Should You Take Probiotics?

good bacteria, bad bacteria and probiotics

What are Probiotics?

The World Health Organization defines probiotics as:
“Live microorganisms which, when administered in adequate amounts, confer a health benefit to the host”
By this definition, there are 3 key components to probiotics:
1. They must be alive
2. They have to be dosed in adequate amounts
3. And they must be bacteria of the type that confer a health benefit

Live Probiotics

Good probiotics are often pricey. They may cost extra but you can be assured that you are getting living and viable probiotics whereas some less expensive products may only contain dead bacteria. A trick to watch out for: probiotic labels that say “x billion viable/live bacteria at time of manufacture.” What the product contained at time of manufacture is completely irrelevant. It’s what they contain when you consume them that matters. What this “guarantee” is really saying is “we’re not sure how much will survive until you take them.” The better manufacturers will usually test their products for at least 6 months beyond the expiry date to ensure that you are still getting living bacteria in the amount claimed on the label when you take it. What the label should say is “guaranteed to contain x billion live or viable bacteria at time of expiry”. See the difference? Knowing that some will die off between manufacture and the time that you take them, the good manufacturers will put extra in when they make it and test it beyond the time of expiry to ensure that even if some did die off, there is still the amount stated on the label when the bottle expires.

Number of Bacteria in Probiotics

The bacteria in probiotics are listed as CFU, which stands for “colony forming units”. It means how many bacteria are in the product that can then reproduce to form a little colony. One or two billion bacteria or CFU’s per serving just doesn’t cut it. When it comes to good bacteria the higher the amount per serving the better. I would typically recommend a product that contains 35-50 billion bacteria per capsule and a wide range of species from the ones listed below. Over 100 trillion bacteria of 500 different species live in a healthy human gut, if you want to have an impact, you need to add more than a drop in the bucket.

Probiotics that Give a Health Benefit

There are a few manufacturers promoting something called “soil based organisms” that are supposed to be what we naturally would have inhabiting our guts if we were eating fresh food plucked from the ground. There has been very little research supporting their use and a few case studies of people who were severely immune compromised and suffered life threatening infections after consuming these products. There is a plethora of research and human experience showing the health benefits of probiotic strains such as Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus reuteri, Lactobacillus plantarum, Lactobacillus rhamnosus, Bifidobacterium bifidum, Bifidobacterium infantis, Bifidobacterium breve, Bifidobacterium longum and Bifidobacterium lactis.

What are the Health Benefits of Probiotics?

Here are the benefits of healthy good bacteria in our digestive tract:
1. Diarrhea prevention, especially when taking antibiotics
2. Colorectal cancer prevention
3. Immune system regulation and enhancement
4. Asthma and allergy prevention
5. Prevention of infection in the gut by harmful organisms like Salmonella, Shigella, H pylori, yeast etc
6. Treatment of Inflammatory Bowel Disease and Irritable Bowel Syndrome
7. They provide the host with vitamins B12 and K
8. They appear to help with insulin resistance in diabetics and in women with gestational diabetes

Probiotic Foods

Certain foods are known to be rich in probiotics. These are fermented foods and many cultures have their own version. Dairy-based foods that contain probiotic bacteria include kefir and yogourt. Non-dairy probiotic foods include fermented foods like raw sauerkraut, kim chi, miso and tempeh. Do these food probiotics work? Research has been done on ingestion of bean and soy tempeh to determine their effect on gut bacteria. Soy tempeh stimulates most the growth of Bifidobacterium bacteria, while bean tempeh stimulates that of Escherichia coli. While it is good to eat probiotic-rich foods for daily gut maintenance, when taking an antibiotic, I would always encourage people to take a good quality probiotic supplement. That way we know exactly how many beneficial bacteria they are getting and of what kind. A serving of commercial yogourt may only contain 1 billion bacteria per serving where just one probiotic capsule would contain 50-100 times that much.

How Often to Take Probiotics

Whether to take probiotics and if so, how much and how often is subject to debate. Definitely any time you need to take antibiotics, you should take a good quality probiotic while taking the antibiotics and for at least two weeks afterward to prevent potentially serious side effects of taking antibiotics.

