Doctor's Heart Series, Chapter 10: Science of Gut Microbes and Probiotics !
Discussion of Probiotics and their implications on health
It was a cold January day; while returning from work was listening to one of the podcasts; the guest was a hepatologist(Liver specialist). He works in the basic sciences lab and is a practicing medical hepatologist. As a practicing physician, I was inspired by this physician's current medical understanding of the disease due to his extensive background in lab research, a rarity these days. Emerging science is changing rapidly, and medical societies are catching up. He was working at the scientific level, researching and working as a physician. There was a moment when I was awe-struck about using fecal microbiota transplantation(transplantation of healthy feces to the patient with the disease) to help reverse Alcohol liver disease or alcoholic hepatitis (a liver disease caused by alcoholism). I have cared for many patients with Alcoholic liver disease; currently, there is no other primary treatment to treat other than giving steroids(powerful anti-inflammatories). So it was an eye-opener for me. However, using fecal transplantation to heal alcohol liver disease was a new concept; this physician was the first in the world. Today's topic of discussion is gut microbiota and the role of probiotics in human health.
Dr. Metchnikoff, Russian Immunologist in Paris at Pasteur institute, was one of the pioneers called the Father of Innate Immunity(defence immunity at birth). He was interested in people living longer, especially the Bulgarian peasants. He attributed it to the consumption of yogurt that contained Bulgarian Lactobacillus spp. Bacteria. He developed the theory that longevity depends on the higher number of Lactobacillus in the gut prolonging life. During the 1892 Cholera outbreak, he was surprised why specific individuals were affected by the disease but others did not. To understand these differences, he drank cholera sample and never got sick. He hypothesized that the difference in cholera infection was due to differences in intestinal microbes, speculating that those with plenty of beneficial ones would be healthier. He drank sour milk for the rest of his life. This concept of probiotics which he termed "orthobiosis," was influential in his lifetime but became ignored until the mid-1990s when experimental evidence emerged. He later shared the Nobel prize with Dr. Paul Ehlrich in Nobel Medicine.
The gut microbiota is a complex ecosystem comprising an estimated 40-100 trillion(100 trillion!) organisms, primarily bacteria but less likely yeast, viruses, etc. The role of gut microbial organisms in health is well appreciated. As a result, probiotics (live Organisms) are a 58 billion-dollar industry worldwide. Most research has focused on gut microbiota and their roles within the microbiome, given their predominance relative to other microbes. More than 1000 microorganisms are in a healthy gut, the majority in the large intestine. In healthy individuals, gut microbiota aid with digestion, metabolism, and immune buildup. Disruption of normalcy in the gut can lead to dysbiosis (imbalance in gut microbial activity) and leaky gut ( as the name suggests, the porous lining of the gut), which is believed to be associated with various potential consequences, including infection, autoimmune deficiency and several medical conditions.
A 'reference man' (one who is 70 kilograms, 20–30 years old and 1.7 metres tall) contains on average about 30 trillion human cells and 39 trillion bacteria, say Ron Milo and Ron Sender at the Weizmann Institute of Science in Rehovot, Israel, and Shai Fuchs at the Hospital for Sick Children in Toronto, Canada.
Dysbiosis…
Dysbiosis is an imbalance in the collection of microorganisms that live in the human body. The human gut microbiota is a complex and dynamic ecosystem that plays a critical role in many aspects of health, including digestion, immune function, and metabolism. When the balance of microbes in the gut is disrupted, it can lead to dysbiosis linked to various health conditions, including inflammatory bowel disease, obesity, and metabolic disorders. The factors that can contribute to dysbiosis include the use of antibiotics, changes in diet, chronic stress, and exposure to toxins or other environmental factors. Treatments for dysbiosis may involve dietary changes, probiotics or prebiotics, fecal microbiota transplantation, or other interventions to restore a healthy balance of microbes in the affected environment.
