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Oct/Nov 2008 Issue
Good for You
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Probiotics: Good Germs for Your Gut
Aiming for peak digestive health
When Renee Deyo’s 7-year-old son, Bryan, gained several inches and six pounds in four months, she knew it wasn’t your run-of-the-mill growth spurt. She attributed it to the healing Bryan’s body had undergone since she began giving him cultured, or fermented, foods and probiotic supplements.
Deyo has tried many biomedical therapies to treat Bryan’s autism, with which he was diagnosed at age two. She tried the gluten-free/casein-free diet, digestive enzymes, B12 shots and chelation, among others. At one point, using a nutritional protocol developed by Amy Yasko, Ph.D., Bryan was taking 120 supplements per day.
“All the therapies helped a little bit but progress was slow” Deyo says, until she started Bryan on the Body Ecology Diet (BED) to aggressively treat his intestinal hyperpermeability—or leaky gut—a condition in which the lining of the intestinal tract is more porous than it should be.
The BED, a dietary program developed by Donna Gates and described in her 1996 book, The Body Ecology Diet: Recovering Your Health and Rebuilding Your Immunity, recommends three major changes: (1) add cultured foods to your diet, (2) change the quality of fats and oils you consume, and (3) drastically reduce your intake of carbohydrates and sugars. Deyo had already done steps 2 and 3 before starting Bryan on the BED so all she had to do was add in more probiotic supplements (he had been taking them in lower amounts all along) and cultured food.
When she did, “Bryan started to get better within 48 hours,” she says. “It was a quick change.”
Leaky gut is associated with over 30 conditions, including acne, allergies, arthritis, autism, celiac disease, chronic fatigue syndrome, Crohn’s disease, eczema, hives and ulcerative colitis, according to Liz Lipski, Ph.D., CCN, author of Leaky Gut Syndrome (McGraw-Hill). Symptoms can include abdominal pain, aggression, asthma, anxiety, bed-wetting, bloating, confusion, constipation, diarrhea, fatigue, gas, insomnia, food allergies, food intolerances, irritability, malnutrition, moodiness, muscle cramps and poor immunity.
How can a compromised gut lead to such a wide range of symptoms and diseases? It all has to do with the immune system. The theory is that when the mucosal surface of the gastrointestinal tract, which serves as an immunological barrier against the microorganisms of the outside world, breaks down, it can suppress your body’s immune system.
“Increased intestinal permeability is well researched,” says Lipski, and is “readily accepted by physicians and other health professionals who focus on integrative and preventive health care.”
Acknowledging that leaky gut theory is not generally accepted by mainstream medicine, Lipski says that “it typically takes a decade or two from the time something has been researched until it is accepted widely.”
Leaky gut develops when an initial insult, such as chronic stress, intestinal infections, poor diet, environmental toxins or prolonged use of non-steroidal anti-inflammatory drugs (NSAIDS, like Ibuprofen), instigates an overgrowth of microbial pathogens, such as bacteria, viruses and/or yeast.
Many of the microscopic creatures attached to our innards are friendly (non-pathogens), helpful to the digestive process. But to do any good, they have to exist in sufficient numbers to keep the unfriendly pathogens in check.
The Good, Bad and Ugly Microbes
Pathogens and non-pathogens coexist in an extremely delicate balance that keeps the immune system functioning well. When the immune system is healthy, the spaces between the cells that line the intestinal tract allow only small molecules of properly digested food to pass through to the bloodstream. However, if pathogens get out of control, Lipski says, “the tissues get ‘leaky,’ which is to say that the cells which are typically tightly bound get loose and large molecules are allowed to pass into the bloodstream.” The abnormal presence of incompletely digested food particles in the blood then activates the immune system, creating more inflammation. This causes additional barrier dysfunction and around it goes, becoming a self-amplifying cycle
Ultimately, “the inflammation can be so severe that nothing can get through,” Lipski says. “This is malabsorption,” which leads to malnutrition and the accompanying health problems.
The key to restoring proper digestion is to close the gaps in the intestinal lining. The way to do this is by correcting the imbalance of pathogens and non-pathogens, which will reduce the inflammation of the lining. That’s where probiotics come in.
What the Research Says
The Food and Agriculture Organization (FAO) of the United Nations and World Health Organization defines probiotics as “live microorganisms that when administered in adequate amounts confer a health benefit on the host.” Most of us don’t like to think of ourselves as a host for microbes but in microbiology circles, that’s just what we are.
The concept of probiotics dates back to Elie Metchnikoff, a 19th century Russian immunologist. He hypothesized that the long, healthy lives of Bulgarian peasants were a result of the fermented milk they drank, which contained beneficial Lactobacillus, and the positive effects it had on their digestive health. Now, more than 100 years later, Linda C. Douglas, Ph.D., R.D. and Mary E. Sanders, Ph.D., assert in an article published in the Journal of the American Dietetic Association that Elie Metchnikoff had it right. Beneficial microbes influence immune development and resistance to infection. Modern-day consumption of beneficial microbes is much lower than that of our ancestors, they contend, which may be contributing to the rise in inflammatory and allergic disorders we see today.