Because of the potential for numerous health benefits of taking probiotics, for most people they should be a regular part of their health maintenance program. Whether that means taking them every day, or taking them for 2-3 months out of every year, may be more to do with individual preference than scientifically proven value. I do encourage people who take probiotics daily, to try to vary the product and strains that they are taking in order to maintain the diversity of gut bacteria that seems to help promote good health.

Cautions

The above strains of probiotic bacteria are generally considered safe, even for infants. The primary contraindications for probiotic use would be:
1. Someone who is severely immune compromised such as a transplant recipient, someone very elderly or very sick, or a patient undergoing cancer treatment.
2. Using soil-based probiotics in any of the above patients and possibly in the general population as there isn’t sufficient safety and efficacy data.

With about a hundred published studies per year, there is new information being revealed every day about the health benefits of taking probiotic supplements. With almost no downside, and plenty of potential benefits, probiotics are a worthwhile addition to your health regimen.

Oh and by the way, a class action lawsuit was filed and won against Dannon/Danone in January 2008 in which the company stood accused of spending $100 million promoting clinical benefits of Activia and DanActive that its own tests had disproved. To add to that, Bifidus Regularis is a made-up name by Danone for Bifidobacterium animalis. Commercial yogurt is not an adequate means to obtain good bacteria.

Our naturopathic doctors are experts on which probiotics may work best for your particular problem as well as how to heal a whole host of gut issues.  Book an appointment now. 

SIBO

woman suffering from SIBO

SIBO: Small Intestinal Bacterial Overgrowth

Despite its name, the small intestine is actually a whopping 20 feet of very important tissue between your stomach and large intestine. The small intestine is divided up into 3 parts. The part closest to your stomach is called the duodenum, next is the jejunum and the last stretch before your large intestine is your ileum. The small intestine has the important job of digesting food and absorbing nutrients to keep us in good health. As if that wasn’t significant enough, it is also a key contributor to a healthy immune system.

The small intestine plays host to specific beneficial microorganisms that help protect our bodies against bad (pathogenic) bacteria and yeast. These good bacteria also do their part to produce vitamins and nutrients like vitamin K and folate. They are the keepers of the small intestine, ensuring that it continues to do its thing, muscling waves of food through the gut.

What is SIBO?

Small intestinal bacterial overgrowth or SIBO occurs when there is an increased number of bacteria and/or a change in the type of bacteria present in your small intestine. Overgrowth of bacteria in the small intestine is considered to be greater than 100 000 bacteria per millilitre of fluid. Most often SIBO is caused by an overgrowth of the wrong types of bacteria that actually belong in the colon (the large intestine). In truth, the small intestine is meant to be fairly clean. Food coming from the top down through the stomach is sterilized by stomach acid. So anything passing into the small intestine from the top shouldn’t contain much in the way of bacteria. Absence of adequate stomach acid may contribute to SIBO as this would allow passage of bacteria into the intestines. Another theory as to how this occurs is that there is a motor complex that propels everything in your intestines one direction – out the far end. This migrating motor complex or MMC can malfunction, allowing a backwash of bacteria from the large intestine to move up into the small intestine.

The bacteria that causes SIBO is like a bad tenant. It invites all its rowdy friends in for a party and damages the cell lining of the small bowel. This can lead to leaky gut, allowing large protein molecules to move through the intestinal barrier and escape into the bloodstream. As you can imagine, this causes a number of problems, including general inflammation, immune reactions that cause food allergies, and autoimmune diseases.

These havoc-causing bad bacteria are also responsible for poor digestion, constipation or diarrhea and malabsorption. Patients with SIBO may suffer from nutritional deficiencies, particularly iron, vitamin B12, and fat-soluble vitamins A, D, E and K, as well as having unintended weight loss, and even osteoporosis.

Do I Have SIBO?

SIBO is considered an under-diagnosed condition as many people do not seek medical care for their symptoms or they get wrongly diagnosed with irritable bowel syndrome.

The Most Common Signs and Symptoms of SIBO

Signs and symptoms of SIBO include:

· Bloating and abdominal swelling

· Abdominal pain or discomfort

· Diarrhea

· Constipation

· Gas and belching

· Weakness and fatigue

In the most severe cases, patients experience weight loss and vitamin deficiency-related symptoms.

