Ep 5: Could probiotics be dangerous?

“What is there that is not poison? All things are poison and nothing is without poison. Solely the dose determines that a thing is not a poison." So wrote Paracelcus in 1538. 

Our understanding of gut microbiome science is still in its infancy and yet we are all familiar with taking probiotics for various conditions - often being promoted as being "potent" and "high dose". 

Whilst there appears to be no immediate consequences to human health now, is there a risk further down the track? We are starting to understand that many chronic conditions seem to be triggered by "dysbiosis" or imbalances in the gut. Could we create such a dysbiosis by indiscriminate use of probioitics and overloading on specific strains? Dr Nick and Ben discuss the theory behind this. 

Transcript

Tempo: 120.0

SPEAKER_01 0:04

Hello and welcome to that pillars of health. I'm Dr. Nick Krasner and I'm with Ben Eshelby. And today we're going to be talking about is there a danger with probiotics? Interesting.

SPEAKER_00 0:16

Good question, because everyone, a lot of people use probiotics.

SPEAKER_01 0:20

Yeah, it is. And I think one thing I'd like to say about this topic, because we've talked a little bit before the podcast about it. And a lot of what we're going to take, talk about is more postulation, more hypothesis. So this isn't the actual truth in the sense that we know exactly what's going on, because actually there's a lot of research in all of this. And I think we may be able to answer this question a lot better in five, ten, twenty years' time. But I think there's a lot of questions that we can think about and think about whether there's possible links to illnesses because of probiotics. So I think this could be very useful, especially for a lot of conditions. So let's carry on, let's leap in there. Ben, you you treat a number of people with microbiome problems. Just before I ask you about it, just so you know the terminology, microbiome is all the sort of non-use stuff in your body. So all the bacteria, viruses, fungi, everything that's in your body, which apparently is about 90% of our body, which is amazing. Sometimes people will talk about the microbiota, and the microbiota technically is the bacteria in the gut. Most people, when they talk about the microbiome, though, they're talk, they're thinking about the microbiota. So they're sort of interchangeable in sort of common speak. So you do a lot with the microbiome. Do you want to tell people what you do here at Formula?

SPEAKER_00 1:40

Yeah, so so basically we do a lot of work with the gut microbiome, which is obviously one of the biggest areas of bacteria in the body. And it's the one that's probably the most well studied. Although I would comment that we still know absolutely nothing in terms of how it all works and fits together. So as you said, Nick, you know, we're we're in the very early stages of understanding this pioneering part of medicine, but we absolutely know that it's it's critical for human health. The other thing we look at is also the skin microbiome, which is also just as important. So if you were to to sterilise your skin and get rid of every single bug off the surface of it, you probably wouldn't wouldn't last too long in this in this world. You'd be uh you'd be under the ground in no time at all.

SPEAKER_01 2:27

Yeah, because I mean I mean, let me take bring up eczema or dermatitis as it's also called. So I have a lot of patients with that, and of course, as a GP, we tend to use a lot of steroids to take it, you know, to reduce the inflammation, and we also use moisturizers. But the microbiome and possibly even the pH of the skin can play a part. And that's something that you look at, don't you?

SPEAKER_00 2:52

Yeah, absolutely. Interestingly enough, it was probably probably about a hundred years ago. A hundred years ago, everything interesting was happening. So a hundred years ago, in terms of the the gut microbiome, that you know, that they found that that peasants were living longer than than the wealthy upper class people. And what they they attributed that to was basically the the fact that that these people who had no money were eating food that wasn't fresh and it was half fermented. And so that sort of gave rise to the whole probiotic industry, more or less, that we see today. That was over 100 years ago. But at the same time that that was happening on the skin, they discovered that with through my microscopy, that things like the acid levels of the skin, or or you know, alkalinity levels, but the skin should be slightly acidic. And they discovered that the bacterial strains and the types of bacteria on the surface of the skin changed with the pH of the skin. Now, it was known back then that the more alkaline the skin, the more likely you were to have a skin problem like eczema or acne or rosacea or all these other sorts of things. And in fact, even just from a beauty routine type perspective, so one of the first cosmetics that was made back in the day when we had just bar soap, so people would wash their face with bar soap, which has a very alkaline pH, because you need to put sodium hydroxide and and animal fat together, people's skin was alkaline, and women were noticing that their skin just didn't look very nice. So one of the first cosmetic products was actually something called a toner. And a toner was basically just acid to reverse the alkaline nature of the bar soap.

unknown 4:39

Yeah.

