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 A probiotic is a bacteria or, in one instance, a healthy yeast, that is intentionally put into yogurt, other dairy products, liquids, powders or pills. The intent is that these bacteria will move through the stomach and small intestine, take up residence in the colon, displace other bacteria and grow in a healthy manner, providing multiple health benefits.
A Wonderful Colon
The human colon is, indeed, a wonderful organ. In the past it was thought that it did nothing except store human waste until it could be passed through the rectum. We in medicine knew that many bacteria and a few viruses and yeasts grew there. However, we had no idea that there are over 1,000 different types of bacteria there and that the total bacteria content in the colon is perhaps 10 trillion (that's trillion with a T), more than 10 times the total number of cells in the entire body.
More than this, we had no idea that this fermenting cauldron of living organisms was a vital health organ to the colon and, indeed, to the body itself. This is true, especially if these organisms are fed the proper plant fiber foods, including prebiotics. You are referred to my essays on A Wonderful Colon and Prebiotics for more in depth information on these two subjects.
So, Just What Do Probiotics Do?
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This would seem to be a simple enough question to ask, but the answer is anything but clearcut. As noted, there are hundreds and hundreds of different bacteria in the colon, so will adding 1, 2, 6 or more make a difference? Additionally, most of these probiotic preparations say they contain 5-10 billion live bacteria. Every food and pill manufacturer selects their own one or more different bacteria, so it is impossible to compare one with the other. There are likely 1,000 billion bacteria already in the colon. So, reason would say that adding just a few types of bacteria and in really small doses to what is already there might not change things very much.
The field of probiotics and, indeed prebiotics too, is still very new and we are just beginning to learn what role probiotics play in health and disease. So, while we in medicine, are always cautious about excessive claims for any new therapy or change in the diet, there are now enough intriguing and positive reports coming into the medical literature, that some tentative conclusions can be reached about probiotics. There are some early favorable results that have been observed, especially in people with certain disorders of the gastrointestinal tract.
Probiotics in Diseases
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 It is a good bit easier to study a probiotic preparation in a well-defined group of patients with a specific disorder. So many probiotic manufacturers have begun to do such testing. Each will use its own group of bacteria, 1, 2 or even 6 or 8. They use their own dosages as well. So trying to compare one study with another becomes difficult to say the least. Having said that, there does appear to be positive and beneficial results occurring in certain situations.
Intestinal infections in infants and children - When certain probiotics are used in these cases, the infection appears to clear more rapidly and completely.
Intestinal infection in the adult by Clostridium difficile bacteria - This C. diff (as we call it) infection is rampant in hospitals and even is increasing in the community. It is particularly common to occur after colon surgery and antibiotic use. Some very clear benefits have been noted when certain probiotics are used in treating the infection.
Pouchitis - With certain types of colon surgery, the surgeon may create a pouch just within the rectum, using a portion of the small intestine. This pouch can then become badly infected with bacteria. Certain probiotics seem to be helpful.
Antibiotic use - When an antibiotic is used for anything such as a cold, it will indiscriminately kill many colon bacteria as well. When this happens, other resistant and sometimes nasty, bacteria grow to fill the void. Many physician, especially pediatricians, are now using probiotics to prevent such problems.
Irritable Bowel Syndrome (IBS) - We now know that the makeup of colon bacteria is different in IBS patients. There are some early studies that suggest that symptoms such as bloating and abdominal discomfort may be helped with one type of tested probiotic.
Colon polyps and cancer - There are no medical studies or evidence that probiotics are helpful in patients who have had colon polyps or cancer.
Ulcerative Colitis and Crohn's Disease - There are some early reports, mostly for ulcerative colitis and pouchitis patients that there may be benefit with some of the probiotics. However, there have been four different bacteria or formulas used so we still do not have clear guidelines.
Allergies - There are some very interesting reports of treating expectant mothers and newborns with certain probiotics. Innfants who were determined to be at risk for early allergies seem to have a significant reduction in the development of allergies. This is very early, but still very promising work.
Immune factors - The word immune and immunity has been used by many in the Dietary Supplement as a buzz word, implying mysterious benefits for the immune system. The fact remains that the immune system of the gut is incredibly robust and intense in most people. It is very hard to prove that it needs to be or even can be improved by taking a pill. Having said that, there is a great deal of research that has shown that when the bacterial makeup is pushed in the right direction, such as by taking probiotics or prebiotics, that certain measurable immune factors are enhanced. The exact meaning of this research and its practical application is still uncertain.
Probiotics in the Healthy
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Can these probiotic bacteria be of any benefit to the person who is already healthy and who consumes adequate vegetables and fruits, whole grains, fish and poultry? While we still don't have all the answers, there is reason to suspect that real benefits may occur. Doing research on a large group of free living, already healthy people over a long period of time looking for really small changes in their future health is very difficult and expensive. Having said that, many people simply take a daily portion of fat free yogurt, which is usually rich in the Bifido and Lacto bacteria. Since we don't know which are the healthiest bacteria, and we do not know which dose may be most effective, there is some guess work. Many disorders of the GI tract seem to improve with probiotics, so we must suspect that benefits will occur for the healthy as well. Additionally, there are very few problems to any of the probiotics. People with HIV, AIDS, immune deficiencies of any type or who are on chemotherapy should probably not take probiotics until it is discussed with the physician.
What Are The Downsides of Probiotics?
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- When a probiotic is stopped, the colon returns to its previous bacterial makeup within 2-3 weeks. Probiotics have to be taken indefinitely.
- Check the expense of probiotics as they are usually not covered by insurance, being considered a Dietary Supplement by the FDA.
- The effective dose for any probiotic bacteria is really not known. Furthermore, you can't be sure of how many live bacteria are present in any preparation, as the FDA does not regulate this industry.
- Except for certain diseases mentioned above, we don't know which of the probiotic bacteria may be better than another. We think that the Bifidobacter, Lactobacillus and Acidophilus are the most important.
- The acid environment of the stomach may kill many of the probiotic bacteria ingested.
Some Recommendations
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- If you take a probiotic, use a reliable manufacturer for your best assurance of quality.
- Low fat yogurt may be the most cost effective way to get a daily dose of probiotics.
- Take probiotics with food so that the bacteria do not stay in contact with the stomach acid very long. Avoid taking them with fatty foods (oils, butter, sausage, bacon) as fat in any form delays emptying of the stomach and gives the stomach acid more time to kill the bacteria.
Summary
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The colon is an incredibly complex and dynamic organ. Its mix of so many different bacteria results in many health benefits provided the diet is adequate in the fibers that feed the beneficial bacteria. Probiotics added to this mix may have importance for those with certain gastrointestinal disorders as well as for the healthy person. Your physician can be consulted for advice. The field is still very new so we can expect considerable new positive information in the years ahead.
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