The Evolution of Probiotics

In clinical practice, we see patients with complaints that cross the entire spectrum of health. One of the most common concerns that presents is associated with digestive or gastrointestinal (GI) health. Patients may have constipation, diarrhea, bloating and/or chronic GI infections such as Candida; or associated problems such as small-intestine bacterial overgrowth (SIBO). We have a unique opportunity to provide some simple, effective and evidence-based options to support this large demographic.

Probiotics have ample research suggesting their ability to support a healthy digestive tract. In recent years, our understanding of the digestive tract has increased exponentially with the completion of the Human Microbiome Project and follow-up investigations. As our understanding evolves, so must our clinical interventions.

Understanding The Microbiome

In order to properly frame the evolution of probiotic therapy, it is important to discuss the microbiome. The digestive tract is a an extremely dynamic environment that, when properly balanced and healthy, works in amazing ways. The microbiome is the ecological community of commensal, symbiotic and pathogenic microorganisms within our bodies.¹ When this environment is out of balance, patients will experience a myriad of symptoms associated with and remote to GI dysfunction.

The Human Microbiome Project Consortium analyzed a large cohort and showed that the microbes found in different areas of the body varied significantly, but did find an "estimated 81-99% of the genera, enzyme families and community configurations occupied by the healthy Western microbiome."² What exactly does this mean? Researchers have identified the vast diversity of the microbiome, but have also found most of the organisms which are associated with healthy GI function. This is important to know, as more evidence is pointing to a myriad of effects the microbiome has on overall health.³

Supporting a Healthy Microbiome With Probiotic Therapy

When examining the literature and the increased understanding of the microbiome and the microbiota within, it brings to light tremendous clinical applications if a practitioner can adequately support a healthy, thriving microbiome. The clinical use of probiotics has been evolving over time, with effective research driving improved and innovative formulas that work well in practice. One such approach brings a relatively new, but documented concept to a probiotic formula. The probiotic bacteria formula is based on soil-based organisms (SBO), which have been shown to be closely linked to the evolution of our digestive tract.⁴

The early generations of the clinical application of probiotics have focused on specific species that are cultured within a laboratory. These cultured organisms are then used to create either a "designer" product with a highly specific indication, such as Lactobacillus salivarius in vaginal health.⁵ Another route many manufacturers take is to create a product with the largest number of colony-forming units (CFU) per dose.

It is somewhat of an "arms race" to see who can come up with the most potent probiotic in the hopes that a larger number of organisms survive and are able to inhabit the appropriate area of the digestive tract. When the variety of bacteria in the digestive tract is in the thousands, if not more, is there the potential to have "too much of a good thing" and imbalance the system when using huge quantities of a few select organisms?

Another option is to consider a type of beneficial bacteria which was actually developed from studies looking at the relationship of the microbiota on the root system of plants and the microbiota in the human digestive tract. Studies have shown that many of the SBOs found around plant root systems match what is found in the human GI tract – likely due to evolutionary effect of humans eating these plants, and the associated bacteria, throughout our own evolution as a species.⁶

SBOs are naturally hearty and stable, and able to easily navigate the acidic nature of the stomach in order to arrive to their final destination within the digestive tract.⁷ This allows SBO products to focus more on the actual probiotics within, instead of determining the best way to deliver them to the appropriate area of the gut. Many of the other probiotic species used in supplements are very fragile, thus needing elaborate coatings and delivery systems to protect the probiotics and/or billions upon billions of colony-forming units (CFU) in order to deliver a clinically effective dose to the target site. Additionally, the SBO-based probiotics have shown a greater ability to germinate and colonize the small intestine, as studies have demonstrated a significantly higher number of SBO species 15 days after supplementation versus non-spore-forming species.⁸

Solid emerging evidence supports the clinical effectiveness and safety of SBO-based probiotic products. With the proper variety of SBO organisms, efficacy has been shown in treatment of irritable bowel syndrome (IBS)^9-10 and potentially in the support of mental health, due to the gut-brain axis.¹¹

With the systemic health effects the digestive tract can exert, supporting its foundational function should be a cornerstone in preventing ill health and supporting patients who have chronic gastrointestinal health problems. As we learn more about the complex interaction of the digestive tract and the rest of the body, SBO-based probiotics may be shown to have a much larger clinical effectiveness than previously thought due to their ability to support a healthy microbiome.

When using probiotics in a clinical setting, it is important to understand how each of the organisms in the product you are using can affect your patient. Is there a chance long-term use of the product could negatively affect the delicate microbial balance within the gastrointestinal tract? Will the product support the microbiome and help it to be more resilient to the many external insults known to cause problems?

In clinical practice, it is of the utmost importance to be using the highest quality and most recent evidence on which to base your clinical decision-making process. In my evidence-informed opinion, supporting the health of our microbiome can go a long way toward building a healthy foundation and supporting the health of our patients.

References

1. The NIH HMP Working Group. (2009). The NIH Human Microbiome Project. Genome Res. 2009 December; 19(12): 2317–2323.
2. Human T, Project M. Structure, function and diversity of the healthy human microbiome. Nature, 2012;486(7402):207-14.
3. Sekirov I, Russell SL, Antunes, LCM, et al. Gut microbiota in health and disease. Physiolog Rev, 2010;90(3):859-904.
4. Ramírez-Puebla ST, Servín-Garcidueñas LE, Jiménez-Marín B, et al. Gut and root microbiota commonalities. Appl & Environ Microbiol, 2013;79(1):2-9.
5. De gregorio PR, Juárez tomás MS, Leccese terraf MC, et al. In vitro and in vivo effects of beneficial vaginal lactobacilli on pathogens responsible for urogenital tract infections. J Med Microbiol, 2014;63(Pt 5):685-96.
6. Dethlefsen L, McFall-Ngai M, Relman DA. An ecological and evolutionary perspective on human-microbe mutualism and disease. Nature, 2007;449(7164):811-8.
7. Bader J, Albin A, Stahl U. Spore-forming bacteria and their utilisation as probiotics. Beneficial Microbes, 2012;3(1):67-75.
8. Duc LH, Hong HA, Barbosa TM, et al. Characterization of Bacillus probiotics available for human use. Appl & Environ Microbiol, 2004;70(4). doi:10.1128/AEM.70.4.2161
9. Bittner AC, Croffut RM, Stranahan MC. Prescript-assist probiotic-prebiotic treatment for irritable bowel syndrome: a methodologically oriented, 2-week, randomized, placebo-controlled, double-blind clinical study. Clin Therapeutics, 2005;27(6):755-61.
10. Bittner AC, Croffut RM, Stranahan MC, et al. Prescript-assist probiotic-prebiotic treatment for irritable bowel syndrome: an open-label, partially controlled, 1-year extension of a previously published controlled clinical trial. Clin Therapeutics, 2007;29(6):1153-60.
11. Maes M, Kubera M, Leunis J-C. The gut-brain barrier in major depression: intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression. Neuro Endocrin Letters, 2008;29(1):117-24.