Probiotics and Gut Health

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Hi, I'm Joan Sechrist, registered dietitian with health and preventive services for Optima Health. I am happy for the opportunity to speak with you today about probiotics and gut health. I’ve spent my entire career studying nutrition and it's been an exciting time due to the continuous research in all areas of nutrition. Let's talk about probiotics.

First, my objective today is to discuss the objectives of the presentation. First, we want to define specific functional components of foods that may improve gut health. Also, we're going to describe prebiotics and probiotics. And we're going to list foods that improve gut health. Be sure to check with your healthcare provider about specific recommendations for your gut health. This presentation is just general information about gut health.

First thing I want to do is ask you a question and take a minute to think about it. What is a probiotic? And I’ll give you some answers. Is it bacteria? Is it live culture? Is it micro-organism with health benefits? Or is it all the above? Take a minute and think about that.

If you said a probiotic was all the above; it was bacteria, live culture and a microorganism with health benefits, you were correct.

Well, how do we define gut health? It's the absence of digestive disease. It includes normal bowel function and regular bowel movements. And there's an absence of GI symptoms like gas, bloating and pain. If we talk about digestion in a little bit more detail, first thing you'll know from your own lives, your digestive tract is busy, 24 hours a day, 7 days a week from your mouth all the way through to your stomach down through your intestines. From the first bite that's chewed and traveling all the way through our digestive system. There's enzymes in our saliva and then there's bacteria and peristalsis as the food gets into smaller and smaller bits. As it gets to the small intestine, nutrients are extracted, like, vitamins and minerals, protein, carbohydrate, fat, which we need every day. Finally, what is ever leftover is eliminated as waste.

Here's an interesting fact, the GI tract is about 30 feet long. It includes a complex community of bacteria and other microbes that helped digestion. Here’s some definitions that we need to just go through before we go on through the rest of the presentation. The first one is the microbiome which is a genome or genes. That's a group of micro-organisms that live in an environment. The microbiota - community of micro-organisms in the GI tract are different for every person. Just like a fingerprint. Microbiota diversity includes the number and the different types of micro-organisms in the gut. Increase diversity is much better for us, so we want to have an increased number and types of organisms that can help, micro-organisms that can help in the digestive process. Lastly, dysbiosis, which is microbial imbalance. That means there are too many of one type of microorganism and not enough of others. And that can lead to microbial imbalance which can also lead to health issues.

What about microbes in the body? What did they do? They produce energy. They produce vitamins - vitamin K and biotin. Microbes enhance calcium absorption, which is so important for bone health, especially at, throughout our lives. Microbes also play important roles in certain diseases like obesity, type 2 diabetes, irritable bowel syndrome and colon cancer. Our GI tract is home to trillions of micro-organisms. Laid end to end these microorganisms would circle the earth about 2 and a half times. That's a lot. Most of them are, microbes, are found in the colon.

There's microbes in the body that are pathogenic, or meaning harmful bacteria. What happens in our GI tract is the reduction in pH goes down. The number of pathogenic or harmful bacteria go down. That means not so much the pH of the food that we're actually eating, because it kind of, as it goes through the tract it doesn't stay the same pH is when we eat or drink it. But as it gets broken down in the intestine, the actual nutrients break down to things, let’s say short chain, fatty acids which are very helpful. They keep the pH, and they help harmful bacteria reduce. Our diet is very important and it affects the microbes in our GI tract.

To give you an example, a diet that's very high in animal based products, animal based proteins, tends to increase the pH of the GI tract as the proteins are broken down and that would be not beneficial to getting rid of pathogenic bacteria. We want to keep the pH low by having a diet that's high in fruits, vegetables, and fiber and lower in animal based products.

Well, our microbes, are friends or our foes? Well, microbiota diversity changes when there's antibiotics introduced or high fat and high sugar diet and a low fiber intake; which decrease diversity of microbes. So we want to, said a minute ago, we want increase diversity so when there's an unhealthy diet high in fat and high sugar and low fiber, that tends to decrease the microbiota diversity and can set us up for health issues. And sometimes antibiotics are needed, they’re required to help us get over an illness. But then we go back to our regular eating habits and the micro biotic diversity can balance back out.

