By Melody Khorrami, PharmD, RPh, INHC
As consumer use of probiotics increases, the need for education around choosing the right probiotic combination and which strains are most valuable for specific health conditions is also expanding. When choosing the right probiotic, two important factors to consider are strain specificity and disease specificity as they relate to the usefulness for a particular medical condition. There is evidence to suggest that the practicality of probiotic use is related to both strain and disease specificity.
What are probiotics?
Probiotics are defined as “live microorganisms that, when administered in an adequate amount, provide a health benefit to the host”. There are many different brands and strain combinations on the market, including a variety of colony-forming units. Colony-forming units (CFU) are the number of live and viable microorganisms in one serving of probiotic dietary supplements or medical food. CFU counts range from millions to trillions; however, most of the clinical data is in count ranges of billions.
Probiotics can support health in several different ways: they can help your immune system function properly, aid in digestion by helping to break down food, help produce vitamins and help with nutrient absorption, and assist with keeping harmful bacteria out. Since probiotics are live microbes they can impact the microbes that already reside in our body but they typically do not permanently remain in the gut. The way that probiotics generally provide their health benefits is by passing through the human gut and interacting with the immune and gut cells with which they come into contact. Keep in mind that every person’s body and bacterial composition is unique to them, so using products that are supported by science and having a goal in mind with your healthcare provider on why you want to use a probiotic is important. Probiotics can be used for general gut health maintenance, but doses will differ according to intended uses for specific health conditions.
How to distinguish one probiotic from another:
With so many different probiotics on the market, it is difficult to know which probiotic product to choose based on the specific health condition. The challenge lies in being able to differentiate one product from another based on the manufacturing process, quality control, and intended effect of the strain combinations in the product. Probiotics are identified by strain specificity, which includes the following components; genus, species, sometimes a subspecies, and the alphanumeric strain designation. With the introduction of genomic analysis, the role of strain specificity started to be taken into consideration. Various probiotic guidelines also started to make recommendations utilizing the specific strain designations from clinical trials.
It is important to note that just because a probiotic has a larger dose or contains lots of strains does not necessarily mean it is more effective.
Some studies point to single-strain probiotic products and their benefits for specific health conditions and others with better outcomes with specific multi-strain blends. The effectiveness is best determined by clinical trials and the strain combinations and intake amounts used in those trials related to certain health conditions.
Other challenges in choosing the right probiotic mixture are that while one mixture may be effective for one health condition it may not be effective for another. Intended uses for probiotics with clinical data range from use in antibiotic-associated diarrhea, irritable bowel syndrome, ulcerative colitis, pouchitis, hepatic encephalopathy, traveler’s diarrhea, skin conditions such as atopic dermatitis, vaginitis, and colic in babies.
When choosing a probiotic, it is important to look at the data related to that product in certain health conditions. The data should not only be related to genus and species but should include the distinct strains and amount taken during the clinical trials. Choosing the right probiotic strain combination can be challenging and attention needs to be given to the specific strain and the disease or condition it is being used to treat. As a consumer, it is important to choose products that have strong clinical trial data. When in doubt you can call the product’s manufacturer to request scientific data on their exact product.
Please note: This article was written for educational purposes only. Please consult your healthcare provider before making any changes to your healthcare plan.
By Melody Khorrami, PharmD, RPh, INHC
Stress management is an important area that is discussed during GI visits for patients who are dealing with irritable bowel syndrome. The relationship between the brain and the digestive system is important to consider when developing a plan for managing irritable bowel syndrome (IBS). Certain emotions such as stress, depression and anxiety can activate signals in the gut (the stomach and intestines) which cause gastrointestinal distress. Improving psychological and emotional health can also help to improve digestive conditions such as IBS. This may require that you work with not just your doctor but also a nutritionist and a therapist.
Why stress can be a trigger for IBS?
