Everything you wanted to know about probiotics
By Dr. Debby Hamilton, MD, MPH
By Dr. Debby Hamilton, MD, MPH
The microbiome is the ecosystem of microorganisms living within the body. While there are different microbiomes in different areas of the body, the most well-studied is the microbiome in the digestive tract. More probiotic, beneficial bacteria inhabit this microbiome than we have cells in our entire body, which means the gut microbiome is incredibly complex and vital to our overall health and wellness.
The beneficial bacteria in our gut microbiome are essential to a balanced immune system, digestion, and regulation of the gastrointestinal system. They serve many functions including crowding out bad bacteria and producing vitamins and natural antimicrobial compounds.
Because the American diet has increased intake of processed foods, along with the over-prescription of antibiotics, many people discover they have a disruption in their microbiome, leading to a decrease in essential beneficial bacteria. A decrease in probiotic bacteria can result in dysbiosis, a concomitant increase in pathogenic bacteria, and an overgrowth of yeast. Dysbiosis can lead to an imbalance of the immune system, with a decrease in immune tolerance and an increase in the risk for autoimmune disease. Dysbiosis is also an inflammatory state, which is known to contribute to the development of autoimmune diseases and chronic digestive issues.
As we discover more about the importance of the microbiome, research continues to indicate the value of probiotics.
Because of the challenges of our diet and environment, supplementing with beneficial probiotic bacteria can help maintain a healthy microbiome. Fermented foods and yogurts are a viable option. However, these natural sources may not provide enough probiotics. Therefore, it is important to understand the various benefits offered by probiotics so that patients can adequately supplement based on their needs.
There are two types of probiotics available: food-derived (live) probiotics and soil-derived (spore forming) probiotics.
Spore forming probiotics are primarily of the Bacillus family. Spore forming bacteria are named for their hard outer shell, the spore, which helps them survive in harsher environments, such as soil. The spore protects against water, heat, as well as other microbes, until conditions are right for them to activate.
When spore-based probiotics are ingested, the spore protects the bacteria from both the stomach acid and the bile acid so that they can easily pass into the intestine. Once inside the intestine where conditions are appropriate, they come out of their spore, and colonize like any other probiotic bacteria .
Spore-based probiotic bacteria play many roles in supporting the health of the gut. While a relatively recent addition to probiotic supplements, spore-forming probiotics have always been familiar residents of a healthy microbiome. Two of the most well-known and researched spore-based probiotic bacteria are Bacillus coagulans and Bacillus subtilis. Bacillus subtilis, for example, was discovered in 1915 and was used as therapy for gastrointestinal and urinary tract illnesses prior to the discovery of antibiotics. Bacillus subtilis has been found to produce 66 anti-bacterial compounds. Multiple studies have shown that by colonizing the GI tract, soil-based probiotics may support healthy digestive function.,, Once spore-based probiotics colonize the intestine, they compete for space and crowd out less desirable bacteria. In addition to physically crowding out other microorganisms, they produce lactic acid, which supports a healthy bacterial balance. They are also known to promote the growth of other beneficial bacteria, such as lactobacillus and bifidobacterium.3
Spore-based probiotics have been found to support many functions, such as positive changes in microbiome and metabolism, support for metabolic blood sugar issues, and support for immune function.,
Food-based probiotics are primarily of the Lactobacillus and Bifidobacterium family. Occasionally, Streptococcus species (such as Streptococcus thermophilus from yogurt cultures or Streptococcus salivarius) are utilized in supplements. Both Lactobacillus and Bifidobacteria species are non-spore forming, gram-positive bacteria that are a stable component of the microbiome. Colonization of the microbiome by both species occurs during vaginal birth. They are also present in fermented foods and dairy products, which is why they are referred to as “food-based” or “dairy-based” probiotics. An imbalance of either of these groups of bacteria can lead to dysbiosis.
Fermented foods have been part of many cultures’ diets. They contain natural probiotics and offer many health benefits. With modern diets decreasing consumption of fermented foods, increasing consumption of processed foods, and over-utilizing antibiotics, many people have lower levels of beneficial bacteria. As with soil-based probiotic bacteria, Lactobacillus and Bifidobacteria produce beneficial compounds that support the microbiome. Lactobacillus, as the name suggests, excretes lactic acid by fermenting sugars. Bifidobacteria produce short-chain fatty acids, which are essential for maintaining the balance in the microbiome.
Lactobacillus Rhamnosus GG is one of the most studied probiotics, with over 800 published studies, including approximately 200 clinical studies. It has a higher survival rate through the gastric juice compared to some other Lactobacillus and Bifidobacterium species. While in the intestine, it has good adhesion to intestinal epithelial cells and increases the secretion of protective mucins. L. Rhamnosus GG supports the immune system, and research indicates it can support the reduction of eczema and allergies. Multiple studies have also shown L. Rhamnosus GG to improve digestive symptoms ranging from abdominal pain to diarrhea., Lactobacillus Salivarius has also been found to have immunomodulating properties, specifically supporting regulatory T cells (Treg) and IL-10, which help improve immune tolerance.
Bifidobacteria strains are some of the first strains that inhabit the digestive tract for infants and help establish a healthy microbiome. As with Lactobacillus, Bifidobacteria strains have shown efficacy in supporting immune and digestive function.,  Bifidobacteria Lactis specifically is known as one of the strongest for immune support.17 It has also been studied for supporting the intestinal microbiota during antibiotic therapy.
The importance of the microbiome and its impact on our immune system, our response to infections, our digestion, and even our mental health is well researched. Because our diet and environmental exposures often harm our microbiome, their may be benefits to proper supplemental support with a broad range of probiotic bacteria.
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