Wednesday, April 23, 2014

Wisdom Wednesday: Probiotics Revisited

I frequently mention probiotics in my blogs. You can read my first blog of 2014 discussing the topic by Clicking Here. If you haven’t read that one, please take a few minutes to read it and last week’s Wisdom Wednesday on GALT.

Organisms in the gut can be friendly (probiotic), comensal (neutral), or pathogenic (bad). This well accepted classification has been challenged by recent research. At issue is the fact that what is probiotic for you might be pathogenic for me. Let’s look at each group individually:
The pathogenic bacteria that cause Montezuma’s revenge (traveler’s diarrhea) when you visit Mexico or the Bahamas do not harm the local population. For them, the organisms are comensal or even probiotic. They are indigenous to the local population over many generations and cause no harm. You and your family have similar organisms based on where you live and what you eat.

Comensal bacteria are neither good nor bad. They remind me of teenagers. If they are around other good kids, then they behave. But if they hang with troublemakers, they will get into trouble themselves. Candida often falls into this category. A little bit of Candida in the gut is comensal and maybe even acts as a probiotic in some people. However, overgrowth creates a pathological state. I often tell patients that Candida is an opportunistic infection. If you create the wrong environment in the gut, it will quickly multiply and create symptoms.

Probiotics are the least well understood category. Lactobacillus acidophilus is thought to be healthy for most of us, but not all. Lactobacillus bulgaris is also a good guy most of the time. However, your gut flora is unique to you. There is no probiotic product that is healthy for everyone. In fact, even dead probiotics create an immune response as I noted in my blog on GALT.

If you were born by vaginal delivery, then you were inoculated by your mother with Lactobacillus bulgaris. As an infant your gut bacteria grow and thrive first on breast milk, then becoming more diverse as different foods are slowly added to the diet.

In theory, you should never need a probiotic; your body has nurtured a unique blend of probiotics perfectly suited to you and your environment. However, antibiotics, chemotherapy, and radiation therapy distort and destroy the healthy gut environment. Today, there are antibiotics in drinking water so that even if you have never willingly taken an antibiotic, they may be entering you system on a regular basis.

Fermented foods contain active bacterial cultures. While there is potential benefit from probiotics contained in these foods, there is also potential harm. The Paleo Diet restricts the use of fermented foods while the Mediterranean Diet includes some cultured dairy products.

Currently, laboratories around the world are working to identify all the organisms in the gut through DNA analysis. Every month a few more organisms are isolated, cultured, and identified. Slightly more than 100 bacteria can now be identified through DNA analysis of a simple stool specimen. However, there are thousands of unidentified organisms that are common place in digestive tracts around the world.

Eventually, it will be a simple process to analyze a stool specimen to see what you have and what you need. Currently, when a stool analysis is complete, it will list the probiotics, comensal, and pathological organisms found. Generally no more than 10 organisms are isolated and most of them will be labeled as comensal. However, if the secretory IGA is either high or low, then the immune system has been compromised and those comensal bacteria are probably an issue and need to be treated.

Try to avoid antibiotic use. Do not drink tap water or even filtered water. I recommend distilled water. A small home distiller will make up to 5 gallons per day. They cost just over $100 and generally last 3-4 years. If you have to take an antibiotic, follow it up with a simple probiotic like Lactobacillus acidophilus. Run through a bottle, one capsule after each meal, and then stop. Do not take a probiotic daily. If you have a chronic problem with dysbiosis, then a complete digestive stool analysis may help. Just remember, the test has limitations.