Who is at risk for SIBO? How Do You Get SIBO?

While the elderly may be the most vulnerable population for developing SIBO as its prevalence rises with age, there are multiple other risk factors that can increase your chances, no matter your age. These include:

· Medication use, especially antibiotics

· Gastric acid suppression or Low Stomach Acid (due to stress, medications such as proton pump inhibitors (PPI’s) or antacids, and lifestyle factors)

· Fibromyalgia

· Celiac disease

· Crohn’s disease

· Prior bowel surgery

· Diabetes Types I & II

· Irritable bowel syndrome

Studies also indicate that moderate alcohol consumption (one drink per day for women and two for men) promotes the overgrowth of certain types of bacteria and also impairs vital functions. This results in small bowel injury and decreased muscle contractions impairing the migrating motor complex.

If you are experiencing any of the symptoms mentioned above or think you might be at risk, then we encourage you to make an appointment to assess your symptoms and get tested. Specialized testing can be accomplished through a breath test. This breath test measures your hydrogen and methane gas levels produced by bacterial metabolism and can be a very helpful indicator to determine if you are suffering from SIBO.

What Causes SIBO and How Can You Treat It?

Despite multiple courses of antibiotics being a risk factor, specific antibiotics (like Rifaximin) are still most often used to treat SIBO. However, studies show that SIBO returns in nearly half of all patients within a year after treatment.

Successful treatment of SIBO must be handled just like any other health condition – not with a temporary Band-aid solution, but by addressing the underlying cause! Intestinal bacteria can be influenced by numerous factors beyond what we eat and how much. Environmental effects, drugs, alcohol, sedentary lifestyle, mood disorders, hormone imbalances and lifestyle factors such as stress can all be contributing factors to poor gut health. Therefore, the treatment must be unique to the individual and all-encompassing.

Once you have identified the cause, treat SIBO symptoms through a healthy diet, nutritional supplements and positive lifestyle changes that help return the body to balance.

Tips for dealing with SIBO

  1. Eat three meals per day spaced 4-5 hour apart and avoid snacking. We need to give our body time in between meals to fully digest the previous meal.
  2. With guidance from your naturopathic doctor try an elimination diet for two weeks to get your body back on track by reducing inflammation and bacteria overgrowth. If this doesn’t seem to help, you may want to pursue food sensitivity testing through one of our ND’s. The test checks for antibodies in your bloodstream to either 96 or 184 foods. Employee benefits will sometimes cover the cost of this test along with other lab or diagnostic testing.
  3. Enjoy foods that assist digestive health like fresh pineapple which is rich in bromelain and can also help lower inflammation, and bananas which are an excellent source of potassium and manganese that your stomach lining needs for healing. Boiled cabbage water is an excellent source of the amino acid glutamine that helps heal the gut lining. Vitamin A is also essential for a healthy gut. Eating liver and beta carotene-rich foods like leafy greens and orange vegetables like carrots as well as taking cod liver oil help insure adequate vitamin A intake.
  4. Keep your fat intake in check. Research has shown that a high-fat diet, increases the growth of fat digesting bacteria at the expense of other more healthful ones. That is, microbes from the Clostridiaceae and Peptostreptococcaceae families increased while beneficial bacteria from the Bifidobacteriacaea and Bacteroidacaea families (which are commonly associated with leanness) went down.

How to Get Rid of SIBO: The Steps for Successful Treatment

    1. Elimination/modification of the underlying causes. This may involve changing your diet to a whole food, low FODMAPs diet, reducing your stress, eating 3 meals per day, reducing or eliminating the need for antibiotics, optimizing digestive juices like stomach acid, bile and pancreatic enzymes.

    2. Induction of remission (antibiotics or natural anti-microbials and elemental diet)

    3. Maintenance of remission (promotility herbs, dietary modifications, healthy lifestyle, optimized digestive juices, repeat or cyclical antimicrobials, hormone balancing, reduced alcohol intake).

