By Amie Richmond - Senior Nutritionist at Body Fabulous
When I opened my nutritional health clinic, Body Fabulous in 2014 I already had a good understanding of gut health and the importance of our microbiome but as the range of health complaints I started to see in clinic increased, I realised so many of these patients had one thing in common – their gut.
Suggesting probiotics and probiotic rich foods to patients who were taking or had recently taken antibiotics was already widespread practice in our clinic and the results never failed to amaze me.
Antibiotics can sometimes wipe out the protective gut bacteria, resulting in diarrhoea and other gastrointestinal issues but could these probiotics do more? I was keen to find out and began some research of my own.
Antibiotics are medicines (such as penicillin or its derivatives) that inhibit the growth of or destroy microorganisms. Improving a patient’s gut health after antibiotics is one thing but I subsequently found that treating other illnesses and conditions with these good bacteria has proved to be massively beneficial.
So what is a probiotic? Simply put it is substance which stimulates the growth of microorganisms, especially those with beneficial properties (such as those of the intestinal flora). So antibiotics destroy microorganisims and probiotics stimulate their growth. There is a time and a place for antibiotics and they save many lives but over use of them in our society has caused massive issues. Antibiotics kill off the ‘good’ and ‘bad’ microorganisims leading to a host of other health complaints in some patients.
My initial research into probiotics involved me understanding the different strains of these bacteria. With well over 500 strains of probiotics, it would be impossible for a supplement to contain them all so which one’s are the best?
The most important aspect of understanding probiotics is to identify the main species required to treat a patient and then the correct strain of that species. I identified 4 major species to research in clinic and looked closely at supporting evidence to their effectiveness;
The predominant and most important bacteria that reside in the small intestine are the Lactobacillus species. There are over 180 strains in this species including L. acidophilus, L. fermentum, L. plantarum, L. rhamnosus, L. salivarius, L. paracasei, L. gasseri and L. reuteri. The Lactobacillius species is used in clinic for overall digestion, nutrient absorption, relief from occasional cramping, gas and diarrhoea, immune health, urinary and vaginal health, detoxification, oral health and liver health.
The Bifidobacterium species are another majorly important group of probiotics found in the walls of the large intestine. Like the Lactobacillus strain, Bifidobacterium produce lactic acid, which provides up to 70 percent of the energy required by cells that line the intestinal wall. Bifidobacterium also produce B-complex vitamins and vitamin K. This species also helps with digestion, immunity, detoxification and diarrhoea but I most commonly use them for nutrient absorption issues and relief from bloating and constipation. There are over 40 strains in this species but the commonly applied bifidobacterial probiotics on the market include B. longum, B. bifidum and B. infantis.
The Bacillus species are spore-bearing bacteria that are highly resistant to heat, moisture and light, making them highly resistant to stomach acid. Mainly found in the small intestine, Bacillus also resides in the body longer than other bacteria and is excreted slowly. There are over 200 strains of the Bacillius species and in clinic we use it for treating certain digestive issues, for relief from occasional constipation and for vaginal health.
Streptoccocus Species is found in the oral cavity’s mucus membranes and is known for its ability to produce BLIS (bacteriocin-like inhibitory substances), which inhibit the ability of other undesirable bacteria to grow. Great for overall oral health and immunity there are over 50 strains in this species including S. Salivarius K12 and S. Salivarius M18.
In years gone by we would be exposed to far more of these bacteria naturally but as our daily lives have become so sanitised it is clear that we are ALL deficient in some strains of good bacteria.
My first research patient was a young boy with attention deficit disorder (ADD). At 12 years old the child presented with acute behavioural issues resulting in difficulties at school and in friendship groups. His mother brought him in to see me and after research into his gut health I discovered some classic irritable bowel syndrome issues otherwise known as IBS.
Countless strong medications had been prescribed to the child from his GP to help calm his outbursts and temper issues but his difficulty in concentrating and sitting still was very evident on meeting him. Whilst medications were helping in some respects the child’s bowel health had not been treated.
The boy had regular diarrhoea which started after a 30 day course of antibiotics for a previous infection unrelated to his ADD. In researching his condition further I was struck to find this quote on the NHS website;
“Preventing antibiotic-associated diarrhoea (AAD)
There's fairly good evidence that taking high doses of some probiotics (Lactobacillus rhamnosus or Saccharomyces boulardii) while taking antibiotics can help prevent children getting AAD.
Without probiotics, antibiotics can sometimes wipe out the protective gut bacteria, resulting in diarrhoea.
Probiotics given with antibiotics may also reduce the risk of developing a Clostridium difficile (C. difficile) infection.”
I subsequently suggested to the patient’s mother that a course of probiotics that included the strains Lactobacillus rhamnosus and Saccharomyces boulardii could be tried to treat the diarrhoea.
Lactobacillus rhamnosus is one of the most widely used probiotic strains. Various health effects are well documented including the prevention and treatment of gastro-intestinal infections and diarrhoea and stimulation of immune responses. Saccharomyces boulardii, or S. boulardii, is actually not a type of bacteria. It's a yeast that happens to function like a probiotic in the body.