Psychological stress is an important factor in the development of irritable bowel syndrome. Studies have shown that psychological stress can have an impact on intestinal motility, sensitivity, and permeability. There are complex interactions between the nervous system, hormones, and the immune system that can affect the intestinal microbiota, which contribute to IBS. IBS is sensitive to stress, and treatment should incorporate stress management. An integrative approach to IBS management is important, including pharmacological treatments, dietary changes, adding the right probiotic, and relaxation techniques. When stress stimulates the hypothalamic-pituitary-adrenal axis, HPA, it triggers cortisol release, which can affect the gut function and create an imbalance in the microbiota. Chronic stress can contribute to dysbiosis, one factor in developing IBS. There is a strong correlation between co-morbidity of psychiatric disorders, such as depression and anxiety, and the severity of IBS symptoms.
Negative emotions like anxiety have a major role in gut functioning because of the brain-gut axis. Homeostasis or the ability of the body to maintain a certain state of equilibrium, can be disrupted by negative emotions, like stress, if they are not processed in a healthy manner. The gut-brain-axis has an important communication role between the gut and the central nervous system. Dysregulation in this pathway can create altered bowel motility and hypersensitivity, which contributes to IBS symptoms.
Stress management is possible!
For many patients who receive a recommendation to reduce or manage stress, it is pretty clear why it is essential, but the bigger question is: how can they go about managing the stress in a healthy way? Here are some suggestions for you the next time your doctor indicates reducing stress levels to manage a gut disorder.
There are some every day wellness steps you can take to improve your psychological well-being. These include the following:
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Exercise:Practicing yoga, or swimming a couple times a week can help with abdominal pain, and with calming the intestines. Aerobic exercises such as a brisk walk can help to lower stress in the body by reducing stress hormones in the body such as adrenaline and cortisol.
- Meditation: Meditation is a form of deep relaxation which has been used for centuries. It can help to bring emotional balance and reduce stress in the body. Dedicate a few minutes in the morning to set up your day easefully or at night before bed to calm your nerves and reflect on the positives of your day.
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Quality sleep: Stress is a major factor for poor sleep, and conversely poor sleep quality is a major factor for increased stress. Sleep allows the body to recharge and sleep deprivation can affect mood, having good judgment and decision-making skills, and memory. Survey findings have shown that adults who sleep less than 8 hours a night are more likely to have increased stress and feel more irritable.
- Spending time in Nature: According to studies, taking time to connect with nature, even as little as 20 minutes a day can lower the stress hormone cortisol in the body. Consider taking a walk outdoors daily and take in fresh air.
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Cognitive Behavioral Therapyand psychodynamic psychotherapy: Working with a licensed therapist can help you learn tips for managing your anxiety and stress. Most cognitive behavioral therapy interventions aim to modulate behavioral patterns and reduce irrational fears. Psychodynamic psychotherapy focuses on interpersonal and intrapersonal conflicts and how they may contribute to developing and maintaining symptoms in IBS. Learning the right tools to manage your stress and emotions will impact your gut health and improve the rest of your life profoundly.
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Nutrition: Eliminating processed foods and eating a whole food diet are important factors in managing the stress response and improving mood. Foods that are included in the Mediterranean diet such as poultry, wild caught fish, an assortment of vegetables and fruits, and healthy fats can be helpful in stress management. Eliminating high sugar foods and drinks, and reducing alcohol and caffeine, are an important part of stress management and a healthy brain. Another aspect to consider is keeping blood sugar balanced. Being chronically in a low blood sugar state can be stressful on the body, so making sure not to skip meals, and eating on a more consistent schedule can be helpful in balancing blood sugar levels and allow you to manage stress better. Working with a nutritionist or licensed dietician can help with creating a nutrition plan that works for you and your life.
Stress is a major problem in its contribution to the development of many health conditions including gut conditions like irritable bowel syndrome. Learning the tools needed to manage stress and other negative emotions is arguably one of the greatest personal endeavors you can undertake. There are ample resources available to those who want to learn new techniques for managing their stress and anxiety. Unlearning patterns, and addressing the root cause of your emotional state can be important in healing the underlying issues that contribute to your state of stress.
