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NIFS Healthy Living Blog

Choosing and Using Probiotics for Gut Health

Screen Shot 2020-07-21 at 12.20.41 PM“Take a probiotic; it helps with your gut.” We have all heard it from friends, doctors, and Registered Dietitians. Is it really that simple, though? It is no secret that probiotics really do help with a variety of gastrointestinal (GI) issues. However, did you know that there are specific strains of probiotics that help with specific symptoms, and while one strain may help with one GI symptom, it may not help with another? Not all probiotics are created equal, and not all supplements labeled “probiotic” will yield health benefits.

What Are Probiotics and Prebiotics?

Probiotics are live microorganisms (tiny living things), mainly bacteria and sometimes yeast, and are intended to have health benefits when ingested. They are similar to the helpful microorganisms naturally found in the gut. Probiotics are found in supplements and fermented foods, such as Greek yogurt with added Lactobacillus and Bifidobacterium, kombucha, tempeh, kefir, and sauerkraut.

Do not confuse these with prebiotics, which are the food source for the “good” bacteria in our GI tract. Prebiotics are “a selectively fermented ingredient that allows specific changes, both in the composition and/or activity in the gastrointestinal microflora that confers benefits upon the host’s well-being and health.” They are carbohydrate compounds, primarily oligosaccharides, that withstand digestion in the GI tract and reach the colon where they then are fermented by the gut microflora, helping the good bacteria to grow. In short, they fall under the categories of soluble fiber and fermentable fiber. This is important, because even if you are taking a probiotic or eating foods rich in probiotics, you may not be receiving the maximum amount of benefits if you are not eating enough prebiotics (soluble and fermentable fiber). Foods rich in prebiotics include green bananas, onion, garlic, asparagus, artichokes, and leeks.

How Do Probiotics Work?

The human GI tract is colonized by many microorganisms, such as bacteria, viruses, fungi, archaea, and protozoa. The totality of these organisms is known as the gut microbiota, microbiome, or intestinal microflora and can affect the health and disease state of a human. Probiotics typically work in the GI tract to alter the intestinal microflora, adding good bacteria to the microbiome. The mechanism of action depends heavily on the species and strains because different species and strains have different effects. Some of the known mechanisms include the following:

  • Inhibit the growth of some pathogens (microorganisms causing disease or sickness).
  • Help with vitamin synthesis (B vitamins and vitamin K).
  • Increase absorption of protein.
  • Reinforce the gut barrier, keeping food and other GI contents from leaking into the bloodstream.
  • Neutralize toxins.
  • Lower the pH in the colon, which could help speed up stool for those who are constipated.
  • Replenish good bacteria after taking antibiotics, which may help resolve diarrhea from antibiotics.

Probiotics and Gut Health

The gut microbiota is the center of much current research. Researchers are suggesting that an imbalance in the gut microbiota could lead to several health issues including immune dysfunction, infection, obesity, and GI problems. The imbalance can come from medical conditions, stress, and antibiotic usage (which destroys bad and good bacteria).

Using a probiotic to restore balance has been shown to alleviate symptom persistence in irritable bowel syndrome (IBS) by 21% using both single-strain and multiple-strain supplements, with the mixtures being most effective. Studies also found symptom relief in ulcerative colitis, reduction in acute diarrhea duration and frequency, and lower risk of diarrhea from antibiotic use by 51% or clostridium difficile infection.

A healthy gut with plenty of good bacteria has also been shown to improve the immune system, combat inflammation, and potentially reduce bad cholesterol (total and LDL cholesterol).

Picking Probiotic Supplements

Remember, not all probiotic strains and species are created equal. Trying to figure out exactly what strain, species, and genus of probiotic will work for you and your needs can be tedious, because there are thousands upon thousands of variations. It may take some trial and error to finally find a probiotic that meets your needs.

The good news is that both Lactobacillus and Bifidobacterium are the most studied probiotic genera. There are several studies of strains from these two genera that have produced positive results. Below is a list of conditions with the genus and strain of probiotic that has shown promise in helping with the condition.

