “Lactobacillus Rhamnosus GG” listed rather than “Lactobacillus Rhamnosus”.
Additionally, probiotics can be added to the diet from fermented foods.
Foods rich in probiotics
Fermented foods contain a wide range of bacteria as well as by-products of the fermentation process. This can further support the balance of the microbiome as well as the integrity of the gut lining.
Fermented foods include:
- Yoghurt
- Kefir
- Sauerkraut
- Kimchi [8]
Conclusion
Probiotics can be administered in ways that can be symptoms and condition-specific. Not only for gut health-related issues but also for general health and wellbeing.
The dose and duration of these can depend on the condition as well as other health issues or concerns. It can also be that probiotics are taken alongside other gut health supplements or dietary adjustments to see the desired change in symptoms.
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