What's better than probiotics?

Many people take probiotics in the hopes that it will help reduce gastrointestinal struggles with excessive gas, bloating, diarrhea, constipation and other common complaints. Sometimes they help, sometimes they don’t. But why? Just what are probiotics and how are they created? 

In this episode of the Defiant Health podcast, let’s discuss the ups and downs of commercial probiotics, why they are really little more than haphazard collections of microbes assembled without rhyme or reason. Then let’s discuss how you can do better than taking some random commercial probiotic off the shelf. 

Chapters

• 0:06 The Problem With Probiotics
• 0:52 What Probiotics Really Are
• 2:44 Dose Matters More Than Labels
• 5:15 The Myth Of Mixed Microbe Formulas
• 6:35 Risks, Gimmicks, And Marketing Hype
• 9:32 A Better Path: Fermented Microbes
• 12:13 Targeting SIBO With Specific Strains
• 15:08 Fermented Foods As Microbe Catalysts
• 17:24 Feed The Microbiome With Smart Fibers

Transcript

William Davis, MD: 0:06

Many people take probiotics in the hopes that it will help reduce gastrointestinal struggles with excessive gas, bloating, diarrhea, constipation, and other common complaints. Sometimes they help, sometimes they don't. But why? Just what are probiotics and how are they created? In this episode of the Defiant Health Podcast, let's discuss the ups and downs of commercial probiotics, why they are really little more than haphazard collections of microbes assembled without rhyme or reason. Then let's discuss how you can do better than taking some random commercial probiotic off the shelf. Let's talk for a few minutes about something that's better than a probiotic. Now I know a lot of you rely on probiotics to rebuild a broken gastrointestinal microbiome. Perhaps you have bloating or diarrhea or have food intolerances and want to rebuild or restore lost microbes, push back some of the unhealthy ones. So one of the tools in your toolbox to do so can be a commercial probiotic. But let's talk about there are better ways to do it than just taking a commercial probiotic. So what exactly are probiotics? Well, they're typically in capsule form, sometimes other forms like sachets or stick packs, but they're essentially powdered or what are called lyophilized, freeze-dried forms of microbes. And they're freeze-dried to keep them viable and keep them away from moisture that degrades them. And it's typically made of one or more species of microbes, typically many species, maybe five, ten, or even more species of microbes, each of which have been chosen by a formulator because they have been shown to have some kind of beneficial effect in mice, perhaps in humans, or both. So a typical formulation process would be something like this. The formulator says, well, I think lactobacillus vulgaricus is good. Let's throw that in. I think that Lactobacillus acidophilus is a good microbe with some evidence for beneficial effects. Let's throw that in. How about some bifidobacteria bifidum? That's been shown to have some interesting effects. Let's throw that in. And so on. In other words, the vast majority of commercial probiotics, really nothing more than haphazard, slap-dash collections of microbes, chosen to some degree at random. And then some number put into a capsule. Now the capsule, of course, limits the number of microbes you can fit into a capsule. You can't fit hundreds of billions, there's not enough room. So typically, if a company chooses, say to put in ten species into a capsule, there's usually only a few billion at most of each species, which sounds like a lot, but is really a very small number. It's looking as if the science is telling us that it really takes more like tens of billions, maybe hundreds of billions, to really have a biologically meaningful effect. In other words, so for instance, there's a very interesting study using a strain of Lactobacillus gaseri. And this was a study from South Korea. And the comparison was between placebo, one billion counts per day, and 10 billion counts per day. And the end point they looked at was waste circumference. So of course the placebo showed no change over 90 days, 1 billion per day, no change likewise, 10 billion, about 3.5 centimeters of about 2 inches of reduction in waste circumference with no change in diet, no change in exercise program. So very interesting finding, right? They also did cross-sectional imaging of the abdomen, and it showed more than 20 square centimeters of reduced abdominal visceral fat. Very interesting findings, right? So that occurred at 10 billion per day. But what would have happened at 50 billion or 100 billion, or for that matter, 500 billion? Well, we don't know. So the people who performed that study, like my efforts, we don't have the unlimited research budgets that the pharmaceutical industry has. And when you add additional arms, different dosing arms, it increases your costs dramatically. So if that study, let's just say, costs $150,000 to do, and you wanted to add a $50 billion, $100 billion, et cetera, arms, your costs go up into three, four, five hundred thousand dollars. And so that's for that reason a lot of us have very limited what we call dose response data. I tell you that because most commercial probiotics have very low counts of microbes. So you can't expect them to accomplish much. If you're going to war, if this was a war going on, and you're going up against an army of a hundred thousand soldiers, and you come in with a thousand soldiers, you're not going to win, right? Same thing here. In order to go against the trillions of