Experiencing stress and negative emotions are a part of the human experience, but if they are not processed in a healthy manner they can lead to manifestations of physical health problems. The gut-brain connection is revolutionizing our understanding of what the trillions of bacteria, are doing in the gut.
By Melody Khorrami, PharmD, RPh
As we enter a new year, it is always helpful to take a moment to reflect on the past year. Journaling about your personal progress, both professionally and socially, and re-examining your life vision can help you set new goals. As you assess the past, try to practice grace and gratitude for all the twists and turns of life. Many of us will use this time of renewal to focus on health and wellness goals. Here’s a thought: start with your gut!
Research in the gut microbiome space has erupted in the last couple years. Our gut is home to trillions of microbes that create a dynamic environment which influences so much of our health and well-being. These microbes are responsible for the digestion process, metabolism, and immune function. There are a variety of factors that can affect the gut microbiome which include your diet and lifestyle, environmental changes, the aging process, stress, and the use of unnecessary antibiotics.
Individual variations in the human microbiota are always present, that is why bio-individuality is important in this space. Research has suggested a link to an imbalance of gut bacteria and some common health conditions. These include, irritable bowel syndrome, inflammatory bowel disease, obesity, diabetes, as well as possible links to mental health conditions through the gut-brain axis.
So now you might ask yourself: How can I support my gut health in the new year? Starting slowly and sustainably is key, and as always, be patient with yourself as you make these changes!
Tip 1: Manage your stress
The gut-brain axis has been an important area of research the last couple years. There is increasing evidence that dysbiosis, or an imbalance of gut microbiota, can contribute to anxiety, and depression. Excess stress can also be a trigger for negative digestive symptoms. Research has shown that using mind-body techniques such as mindfulness-based stress reduction practices can assist with managing stress that could be contributing to digestive issues and other conditions.
Incorporating movement in your everyday life can help reduce stress, this includes practices like yoga, which has been shown to lower cortisol, the primary stress hormone. As always, if you feel like your stress and anxiety have gotten to unmanageable levels seeking professional counseling or psychotherapy is an important measure to take. In fact, therapy can be a wonderful way to explore and reflect on the root cause of your emotions and stress and find the tools to learn more about yourself.
Tip 2: Adjust your diet
Have you heard the term you are what you eat? Our gut microbiome is heavily influenced by the foods that we eat. Eliminating processed and high sugar content foods and incorporating more nutrient dense foods are a great first step that will help your beneficial gut bacteria thrive. Some studies have shown that altering your diet can create temporary microbial shifts within just 24 hours. Incorporating prebiotic foods such as garlic, artichoke, onions, asparagus, leeks, bananas, flaxseeds and oats and more fiber into the diet can help modulate the gut microbiota. Some examples of high fiber foods include, pears, berries, chia seeds, avocados, brussels sprouts, lentils and chickpeas.
Working with a nutritionist or dietician can be a great way to figure out food sensitivities, and to find sustainable ways to include more nutrient dense foods into your diet and find a plan that works for your lifestyle.
Tip 3: Consider a probiotic
As research increases around the relationship between the gut microbiome and different diseases the interest around probiotics has also increased.
While you should always start with lifestyle and diet when approaching gut health, incorporating a well-studied probiotic can also be beneficial in certain circumstances. The most used strains are from the Lactobacillus and Bifidobacterium genera. Other strains such as the Enterococcus and Streptococcus genera are also used in probiotic products.
With so many probiotics on the market it can be challenging to find a product that has its own clinical studies and is a multi-strain product. Probiotics can help your body maintain a healthy community of microbes and can have an influence on your body’s immune response and digestive process. Here are a couple questions to consider when choosing a probiotic:
- Does this specific product have clinical trials to show a health benefit?
- How does this probiotic brand ensure potency of product?
- Does this product contain an appropriate CFU count? (CFU is the unit used to estimate the concentration of microorganisms in the product)
- Does the product have diversity in strains that are used?