Within 2 weeks of taking this combination of bacteria and yeast the child’s diarrhoea had completely gone but the unexpected results included a marked improvement in behaviour. Whilst there is no scientific evidence to support this theory that the balance of bacteria had improved his ADD condition, it was certainly a welcome side effect and a great relief to his mother!
You can get probiotics from supplements, as well as foods that are prepared by bacterial fermentation such as some yogurts, kefir, sauerkraut, tempeh and kimchi.
The gut flora actually performs many functions that are important for health. It manufactures vitamins, including vitamin K and some of the B vitamins. Most of the gut flora is found in the colon, or large intestine, the last part of the digestive tract.
To help me understand if these probiotics could help with other conditions I looked at patients suffering with obesity.
Mary aged 51 presented with a well balanced food diary with no obvious signs that her portion sizes were excessive. After years suffering with obesity and obesity related illnesses, Mary was desperate for help and advice.
I started studying nutrition after losing 65kg myself so I was well aware of the emotional and physical problems related to obesity but Mary’s well balanced diet and exercise regime was puzzling me. Mary presented with very slender arms and legs but significant weight around her waist area.
My research took me to the US National Library of Medicine, National Institutes of Health. Their most impressive study on this was published in 2013. It was a study of 210 individuals with central obesity (fat around the middle).
In this study, taking the probiotic Lactobacillus gasseri caused people to lose 8.5% of their belly fat mass over a period of 12 weeks.
Lactobacillus gasseri is a species in the genus Lactobacillus, which is a type of bacteria naturally present in the human digestive, urinary, and genital systems.
Mary decided to start taking a probiotic supplement containing Lactobacillus gasseri and was delighted to find that after 14 weeks she had lost over 5 inches from her waist.
Again further studies must be undertaken to prove that this strain is effective at treating weigh loss but initial research is promising. The NHS themselves declare ‘it does seem that for most people probiotics appear to be safe. If you wish to try them – and you have a healthy immune system – they shouldn't cause any unpleasant side effects.’
My next patient case came several months later with a gentleman in his 40s suffering with severe lactose intolerance diagnosed using our igG testing. The patient complained of stomach cramps, flatulence and diarrhoea after consuming even the tiniest amounts of lactose and was finding it hard to avoid all sources in his diet.
We were able to identify hidden sources of lactose in his crisps and gravy powder but we also decided to trial Lactobacillus acidophilus to see if it would help.
A 2016 double-blind placebo* control trial assessed the effect of Lactobacillus acidophilus DDS-1 on alleviating lactose intolerance symptoms like diarrhoea, vomiting, flatulence and abdominal cramps. The study involved 38 participants with lactose intolerance and they all got a chance to take the placebo and the probiotic supplement containing 10 billion CFUs of Lactobacillus acidophilus DDS-1 as it was a 2-arm crossover study. They found a statistically significant improvement in diarrhoea, abdominal cramps, vomiting and overall symptom scores compared to the placebo group.
This time after just 7 days of taking the probiotic Lactobacillius Acidophilus, the patient was able to consume very small amounts of lactose with no uncomfortable side effects, allowing him to enjoy some of his favourite treats again! Whilst by no means a cure for lactose intolerance again the results indicate a marked improvement in tolerance levels.
Aware that a growing number of my patients were being offered prescription medication for anxiety or depression, I then set about researching the ‘brain gut axis’ and the links between low mood and a poor diversity of bacteria in the gut.
B. Longum is one of the species researched for the role of probiotics in the gut brain axis. A report from University College Cork found in a study of healthy men that supplementing with B. Longum 1714 caused stress levels to decrease and memory to improve.
In the study, healthy men took a daily capsule of a billion probiotic bacteria for a month, and then switched over to a placebo for a month, or vice versa. None of the men knew which pill they were getting. At the start and after the first and second months, their stress levels and memories were tested, along with brain activity via an EEG machine and results showed a marked improvement.
“When they were given these bacteria they were less anxious and their capacity to memorise material seemed to be enhanced.” The findings were released at the Society for Neuroscience.
David 34, had been on antidepressants for over 6 years and came to our clinic to see if there was any way he could improve his mood naturally. I started him on B. Longum powder and in conjunction with his GP he slowly reduced his medication, eventually stopping all medication after just 6 months of starting his probiotics.
David and his supportive GP where delighted with the results, however It is fair to say that this strain has not been effective for all my patients therefore more research needs to be done in this area.
Over 300 researchers, physicians, dietitians and other healthcare professionals gathered in Rome last March, for the 7th edition of the Gut Microbiota for Health World Summit 2018. They discussed the latest developments in the field of gut microbiota and their application to clinical practice. There conclusions found that although more research and clinical studies are required, the gut microbiota is key in diagnosing, managing and treating disease.
In conclusion I feel that probiotics could be an exciting new field of treatment for those suffering with a range of health complaints and our research work at The Body Fabulous Health Clinic will continue to investigate and research new findings.
US National Library of Medicine, National Institutes of Health
*M. N. Pakdaman, J. K. Udani, P. M. Jhanna and S. Michael , “The effects of the DDS-1 strain of lactobacillus on symptomatic relief for lactose intolerance - a randomized, double-blind, placebo-controlled, crossover clinical trial,” Nutrition Journal, vol. 15, no. 1, pp. 1-11, 2016