SPEAKER_01 4:39

One thing I'd like to say for anyone listening: do not put acid on your skin. Okay. No. So if you're listening to this.

SPEAKER_00 4:45

Don't open up the car battery or something like that.

SPEAKER_01 4:47

No, definitely not. So again, this is just an interesting conversation. Only use products that have, you know, on the shelf for skin. That's right. So I'm sure our listeners probably didn't need to hear that, but being a doctor, I always liked what we call safety net. It's it's it's that sort of little bit of OCD I have. So that's that's really good. I mean, do you have any specific cases that that you've noticed that have been affected by the pH or potentially by the pH of the skin?

SPEAKER_00 5:13

Yeah, absolutely. So we say it all the time. And just to clarify with the with the acid, when I'm talking about they acidify the skin, roughly the same acid level as a tomato. So it's not, we're not talking battery acid here, we're talking about very, very mild sorts of things that are formulated as a as a cosmetic. But in terms of in terms of that and looking after the skin, yes, like when we see people with with eczema, we'll often see that their skin has a very alkaline pH. And so when I say alkaline, it's probably actually still acidic, but if people, people who have done grade 10, 11, and 12 chemistry will know that a pH of one is like battery acid and 14 is bleach. pH of seven is water, so the scale goes from one to fourteen. Seven is neutral, and where we where we really want to lie is around a pH of 4.5, which is which is about tomato juice. And and at that pH of 4.5, you find that skin looks healthy, uh, and you generally have fairly fairly few issues on the surface of the skin. But when we test someone that's got, you know, like acne or or eczema or something like that, uh, you find that it becomes more alkaline.

SPEAKER_01 6:21

Yeah. So say you've got a patient, we were talking earlier, that there was a patient with eczema. It was a very young child that you saw. And actually you you look you found that maybe probiotics have played a part in making the eczema worse.

SPEAKER_00 6:39

Yeah, well, that's right. So let's let's touch on what this whole episode is really about, the danger of probiotics. So I guess I guess the interesting thing about that particular person I was I was talking about was they were taking a probiotic. Now, the the eczema that we were looking at, we can look at the skin, but we also look at the gut microbiome. And we did a gut microbiome test, and what the result of that test came back with was this particular person had an overgrowth of a beneficial bacteria called bifidobacterium. Now, that was exactly when when we looked at what this person was taking, they were taking a supplement of bifidobacterium, and what we'd we'd found was the results had said that they had a higher than normal level of bifidobacterium. Now, from a healthy, we're only still starting to understand how this sort of works and and you know what levels are healthy and whatnot. But from the data that we have now, it appeared that this person had well above average levels of bifidobacterium. Now, when we look at that from a health perspective, people say, oh, you know, probiotics must be good because you just have them and you know, a small amount must be good, so you know, even more must be even better. But we actually really don't know what we're doing with like with the with the probiotics. So if this person had an overgrowth of this probiotic for the next 20 years, what what knock-on effect would that have on their health? That's the question.

SPEAKER_01 8:11

Yeah, and I think that comes back, we say beneficial bacteria, but actually our our microbiome, we're an ecosystem, and it's all about balance. So it's it's about having the right amount of each thing to have it. And do you think having this other bacteria in the gut, could that have had an effect on the pH of the skin?

SPEAKER_00 8:30

Possibly. I mean, it would indicate that there's a we know or we're starting to understand that when there's a problem or an imbalance in the gut microbiome, it often spreads out to the skin. And that's called the gut-brain skin axis, like they talk to each other. But when we talk about, you know, bifidobacterium, it does wonderful things. It makes these products that we've talked about in previous podcasts called short chain fatty acids, and they're beneficial, like they they get rid of inflammation, they'll increase energy, they'll increase brain function, increase heart function, increase lung function. But when they're when they're overgrown, the question mark is what does that do? We know that we are made up of 90% bacteria. We know, or it seems to be that, you know, things like Alzheimer's and Parkinson's and and you know, degenerative diseases are caused by imbalances in the gut. Now, that doesn't mean bifidobacterium is going to cause that, but as time goes on, what potentially could go wrong? And it's a big question that we actually don't really know the answer to, and I don't think anyone's really looking.

