Do I Need Probiotics?

Yes.

We all do, and we need a lot of them. Historically, humans had a lot more contact with microbes through their food and through interacting with their environment (hence kids’ fondness of eating dirt and other seemingly inedible natural objects) and from Mom.

Photo by: Markus Spiske

Photo by: Markus Spiske

These days, we eat very little natural food and produce. That which we do eat tends to be carefully sterilized to protect us from evil microbes that have become opportunistic thanks to modern growing practices. We also consume a ton of “non-foods” and inflammatory substances that wreak havoc on our intestinal lining, disrupting the pH of the system thereby making it harder for our existing probiotic species to survive and thrive. American diets are notoriously lacking in fiber from an early age which is the natural “fertilizer” for probiotic microbes.

The result? Our guts are sick. I just looked back at my schedule in the last two weeks and guess what? 46% of all the patients I saw had a chronic illness directly within their intestinal tract and/or involving microbiome health. This is not counting all the patients with conditions that are indirectly affected by their GI tracts. Chronic constipation, chronic diarrhea, IBS, abdominal bloating, indigestion/reflux, chronic fatigue from dysbiosis and inflammatory bowel diseases are rampant, and in large part this is due to the lack of TLC we give our intestinal tracts since birth (quite literally). The lack of “good bugs” and “fertilizer” in childhood and adolescence sets us up for significant abnormalities in digestive motility and function down the road.

Another huge problem is that because of the very systematic integration of the intestinal tract and digestive organs, a problem in one organ will most often result in a problem in another. Chicken-or-egg questions arise about which condition came first, and I caution patients that often times this question goes unanswered because the digestive system is so integrated. For example: a patient starts having acid reflux because they are eating a pro-inflammatory diet in the context of vulnerable gastric tissue. Instead of modifying that diet to correct the problem, he/she grabs a “quick fix” antacid. This becomes a prescription antacid (like a PPI/proton pump inhibitor) from his or her doctor which effectively turns off the digestive enzyme cascade causing a series of changes in the way food is digested and the way the intestinal tract propels foodstuff forward. Eventually the patient then suffers from a motility hiccup (my own term) and bacteria inappropriately colonize the wrong part of the intestine resulting in an uncomfortable overgrowth. In my office, this patient is now considered to have multiple disorders: acid reflux, dysmotility, SIBO manifesting as irritable bowel and possibly LIBO as well. They are different problems, but all part of the same machine. And if the first problem had been corrected properly, the other problems may not have happened.

Naturopathic doctors have been aware of the harms of a sick microbiome for decades, but mainstream medicine is finally catching on because thousands of publications show a correlation between most chronic diseases and microbiome dysfunction. Your health trajectory is in fact dependent on the health of the bacteria within you. This is true of neurological disease, gastrointestinal disease, psychiatric conditions, autoimmune conditions, and so on.

Do you see that this is a problem? I hope so. Here’s what I recommend you do to nurse your gut:

Photo by: Brett Jordan

Photo by: Brett Jordan

Step 1: Constantly inoculate your intestines with probiotic bacteria.

A HIGH-QUALITY probiotic is a convenient and reassuring way to do this because you know exactly the quantity and the species of bacteria you are providing your gut. Now, I capitalized high-quality because most off-the-shelf brands are not going to be tested for shelf stability. This means that what it says on the label was true perhaps at the time of manufacture, but could be completely false by the time you ingest it. If you are going to use a probiotic supplement, go through a professional to ensure quality.

You can also consume fermented foods. **Not all patients are able to tolerate these initially, especially if they already have a digestive disease. Those individuals should seek naturopathic/functional medicine guidance. Everyone else can enjoy a medley of options such as all types of naturally fermented vegetables, kefir (dairy and non-dairy such as coconut), yogurt (non-dairy options encouraged), miso, tempeh, kombucha, etc.

Do your best to include in your diet organic produce that still has a little dirt. Most of the microbes we get from plants come from directly from the soil. If your food is sterilized, you won’t receive this benefit.

For gut maintenance, I recommend dabbling in more than one type and rotating them to ensure balanced intake of many strains of bacteria. This rotation concept can be applied to probiotic supplements as well.

Step 2: Feed your probiotics.

Probiotic food is called “prebiotics”. **Again, not all patients can tolerate these and may find themselves quite sick from them. These individuals should consult with a naturopathic/functional medicine doctor to find out why and how to fix the problem. All high-fiber foods (fruits, vegetables, seeds, beans, legumes) will promote probiotic growth because all fiber is indigestible by humans and instead moves along your GI tract to feed your gut bacteria. That said, extra emphasis can be placed on foods like: garlic, onion, bananas, chicory, dandelion, chia, and added ingredients like inulin and fructooligosaccharides. Make sure you are consuming an absolute minimum of 25g of fiber per day.

(Side note: there is a diet called the low-FODMAP diet which is used to treat patients suffering with SIBO. Since SIBO is an issue where bacteria are overgrowing in the wrong place, these patients need to cut their prebiotic intake way down. So if you don’t have SIBO and you want to prevent digestive dysfunction, you can look at that diet and be sure to eat everything it says not to eat! A little reverse engineering tip from me to you.)

Step 3: Protect your environment.

Medications are a huge issue for gut health. Basically, medications are built to destroy it. I wish I was kidding. You think that you’re taking a medication that is just the drug ingredient, but there are a lot of disruptive additives in meds that are butchers to your intestinal health and delicate pH. If you are on a long list of medications or you take over the counter medications frequently for one reason or another (like when you’re battling colds and flus, for example), you may want to consult a naturopathic or functional medicine doctor to help treat you and your body so that you become less dependent on those substances.

Avoid eating non-food additives - food colorings, preservatives - all the junk in processed foods as well as genetically modified ingredients as these all harm your intestinal lining through one mechanism or another.

Reduce chronic sources of stress. Your stress hormones (like the hormone cortisol) are, when secreted in high amounts frequently over a long period of time, acting as gut-lining-eroders. Cortisol is catabolic and degrades tissue over time making it very hard for probiotics to thrive. Think of your gut as a fertile pasture. If not cared for, if the ecosystem is dug up, crops abused, and the minerals in the soil not replaced, it becomes a desert where no productive life can grow. In addition to “erosion” of the gut lining, stress hormones also cause motility issues. Fight or flight is your body’s stress response state. Rest and digest is the body’s alternate state. You can only be in one or the other at any given time. Many of us eat on the go, eat when stressed, eat when sick, and so on. We are playing Russian roulette with our digestive function. This will result in those “motility hiccups” that cause SIBO and similar conditions.

Step 4: Pay attention to how you eat.

We think about what we eat in medicine, but we forget to focus on HOW we eat. Eat slowly and while relaxed. Eat infrequently - don’t graze all day. Be sure to have a nice long fast from food overnight. Following these recommendations allows the muscular activity of the intestinal tract (yes, there is a lot of muscle in there!) to self-regulate and propel foodstuff in the right direction. We want normal muscular function, healthy secretion of digestive enzymes from our stomachs, pancreases and gallbladders and beneficial bacteria to be able to collaborate and do their thing to allow for the optimal digestion the way the GI tract was designed to accomplish.

Wow! Maintaining gut health in four simple steps! I’m good…

Let me know your thoughts, and if you think I’m missing an essential!

In health,

Dr. Otto