  • Acute diarrhea: Lactobacillus paracasei or Lactobacillus rhamnosus or Saccharomyces boulardii
  • Antibiotic-associated diarrhea: Lactobacillus casei, Lactobacillus bulgaricus, Lactobacillus acidophilus, Lactobacillus rhamnosus
  • Overall symptoms of IBS: Bifidobacterium bifidum, Escherichia coli
  • Abdominal pain: Bacillus coagulans, Bifidobacterium bifidum, Lactobacillus plantarum
  • Bloating/distention: Bifidobacterium animalis, Bifidobacterium bifidum, Lactobacillus reuteri
  • Constipation: Bacillus coagulans, Bifidobacterium animalis, Oligofructose (prebiotics)
  • Lactose maldigestion: yogurt with Lactobacillus delbruecki susp bulgaricus and Strepococcus thermophilus
  • High Cholesterol and LDL: Lactobacillus acidophilus, a mixture of Lactobacillus acidophilus and Bifidobacterium lactis, Lactobacillus plantarum (more research is needed here)

If you are struggling with GI symptoms and considering a probiotic supplement, it is important to talk this over with your Registered Dietitian (RD) and primary care provider. They can help to identify the correct genus, strain, species, and dose you need.

Feed Your Gut

For those healthy individuals, you most likely do not need a probiotic supplement. If you really want to help your gut, follow these tips:

  • Eat foods rich in probiotics. When seeking foods with probiotics, the product must have active and live bacterial culture and indicate that on the label. A good rule of thumb is at least 1 billion colony-forming units or 1 billion CFUs, containing the genus Lactobacillus, Bifidobacterium, or Saccharomyces boulardii. Probiotic-rich examples include Greek yogurt, kombucha, tempeh, kefir, and sauerkraut. Be sure to check the label for the specific genus of probiotics(s) in the products, as they will differ. Also note that the starter cultures in Greek yogurt are Streptococcus thermophilus and Lactobacillus bulgaricus, but these are often destroyed by our stomach acid and offer no benefits. Get the Greek yogurt brands that add extra bacteria to the starter cultures (check the label).
  • Feed your probiotics with prebiotics to help the probiotics multiply in your microbiome.
  • Sleep at least 7–8 hours each night.
  • Maintain a healthy weight and body fat percentage.
  • Manage stress.
  • Balance your diet, keeping it loaded with fruits, veggies, lean proteins, fiber, and whole grains.

As always, reach out to the NIFS Registered Dietitian for nutrition help, including nutrition management of gut-related issues. We are here for you.

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This blog was written by Sabrina Goshen, NIFS Registered Dietitian. To learn more about the NIFS bloggers, click here.

Topics: nutrition digestion gut health supplements dietitian probiotics dietary supplements

Taking Dietary Supplements Safely: Advice from a NIFS Dietitian

GettyImages-505820296Dietary supplement usage is reaching an all-time high. The 2019 Consumer Survey on Dietary Supplements revealed that 77% of Americans consume supplements. This is a dramatic increase from the 53% reported by the NHANES in 2010. Americans are spending $38.8 billion a year on supplements, with more than 85,000 supplements on the market. Reasons for consumption are widespread, ranging from athletes hoping to boost performance to people who need more Vitamin D for bone health.

With the rise in supplement usage, it is important to be an informed consumer. While there are numerous reasons for this, one of the biggest is that supplements are loosely regulated by the FDA, meaning labels may not display what is truly in the supplement. Also, claims marketed about the benefits of a supplement may be false because companies are not required to obtain authorization from the FDA prior to making such nutritional support claims.

How can you know whether what you’re taking is safe and effective? Let’s dive in!

What Is a "Dietary Supplement?"

According to the Dietary Supplement Health and Education Act of 1994 (DSHEA), a dietary supplement means “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following ingredients:

  • Vitamin
  • Mineral
  • Herb or other botanical
  • Amino acid
  • A dietary supplement used by man to supplement the diet by increasing dietary intake
  • A concentrate, metabolite, constituent, extract, or combination of any ingredient described in the above.”

Are Dietary Supplements Regulated? Can Supplements Be Trusted?

Technically, yes, supplements are regulated by the FDA under the DSHEA. However, there are loopholes to consider:

  1. The FDA does not inspect products before they are sold, nor do they require registration unless the supplement contains a new ingredient not yet on the market.
  2. The only formulation standard is the Current Good Manufacturing Practice (GMP); however, 2013 report by the FDA revealed that 70% of inspected manufacturers were in violation of GMPs. Not all products even get inspected after being on the market. The FDA states the manufacturer is responsible for ensuring safety and quality, but clearly some manufacturers are doing a poor job, and the FDA is only catching some.
  3. Nutrition supplements may not claim to diagnose, cure, prevent, or treat diseases. Sure enough, some manufacturers have managed to ignore this. A 2003 study found that 81% of 338 herbal supplement retail websites made one or more health claims, and 55% claimed to diagnose, cure, prevent, or treat specific diseases.

