My pharmacy students are great! We were discussing the vagaries of probiotics and wondered what sort of evidence was out there that showed real benefits from taking probiotics and how to select an actual effective product from the multitude of probiotics lining our shelves. The ads we had been seeing made all sorts of promises that we could not rationalize and prescription orders for probiotics concurrent with antibiotics which also seemed futile. One of the questions we came up with was how can taking an oral probiotic promote vaginal health, as more than one advertised product proclaimed. I postulated that the only mechanism that I could imagine involved poor wiping technique. That, it turns out, taint far from the truth.
Our bodies are host to billions of microorganisms, with close to 1,000 species in the GI tract alone, and E. coli one of the prime inhabitants of the colon. Most of these organisms are bacteria, although we do support some fungi too, mostly candida. Many of these organisms are beneficial to us, aiding digestion and keeping pathogenic microbes in check. All told , these “good germs” outnumber our larger-in-size human cells by about ten to one, so it behooves us to be nice to these friendly microbes. In 2008 the Human Microbiome Project was started by the NIH to identify and characterize these tiny critters.
When should probiotics be used to support a healthy microbiome in our bodies? Fortunately there have been many studies that can help answer that question. The World Health Organization has concluded that probiotics are “Live microorganisms which when administered in adequate amounts confer a health benefit on the host,” clearly establishing a healthy impact for probiotic supplementation.
Much work has been done with premature infants. Preemies delivered by Caesarian section are not exposed to mom’s vaginal flora and are often under such intensive medical support are not even able to access natural breast milk direct from the source for days. This gives these kids a greater risk of being “populated” by many microbes with pathogenic potential. A nasty sounding disease called necrotizing enterocolitis can occur in preterm infants and has a mortality rate around 25%. Even 25% of survivors will have long-term problems. Two friendly species have been identified that tend to exclude the Clostridium pathogen in these babies, Lactobacillus and Bifodobacteria. Normally, these are introduced when ingested during vaginal birth and further supported by breast feeding.
WHO estimates that a child dies from diarrheal disease, somewhere in the world, every 15 seconds. Rehydration and probiotic support are recognized as the hallmarks of clinical management of these devastating diseases. Two species have been identified as having the strongest evidence of a beneficial preventive effect, Lactobacillus rhamnosus and Bifidobacteria lactis. I’m thinking that our gut had better have a healthy population of Lactobacillus and Bifidobacteria!
Prilosec,Nexium, and other proton pump inhibitors are used to treat GI problems such as Gastro-Esophageal Reflux Disease (GERD) to the tune of $14 billion per year in this country. There’s a gram-negative bacteria called Helicobacter pylori that has been implicated as a contributing factor in GERD, peptic ulcers and even gastric cancer, with a powerful antibiotic regimen often used to eradicate it. Studies show that support with Lactobacillus can help to suppress H. pylori. Probiotic support with VSL#3, an expensive product with very high doses of four Lactobacilli species and three Bifidobacteria species had a significant positive impact on patients with inflammatory bowel disease and Crohn’s disease.
The impact of these microbes is staggering. The Danes have shown that differences in the vaginal microbiome can strongly influence the appearance of allergies and asthma in children. Another study showed that daily intake of Lactobacillus leads to transfer of these friendly bacteria from the rectum to the vagina (remember my earlier supposition?), which lead to a healthier vagina with fewer yeast cells and coliform (like E. coli) bacteria. I feel vindicated, and no, wiping technique does not appear to be a factor.
As we learn more about our microbiome and the various strains of the friendly bacteria available in probiotic products, it is becoming apparent that proper selection is important. This is no easy task. The number of probiotics on the market is legion and spans the vitamin, stomach remedy, and natural product aisles, all the way to the dairy section.
Yogurt, of course, can be a probiotic if it’s a live culture. Interestingly, there are a few studies that seem to indicate that yogurt is not as effective as an oral supplement, although that may have more to do with cell count. In my early years as a consultant pharmacist for a facility for young people with behavioral problems we had a terrible problem with recurring yeast infections in the young ladies and one of the consulting doctors recommended douching with a mixture of plain yogurt and warm water. It seemed to provide some benefit, although this is entirely anecdotal. If you like yogurt there are many good reasons to make it part of your diet. I would still suggest a good probiotic, however.
If you have colitis issues, then VSL #3 may be the best choice for you, Florajen 3, although with fewer cells per capsule, is less expensive and gluten-free if celiac disease is a consideration. Remember, the idea is to maintain a healthy GI microbiome and regular use of Culturelle, Align or even a store brand may be of some benefit. I did my research and probiotic selection before I started this blog and have been taking Florajen 3 for many months and I am quite happy with it. My primary reason is to help maintain a healthy weight. The search for the right combo of species started when I read a Mother Jones article on happy gut bacteria. Both VSL and Florajen require refrigeration and are usually found in the pharmacy.
Probiotics are often used to repopulate the friendly gut bacteria after a course of antibiotics. During my stint in a hospital outpatient pharmacy I learned the importance of Florastor, a fungus-based probiotic. This product was very helpful in maintaining some degree of normal bowel function when treating Clostridium difficile infections with oral vancomycin. Vancomycin tends to wipe out all the bacteria in the GI tract, so using Florastor is a rational way to provide support for a healthier microbiome during treatment with powerful antibiotics.
There is so much more to discuss about probiotics and your health and I may revisit this topic in the future (we didn’t even touch on the new skin spray probiotics!). The paper that vindicated my taint theory was discovered by U of Arizona PharmD candidate Megan Handley and is found in Clinical Microbiology Reviews, October 2003. I have no financial interest in any of the products nor their manufacturers mentioned in this post and provide links only to let you learn more on your own.