Some commercial probiotics found lacking when compared to traditional alternatives

Kefir appears to offer significantly greater benefit than commercially produced probiotic drinks.

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Dr Michael Mosley has been helping to run a study for the BBC  looking at the relative benefits to gut health from a range of products. Volunteers and scientists collaborated to try to discover which of three probiotics/prebiotics had the biggest positive impact on gut bacteria.

The first product was a commercially available drink, branded as a probiotic and available in major supermarkets. The second item up for comparison was kefir, a traditional milk and yeast fermented substance, a little like yogurt. These first two foods were compared with vegetables high in natural prebiotic fibre called inulin. Inulin is found in range of foods including chicory (chicory root is a rich source) and scallions (onions, leeks and garlic).

The poorest preforming of the three in this trial was the probiotic drink. The participants in this group demonstrated a modest (statistically non significant) change in lachnospiraceae gut bacteria. Conversely significant changes in gut flora were seen in the group consuming prebiotic fibre. The people that consumer kefir enjoyed the most positive increase to gut bacteria.

It should be pointed out that any comparison between prebiotics and probiotics is not a like for like test. Prebiotics deliver the food that supports existing bacteria and create the conditions for further colonization. A probiotic is intended to introduce microorganisms directly into the body.

The BBC study concluded that traditionally produced fermented foods (or even home made versions) may offer the greatest benefits to consumers in terms of increased gut flora. A key problem with mass produced fermented foods and drinks is pasteurisation. Pasturised goods are regarded as safer, which also correlates to a longer shelf life. By comparison traditionally made kefir has to be consumed in a relatively short space of time. This is perhaps the choice we consumers face, if we want maximum health benefits from the food we make or buy we may have to sacrifice some of the convenience of long sell by dates.

Understanding gut health

A basic guide to gut health, key terms defined and explained.

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Understanding gut health; 1 the basics

The scientific investigation of gut bacteria and its relationship to wellbeing is at a very early stage. There are discoveries every week that support, coexist with or contradict earlier findings. It’s a rapidly developing and dynamic area of human knowledge. The good news is, there are many resources available to anyone who wants to understand and take control of their own health through diet.

As a starting point there are a few concepts that are best understood at the outset. Not everyone uses these terms in the same way but try these definitions as a starting point.

Microorganism is widely used in talking about gut health, it is a general description for any organism that is too small to see with the naked eye. Some scientists prefer not to use the word but you are likely to come across it widely if you start reading about gut bacteria. Bacteria, viruses, archaea and fungi are all typically included in the term.

Microbiota  is generally used to denote the population of microbes in any given community or system. Flora appears to have largely the same meaning as microbiota and appears interchangeably. For example gut flora means the same thing as gut microbiota.

The aggregate of all the genes of an entire population of microorganisms  in any environment is described as a microbiome.

Typically scientists divide human microbiota into populations linked to their environment, such as skin, mouth, nose, digestive tract, and in females also the vagina. The largest population of microbes occur in the digestive tract, also known as the gut. Bacteria are the largest type of microbe in the human gut and bacteria reflects the dominant interest of scientific research. Gut bacteria are the main recipients of the benefits of prebiotics and probiotics, that is why the term gut bacteria and gut health is so prominent in media accounts of research findings. Technically speaking the plural of bacteria is bacterium but you will rarely see this outside of science journals, bacteria is typically used as the singular and plural form in most everyday situations.

A key point to make is that the gut has an important two way communication system with the human brain. That means to think of fermented food and drinks as only involved in what happens in the intestinal tract is a mistake. What we eat and drink has has the potential to exert a widespread influence across a number of systems.

Probiotics, antibiotics and resistance

The overuse of antibiotics is a major health concern. Probiotics may support the lower consumption of antibiotics by boosting overall health in humans and animals.

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I am in the process of writing a basic guide to probiotics, but a general description is,

‘microorganisms contained in some food and supplements that have proven and assumed benefits to human and animal health’.

A key point at the outset is that it is hard to prove causality in such matters. Demonstrating correlation (people that have particular gut bacteria tend to have or not have a particular illness) is much simpler. The evidence linking probiotics and health is both causal and correlational. The point of probiotics is to change (improve) the profile of gut flora so that it has more positive and less negative microorganisms. This is a long road of which we are at the beginning.

Antibiotics are drugs designed to destroy or inhibit the growth of bacteria harmful to humans, animals or other organisms. I acknowledge the potential lifesaving benefits of antibiotics, they are an important part of modern healthcare. But the widespread overuse of antibiotics in industrialized societies is creating superbugs, bacteria that are resistant to all known antibiotics. This problem was the subject of the film Resistance which I recently saw on Netflix. The issue of superbugs is not new and the discoverer of penicillin, Alexander Fleming discussed resistance in the mid 1940s. If you subject bacteria to an effective antibiotics most will die off, but surviving bacteria can develop resistance to that antibiotic. If you repeat the process often enough you risk creating bacteria over time, that become resistant to every antibiotic they have been exposed to.

Sometimes humans are given antibiotics when they are not needed, and so we may carry around bacteria that have a resistance to some antibiotics, this is a problem in itself. A key point that the film Resistance makes is that contemporary farming methods can involve the routine administration of antibiotics to hundreds of millions of animals every year. Antibiotics appear to make some animals grow bigger, thus increasing their cash value. However intensively farmed animals can live in insanitary conditions, exposed to fecal matter for most of their lives. Forcing animals to live in an environment where high levels of dangerous bacteria are present, thus necessitating the use of antibiotics as a routine measure, can be described as a perfect breeding ground for superbugs.

The standards of animal welfare vary from country to country and the use of antibiotics in the EU generally is lower than some other parts of the world. But it’s still  a major problem according to a recent report. Conceptually the idea of eating animals is increasingly unacceptable to many people. However the logic of forcing animals to live in terrible conditions their whole lives, only sustained by large amounts of antibiotics is obviously flawed. Not only are people eating animals that have endured life long suffering underpinned by the consumption of drugs. But this process may also be creating bacteria resistant to those drugs. The use of last-resort antibiotics for humans such as colostin, is increasing according to official data. When colostin is used it can indicate other antibiotics were ineffective against the harmful bacteria.

So what has this got to do with fermentation and probiotics? Firstly antibiotics generally kill and inhibited some good bacteria. Where health is at risk this is clearly an appropriate course of action. However as the importance of gut flora to health becomes better understood we should consider the need to maintain gut bacteria at healthy levels. Secondly the better our overall health the lower the risk of illness and presumably the less need there will be to take antibiotics. Just to be clear, probiotics are not a substitute for antibiotics, there are some very dangerous bacteria in our environment for which antibiotics may be the only cure. My position is to abandon the overuse of antibiotics in animals and humans so that when we (and animals) get really sick we will have antibiotic treatments that continue to work. The third point is eating animals that have lived a life in potentially dangerous bacteria, sustained by routine antibiotic consumption seems irrational.  Wouldn’t it make more sense to maintain animals in healthy conditions, with feed rich in probiotics, reducing the need for antibiotics in all but essential cases?