The Four P's of Gut Microbiome health. Part 1 - Probiotics.

If you've been living under a rock the last five or so years, you may well ask "What is the gut microbiome?" It’s such an enormous, yet endlessly fascinating, topic that has a big influence on our health. We could all do more to look after our own gut microbiome and collectively educate others on its importance. Here is an excellent primer on the gut microbiome to get you up to speed.

We humans co-evolved with bacteria, and they are a constant, ever-evolving symbiotic presence within - and also on - our bodies. In addition to bacteria, other microbes such as fungi, viruses and protozoa are normally present. Every individual has various microbiome communities - from the nasal cavity, to the digestive tract, to the mouth, the vagina and the skin.

Given that our understanding is still developing, it's important not to overstate the importance of the gut microbiome to different areas of health. But, we must acknowledge that the research is certainly pointing in that direction, in areas as diverse as mental health, skin health, and of course digestive health.

This article is at once both a simplified explanation of gut microbiome health and a reflection of its complexity. I've lost count of the number of articles and social media posts that suggest it's as easy as eating fermented foods or drinks, or popping a probiotic. If only it were that simple, many dedicated researchers and qualified health practitioners would be out of work!

So, in no particular order, I present the Four Ps of gut microbiome health:

• Probiotics
• Prebiotics
• Polyphenols
• Pathogens

Addressing all of these is important if you want to keep your gut microbiome and general health in tip top shape. As always, I have provided key action points for you to implement if this is an area you want to support. Try not to feel overwhelmed– I suggest trying things gradually and you can keep a print out of this article series to keep it on your fridge to remind you of the different things you can do.

In putting together this series, I’m indebted to the work of my colleagues, the experiences of my clients and also to Jason Hawrelak, PhD, in particular, who is the naturopathic gut microbiome guru.

The first article in the series is all about Probiotics. Each week I’ll bring you a new topic, as outlined above.

{Probiotics}

We've all heard of probiotics by now, I'm sure. There is so much advertising for probiotic products and they are also becoming routinely recommended by doctors, usually for digestive upset or poor immunity.

Probiotics can simply be defined as ‘Live microorganisms which when administered in adequate amounts confer a health benefit on the host’ (FAO, 2001). In real terms, this covers both fermented foods (yoghurt, sauekraut, kombucha, kefir, kimchi for example) and freeze-dried probiotic supplements. Humans have been consuming fermented foods for thousands of years in almost every culture on earth. It’s important to know that probiotics generally do not colonise the gut, they pass through and exert their effects only for as long as they are consumed.

Given the thousands of species of probiotic bacteria, the nomenclature structure - or, how these diverse groups are classified by scientists - is important.

In an example, Lactobacillus acidophilus LA5, Lactobacillus is the genus, acidophilus is the species and LA5 is the strain.

Why is this so important? Well aside from the sheer numbers of bacteria that require classification, the benefits of probiotics are strain-specific.

This means that when looking to use a probiotic, the specific strain of one Lactobacillus acidophilus bacteria (for example LA5) may be of benefit where another Lactobacillus acidophilus bacteria is of no benefit. This is because the research results for one strain are usually not applicable to other strains.

No one wants to waste their money on worthless probiotic strains, so if you're looking to treat a particular condition, always look for the strain identifier listed in research and then seek out a product that contains that strain.

Some supplement companies do not list the strains on their products, so if this is the case, I would hesitate to use that product because you really do not know what you’re getting. Some companies refuse to list the strains as they argue their product is a proprietary blend – I take issue with this as I believe complete transparency is the sign of an ethical supplement company. If they don't list the strain, you have to wonder if they have included strains in there that have much of a benefit at all.

Probiotics exert their effects in different ways, such as:

• binding to viruses
• inhibition of bacterial toxins
• production of antimicrobial substances
• interaction with human immune cells
• production of beneficial compounds including short chain fatty acids (SCFAs) such as butyrate
• anti-inflammatory effects
• up-regulation of secretory IgA, one of the most important factors in gut-immune health (fun fact: did you know most of the immune system is located in the gut?)

Specific strains of probiotics have been found to provide health benefits across most body systems and in different health conditions such as eczema, urinary tract infections, IBS and IBD (eg. ulcerative colitis) and traveller's diarrhoea. In many cases though, the science can't yet tell us what strain may be useful for a particular condition.

Soil Based Organisms (SBOs) or spore based probiotics

These type of probiotics have become quite popular in the last few years, especially products like Prescript Assist and MegaSpore. Many people report anecdotally that these probiotics are tolerated much better than the more traditional types of probiotic products.

Spore based organisms are essentially dormant and have an indefinite life span in the dehydrated state found in a supplement. This means the product does not need refrigeration, so is very convenient for storage and travel.  When taken internally, they germinate and colonise the intestine for a short period of time.

Around a year ago, I read that Prescript Assist changed their formula and as a result, they are not recommended by many integrative practitioners anymore. Having dug a little deeper, it seems there has been some sort of dispute between the manufacturer and one of the main distributors with the result being that some potentially very misleading information has been put out to dissuade people from purchasing Prescript Assist. Because of this confusion, it is unfortunately difficult for me to make any recommendation about the product.

What you can do: If you're looking for a specific benefit from probiotics, consider seeking help from a qualified health practitioner who can advise you on the best product for your needs. You may also want to include some of the probiotic foods mentioned above, though I do recommend caution for those with histamine issues and complex conditions such as CFS, where some individuals may be sensitive to probiotics that produce d-lactic acid. As always, start slow with any new food or supplement, but also have some fun exploring the possibilities!

Always aim to use probiotics that have an established safety and efficacy profile in humans. Generally, each dose should contain at least 10 billion CFUs (colony forming units) although that requirement may be higher in some conditions.

A couple of excellent resources include this summary of probiotic research for different conditions by Zad Chow, and Probiotic Advisor, a subscription service from Jason Hawrelak, PhD which is regularly updated and also contains details of the actual products that contain the strains listed in the research.

Keep an eye out for the next article in the series, where I'll cover all things Prebiotics.