Food borne pathogens, we talked about that, which decrease diversity of microbes. They really, it allows an environment for the harmful bacteria, like clostridium, staph aureus, e. coli, and listeria to flourish. And that increases our susceptibility to illness. So, uh, we also want to talk about dysbiosis. And dysbiosis, we talked about the pathogens or the harmful bacteria colonize and create microbial imbalance. Some of the symptoms we noticed from our GI tract are gas and bloating.

It's interesting, our microbiota changes over a lifetime. And we can thank Professor Tomotari Mitsuoka. He discovered the intestinal ecosystem several decades ago. What we have found is that in a baby, especially with a vaginal birth, that microbiota starts the exposure to microbes starts and as a child grows, there's an increase in the diversity of the microbiota. As we reach adulthood, there's a distinct microbiota community in our GI tract. And then, as we reach elderly years, beyond adulthood, there's less diversity. Sometimes that can be due to chronic inflammation, a sedentary lifestyle, decrease fiber intake, or certain medications that we've taken. So the microbiota changes over lifetimes.

Well, let's talk a little bit more specifically about probiotics. What are probiotics? Probiotics are defined as live micro-organisms that are intended to have health benefits. Here's the fun fact, there's 10 times more probiotics than cells in our body and most are found in the colon. Professor Elie Metchnikoff is the father of probiotics. He was working in Bulgaria and wanted to study people that were a 100 years of age or older. And what he found was that these particular, uh, centenarians (people older than 100 years old) were drinking fermented yogurt drinks on a daily basis. In his study, he found a probiotic called Lactobacillus bulgaricus which he discovered improved health and may have helped in their longevity. So, the next time you buy, or, you eat yogurt with live culture look on the label for lactobacillus bulgaricus and you can thank Professor Elie Metchnikoff for discovering this important probiotic. Probiotics are very important in immune functions. He studied and researched how did the probiotics improve people's health. Interesting fact, probiotic comes from the Latin meaning “for life”. Again, probiotics are active cultures or active microorganisms.

What do probiotics do? Well, they help to digest foods. They destroy pathogens, which are disease causing, the harmful bacteria as they are in the GI tract, but bacteria normally present help to, in the method of digestion. Probiotics produce vitamins. Some examples of probiotics include a variety of micro-organisms. The most common are bacteria that belong to groups called lactobacillus and bifidobacterium, which, by the way is Latin meaning "2 parts or split the by”. Also, there are other bacteria that can be used as probiotics like yeast. To give you an example of a bacteria that normally lives in our GI tract: e. coli lives there normally and it has a strong function. However, they just found a couple years ago there was romaine lettuce tainted with eco by from contaminated water that led to very serious illness and in some cases, even death. So, there's an example of a bacteria that lives in our gut normally, normal function, and harmless until there's a problem where it's introduced through a food or a beverage.

Well, what are some sources of probiotics? What the first thing are fermented dairy foods, like yogurt with active cultures. Kefir products and aged cheeses like, I'm thinking the cheeses, like feta or cottage cheese. How about non-dairy foods that have beneficial cultures like kimchi, sauerkraut, fermented soy bean like miso (which is fermented soybean paste) and tempeh (which is fermented soybeans) and cultured non-dairy yogurts and sour cream with active cultures. So when we think of probiotics, we think of foods that have active cultures, active cultures in them. Some examples of foods that are not probiotics includes sour dough, bread, wine, beer and vinegar because there are no live cultures due to heat treatments and food processing.

What are some benefits for probiotics? Well, the desirable community of microorganisms and the GI tract. They, probiotics, also stabilize the barriers in the GI tract against pathogenic or harmful bacteria. Probotics help to repopulate bacteria especially after antibiotic course, or an illness. Probiotics simulate the immune response, which is very, very important.

What about probiotic supplements? Well, the first thing about dietary supplements is that they don't require FDA (Food and Drug Administration) approval before being put on the market. There's the lack of regulation so you worry about the safety and effectiveness of these dietary, all dietary supplements, which can also can include probiotics. They're sold grocery stores, health food stores and pharmacies. What happens is, if there's an issue after the fact that gets reported to the FDA (Food and Drug Administration) but they don't require pre-approval by the FDA. Since their dietary supplement that can't make a drug health plan, like, to treat diagnose, prevent or cure diseases. Only drugs can do that, not supplements. The FDA (Food and Drug Administration) has not approved any probiotic to prevent or treat a disease or condition in humans. Additionally, supplements are not the same as fermented foods. There's a different strength and strain of live cultures that don't make comparisons easy. For example, CFUs (colony-forming units) are different in different supplements and that's how they determine the amount of probiotic in the supplement. Colony-forming units, healthy foods, formed the foundation of, for immunity, not supplements. And what really has happened is that there's been a growth in the supplement industry, which really has exceeded the research and approval process by the FDA (Food and Drug Administration).

