The term “probiotic” is getting much attention in professional circles as well as in the advertising media but is still poorly understood by many. The term describes beneficial bacteria that are added to our diet to help populate our digestive system with a healthy population of good bacteria. It is becoming ever clearer that a healthy population of bacteria is very important for our overall health. Our gut is the most intimate contact between the interior of our body and the outside world much as our skin is. The gut must remain permeable to nutrients which we absorb from foods yet impermeable to invading bacteria and viruses. The bacterial population of our gut plays important roles in both of those functions. It is also very important in the function of our overall immune function. I will leave that for another time. The purpose today is to discus the use and function of probiotic products.
The human gut is populated by tens of billions of bacteria of a yet to be discovered number of species. In excess of six hundred have already been isolated and identified. Some of these species are beneficial, some are harmful and some are a bit of both. Unfortunately modern society tends to have a negative impact on the health and balance of the members of the probiotic population. Chlorinated water, antibiotics both as medications and in our food and even our food choices can cause an imbalance in this population. When this balance is severely disrupted it is termed “Disbiosis”. A disbiotic gut is not a happy thing. We perceive this disbiosis as digestive symptoms of some sort. We may have gas and bloating, constipation or diarrhea, or even both or all of the above. One of the unfortunate aftereffects of having bariatric (weight loss) surgery is it can allow the gut to become disbiotic more easily.
In the DS gut food reaches the large intestine far more nutrient rich than in the “normal” gut. This provides the population of bacteria living there much more food. Given more food the population can flourish. If this population is out of balance it is even more sensitive to poor food choices thereby making the symptoms of this imbalance even worse. This is why the DS patient needs to make prudent food choices and may well enjoy great benefit from proper doses of high quality probiotic products containing the correct species.
The problem is that not all probiotic products are what they say they are and not all probiotic products have the same species. Add to that the fact that each gut is individual. We may need to do some experimentation to find the right combination of dose and product.
Some people have what I term a McDonald’s mentality. A Big Mac in one town is exactly the same as one from a different town or, as another example, a gallon of Shell unleaded gasoline is essentially the same as a gallon of gas from the Chevron station. This is not the case with probiotic products. Some products contain only one species and some contain thirteen or more. These various species, with one exception fall, into two large groups these are Lactobacillus species which predominate in the small intestine and Bifidobacterium species which predominate in the large intestine. The one exception is actually not a bacterium at all but rather a specific yeast. This yeast is very important and beneficial. It is called Saccharomyces boulardii. Some patients have reported good results with single species products such as Align (B. infantus), Culturelle (L. rhamnosus) or Floristor (S. boulardii). My feeling is that these products are overly expensive as they are heavily advertised and that cost is built into the price. They also tend to be rather low dose.
We also need to address the correct dosage. It is important to read the label. Minimum “therapeutic” dosage is thought to be 20 billion colony forming units (CFU’s). I personally am using 50 billion CFU’s per day as maintenance. I have taken as much as 200b CFU’s per day. I am also aware of research going on that also is looking at similarly high dosage.
I think a good product to start with is “Primal Defense Ultra”. Make sure it is the “Ultra” as it is the stronger blend. It is reasonably priced and contains a total of 13 species including the very important S. boulardii. For DS patients experiencing a disbiosis creating very foul flatus and stool. This species as an ingredient is very important. The S. boulardii has very specific activity against some of the nastiest bad guys in our gut such as Clostridium difficile, Candida albicans and even Entameba histolytica and Giardia lamblia which have been shown to enhance the effectiveness of conventional therapy for these conditions. In less severe cases the probiotics alone may be sufficient to correct the disbiosis but more severe cases antibiotic therapy may be indicated.
As stated previously the dosage needs to be sufficient. Three caps per day of Primal Defense Ultra (PDU) is a commonly used dose. This provides a total of 45b CFU’s with 12b of that total as S. boulardii. This was the dose used in a recent case study looking at DS patients with recurring frank C.diff treated with antibiotic and S. boulardii. Statistically very significant benefit was shown.
Also as stated previously every gut is different. Some may do well on small doses and some may need more. Every patient needs to find the dose that works for them. We need to start slowly and work up. Some increase in gas and bloating may occur. Once the disbiosis is improved patients can experiment with different blends. It is suggested that there be several species of both the lacto and bifido groups. The only allergic reaction I have heard of is one patient who developed a slight rash which subsided after lowering the dose. You can find this is most health food stores but it is a much better deal on line. Typically about 90 caps for $37 vs. 218 caps for about $50. General rule of thumb is that the refrigerated brands are superior to the less expensive freeze dried ones. But, many do well with the less expensive brands. Again, you need to experiment.
Also as stated prudent food choices are extremely important. Things like lean protein, complex carbohydrates and whole grains. Avoidance artificial sweeteners and simple sugars and white flour are all prudent decisions.
By: David Caya, DC
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