Conway McLean, DPM, Journal columnist

Our understanding of health and well-being grows daily. The wealth of information composing modern medicine is vast, with research continuing on many fronts. Still, close inspection reveals certain topics about which we know too little. Nutrition and gut health may be one of those.

Investigation is on-going into how the foods we eat might enable us to become more disease-resistant and allow our bodies to fight infection more effectively. These efforts make the headlines regularly, touting the benefits of some vitamin or supplement. One seen frequently is the term probiotics, which at least sounds healthy. Does the average American know enough about this oft-mentioned substance to make informed decisions? So what are probiotics?

The public opinion on bacteria is overwhelmingly negative, safe to say. We use harsh, even poisonous chemicals in our homes every day, in hopes homemakers can destroy every last microbe. Bacteria make you sick, is the oft heard refrain. But not all of these bugs are bad, and the “good” bacteria are essential to life for every one of us.

Turns out each of us is host to an estimated 100 trillion of these microorganisms, residing in every healthy person’s bowels. These bacteria don’t make us sick; instead they aid digestion and the absorption of nutrients. Also, they are essential to our immune system. It is a diverse community of microbes, including differing combinations of bacteria, fungi, viruses, even protozoa. Gut-dwelling microbes keep the harmful microorganisms in check, but vary significantly from person to person. This assortment of organisms is distinctive for each of us, as unique as fingerprints, no two people having the same collection.

Probiotics are living microbes we ingest, contained in a variety of foodstuffs, functioning to keep us healthy. These products have been consumed in various forms for millennia, some common examples being yogurt, pickles and kimchi (basically a spicy coleslaw). These foods provide us with good bacteria which apparently helps to restore our gut flora, the collection of bacteria residing in our gut. For the great majority of healthy people, probiotics are quite safe and cause no harm. 

When an infection develops, too often it means a preponderance of bad bacteria has developed, knocking your system out of balance. The theory is the good bacteria help to eliminate the excess bad bacteria. Probiotics are a way to restore the equilibrium of our gut flora by adding the good ones. These living, healthy micro-organisms, when eaten, exert a positive influence on the health of the host (which would be you).

But what does the research show? We have studied the effects of probiotics on many different health problems and sufficient quality studies have been performed to say they are beneficial. Perhaps the condition most researched is diarrhea, where numerous trials have shown some probiotics can prevent or shorten a bout of this common problem, especially when caused by antibiotics. Antibiotic-associated intestinal disorders, especially diarrhea, often occur in patients who receive these drugs. This challenging manifestation of these oft-prescribed medications results from a decrease in the numbers and functioning of our intestinal flora.

Good evidence exists for the treatment of gastroenteritis (the stomach flu) as well as alleviating symptoms of lactose intolerance. Inflammatory bowel disease is a challenging condition, characterized by chronic inflammation of the intestines without a known origin. It seems to be influenced by certain members of our gut flora, explaining why trials have demonstrated probiotics provide statistically significant benefits in treating IBD (inflammatory bowel disease).

The manner in which probiotics are ingested vary greatly, from pickles to the ancient practice of imbibing a fermented tea. For the average Westerner, the addition of probiotics will be noticeably beneficial (consumed in a reasonable fashion, of course). Yogurt can be a source but many commercial brands have no active “culture”, as there aren’t any living (good) bacteria present. Kefir is a fermented dairy drink becoming more popular for its health benefits. Fermented foods are often a good source of probiotics, from pickles to kombucha tea, miso soup to sauerkraut. Sourdough bread is often chosen because of the presence of probiotics in this trendy bakery item.

These are foods easy to introduce into your diet and you may already be consuming probiotics in some form, unknowingly. (Always an important caveat is to check the label for “live and active cultures”.) Try a little yogurt with breakfast, pickles for a midday snack, some miso soup as an appetizer. You can also add probiotics to your food plan through dietary supplements. As to be expected from a “vitamin” that isn’t FDA regulated, quality and number of living bacteria varies.

Good research is expensive. There are many levels of evidence provided by these investigations. A case study is often looking at a single individual, providing insufficient evidence to draw any kind of conclusion. The more people involved in a study, the more powerful the evidence. Naturally, larger studies become prohibitively costly. But who will fund such an inquiry when the topic is simply good nutrition and not some expensive new drug, with all its consequences and complications? Nutritional research is too often under-funded and of inadequate length. And therein lies the challenge: how to get enough individuals enrolled and do it for long enough.

Probiotics allow us to alter, in a positive way, the efficiency and function of our all-important, inherent intestinal flora, the veritable zoo of microbes residing in our gut. We have only hints of the complexity of the relationship between our microbiome and the human body. As we learn more, likely we’ll develop more effective strategies. But for now, when it comes to helping our gastro-intestinal tract, as well as our immune system, probiotics are an easy and now PROVEN method. The evidence for positive effects of some probiotics in specific clinical situations is now strong. Improves your body’s digestion and function… all while eating better. Sounds like a good deal.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.