microbes, many unhealthy species in the disrupted gastrointestinal microbiome, you come in with small numbers, like a few hundred million or a few billion, you really don't have much of a chance to have an impact. So that's a common problem in most commercial probiotics. Another pitfall, another problem of commercial probiotics is that because they're created haphazardly, there's no attention paid to what are called collaborative effects or effects in which microbes work with each other, typically by shared metabolites or other factors. In other words, microbes, just like humans and other creatures, live in communities and they cooperate or fight against one another. Well, if you just throw together a bunch of random microbes, they may or may not cooperate with each other, and you may not get the kinds of effects that you could have had, say, if you had maybe a half a dozen of collaborative or cooperative species. Now that's in their defense of the people who formulate probiotics. A lot of that information has not yet been sorted out. It's only getting started. And so the current crop of probiotics on the shelves right now don't have not incorporated these factors. So stay tuned. As the science progresses, that will be incorporated and we'll have better collections of microbes that have shared effects, that collaborate, cooperate with each other. Now, there's even some probiotics that are harmful. You know, the FDA has a policy that if you include a microbe that's foreign to humans, that is, maybe it came from another mammal, another creature, or even soil or someplace else, that it should go through an approval process. Unfortunately, the manufacturers who've used some very unusual microbes, typically non-human sourced microbes, as compared to the ones we've been using, which are all human-sourced, some of these companies have used these non-human sourced microbes that have not been scrutinized, not have not been tested, and I think have potential harmful effects. Now I can't, I don't want to name those companies because there's that we live in the litigious society, but know that there are products out there, got to be careful, that are probably harmful. These are typically products with lots, with dozens, if not hundreds, of different species of very low counts, with very unusual names that we want to avoid. And then lastly, there are a growing number of gimmicks being incorporated into probiotics because it's a competitive market. And because most of these products have nothing special about them because they're just haphazard collections of species, some companies have resorted to gimmicks. One of the gimmicks, for instance, is to encapsulate the microbes in such a way that there's delayed release into the colon. Well, if you've been following my conversations, you know that most of the problems in the microbiome occur in the small intestine, not the colon. There can be problems in the colon too, but a lot of the problems that arise from the microbiome are because of the unwanted species in the small intestine. So why would you want a delay release of beneficial microbes into the colon? You want them to release in the small intestine. So causing delayed release into the colon is a bad idea, in my view. Another gimmick is to rotate microbes. One week or one month you have this collection of microbes, another month you have another collection. Well, all right, interesting idea, but it's never been scrutinized. There's no evidence that this is somehow better, but it typically leads to very costly products. Then, of course, there are many claims, virtually all of which are marketing claims, not scientific claims. Because it's very difficult with the regulatory restrictions on products to make actual claims. In other words, we can't say things like take this probiotic and your ulcerative colitis will get better. That would be the FDA and the FTC, Federal Trade Commission, would clamp down on that kind of a claim and close that company down or close that product down, impose very hefty fines. So the claims I'm more concerned about are marketing claims, outsized and sometimes misleading marketing claims. So beware. Marketing is not science. It's just meant to sell you something, so be careful. Now, because of that issue of very low microbial counts, it's one of the reasons why we have resorted to fermenting microbes, as typically something called we call yogurt. It's not really yogurt, right? It looks and smells like yogurt. It's just fermented dairy. Because it smells like yogurt, we call it yogurt. But we're going to ferment human-sourced microbes. My favorites are, of course, are a strain of lactobacillus rotori, a strain of lactobacillus gaseri, and the most recent formula I'm using is uh bacillus subtillis. I replaced bacillus coagulants. There's nothing wrong with bacillus coagulants, but it proved to be somewhat unreliable in generating very high counts with our fermentation methods. So I replaced it with a much more reliable microbe, bacillus subtilis. So these are three lactobacillus rotori, lactobacillus gastri, bacillus subtillus, that we ferment. Typically in dairy, though you can use other things to ferment, like hummus and salsa and other things. But if we use in dairy, we get very high counts. So for instance, if we fermented lactobacillus rotorite by itself, rotorite doubles every three hours, so-called asexual reproduction, every three hours at human body temperature. So we're going to let it double 12 times, 36 hours. When we count the number of microbes in this lactobacillus rotorite yogurt, we get around 300 billion counts per