The Evolution of Probiotics
Friday, January 30, 2015 10:04 PM

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.

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. When this environment is out of balance, patients will experience a myriad of symptoms associated with and remote to GI dysfunction.

Researchers have identified the vast diversity of the microbiome, but have also found most of the organisms which are associated with healthy GI function.  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."

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. Another route many manufacturers take is to create a product with the largest number of colony-forming units (CFU) per dose.

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, 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, and 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 the evidence-informed opinion, of the author, supporting the health of our microbiome can go a long way toward building a healthy foundation and supporting the health of our patients.