What Can You Do to Be Safe When Taking Supplements?

Blind trust in supplements is unwarranted; however, there are steps you can take to ensure your safety while taking them.

  • Check the label for a stamp indicating third-party verification. Independent third parties are hired by manufacturers to thoroughly test products, ensuring accuracy of ingredients, potency, and amounts; absence of toxic compounds; and production in compliance with FDA GMPs. Credible third parties include NSF International and US Pharmacopeia (USP).
  • Athletes: look for the NSF Certified for Sport stamp. The USA Doping Agency (USADA) has recognized this program as best suited to assist athletes in choosing supplements that do not contain banned substances for sports.
  • Download the NSF International App. It shows which products are NSF approved—right at your fingertips anytime, anywhere.
  • Check out the Dietary Supplement Fact Sheets published by the National Institutes of Health: Office of Dietary Supplements. This government agency has quick fact sheets about a variety of dietary supplements, including vitamins, minerals, probiotics, botanicals and herbs, and more.

Speak with a Registered Dietitian for supplement guidance and which supplements may (or may not) be right for you. NIFS Registered Dietitians are available to help you!

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This blog was written by Sabrina Goshen, NIFS Registered Dietitian. To learn more about the NIFS bloggers, click here.

Topics: NIFS nutrition supplements dietitian drugs sports nutrition dietary supplements registered dietitian

Using Peppermint Oil for Irritable Bowel Syndrome

GettyImages-1030882342Peppermint oil is a commonly used nutrition remedy for Irritable Bowel Syndrome (IBS), other digestive problems (abdominal pain), the common cold, and headaches. We will focus on gut health in this blog. This remedy has been mentioned in records from ancient Greece, Rome, and Egypt and is becoming more popular in the modern age.

It is suggested that peppermint oil in enteric-coated capsules may improve IBS-related symptoms, such as abdominal pain. A meta-analysis evaluated 726 patients across nine studies, all of which were assessing the use of peppermint oil for treatment of IBS. All the studies showed a significant improvement in IBS symptoms and abdominal pain. The only adverse effect commonly noted was heartburn. Furthermore, another study was done where 65 IBS patients completed the study. There was a placebo group and a group treated with peppermint oil. Over the course of six weeks, those taking peppermint oil said abdominal pain (upset stomach, bloating, and gas) markedly improved, whereas the placebo group saw no significant changes. No other IBS symptoms improved. Two weeks after trials ended, the pain score increased back to the normal (same report as prior to treatment).

Drug Interactions and Additive Effects

According to the literature, the most common drug interaction is enteric-coated peppermint oil capsules taken at the same time as antacids. It is suggested that the two not be taken together, because the enteric coating will be broken down too quickly, which can result in heartburn.

Side Effects

Peppermint oil has been recognized as safe. Possible side effects associated with peppermint oil include allergic reaction and heartburn. The most common side effect associated with peppermint oil supplementation is heartburn, especially among those with IBS.

The Clinical Bottom Line

A significant amount of research shows that peppermint oil supplementation in those with IBS helps reduce abdominal pain. Additionally, it is safe. I would suggest someone struggling with IBS take peppermint oil. However, if they begin to experience excessive heartburn, I would suggest not taking peppermint oil or making sure they are not taking it with an antacid. Furthermore, it is important to remember that peppermint leaf is NOT the same thing as peppermint oil. Peppermint oil is going to be more concentrated and has the research to back up the benefits. On the contrary, peppermint leaf will be less toxic and does not have the research to support usage. 

Further Research

Much of the research done to prove peppermint oil helps with IBS was short term. Not many studies have looked into the long-term effects and safety of supplementing peppermint oil. Thus, I believe future research should look into that.

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This blog was written by Sabrina Goshen, NIFS Registered Dietitian. To learn more about the NIFS bloggers, click here.

Topics: digestion supplements illness prevention dietary supplements IBS irritable bowel syndrome