half cup or 120 milliliter serving. In other words, we're getting super duper big numbers. And I believe that's part of the reason why we're seeing such significant biological effects. And you may have gathered from my conversations that that combination of three microbes, lactobacillus rotarite, lactobacillus gasserite, bacillus subtlis, that I call SIBO yogurt, or more properly now we individually ferment them to get the highest counts possible. You can co-ferment all three, but we really don't know what happens to the relative numbers of microbes as they compete with each other. My suspicion is bacillus subtle takes over, and who knows, I don't know, sixth or seventh batch or so. So if you do co-ferment them together, you want to start over every few batches so that one microbe doesn't become too dominant. But regardless, we're going to use those microbes, chosen specifically because they colonize the small intestine as well as the colon and produce bacteriocins, natural peptide antibiotics that are effective in killing unwanted microbial species, such as fecal microbial species like E. coli and salmonella and campylobacter, that very commonly have overproliferated in the colon and then ascended to occupy the 24 feet of small intestine. Of course, that's called small intestinal bacterial overgrowth, SIBO or SIBO. And that is a source for huge health problems in at least half the U.S. population. You might be experiencing it as brain effects, depression, dementia, Parkinson's disease, suicidal thoughts, anxiety. You might be experiencing it as skin effects, various skin rashes, rosacea, psoriasis. You might be experiencing it as joint pains, muscle aches, like fibromyalgia, rheumatoid arthritis. You might be experiencing it as an amplification of heart disease, like recurrent atrial fibrillation or coronary disease, coronary athosphrotic plaque rupture, heart attack, sudden cardiac death. In other words, we have to reconsider virtually all common chronic human disease in light of the contribution of SIBO and the toxic compounds that they deliver into the bloodstream that thereby export all these effects of the gastrointestinal microbiome to other parts of the body. So taking a haphazardly created commercial probiotic will do virtually nothing for this process. So for that reason, we chose those three microbes, ferment them using extended fermentation, get super duper high counts. This is better than taking a haphazardly created commercial probiotic. And of course, you've been found by conversations, including that my super gut book or my William DavisMD.com blog with thousands of blog posts, my Define Health Podcast, or my two-way membership website where we have these conversations frequently via Zoom, which is the inner circle.dr Davisinfinfinite Health.com, you know that we go further. Yes, we do those three microbes as the SIBO yogurt or equivalent, but we also incorporate lots of fermented foods because the observations from people like doctors Erica and Justin Sonnenberg from Stanford University who have shown that fermented foods, kimchi, kombucha, fermented veggies, sauerkraut, are among the most important things you can do to restore microbes to the gastro-intestinal tract. The curious thing about that is the microbes in the fermented food, these are species like Leucunostoc mesenteroides, or various Petiococcus species and others. They themselves really don't take up residence, maybe for a short time, but then you pass them out into the toilet. So why are they helpful? Somehow, the consumption of the microbes in fermented foods causes beneficial species to be cultivated or to proliferate. So while you get that Petecoccus or the leuconostoc in the fermented food, you'll see an increase in beneficial species like Fecalobacterium, acromansia, clostridium species, and many others. So fermented foods, despite not having those probiotic species, but other species cause proliferation of microbes in the GI tract. And by the way, the microbes that proliferate are typically ones you cannot get and cannot grow yourself. Like Fecalobacterium will not grow as yogurt. You can't ferment it in food. So this is an indirect way to cultivate beneficial species. And of course, we're sure to get fiber sources in our diet, not brand fiber, like in brand cereal or whole grains. We're talking about fibers that nourish microbes. These are foods like legumes, black beans, white beans, kidney beans, lima beans, chickpeas, hummus, other root vegetables, asparagus, brussels sprouts, onions, garlic, shallots, all the foods that nourish microbes because they amplify the effects of the fermented foods. The fermented foods trigger the proliferation of those beneficial species. The fibers further add to the growth of those or proliferation of those beneficial species. So this is far better. Now you can still add a probiotic, but you can see the probiotic is kind of like icing. Maybe it helps, but this haphazard collection of microbes that you get in a probiotic is not the foundation, it's not the cornerstone of what you should be doing to rebuild a broken, busted microbiome ruined by your exposure to antibiotics and other factors. So we rebuild the microbiome by reinstilling those microbes that you've lost that are small intestine colonizers, bacteria producers. We get lots and lots of fermented foods, we add fibers. This is how you take back control. And then you can add the probiotic on if you want. Some commercial probiotics do have some claims about specific effects. You'd add that on. But don't let the commercial probiotic be the cornerstone of your efforts.