Probiotics.

I recently had to take some antibiotics. After my week or so dose I felt my stomach and general intestinal situation to be interrupted in terms of, well stuff we don't need to go into. But suffice it to say, my normally functioning body, was running haphazardly and uncomfortably.

Now being a know-it-all, I really just went into a thought process of "I'll just get back to eating normal and it'll fix itself", which, over time, it may have done. But I was in quite a large amount of discomfort. My hippie girlfriend suggested probiotics. Having done my sports science degree (minoring in nutrition), I had done some research into probiotics, but honestly? I was in such meathead mode at uni, that if it didn't get you big, I didn't care.

I started taking the probiotics, as it seems to follow that taking antibiotics for a streptococcus infection could reduce my gut bacteria too, some of which are streptococcus. I instantly felt better, more regular. Seems hippies still know their stuff eh?

It did inspire me to thought. I'm a reasonably healthy guy, with a reasonably healthy lifestyle, I eat a lot of yogurt, I eat a bit of fruit and vegetables, it was only when I had a chemically enhanced disturbance, did I feel out of whack. But, and here's the point (eventually), it got me to thinking about my clients, some of whom may have diets less strict, less focused on fruits, vegetables etc. I asked myself "could they benefit from a probiotic supplement?" Perhaps one cycle done bi-yearly? I'm going to do some research, and let's see what conclusions we can find, and let's see if they support my prior assumptions.

Firstly, lets define our terms, what exactly do we mean, when we say probiotics? Well, Charles Poliquin offers a definition on his blog from the World Health Organisation:

"Live microorganisms which when administered in adequate amounts confer a health benefit on the host." (Poliquin, retrieved 21/02/11)

Le's not get into textual analysis, as Poloquin does in this article (though I do recommend you read it, below), on whether this is a good definition, but rather work with what we have. Or better yet, lets look to Wahlqvist to see what he has to say:

"Probiotics are viable micro-organisms which are beneficial to health by improving the intestinal micriobial balance." (Wahlqvist 2002)

While this definition still contains come generic language, I, and Poloquin don't like, we do get a little more detail in it, let's turn to Bob Calvin, who has a great in-depth review of probiotics here:

"Our digestive tract is host to a plethora of living microorganisms some "friendly" and some "harmful." "Friendly" microorganisms aid in digestion, immune function, absorption of minerals, treat inflammation, and prevent the build-up of "harmful" microorganisms, while "harmful" microorganisms can lead to disease, infection and a suppressed immune function.
The widespread use of antibiotics is effective in killing "harmful" as well as "friendly" microorganisms (emphasis added). This poses a problem and can lead to decreases in immune function and translocation of harmful bacteria from the digestive tract into other organs such as the liver and lymph nodes." (Calvin 2006)

 Let's also refer back to Wahlqvist for confirmation of the importance of probiotics in gut function:

"The gastrointestinal tract normally contains large numbers of bacteria (natural microflora) including 107-8 organisms in the oral cavity (predominantly Streptococcus, Veillonella, Neisseria), 102-3 organisms in the stomach and small intestine (Lactobacillus, Streptococcus), and 1010-11 organisms in the large intestine and colon (Bifodobacterium, Bacteroides, Eubacterium, Peptostreptococcus)."  (Wahlqvist 2002)

This certainly seems to confirm my assumption regarding the possible death of streptococcus in my gut and intestinal tract from the antibiotics and my resulting discomfort. But why would I have felt sick? Wahlqvist has the answer:

"The most commonly used probiotics are lactobacilli and bifidobacteria. The reported beneficial effects of probiotics include alleviation of the symptoms of lactose intolerance, immune system enhancement, shorter duration of diarrhoea caused by rotavirus, decreased faecal mutagenicity, decrease in the levels of pathogenic bacteria, decreased faecal bacterial enzyme activity and prevention of the recurrence of superficial bladder cancer." (Wahlqvist 2002)

As far as a recommendation to clients, I only see benefits listed above, particularly if you have taken an antibiotic. Due to the strenuous nature of training, the boosted immune function could be worthwhile too. As a study by Berggren et al 2010 states:

"The common cold is a viral infection primarily caused by rhinoviruses.  Previous studies have shown that probiotics, alone or in combination with prebiotics, have reduced the incidence of upper respiratory tract infections. Swedish researchers enrolled 272 men and women in a 12-week long study, during which subjects were supplemented daily with supplemented either with 109 cfu (colony forming units) of probiotics or placebo.  The team found that the probiotics reduced the incidence of one or more episodes of the common cold (emphasis added). Among those who received the probiotics, both the total symptom score and number of symptom days among were markedly reduced. The researchers conclude that:  “Intake of the probiotic strains Lactobacillus plantarum and Lactobacillus paracasei reduces the risk of acquiring common cold infections.” (Berggren et al 2010)

Bob Calvin goes on to list some other benefits and suggested times to take said you probiotics:

"The use of a probiotic supplement can be an effective way to promote the growth of "friendly" microorganisms within the digestive tract. A quality probiotic supplement should include a wide array of friendly stands of bacteria. Some examples include: L. plantarum, L. acidolphilus, B. longum, L. sporogenes, L. casei and L. salivarius.
Start by taking one or two probiotic capsules before bed. Another option: Foods such as yogurt (with live active cultures) and fermented foods such as fermented vegetables (pickles, cabbage), miso and soy sauce are also good natural sources of "friendly" bacteria." (Calvin 2006)

Conclusion
Sure, from this limited review, we only get the most basic of conclusions, but it seems at least from this superficial analysis that probiotics have a place, after antibiotic use, for immune response etc. Overall the benefits of probiotics are definitely there, I guess it comes down to the cost/benefit ratio. My girl picked up the probiotics I'm taking for $34 with about 50 tabs in it (at about 3 a day), so it is expensive, although I received this email from her:

"I think you can get less expensive ones, probably the stuff you have to leave in the fridge is cheaper. Brands I've used that don't require being in the fridge are microgenics, natures way and natures own. You can get a month's worth of microgenics for around $20-25 and the ones you got are technically one a day too - although the guy recommended 3 times for when your immune system really needs it."

I certainly think my clients, particularly the ones who are not getting several serves of veggies and fruit a day, could benefit from this. Check my sources, review the literature for yourself, disagree? Tell me why, who knows, you may convince this know-it-all.

References

Bergrren  A. Ahren I. L., Larsson N., Onning G., (2010). Randomised, double-blind and placebo-controlled study using new probiotic lactobacilli for strengthening the body immune defence against viral infections.European Journal of Nutrition. Retrieved 21/02/2011. http://www.worldhealth.net/news/probiotics-may-help-ward-common-cold/ 

Calvin B., (2006)., Digestive Health. Retrieved 21/02/2011. http://www.coreperformance.com/knowledge/nutrition/digestive-health.html
 

Poloquin C.,What Makes a Probiotic a Probiotic? Put Your Product to the Test With This 4-Question Quiz. Retrieved 21/02/11. http://www.charlespoliquin.com/ArticlesMultimedia/Articles/Article/447/What_Makes_a_Probiotic_a_Probiotic.aspx?lang=EN

Wahlqvist M.L., (2002). Food and Nutrition (2nd ed.).  Crows Nest, NSW. Allen & Unwin. Pp- 121-122.

Further reading

This is a collected group of articles on probiotics if you would like further reading.