SIBO Diet Food List (derived from the work of Dr. Alison Siebecker)

Foods to Eat with SIBOFoods to Avoid with SIBO
Nuts and Seeds
Almonds
Almond flour
Coconut: flour/shredded/milk
Hazelnuts
Macadamia
Peanuts
Peanut butter
Pecans
Pine nuts
Pumpkin seeds
Sesame seeds
Sunflower seeds
Walnuts
Nuts and Seeds
Cashews
Pistachios
Pumpkin seeds
Legumes
Lentil: brown, green or red
Lima beans
Legumes
Borlotti beans
Cranberry beans
Kidney beans
Red beans
Navy beans
White beans
Haricot beans
Baked beans
Spilt pea
Butter beans
Cannellini
Chickpea
Garbanzo beans
Fava beans
Broad beans
Pinto beans
Soy beans
Protein Sources
Bacon
Broth: homemade meat or marrow bones
Beef
Eggs
Fish
Game
Lamb
Organ Meats
Pork
Poultry
Seafood
Protein sources
None
Sweeteners
Honey: alfalfa, cotton, clover, raspberry
Stevia-pure (no inulin) in small amounts, occasionally
Sweeteners
Agave syrup
Barley Malt syrup
Brown Rice syrup
Cane sugar (Rapadura, Sucanat)
Coconut sugar
Fructose, powdered
High-fructose corn syrup
Maple syrup
Molasses
Sugar/Sucrose
Sucralose
Polyols/Sugar alcohol: isomalt, erythritol, lactitol, maltitol, mannitol, sorbitol, xylitol
Beverages
Coffee 1c/day (weak)
Tea: black (weak), chamomile, ginger, green, hibiscus, lemongrass, mate, mint, oolong, rooibos/rooibos chai, rose hip
Water
Beverages
Fruit Juices
Coffee substitutes with chicory
Coconut milk-with
thickeners (guar gum, carageenan)
Soda (fructose, sucrose)
Tea: chicory root, licorice, pau d’arco
Fats and Oils
Bacon fat
Butter
Coconut oil
Cod liver oil & Fish oil
Duck fat
Garlic-infused oil
Ghee
Lard & Tallow
Medium Chain Triglyceride/MCT oil
Macadamia oil
Olive oil
Palm oil
Polyunsaturated Vegetable Oils: Borage, Canola Flax, Grape seed, Hemp, Pumpkin seed, Sesame, Sunflower, Walnut
Fats and Oils
Soybean oil
Herbs, Spices, Condiments and Seasonings
All spices (except onion & garlic)
Garlic-infused oil
Ginger (fresh & dried)
Mayonnaise, homemade or commercial with honey
Mustard - without garlic
Pickles/Relish - no sweetener or garlic
Tabasco sauce (McIlhenny Co)
Wasabi - pure
Vinegar: apple cider, distilled/white, red & white wine (NOT balsamic)
Herbs, Spices and Seasonings
Asafoetida powder
Chicory root (leaves ok)
Cocoa/chocolate-unsweetened
Gums/Carrageenan/Thickeners
Sauces or Marinades with High Fodmap ingredients
Soy Sauce/Tamari
Spices: Onion & Garlic powder
Vinegar: balsamic
Fruit
Berries: blueberry, boysenberry, strawberry, raspberry
Carambola
Citrus: lemon, lime, oranges, tangelos, tangerine
Currants
Dragon Fruit
Durian
Grapes
Guava
Kiwifruit
Longon
Melon: cantaloupe/rock, honeydew
Papaya/Paw Paw
Passion fruit
Pineapple
Pomegranate
Prickly Pear
Rambutan
Rhubarb
Fruit
Apple
Apricot
Avocado
Berries: cranberry
Cherries
Citrus, grapefruit
Custard Apple
Date, dried
Fig, dried
Mango
Nectarine
Papaya, dried
Peach
Pear
Pear: nashi
Persimmon
Plum
Pomegranate
Prunes
Raisins
Tamarillo
Watermelon
Canned fruit
Vegetables
Artichoke Hearts (small amounts)
Arugula
Bamboo Shoots
Beets
Bok Choy
Broccoli
Brussels Sprouts
Cabbage
Carrot
Celery Root/Celeriac
Chives
Cucumber
Eggplant
Endive
Fennel bulb < 1 cup
Green Beans
Greens: lettuce, collard, chard, kale, spinach
Olives
Peas, green
Peppers: Bell/Sweet Peppers: Chili
Radicchio
Radish
Rutabaga
Scallion: green part
Snow Peas
Squash: Butternut Kobocha, Sunburst, Yellow, Zucchini
Tomato
Vegetables
Asparagus
Bean Sprouts
Canned vegetables
Cauliflower
Corn
Garlic
Jerusalem artichoke
Leek
Mushrooms
Okra
Onions
Potato: white/all colors
Potato: sweet
Scallions: white part
Seaweeds
Shallot
Starch powder: all
arrowroot, corn, potato, rice, tapioca
Sugar Snap Peas
Taro
Turnip
Water Chestnuts
Yam
Yucca