Leaky gut syndrome…
Gut health is paramount for well-being. However, dysbiosis can happen due to lifestyle factors, poor dietary habits, and stressful environments, leading to disturbances in the gut lining called Leaky Gut Syndrome. When the lining gets disturbed or damaged, harmful bacteria, toxins, and undigested particles can leak into the bloodstream. They can cause a cascade of events, potentially leading to health issues. Symptoms of leaky gut syndrome may include digestive problems, such as bloating, gas, diarrhea, fatigue, headaches, joint pain, and skin problems. However, evidence suggests that increased intestinal permeability(leaking of toxins thru damaged gut lining) may be a factor in some cases of autoimmune diseases, such as celiac disease and inflammatory bowel disease. The treatment for leaky gut syndrome typically involves addressing the condition's underlying causes, which may include dietary factors, such as consumption of processed foods, sugar, and gluten, as well as environmental toxins and stress. Lifestyle modifications, such as getting enough sleep, reducing stress, and engaging in regular exercise, may also be helpful. Specific dietary interventions that are beneficial in some cases include eliminating trigger foods, such as dairy, gluten, and soy, and increasing the intake of fiber-rich foods and probiotics, which can support the growth of beneficial gut bacteria. In addition, vitamin D, may also help repair the intestinal lining and reduce inflammation in the gut.
Gut bacteria, such as Lactobacillus rhamnosus, produce a variety of neurotransmitters that can reach the brain through nerves that connect the gastrointestinal tract to the central nervous system. Some of these microbe-produced neurotransmitters include serotonin, a vital excitatory neurotransmitter that plays a role in happiness, anxiety, and depression. A study in rhesus monkeys showed that stress was connected to changes in the composition and diversity of the primates’ gut microbiota; In 2011 Dr. Cryan – of the Irish laboratory – found that mice that ate a particular probiotic were more relaxed than those who did not eat the supplement. A stressed microbiome can also cause these patients to be more sensitive to any type of pain, and mental stress and anxiety can further exacerbate these pain signals.
Prebiotics, Synbiotics & Probiotics
The Gut Microbiota consists of various microorganisms, including bacteria, yeast, virus, etc. Most of the organisms that call home help keep the gut lining healthy. The prebiotics are the food for the gut microbes to stay healthy, hence eating more fiber during a meal helps for better maintenance of gut health; for example, the Mediterranean diet is considered one of the most nutritious diets and is the go-to diet for Heart health, the primary foods heavily consumed are fresh vegetables and fruits consumed along with the cooked food. The probiotics are the live organisms of gut microbial symbiosis, boosting the levels in the gut, thus healing when the lining gets disturbed. They are usually abundant in yogurt, Kefir, kimchi, etc. Finally, synbiotics are supplements that include both prebiotics and probiotics, creating the perfect environment for microorganisms to thrive and thus helping maintain gut health.
Prebiotics…
Prebiotics are non-digestible dietary and specialized plant fibers that serve as food for the beneficial bacteria in the gut. They are typically found in certain fruits, vegetables, and whole grains. Prebiotics help promote the growth and activity of beneficial bacteria in the gut, which can positively impact overall gut health and may also support immune function. There are two main types of dietary fiber: soluble fiber and insoluble fiber. Here's a brief overview of each:
Soluble fiber: This fiber dissolves in water to form a gel-like substance. It is found in oats, barley, legumes, fruits, and vegetables. Soluble fiber can help lower cholesterol levels and regulate blood sugar levels.
Insoluble fiber: This fiber does not dissolve in water and passes through the digestive system largely intact. It is found in whole grains, nuts, seeds, and the skins of fruits and vegetables. Insoluble fiber helps promote regularity and prevent constipation.
As per the National Institute of Health, an estimated 95% of American adults and children do not consume recommended fiber. USDA’s recommended daily amount for adults up to age 50 is 25 grams for women and 38 grams for men. Women and men older than 50 should have 21 and 30 daily grams, respectively.
Synbiotics…
Synbiotics are a combination of prebiotics and probiotics that work together to promote gut health. By providing a source of food for the beneficial bacteria in the gut, prebiotics can help to increase the effectiveness of probiotics. This can lead to a more robust and diverse microbiome, which may have a positive impact on overall health. Research is significant in this area as it provides synergism between both important in gut health.
Synbiotics = Prebiotics(Apple) + Probiotics (Yogurt)
Probiotics…
Probiotics are live microorganisms that provide health benefits to their host when consumed in adequate amounts. They are typically found in fermented foods and supplements. Probiotics can help to balance the gut microorganisms by adding beneficial bacteria to the system, which may help to improve digestion, support immune function, and may have other health benefits. They are available in different types, each with its own unique benefits. Here are some common types of probiotics:
Lactobacillus: This is a probiotic type naturally found in the human digestive system. It helps to break down lactose, the sugar in milk, and has been shown to improve digestive health.