The scientific evidence for the positive effects of probiotics is still emerging; however, many health effects have been documented in the mainstream medical literature. Some of these benefits are: regulation of the immune system (both enhanced immune response to pathogens and down-regulated autoimmune and inflammatory responses); shortening the duration of infectious diarrhea in infants; enhanced gastrointestinal tolerance to antibiotic therapy; and control of symptoms associated with lactose intolerance.
According to Douglas and Sanders, promising areas of research include reduction of incidence and improvement of symptoms in some allergic diseases, improved symptoms for those with irritable bowel syndrome, and reduction of Clostridium difficile (a bacterium that causes symptoms ranging from diarrhea to life-threatening inflammations of the colon) in subjects taking antibiotics.
Although probiotics are frequently used to treat Crohn’s disease, Douglas and Sanders note that well-conducted studies have shown contradictory results. They point out that these results may be due to improper probiotic choice or inadequate dosing.
More research on probiotic supplementation is needed, including which probiotic (or probiotics) is best for which condition, how much one needs to take for it to work, which form—supplements of cultured foods—are the best delivery systems, and whether one format is better for one condition but not for another.
Quality, Safety and Effectiveness
The Food and Drug Administration (FDA) considers probiotics to be nutritional supplements, rather than drugs, so regulation is less stringent. Manufacturers can sell their products with little or no research to back up their claims. But truth in probiotics advertising is about to get a boost. The International Probiotics Association (IPA), a newly established 41-member group, which includes many probiotic suppliers and product manufacturers, will soon be providing some much-needed quality control. Probiotics manufacturers will be able to apply to the IPA this fall to have their products tested by third-party independent agencies. If they meet IPA criteria, they will be eligible to receive its quality seal.
There are many products now on the market claiming to contain probiotics but not all meet the definition of a probiotic as outlined by Douglas and Sanders: (1) a purified strain of the candidate microbe, usually a bacterium or yeast; (2) identified to the strain level (probiotics are identified by genus, species and strain) using biochemical and genetic techniques, (3) that is safe for target consumers.
Where safety is concerned, the most common side effects of probiotics are mild and digestive (gas and bloating), according to National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM). The Center also cautions that the safety of probiotics “has not been thoroughly studied scientifically. More information is especially needed for how safe they are for young children, elderly people and people with compromised immune systems.”
Probiotic supplements are readily available and easy to find in natural food stores—but the quality of many brands is not as easy to assess. Until IPA’s quality seal program is available and widely used, how can you tell which supplement manufacturers are living up to their advertising claims?
One way to research products is to consult ConsumerLab.com, an independent online reviewer of nutritional supplements. Its recent report on probiotics revealed that of the 16 tested, five did not contain the listed amount of probiotic organisms and one was contaminated with mold. To get a full report, you can subscribe to ConsumerLab.com ($29 per year).
Bryan Deyo is now on five different probiotic supplements, including VSL#3, which is exponentially more potent than most other products. After she added the additional probiotics, along with cultured food and drinks, to her son's diet, Deyo says that Bryan experienced major developmental progress, including greater interest in his surroundings, playing with more toys, talking more, and being more socially and emotionally “available.” In addition, she says, “Bryan’s bowel movements were finally normal for the first time in years.”
Deyo rotates Bryan’s probiotics “so he won’t become sensitized to any of them.” She alternates between pills and food/drinks because she doesn’t know (nor does anyone) which format is best for Bryan.
After consulting with Lipski, Deyo also began giving Bryan prebiotics, which are non-digestible food ingredients that help the good bacteria already in your gut multiply. Common food sources of prebiotics include whole grains, onions, bananas, garlic, honey, leeks and artichokes, among others. Examples of prebiotic supplements are inulin, fructo-oligosaccharides (FOS), polydextrose, arabiogalactan and polyols, such as lactulose and lactitol.
Because prebiotics are, by definition, non-digestible, they may cause problems for people on certain restricted diets. For example, the Specific Carbohydrate Diet (SCD), a gluten-free/casein-free diet developed by Sidney Valentine Haas to treat Crohn’s disease and other gastrointestinal problems and later promoted by Elaine Gottschall for children on the autistic spectrum, prohibits inulin and FOS. Many probiotic supplements, including VSL#3, are also prohibited on the SCD.
Supplements that contain both probiotics and prebiotics are called synbiotics. The two components work synergistically to make probiotics more effective than they would be if taken alone.
Deyo noticed the changes in Bryan at home but she also began getting very positive, unsolicited comments about his progress from everybody who knew him, including his teacher and parents of the other kids in his class. Bryan’s lab tests confirmed what Deyo was witnessing. Although she doesn’t officially follow Yasko’s entire protocol any longer, Deyo still consults with Yasko regarding the results of Bryan’s Comprehensive Stool Analysis, which Bryan undergoes regularly.
According to Deyo, during her last consult with Yasko—who did not know that Bryan had begun any new treatments—“Dr. Yasko said, ‘Whatever you’re doing, keep doing it; his test results are beautiful.’”
“His bacteria levels are better … and he has no strep infection now, after having it for three years, ”Deyo says.
Deyo doesn’t claim that probiotic supplementation should get full credit for all of Bryan’s recent improvements but she is convinced they wouldn’t have happened without it. After a long plateau in his health, “Bryan has made more progress in the last two months than in the last two years,” Deyo says. And she couldn’t be happier. LW.