Download our free one-week SIBO diet guide, low FODMAPs meal plan here.

Do any of the above symptoms or risk factors sound familiar? Do you think you might be suffering from SIBO? We can help! Please contact us and we’ll get to the bottom of what’s going on and create a plan of action to bring your body back to good health.

Call or email us at 416-481-0222 or Info@ForcesofNature.ca for more information or to book an appointment.

To your best health!

The Team at Forces of Nature Wellness Clinic – Naturopathic Doctors, Chiropractor, Massage Therapist, Acupuncturist/TCMP, Osteopath, Registered Dietitian, Psychotherapist

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/

https://www.ncbi.nlm.nih.gov/pubmed/22109896

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890937/

 “Small intestine microbiota regulate host digestive and absorptive adaptive responses to dietary lipids,” Cell Host and Microbe (2018). DOI: 10.1016/j.chom.2018.03.011

How to Test and Treat Small Intestinal Bacterial Overgrowth: an Evidence-Based Approach. Curr Gastroenterol Rep. 2016 Feb;18(2):8. doi: 10.1007/s11894-015-0482-9.

Gut Health

how to heal your gut

How to Heal Your Gut

Many of the disorders that our naturopathic doctors frequently treat, are related to poor gut health including autoimmune disorders, allergies, eczema, psoriasis, recurrent infections, low immune function, inflammatory bowel disease, acne, hormone imbalance, irritable bowel syndrome and yeast infections.

Patients suffering from these conditions will often have gut overgrowth of yeast, harmful bacteria and parasites, inadequate beneficial bacteria, inflammation, small intestinal bacteria overgrowth (SIBO) and leaky gut. Healing gut issues requires a multi-pronged and stepwise approach:

  1.  Remove food sensitivities that are weakening the immune system and damaging the intestinal lining.
  2. Remove any harmful organisms that are damaging the gut.
  3. After the two above steps, then we can repair the gut lining.

Supplements to Repair the Gut Lining

L-glutamine – L-glutamine is an amino acid that is an important fuel for cells that line the digestive tract.
Vitamin A – Vitamin A is vital to the health of mucous membranes – the tissue that lines the digestive and respiratory tracts.
N-acetyl glucosamine (NAG) – This is a different glucosamine from the one that is used for arthritis. It has been shown to have anti-inflammatory effects in inflammatory bowel disease.
Zinc carnosine – A special form of zinc that helps increase antioxidants in the gut and protect the lining of the stomach and digestive tract from damage.
Aloe vera – The gel from inside the aloe plant helps protect the lining of the digestive tract from damage.
Citrus pectin – Research has shown that pectin can help the lining of the digestive tract heal from injury.
Research:

Rolandelli RH, Koruda MJ, Settle RG, Rombeau JL. The effect of enteral feedings supplemented with pectin on the healing of colonic anastomoses in the rat. Surgery. 1986 Jun;99(6):703-7.

Azuma K, Osaki T, Kurozumi S, Kiyose M, Tsuka T, Murahata Y, Imagawa T, Itoh N, Minami S, Sato K, Okamoto Y. Anti-inflammatory effects of orally administered glucosamine oligomer in an experimental model of inflammatory bowel disease. Carbohydr Polym. 2015 Jan 22;115:448-56. doi: 10.1016/j.carbpol.2014.09.012. Epub 2014 Sep 21.

Beaufrère AM, Neveux N, Patureau Mirand P, Buffière C, Marceau G, Sapin V, Cynober L, Meydinal-Denis D. Long-term intermittent glutamine supplementation repairs intestinal damage (structure and functional mass) with advanced age: assessment with plasma citrulline in a rodent model. J Nutr Health Aging. 2014 Nov;18(9):814-9. doi: 10.1007/s12603-014-0468-6.

