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The health benefits from the diversity and population of the microbiome in our gut have been well documented, ranging from digestive relief in irritable bowel syndrome to predicting and preventing the onset of asthma, dermatitis, and even breast cancer (1). There has also been a growing trend towards probiotic-based foods like kimchi, sauerkraut, yogurt, and kombucha. And while most of us are now aware of the fact that probiotics support a healthy gut, it’s important to remember that it is not a “one-size-fits-all” approach. What are probiotics, and when should I use them? Probiotics are live organisms -- typically bacteria or yeast -- that stimulate the growth of beneficial microorganisms that make up our intestinal flora. Regular consumption of probiotics creates a healthy microbiome which is essential to gut and overall health.

The most common time to take a probiotic is during + following antibiotic use. Antibiotics degrade the population of our good flora, and therefore they require replacement. Some antibiotics, such as amoxicillin, ciprofloxacin, etc, have also been shown to allow for opportunistic infections from candida, or yeast. The primary concern for antibiotic use is ultimately the results of dysbiosis, which is a severe imbalance in desirable vs undesirable bacteria in our gut. Some of the other benefits of probiotic use can include: • Boosting your immune system • Improving immune dysfunction, such as in seasonal allergies, eczema, asthma, etc. • Improved digestive function • Increased absorption of nutrients, and elimination of waste • Fighting pathogens There are many readily-available sources of probiotics, from supplements to food. Supplements usually only contain single strains of bacteria, sometimes in isolation, or other times multi-strain. Unfortunately, some evidence suggests capsulated probiotics don't populate our gut long-term. If you are looking for ways to increase your probiotics consumption, it may be best to start with probiotic-rich foods like some of these: • Yogurt (make sure to choose a yogurt with live or active cultures) • Kefir • Sauerkraut • Kombucha • Miso What to expect when you are taking probiotics? Most people can tolerate probiotics fairly well; however, the most common side effects are a temporary increase in gas and bloating, constipation, and thirst. The cause of these side effects in some people is not entirely known, but they usually subside after a few weeks of continued use. And while there may be several health benefits associated with taking probiotics, there are some people who should always seek advice before starting a probiotic. These people include individuals on immunosuppressive drugs, those with a compromised immune system, or a serious illness which predisposes them to more severe complications. Can probiotics make you feel worse? Our intestinal tract is a veritable colony of microorganisms. There are trillions of these little guys inhabiting our GI tracts and the exact combination and strains make for an incredibly complex interaction within us. When we introduce different species into the mix, it can cause a temporary impact on our intestinal environment. The equilibrium that existed previously has been thrown off balance and needs to readjust. Once the new – and hopefully more beneficial – balance establishes itself, the symptoms should stop. One primary instance where probiotics may persistently make symptoms worse is in cases of small intestinal bacterial overgrowth (SIBO). Since the root of this problem is already an overgrowth of bacteria in the wrong place (the small intestine), adding more bacteria to the mix can often aggravate symptoms. SIBO symptoms look a lot like IBS, which is why it is important to speak to your naturopath before starting a probiotic. You should always introduce probiotics slowly – a process called “titrating” – and increase to a full dose gradually. The Must-Knows when choosing a probiotic #1: Not every probiotic is the same. L rhamnosus GG has been shown to decrease the incidence of asthma and allergies in children, L. acidophilus is helpful in preventing repeat yeast infections, and B. lactis has been shown in clinical trials to improve intestinal dysbiosis and IBS symptoms. Taking an over-the-counter probiotic is useless unless it contains the proper strains indicated for your concern. This is where you want to speak to your ND to choose a probiotic that's right for you. #2: Most probiotics cannot survive at room temperature. Multiple consumer reports have confirmed that many probiotics taken off the shelf are no longer alive, and therefore relatively unhelpful. Many strains of probiotics must be kept at < 8 degrees C or they will degrade at roughly about 4% per day. Meanwhile, some strains of probiotics are completely safe at room temperature, such as S. boulardii, which makes it great for travel. Do your research before buying strains off the shelf, or stick to probiotics found in the refrigeration section of your health food store. #3: Quantity matters. Some probiotics will claim to be over 50 billion bacteria per capsule, but in fact, contain less than 5 million colony-forming units of the desired strains (this is very common with l. acidophilus). Many clinical trials show no benefit to probiotic strains until they reach a certain quantity of exposure. Always read the label, which breaks down the strains and counts of each colony. #4: Watch for fillers and Prebiotics. For those searching for probiotics for gas, bloating, IBS, IBD, etc, if a probiotic makes you feel worse, it may not be the actual bacteria. Many capsulated probiotics contain prebiotics such as inulin, pectin, potato or tapioca starches, maltodextrin, and/or fructooligosaccharides (FOS), which in and of themselves can create gas and bloating. Many are also washed in dairy, which can be a problem for those sensitive to dairy products. When is it time to call the doctor? Once starting a probiotic, if you haven’t presented with an exacerbation of symptoms (suggesting potential overgrowth of bacteria in your gut), no infectious pathogens are present, and your symptoms are on the mild end of the spectrum, you can probably keep taking it. Eventually, your GI tract will settle back down to normal. If you find that you cannot tolerate probiotics, it could be a sign of gut pathogens like parasites or bacterial infections, as well as potential overgrowths. Because each of these issues requires a different treatment approach, it is important to have functional GI testing done to work out exactly the root cause of the problem. If you want further help or wish to discuss ways to support optimal gut health, please feel free to contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule a consultation today!


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