What about probiotics promise in research studies? Well, they studied the reduced rates of childhood diarrhea associated with antibiotics by using probiotics.  Also, a decreased recurrence of C. diff in adults. But use clinically with approval by the American Gastroenterological Society for a health condition called NEC (necrotizing enterocolitis)in the preterm low birthweight infants. Interesting fact -the American Gastroenterological Society has just released clinical guidelines in 2020 on the use of probiotics and they caution that many manufacturers make supplements that make health claims for probiotics without sufficient evidence from clinical trials and there's a lack of consistency in these studies. And they concluded the probiotic industries largely unregulated and that the supplements can be expensive. So, what we need are long term clinical studies; random control studies with long term dietary changes that occur with different types of foods. There's a concern that there's a lack of consistency when there's a dietary supplements of probiotics. Again, it goes back to each person, has a variance of micro-organisms in their GI tract. But we said it a while ago about that, everyone has their own fingerprint in their GI tract. It's difficult to control a random control study when there are so many other variables to take into account.

What about the safety of probiotics? In healthy people, there are very few side effects; only mild digestive symptoms like gas. Some of the possible risks are the introduction of opportunistic infections and allergic reactions. Also, there's potential transferable antibiotic resistant genes. When you ingest a live micro-organism that can lead to pot possibly dangerous infections in critically ill patients that have recently had surgery, very sick infants, or those with weakened immune systems. Lastly, don't postpone seeing your healthcare provider about any health problem, thinking that the probiotics will treat whatever your health issue might be.

What about prebiotics? Take a minute to answer the following question. What is a prebiotic? Is it a micro-organism? Is it just a different name for probiotics? Is it a food that confers a health benefit? Or all of the above? Take a minute and think about that.

If you answered a prebiotic is a food that confers a health benefit, you are correct. A prebiotic is a food that confers a health benefit. A probiotic is a micro-organism, prebiotic is a food like fiber.

What are prebiotics? They're not the same as the probiotic. We just said prebiotics are natural non-digestible food components. They support good bacteria. So prebiotics are defined as dietary substances that favor the growth of beneficial bacteria over harmful ones. That source of prebiotics is dietary fiber that you find in fruits, vegetables and whole grain. So, prebiotics are mainly coming from foods that have fiber in them like, fruits, vegetables and whole grains.

Well, what are the functions that prebiotics? They stimulate the growth and reproduction of useful microflora. They improve the work of the digestive system because that fiber provides the food or the energy to keep the probiotic micro-organisms alive. Increased fiber intake from prebiotic helps reduce constipation and also help stimulate peristalsis, which keeps things moving through the guts. Prebiotics help maintain an optimal pH in the intestine and it helps to avoid dysbiosis, microbial imbalance. It also, by increasing, by keeping the low pH in the lower GI tract, it helps to decrease those pathogenic or those harmful bacteria we've already been talking about. So, prebiotics comes from fiber - fruits, vegetables, whole grains, and it kind of provides the food or the energy that the probiotic micro-organisms to need to survive and do well.

Well, what are some of the sources of prebiotics? We talked about fiber from fruits, vegetables and whole grains. Some specific examples include bananas, onions, garlic, leeks, asparagus, artichokes, soybeans and whole wheat foods. They provide the energy and the healthy environment for probotics to grow, that they need. Prebiotics are fiber and probiotics are fermented foods.

What about symbiotics? That refers to products that combine probiotics and prebiotics. There's a synergy. Prebiotics are bacteria promoters from food and they work with probiotics, which are the micro-organisms. Then there's symbiotics, that can help restore and approve health because you're getting both the probiotics and the probiotics together. Some examples of symbiotics would be bananas with active culture yogurt or stir frying asparagus with tempeh. You might already be combining prebiotics and probiotics. Some more examples might be grilled asparagus with garlic and sour cream or brown rice with feta cheese or kombucha, which is fermented black and green tea, that might chia seeds. There are all sorts of combination that you can have. Fruits and vegetables and whole grains with even aged cheeses: cottage cheese, sour cream.