Lan A, Blachier F, Benamouzig R, Beaumont M, Barrat C, Coelho D, Lancha A Jr, Kong X, Yin Y, Marie JC, Tomé D. Mucosal healing in inflammatory bowel diseases: is there a place for nutritional supplementation? Inflamm Bowel Dis. 2015 Jan;21(1):198-207. doi: 10.1097/MIB.0000000000000177.

Werawatganon D, Rakananurak N, Sallapant S, Prueksapanich P, Somanawat K, Klaikeaw N, Rerknimitr R. Aloe vera attenuated gastric injury on indomethacin-induced gastropathy in rats. World J Gastroenterol. 2014 Dec 28;20(48):18330-7. doi: 10.3748/wjg.v20.i48.18330.

Deters A1, Zippel J, Hellenbrand N, Pappai D, Possemeyer C, Hensel A. Aqueous extracts and polysaccharides from Marshmallow roots (Althea officinalis L.): cellular internalisation and stimulation of cell physiology of human epithelial cells in vitro. J Ethnopharmacol. 2010 Jan 8;127(1):62-9. doi: 10.1016/j.jep.2009.09.050. Epub 2009 Sep 30.

Ueda K, Ueyama T, Oka M, Ito T, Tsuruo Y, Ichinose M. Polaprezinc (Zinc L-carnosine) is a potent inducer of anti-oxidative stress enzyme, heme oxygenase (HO)-1 – a new mechanism of gastric mucosal protection. J Pharmacol Sci. 2009 Jul;110(3):285-94. Epub 2009 Jun 19.

Migrating Motor Complex

gut picture showing migrating motor complex

What is the Migrating Motor Complex (MMC)?

These are waves of electrical activity that pass through the gut between meals.

What does it do?

The MMC help to move food, waste and fiber from the stomach through to the colon.

Why is is important?

The MMC is important because it also keeps sweeping bacteria out of the small intestine and prevents backwash of bacteria from the large intestine up into the small intestine.

What happens if the MMC isn’t working?

The result of poor MMC function is constipation and/or SIBO, or small intestinal bacteria overgrowth. This can cause lots of digestion problems (bloating, gas, constipation, diarrhea, food allergies).

How can I help my Migrating Motor Complex work better?

Part of what stimulates the MMC is fasting, so take breaks between meals. A hormone produced by the stomach called motilin also helps regulate the MMC. Motilin release is regulated by the vagus nerve, the big nerve we talked about a few emails back that comes from the brain and goes to all of the organs of the chest and abdomen. Deep breathing exercises and gargling are two ways of trying to stimulate the vagus nerve. A high cholesterol diet inhibits the MMC, so keep your cholesterol intake low to moderate. SSRI
medications also inhibit movement in the gut.

Our naturopathic doctors have other means of correcting poor function of the MMC and many other gut issues.  Migrating Motor Complex related supplements include 5HTP, ginger and pyridoxal-5- phosphate. Rikkunshito is a Japanese kampo medicine that has been shown to improve gut motility.  Book a consultation with one of our ND’s for more information tailored to you.

By Dr Pamela Frank, BSc(Hons), ND

References:

1. Chen CY, Tsai CY. Ghrelin and motilin in the gastrointestinal system. Curr Pharm Des. 2012;18(31):4755-65.

2. Zhang XM, Dong L, Liu LN. Changes of gastrointestinal myoelectric activity and bile acid pool during cholesterol gallstone formation in guinea pigs. Di Yi Jun Yi Da Xue Xue Bao. 2005 Oct;25(10):1251-5, 1260.

3. Fujitsuka N1, Asakawa A, Hayashi M, Sameshima M, Amitani H, Kojima S, Fujimiya M, Inui A. Selective serotonin reuptake inhibitors modify physiological gastrointestinal motor activities via 5-HT2c receptor and acyl ghrelin. Biol Psychiatry. 2009 May 1;65(9):748-59. doi: 10.1016/j.biopsych.2008.10.031. Epub 2008 Dec 5.