Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
Probiotics: What's The Story With The Good Bacteria?
Posted in Acne by Dr. Sharon Orrange on May 13, 2008

What are they and why do we care? Probiotics are microorganisms that have beneficial properties for the host (that's us). Probiotics are an important way we can alter intestinal bacterial flora. Most are derived from food sources like cultured milk products. The list of probiotics is long, but some familiar names are: lactobacillus, clostridium butyricum, stept salvarius, and a strain of E Coli called E Coli Nissle 1917.

In what kind of illnesses have we studied the use of probiotics? Several studies have shown that probiotics can be effective for many gastrointestinal illnesses (Crohns, ulcerative colitis, irritable bowel syndrome, antibiotic associated diarrhea) and allergies. There was a very compelling study looking at pregnant women treated with probiotics prenatally and it showed a decreased incidence of allergy and asthma in their children. Many ongoing studies on pregnant women and children for prevention of allergy and asthma will soon be published so stay tuned but the evidence for the GI illnesses is quite significant already.

Ok, so how do I take probiotics? The easiest way to incorporate probiotics in to your diet is through fermented milk products, which is the same thing as cultured milk or dairy products. These are dairy products that have been cultured with lactic acid bacteria. Yogurt (plain Turkish yogurt being rich in cultures among others), kefir, sour cream, and crème fraiche are your easy options.

Are all probiotics created equally? No, and benefits observed in one study for one ailment may not be applicable to another. Having said that, yogurt is commonly recommended and make sure it's a yogurt with "live and active cultures". Several are readily available in stores: Activia by Dannon, Columbo, Horizon, Stonyfield, etc. Please buy PLAIN yogurt and avoid the added sugar. There are many probiotic capsules and powders available on the internet but the only real evidence is for the active cultures listed above. One preparation called VSL#3 which comes in powder or capsules (made by Nature Pharmaceuticals) has been studied and shown to be effective for several GI illnesses.

Ahhh the science--how do probiotics work?

Here are our best guesses at how they work:

1) suppression of growth or epithelial binding/invasion by harmful bacteria.

2) Improvement of intestinal barrier function

3) Modulation of the immune system by inducing protective cytokines and suppressing harmful ones.

4) Changing pain perception in the gut.

In my primary care practice who do I recommend give probiotics a try? Aside from the obvious well defined GI illnesses that benefit (Crohns, IBS, etc.) I suggest many of my patients who suffer from low grade symptoms of nausea, loose stools, increased gas pains, abdominal bloating, and "gurgly stomach" give it a try. My women who suffer from chronic vaginal yeast infections also do well when they incorporate the probiotics into their diet and no, you don't have to put the yogurt inside of the vagina you can eat it.

Dr O.

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TOTAL COMMENTS: 21 - View All Comments »

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Displaying comments 21-2 of 21
When taking probiotics - do we need to give them a rest - or can we take them unending?
By fahocha  Nov 09, 2011
I have lactose intolerance (LI), and I have read recently that probiotics have proven beneficial for people with LI. The catch-22, of course, is that most food sources of probiotics are dairy-based. (I do eat kimchee, which has a lot of good bacteria, but one can only handle so much spicy fermented cabbage!)

So I recently began taking Kyo-Dophilus brand probiotics, and I'm pleased with them so far. They are shelf-stable, so they don't have to be refrigerated. The directions say to take one pill twice a day with a meal, but I have just been taking one a day, at dinnertime.

Since staring on probiotics, I have noticed a decrease in cramps and bloating, which I often have, since it is so hard to stay entirely away from dairy (especially when you eat out and buy prepackaged foods a lot). The rest of my family, who do not have LI, have recently begun eating more yogurt, and I think we are all healthier for the probiotics.
By gaaarp  Aug 21, 2008
Dear Dr. O -- I have terrible gas problems and much of the time loose stools. I am lactose intolerant and cannot eat any kind of dairy product. I purchased a bottle of Capricin by ProBIOlogic. I tried to taker them for a week and was so nauseous that I had tos top taking them. Do you have any advise?
Thank you, Marti
By GrammieP  Aug 21, 2008
Thank You. I'm moving away from Meds to a more natural approach to treating my fibro. I going to add this to my list of things to try and try it.
By Maryca  Jun 14, 2008
There was a very interesting (for those of us who study bacteria and are not squeemish about such things) article about this general topic on the Aetiology scienceblog black in December 2007:

I have been studying the Clostridium genus of bacteria (and it is a huge genus, the ones that produce botulinum toxins and other toxins are a rare minority of the strains out there) a bit over the past 3 years, and it is clear that all vertebrates carry many species of Clostridium in their intestines.

