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Do Probiotics Really Work?

Insights + Opinion

"Dr. Hyman, can you tell me more about probiotics? Can supplementing with them really help reduce belly bloat and IBS symptoms? How do you know which ones are good and which ones are a waste of money?"

Well—to be frank, our poop and all the bugs that live in there are the great new frontier in medicine. Who knew!? The health of the 100 trillion bugs in your gut (which outnumber you 10 to 1) is one of the biggest things that impacts your health. Is it as simple as just taking a few probiotics or eating some yogurt? Not really—we have to learn how to tend the gut flora of our inner gardens by being selective of what we eat and how we live; feeding the good bugs and avoiding gut—busting drugs and habits—like eating too much sugar and starch, or consuming too much alcohol, or not managing our stress (yes, your gut bacteria are eavesdropping on your thoughts).

But What About Probiotics?

This is a huge area of research and really, we are at the infancy of understanding how to create and use probiotics. Probiotics are popping up everywhere! They're in yogurt commercials and sold at your pharmacy and grocery store. Ever since gut health has come to the forefront, probiotics have become a popular topic. So, do they really help?

Well, in order to understand probiotics, we need to understand the gut. I see so many patients in my office every week who are suffering from uncomfortable and disabling symptoms like bloating, cramps, diarrhea, constipation and abdominal pain. Often these are signs of irritable bowel syndrome (IBS), which has become a very real problem. Did you know that 60 million people (20 percent of Americans) have an irritable bowel? And even if you don't have gut symptoms, so many other diseases are affected by the health of your gut flora—including obesity, diabetes, heart disease, cancer, autoimmune disease, allergic diseases like asthma and eczema and even depression, ADD and autism!

What causes an irritable bowel? The biggest causes are bad bugs growing in there where they shouldn't, a leaky gut and food sensitivities—all of which drive inflammation and irritation.

Bad bugs grow when we eat a processed diet that's high in sugar and starch; don't eat enough of the right fiber and prebiotics; or take too many gut-busting drugs (like antibiotics, acid blockers for reflux, anti-inflammatories, hormones and more). Think of your gut as an inner garden; just with any garden—when you let the weeds take over, you get into trouble.

Leaky gut happens when your gut lining breaks down. This can be caused by any of number of things, including: stress; too many antibiotics or anti-inflammatory drugs (like aspirin or Advil); using steroids to treat symptoms; intestinal infections; consuming a low-fiber, high-sugar diet and too much alcohol; and more. When the gut lining breaks down, your immune system is exposed to foreign particles from food and bacteria and other microbes. This triggers and activates an immune response, irritating your gut and creating havoc, which leads to an irritable bowel, an irritable brain and other system-wide problems (including allergies, arthritis, autoimmunity, mood disorders).

Basically, the microbial ecosystem in the gut has to be healthy for you to be healthy. When your gut bacteria are out of balance, it makes you sick. Among all that gut bacteria, there are good guys, bad guys and very bad guys. When you have too many bad guys, and not enough good guys, this is a problem. That's where probiotics come in.

Along with other gut-healing nutrients, a low-glycemic, whole foods diet filled with healthy proteins, fats and fiber, and probiotics can improve the health of your gut significantly. Why? Because probiotics help to populate your gut with good bacteria.

There are lots on the market to choose from. I recommend taking very high-potency probiotics (look for at least 25 to 50 billion live CFU's from a variety of strains). Start slowly and observe how the probiotics affect your gut. When you first start taking probiotics, you might notice some uncomfortable symptoms like gas and bloating, but if the symptoms persist for more than a few days, you may need to delay probiotics until their gut is more intact. For example, if you're dealing with what's called Small Intestinal Bacteria Overgrowth (SIBO), you might not be able to tolerate probiotics until your gut is in a better place.

I don't normally recommend actual products but quality varies greatly, so here is a list of my favorite brands. One product I like is VSL#3—a super high potency probiotic. Each dose contains 450 billion live beneficial bacteria which colonize the GI tract with optimal amounts and types of bacteria to protect against inflammation and support immunity and healthy digestive function. You will need to start slowly on this and build up.

I typically prefer pills or powder form because it's the easiest and most effective way to get your daily probiotics in. In cases where someone is dealing with yeast overgrowth or a histamine intolerance and wants to avoid fermented foods, a probiotic supplement might be the best choice.

Another way to get probiotics naturally is to eat fermented foods. If you can tolerate them, probiotic-rich foods like kimchi, kombucha, miso or sauerkraut can be very beneficial. Sometimes, you can also eat whole fat, organic or grass-fed yogurt, if you are not allergic to dairy. Try unsweetened sheep's milk or goat's milk yogurt. These foods can help your gut flora get and stay healthy.

The best way to determine if probiotics work for you and which ones to choose is to work with a Functional Medicine practitioner. Everyone is different, and for some people, deeper gut healing might be required before you start taking probiotics. To tend your inner garden, you might need to do some weeding, seeding and feeding—a process that Functional Medicine doctors follow: first you weed to get rid of the bad bugs using herbs or medications; then you seed the gut lining with good bugs; and then you feed the good bugs with prebiotic foods and fibers to keep everything healthy.

How to Re-Balance Your Gut Flora Today

Probiotics can be very beneficial, but they are just part of the puzzle. Here are my steps to re-balancing your gut flora:

1. Eat a whole foods diet. Your diet should be rich in nuts, seeds, whole grains, beans (if you can tolerate them), fruits and vegetables, all of which feed good bugs. Some of you may not tolerate beans and grains if you have bad bacterial overgrowth. For those, I suggest starting with the 10-Day Detox Diet which eliminates gluten and dairy—big triggers for irritable bowel. this plan helps to eliminate the bad stuff and add the good stuff and it works fast.

2. Avoid the use of antibiotics, acid blockers and anti-inflammatories ... they change gut flora for the worse. Often, you can get off them if you follow my dietary suggestions and fix your gut. A patient recently said that when she eliminated gluten and dairy, all her reflux and irritable bowel symptoms just went away.

3. Take probiotics daily, which are not only beneficial for obvious gut dysfunction but also have been shown to help with depression, skin issues, autoimmune conditions and more.

4. Incorporate prebiotics. Prebiotics are a form of soluble fiber that help feed the good bugs in your gut. Prebiotics include foods like onions, garlic, resistant starch, sweet potatoes, dandelion greens and jicama. So eat plenty of these beneficial prebiotics.

5. Consider specialized testing such as organic acid, stool, gluten sensitivity and food allergy testing if the above strategies don't help you get to the bottom of your gut dysfunction. You might have to work with a Functional Medicine practitioner to effectively test and treat imbalances in your gut.

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