Asking the right questions can help you and your healthcare provider make informed choices related to choosing the right probiotic for your needs.
Please note: This article has been written for informational use only. Please consult your doctor before making any changes to your health and diet regimen.
By Melody Khorrami, PharmD, RPh
As the holidays approach, many of us look forward to gathering with family and friends to celebrate and enjoy delicious meals. We are eager to feast on seasonal treats like turkey, stuffing, potatoes, and rolls; not to mention all the desserts! While all this food and company is wonderful, it can be overwhelming to our digestive systems. Fear not! There are steps you can take to help ease the digestive process. This is supposed to be a fun day and you shouldn’t feel any stress or shame about indulging and enjoying the festivities!
Starting your morning off with fiber rich foods can help keep your bowels moving regularly and feed the good bacteria in your gut to help keep your microbiome healthy. Having regular bowel movements is important in eliminating toxins, keeping your hormones balanced, and reducing constipation. The last thing you want is to be constipated on the holidays, right before enjoying your meal. Fiber is naturally found in most fruits and vegetables. So, make sure to include a variety of these in your meals!
Drinking enough filtered water throughout the day is an important step in preventing dehydration, keeping your bowels moving, and digestion. According to
studies inadequate hydration has also been linked to elevated BMI and obesity. Starting your morning with a glass of filtered water or lemon water upon waking is one of the best things you can do you start your day. This is because your body is in a fasted state while sleeping and can be dehydrated upon waking. Lemon water can help with digestion by increasing the production of HCL, also known as hydrochloric acid. Our stomach secretions are made up of
hydrochloric acid, and digestive enzymes that help us digest and absorb nutrients such as proteins in our foods.
Need I say more? Finding the right movement for your body is important to many aspects of your overall health and wellness. Improved digestion is just one!
Take a walk the morning of your dinner plans and perhaps a second one with family and friends about
15 minutes after eating.
Daily walking can help reduce bloating, aid in digestion, and help balance your blood sugar after a meal.
Incorporating movement such as yoga not only can be beneficial for mental health but can also help with constipation, insomnia and
healthy aging.
Consider a quick yoga session during the day or in the evening! Certain poses can aid in regulating the bowels and decrease bloating. Some
yoga poses that could be helpful for the digestive system include:
- Child’s pose, camel pose
- The twisted lunge
- Revolved chair pose
- Bridge pose
- The supine twist
If certain poses are uncomfortable, you should not overextend yourself, there are usually modifications to the movement you can do and still receive great benefits!
Yoga can help manage the stress of Holiday season by reducing the sympathetic response of the nervous system which is our “fight or flight response”, when we go into “fight or flight” it can
negatively affect our digestive system and in turn cause the digestive system to function improperly. When the stress response is activated, the central nervous system shuts down digestion which causes the slowing down of the digestive muscles and decreased secretions necessary for optimal digestive processes. This can lead to bloating, gas, and constipation.
The digestive system cannot work optimally if the body and mind are constantly stressed.
Practicing a mix of yoga and breath work techniques have many benefits for mental and physical health and this includes aiding in proper digestion. So, grab a yoga mat, and start moving and breathing!
The gut microbiome houses trillions of microbes that play important roles in our digestion and overall health. These microbes help us breakdown the foods we eat and help with absorption of critical vitamins. When there are more bad bacteria than good bacteria present, it results in a condition known as dysbiosis. When you experience dysbiosis, digestion can become harder and you may have more negative GI symptoms after eating such as bloating, gas, and burping.
Probiotics can help ease the discomfort associated with bloating, and gas and help your body digest the foods that you eat. Before you start taking a probiotic remember that each person is different, and your needs may not match the needs of the people around you.
Bio-individuality is key in determining which probiotic strains are best for you. Probiotics have very little regulatory oversight, so it is important to identify reputable brands that offer evidence-based research related to their specific product.
I hope you find these GI tips useful on Turkey Day, stay safe, and enjoy!
***The following article is not medical advice. Please talk to your doctor before making changes to your wellness routine. ***
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