In my opinion, science is just beginning to be able to understand the complexity of factors that contribute to some kind of equilibrium when thousands of species of bacteria are living together in an environment such as the inside of our intestines. More study has been done in cattle than humans, because the efficiency of a beef gut means dollars in the bank for any cattle rancher. They really need to convert grains and grasses into meat and fat as efficiently as possible, to maximize profit.
By DrDuke  Jun 02, 2008
Hey Everyone. Here's a new interesting article about probiotics and bariatric surgery:
By nicholas  May 23, 2008
Thank you to all DS members for jumping in..your experience with different probiotics is great for others to read....both good and bad
Dr O.
By DrOrrange  May 18, 2008
I have been giving my son Probiotics (Natren Life Start) for 3 months to help him with Eczema. The lotion the doctor suggested did NOTHING he just kept getting MUCH worse. After THREE days 80% of his eczema is GONE!!! I have to keep giving him Probiotics though (if I skip 2 days the eczema starts to come back). So something in his biochem must be off otherwise this natural bacteria would thrive. I would like to have an Arterial blood gas draw done to find out if his body is tending to be more on the acidic side(lower pH), bacteria like it more base/alkaline (higher pH). Noraml blood pH is about 7.34.
By EczemaParent  May 18, 2008
I take Probiotic/Acidophilus capsules, 2 capsules every evening after supper, for my intestinal health. I have severe Fibromyalgia with complications of IBS with constipation, as well as drug induced constipation, from my antiseizure meds, Topamax (used to treat Trigeminal Neuralgia), Cymbalta, used both for my FMS and Trigeminal Neuralgia, Norflex, (muscle rexlaxer for FMS), and the narcotics I use to fight the pain. I've been using the Probiotic/Acidophilus for 2 weeks now, and have noticed quite a differencel No longer do I feel bloated, or experience abdominal cramps. I also take a multivitamin 2 times daily, echinacia 2 tabs at night, cranberry caps, 2 twice daaily, vitamin C, 500 mg twice daily. I'm still losing small amounts of weight on a regular basis, but I'm still generally thin,but still at a healthy weight. My doctor is following me carefully, as I am a vegetarian, lacto ovo, eating eggs, dairy and fish. I did enjoy the article on probiotics, and as a nurse, any research that's done is always taken with interest with me Thank you for such a wonderful site to go to, as I've found no support sites for Fibromyalgia.
By snoflake216  May 18, 2008
I have had good experience with Shaklee Probiotics. My doctor sells them and uses them herself. It's helped with pain a good deal. My bowels are much closer to normal and are normal when I get enough fiber. For someone who this is rare for it's really great and such a relief. I have also heard good things about Lactinex (sp?) and culturelle that can be gotten over the counter. Lactinex has to be requested and refrigerated. The yogurt isn't enough for me and gives me gas. They have probably helped more than anything with my IBS.
By Hil323  May 16, 2008
The best probiotics out there that I have come to know is Lifeway Kefir. They cost around $4.00 a bottle, it's like a yougurt drink and contain 10 different strains of active cultures! If you want a capsule try Jarrow Formula's EPS Formula.

By easyrider  May 15, 2008
My DD has many food allergies-we just found out recently.
I'm going to take your suggestion and add probiotics to her daily diet!
Thank you.
By ctm3  May 15, 2008
I have tried taking probiotics on two occasions. Unfortunately, they made me extremely constipated and bloated so I've had to stop the regime. I know of at least two other friends that had similar experiences.
By EternalOptimist  May 15, 2008
great post, Dr Sharon.. thanks for this. I've been wondering about pro biotics.
By Josh  May 15, 2008
I have controlled ulcerative colitis and my GI doc advised me to take probiotics in the capsule forumla, the kind that are refrigerated. He theorizes that the cultures in yogurt are not enough. Anyway, even with my UC under control, my gut behaves strangely, ie gas, bloating, cramps. Taking probiotics has gotten it back on track and I have minimal issues now.
By rmb  May 14, 2008
I take Flora-Q capsules which do not have to be refrigerated and am totally sold on the benefits of probiotics. I am intrigued with the fermented food thing though. My experience has been, especially with sauerkraut, that as soon as the fermented food hits my gut, I get cramps and only a few minutes later will pass it. In other words, it runs straight through me! Go figure ...
By MERF  May 14, 2008
I used to work at a health food store and Probiotics were one thing we answered the most questions about. Capsules work just fine, but, as with so many things, you get what you pay for. So a cheap brand isn't going to give you the same results as a better brand. Also the more cultures in the capsule will raise the price. A product with 50 billion cultures (for someone with serious problems) will cost more than one with 4-8 billion. When buying probiotic supplements, the most effective ones are refrigerated and should remain so at home. The cultures are live but dormant when refrigerated. There are ' shelf stable' formulas that do not have to be refrigerated, but even these do better if kept cold. Heat kills the cultures and that won't be of any help at all!
Hope this helps.
By ALC67  May 14, 2008
I make yogurt smoothies w/ protein powder. I also use soy milk. I have low white counts as well as peri-menopause and a whole host of other medical probs. I find the fruit w/the smoothies and protein powder give me a goot boost of energy.

Is Gluten free goot for IBS? Just curious. DT
By dakotatears  May 13, 2008
Thanks for talking about this.. I have crohns disease and probiotics has been amazing for me.. I take it in powder form..
By nikanika2005  May 13, 2008
I've heard this is good for Celiac Sprue, also. But I do hate yogurt, and will only "do milk' if it is on cereal. Are the probiotic capsules any help at all? Haven't even tried those yet, as I am concentrating on eating gluten free, and that's a chore in itself, lol But, I think I'm doing it. Don't have as much IBS, or tummy aches, and have lost a few pounds to boot, yeeaay for that part!
By Memawshewa  May 13, 2008

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