Dear Julie,
Of all the parts of the microbiome from the ocular microbiome to the oral microbiome, the gut microbiome is by far the most well researched, and we now know that everything our gut microbiome does has an impact on our health. The vitamins they manufacture, the role they play in the production of neurotransmitters, the role they play in the production of short-chain fatty acids that are important for brain health, the role that our gut bacteria play in maintaining the integrity of the gut lining, and their ability to influence the way our immune system functions are well established in the medical literature. This week we conclude our 3 part series on dysbiosis where we discuss ways to treat it.
Treatment of Dysbiosis:
Treatments for dysbiosis include the following: prebiotics, probiotics, colonic foods, and antimicrobials. Prebiotics are complex carbohydrates- also known as oligosaccharides—that are not digestible. This means that they can survive the rough journey through the digestive tract, making it safely into the colon. Other types of carbohydrates never make it that far, as they are digested. Prebiotics selectively stimulate the growth of beneficial microorganisms.
Xylooligosaccharides (XOS) are a preferred form of oligosaccharide that supplement companies are using as prebiotics because one of the primary benefits of XOS is its ability to target good bacteria using a lower dosage than other prebiotics. In fact, doses as low as one gram have been shown to modify the gut microbiome significantly, resulting in an increase of good bacteria and a decrease of the bad.
Probiotics are live microorganisms which when administered in adequate amounts confer a health benefit on the host.
Colonic foods are foods entering the colon and serving as substrates for the endogenous colonic bacteria, thus indirectly providing the host with energy, metabolic substrates and essential micronutrients (Hawrelak, 2006) Examples of colonic foods include carrots, cocoa, green tea, brown rice, and prebiotic foods such as onions, garlic, chicory root, barley, bananas, leeks, and apples.
Probiotic Myths and Pearls:
Myth # 1 – Research conducted on one probiotic strain can be accurately extrapolated to other strains within the same species.
Truth: In order to assess the quality of the bacteria in a given supplement or probiotic food, one needs to know not only the species of bacteria in the product but also the STRAIN. You cannot extrapolate research conducted on one strain to another one. Different probiotic strains have different actions. In the same way that we use different breeds of dogs for different jobs, we use different strains of bacteria for different therapeutic applications. An example of evidence of strain specificity: The Tale of Two Strains….(Manama et al. 1995) Two Lactobacillus rhamnosus strains compared in the treatment of viral gastroenteritis: L. rhamnnosus GG versus L. rhamnosus Lactophilus showed differences in the duration of diarrhea – 1.8 days in the LGG group versus 2.8 days in the Lactophilus group (P=0.04). On day 2 only 19% of patients in the LGG group had diarrhea vs 64% of subjects in the Lactophilus grp (P=0.02). Also, rotavirus specific IgA levels were significantly higher in the LGG group during the convalescent period (P=0.01) showing superior efficacy of one strain of L. rhamnosus from another strain of L.rhamnosus. This is important as patients can spend a lot of money on probiotics not knowing that the strain chosen is going to determine efficacy. Another example is from studies where two different strains of Lactobacillus plantarum were studied in the treatment of irritable bowel syndrome (IBS). Strain 299v of Lactobacillus plantarum was found to significantly decrease abdominal pain severity, frequency, and bloating (Ducrotte et al, 2012). However, Lactobacillus plantarum strain MF 1298 was found in another study to significantly worsen IBS symptoms and patients preferred the placebo. (Ligaarden et al, 2010)
Myth # 2- Don’t use probiotics during antibiotic treatment as antibiotics with kill all the probiotics
Truth: Research shows that concurrent administration of probiotics with antibiotics not only significantly decreases antibiotic-related size effects, but also attenuates antibiotic-associated damage to the gut microbiota (Szajewska et al, 2006). We often prescribe oral antibiotics and it is good clinical practice to prescribe over the counter lactobacillus rhamnosus GG, a very widely available probiotic and one of the most well-researched strains, concomitantly to prevent damage to the gut microbiome from antibiotic use.
Myth # 3- Probiotics are best taken on an empty stomach.
Truth: Research clearly shows improved bacterial survival when taken with a meal (preferably a larger meal). Dairy or fiber or grain based meals optimize survival through the upper gastrointestinal tract (Kialasapthy & Chin, 2000)(Lauren’s-Hastings & Viljoen, 2001)
Myth # 4– Probiotic strains ingested orally will permanently colonize the human gastrointestinal tract and you can re-colonize with probiotic supplements.
Truth: Research clearly shows that NO exogenously supplied probiotic strain permanently colonizers the human gastrointestinal tract. Once you stop taking a certain strain, it will eventually die off. You can not re-colonize permanently by taking probiotic supplements for a limited time.
Myth # 5- Infants should only be supplemented with strains of Bifidobacterium infantis.
Truth: Babies need special baby probiotics. By week one of age in vaginally-delivered, breastfed infants, the flora is dominated by Bifidobacterium spp. & Ruminococcaceae spp. but a multitude of other species are present (Morelli, 2008)(Martin, et al, 2003)(Albesharat et al, 2011).
Myth #6- Giving probiotics in supplement form (ie: capsule, powder, or tablet) is superior to food forms (ie: yogurt).
Truth: Yogurt often contains greater numbers of viable bacteria. In a 1996 study by Sittonen et al, 100 million bacteria provided in a dairy-base led to a greater number of live bacteria in the colon than 10 billion provided in a capsule. Numerous clinical trials have shown that medicinal yogurts have therapeutic effects.
Pearls: Before prescribing any probiotic supplement, make sure you know the strains it contains. Ensure these strains exhibit the desirable criteria (via published research rather than just taking their work for it). Avoid products that do not detail their strain(s). Choose the correct strain to treat the clinical scenario at hand as each probiotic strain should be viewed as a unique therapeutic agent with specific actions and applications. Lastly, you cannot extrapolate research results from one strain to another, even if they are within the same species.
IN THE NEWS:
Sugary Drinks, even fruit juice, associated with an increased risk of cancer in this large prospective study…
Conclusions In this large prospective study, the consumption of sugary drinks was positively associated with the risk of overall cancer and breast cancer. 100% fruit juices were also positively associated with the risk of overall cancer. These results need replication in other large scale prospective studies. They suggest that sugary drinks, which are widely consumed in Western countries, might represent a modifiable risk factor for cancer prevention.