SPEAKER_01 9:35

Yeah, and it's very important that you know one of the things that you you do, Ben, here, is you actually test how much good and bad bacteria there are. So actually, um I would imagine the majority of people taking probiotics have never actually had their microbiome checked. So you're sort of doing it blind. It's almost like me treating somebody's thyroid problem with never seeing a blood test. That's exactly right. And so you could sort of guess a little bit from symptoms, but of course, knowledge is is power. Yeah. And so knowing what someone's microbiome can be very, very useful. Again, we're so early in this science. It's been recognized a lot by gastroenterologists, they've been doing things like you know, poo transplants and things like that to get the right uh bacterium into certain people's guts, which again I would say only a specialist should be doing that. Uh it's very important. So, yeah, so so you had that, so you've had that episode before. I mean, could could different bacteria? I mean, it we are an ecosystem, we are this kind of thing. We know in ecosystems, if you think about like a forest, there's always species that suddenly can grow, like if you put a new species into something and it can take over all the other species and become like the dominant species and then kill off all the other other things, and then the mic the the range of different animals can go down. Can that happen in the garden?

SPEAKER_00 10:54

Yeah, absolutely. Funnily enough, we've we've seen something exactly like that. So I had someone who was making their own fermented foods, and it happened to be, I think it was a kombucha or something like that. Now, the way that you make a kombucha is you have the um the primary source of all of the fermentable bacteria. And this person had this one specifically crafted for them. So it had a number of different bacteria in it, like some of the good ones. There was a couple of lactobacillus and a couple of bifidobacterium strains. And it also had one called sacromyces that was put in it. Now, sacchromyces is an interesting one because they use that for traveller's diarrhea. And the the way that it's believed to work is it actually just outcompetes all the other bacteria, all the bad bacteria. So when you're traveling and you pick up bad bacteria, this sacromyces just knocks it out because it's it's kind of just an aggressive form of bacteria that that sort of protects. Now, in in real life, I guess you could equate that to something like if you're a gardener, it'd say it's a bit like planting Singapore daisy in your garden. So, like it does keep weeds out, but you've got to be careful because sometimes it it sort of overgrows. Now, we did a gut microbiome test on this on this person, and the interesting thing was when it came back, they were deficient in exactly the four strains that this that this particular brew had in it, but there was an overgrowth of sacchromyces.

SPEAKER_01 12:21

So you think sacchromyces have become like the fox or a lion, or I'm basically eaten all of those and become predatory?

SPEAKER_00 12:28

Yeah, it it's almost learned how to kill those ones off to be the dominant species, and then it's actually just continued to kill them off in the gut. I mean, it's just a speculation. But it just goes to highlight like how much how little we actually know about what we're doing with all of these these sorts of things.

SPEAKER_01 12:45

And I think because we're sort of coming to the end of today, and I'd like to sort of just say, I mean, obviously having healthy food, being healthy, low stress, really important with all of these things. If you can, I mean, I you know, seeing an expert's really, really important in all these things. So if you're looking at your health, it can be very useful. There's lots of people who are looking into the microbiome and doing things like that, or generally getting your health checked. I have a general rule that you shouldn't really be spending more money on checking your car and making sure that works than spending it on your own health, which a lot of people do. They'll spend thousands on a car to fix it and then nothing on themselves. But it's an interesting topic, isn't it? And I think it's worth thinking about these things.

SPEAKER_00 13:28

Absolutely. Well, we look at what happened with vitamin B, B6 recently, you know, like it was meant to be just you meant to be able to take it and it just was excreted in the urine. Yes. And then all of a sudden, people started having nerve damage. You know, and so we've just got to be mindful of these sorts of things. It seemed very harmless and inert, but in fact they can be, they can be quite potent. And on one final note, I guess in terms of how good ones can turn bad, a primary example for everyone to sort of think about before you start slamming down the the lactobaxillus acidophilus, we have a we have a very beneficial microbe on the skin. And what it does is it actually secretes like little antimicrobial peptides and stops us getting infections. Now, that would be a good one if we were doing probiotics for the skin, which is starting to become really popular. But the name of that is called Staph aureus. And if I said to you, Nick, here's a Staph aureus cream as a doctor, what would you say?

SPEAKER_01 14:26

Well, we do a lot of times, we do know Staph aureus lives on the skin, but your input Igo and your abscesses and all these things come from Staphoreus. So I I actually do a lot of times trying to kill but Staph aureus. So I think the bottom line with health and with everything is balance. And the whole body works on balance, not too much of this, not too much of that. And I think on that, I think we have done a good job today. I hope, and I hope our listeners have enjoyed it. I've been Dr. Nick Krasner. And I'm Ben Eshelby. And this has been Pillars of Health. See you soon. See you next week.