Some tips for gut health? Well, we've been saying it all long a variety of fruits, vegetables and whole grains. Avoid high fat, high sugar diets. The goal is about 25 to 30 grams of fiber a day. So you can see that if someone's on a low carbohydrate diet, focusing on a high protein intake, they may not be having the best environment for their microbial growth because they're going to take away the sources of fiber in the carbohydrates; limiting the environment for the probiotics to thrive. With fiber, it's hard to achieve 25 grams a day. Well, if you're not doing that much, take it slow. And there's certain people, if they have irritable bowel syndrome or other conditions, they might want to limit their fiber intake. To give you an example of how to get 25 to 30 grams of fiber a day, you might try a total of at least 5 servings of fruit and vegetables combined a day, having whole grain bread that has at least 3 grams of fiber per slice, choosing cereal that has at least 4 grams of fiber per cup and you might choose to have beans and/or lentils. They have 7 grams of fiber in a cup. Other ideas on how to increase your fiber would be to make some trades. If you're used to having white rice, you can more than triple your fiber intake by choosing brown rice. Another example, would be trading mashed potatoes. About a cup of mashed potatoes has about 3 grams of fiber versus cooked black beans. A cup of black beans has about 15 grams of fiber. So you 5 times the amount of fiber so you just change off and make some trades. Going along with that increase fiber intake, you need to drink enough water and help pass things through your GI tract. Another way to keep your GI tract healthy is to avoid tobacco use. And also asking your healthcare provider about a colonoscopy or colon testing if your age 50 or above. Another thing you can do to, two more things you can do to improve your gut health is to keep your hands washed and get your recommended immunizations. Those are key and important because they can help prevent disease and also prevent the need for antibiotic use. Remember we talked about antibiotic use sometimes decreases the bacteria, micro-bacterial diversity. So we want to do as much as we can to prevent the need for antibiotics. You want to make sure that you're daily intake increase includes both probiotics and probiotics. Exercise is another important feature for gut health. There are a lot of reasons. One, it aids in GI function. Exercise can help decrease stress. Exercise can also strengthen the abdominal muscles. And overall, exercise can help all your body to function normally – keeping the muscle in tone and keeping the other bodily systems strong. The best way is food safety. We want to avoid foodborne illness. That means, first of all, keeping temperature control. Cold means cold, hot means hot. We infer food safety; we also want to avoid cross contamination. By that we mean, don't have raw chicken or raw foods, for example, on a cutting board and then, without cleaning it, go ahead and cut your salad ingredients. Cross contamination means something harmful from one food into another. So we want to keep temperature control, but we also want to keep our food preparation safe; where we're keeping the raw food separated from the non-cooked foods. So, there's a lot of things that we can do to protect our gut and improve our gut health.

In conclusion, things that we discussed today: first, we talked about the specific functional components of foods that may improve gut health. We talked about prebiotics like fiber and probiotics microorganisms and their sources. We talked about the adverse effects on the gut microbiota. And we also talked about ways to improve gut health.

Here's the tip that helped me remember the difference between probiotics and prebiotics. Probiotics. P. R. O. and the O stands for organism. Microorganism, live cultures, probiotic organism versus prebiotic P. R. E. E, for energy or environment, and keeping the environment good and healthy for the organism probiotic.

Some of the resources used in this presentation include “Prebiotics and Probiotics: Creating a Healthier You”, which is posed by the American Academy of Nutrition and Dietetics. It was first published in 2018 and then re-released again in 2020.

The NIH just put out “Keeping Your Gut in Check: Healthy Options to Stay on Track” and they also put out a flyer: “Probiotics: What You Need to Know” through the National Institutes of Health.

Optima Health (optimahealth.com) has prevention and wellness information on getting healthy and staying healthy. Some of the prevention programs that you can have access to on the website include Healthy Habits, Healthy You, Eating for Life, yoga, tai chi, tobacco cessation and Move About. There's lots of resources there that anyone can access and there's no charge.

Also, another beneficial tool is on the sentara.com website. They have nutrition information and it gives information on registered dietitian services along with their locations. It can help, a registered dietician can help, with both of medical nutrition therapy to improve patient recovery, but also in wellness and planning a healthy diet. That includes all those things we talked about that keep the gut healthy.

Well, thank you very much for participating in this webinar today. I hope you found the information helpful and beneficial to your gut health.