Bifidobacterium: This type of probiotic is also found in the human digestive system, specifically in the large intestine. It helps to break down complex carbohydrates and has been shown to improve immune function.
Saccharomyces boulardii: This is a type of probiotic yeast that is effective in preventing and treating diarrhea caused by antibiotic use and other digestive issues.
Health Benefits of Probiotics…
Currently, the research on probiotics is at warp speed. However, the benefits of a better lifestyle and living longer emphasize the need for a healthy gut. In this rapid-paced world, the options of various processed foods have taken over our day-to-day lives. Increasing research has been pointing toward probiotics improving metabolic disease, weight loss, body composition, and losing fat mass. Gut health has revealed the importance of serotonin(happiness hormone). Anxiety and depression have been associated in the gut due to the abundant presence of serotonin released in the gut with the oral microbiota. Prevention of antibiotic-associated diarrhea with probiotics. Several strains of probiotics have been studied for their potential to improve fatty liver, also known as non-alcoholic fatty liver disease (NAFLD).
Overall, these studies suggest that probiotics can benefit a variety of health outcomes, including reducing the incidence of respiratory tract infections, eczema, antibiotic-associated diarrhea, and abdominal pain and bloating in patients with irritable bowel syndrome.
However, not all studies have shown consistent results, and more research is needed to determine the optimal probiotic strains and dosages for different health conditions. Nevertheless, some studies are attached, which have shown positive results.
Single Strain vs Multiple Strains of Probiotics…
This is the question I had when thinking about writing on probiotics. The studies have shown robust evidence, especially for preventing AAD, antibiotic-associated diarrhea. Two disease indications had a robust number of RCTs(Randomized trials) for specific probiotic types to prevent AAD(Antibiotic-associated diarrhea) and treat pediatric acute diarrhea. These probiotics should be used at a dose of 1–2 billion cfu/day, starting within 48 hours of the antibiotic and continued for 5–7 days after the antibiotic has been discontinued. Efficacy for treating pediatric acute diarrhea was strongly supported, as attached below.
Side Effects…
They may trigger allergic reactions, and may also cause mild stomach upset, diarrhea, or flatulence (passing gas) and bloating for the first few days after starting to take them. There are certain people who need to use caution when using probiotic supplements. There is a risk of infection in some immunocompromised people.
“Let food be thy medicine and medicine be thy food”, the age old quote by Hippocrates is the ideology of today’s health conscious population.
The idea of probiotics isn’t new; most ancient cultures gave yogurt or buttermilk to people in sickness for healing. Today we know that this provides a wide variety of benefits to gut health, giving overall benefits. For example, in hospitals or outpatients, we give out probiotics to patients with antibiotics to prevent diarrhea or C. difficile infection(Serious large intestine infection). In my opinion, one has to assess the daily intake of nutritional diet, fiber intake, and feeding our gut microbes with healthy foods. There are innumerable choices related to probiotics; natural probiotics are always better(see attached); starting with a cup of yogurt or kefir, or Kimchi is a start for a healthy gut, as with the supplements, a single-strain(single organism) probiotic can still provide considerable benefits.
Gut microbiota has received increasing scientific attention in recent decades due to their regulation of several essential processes in the body. From Dr. Metchinkoff, a pioneer in Innate Immunity to The liver doctor on the podcast, addresses gastrointestinal problems via fecal transplants to therapies that can deliver probiotic treatment to patients with disorders ranging from immune-related gut inflammation to psychological and neurodevelopmental conditions. These new potential treatments and therapies may undermine conventional methods, such as surgery and traditional drug therapies, in treating disease in patients.
Suman Manchireddy MD FACP FHM, Internal Medicine, Leesburg, VA.
Email : Care@ReliantMD.com
Disclaimer: This is purely informational and educational purposes only, seek medical advise prior to starting any testing or treatment regimen. The data presented here is researched extensively and has been condensed for a broader audience.
I have been suffering from acidity for years. The piece works for me as it brings a clarity on the pro/pre biotic world. Looking forward to more of such pieces.
Insightful! Thank you.