Do you need a probiotic?

It’s a question I get asked daily in my new role as a consultant dietitian for a company that I adore. I’m sure I’ll be telling you about that later but essentially I help people make sense of their gut microbiome and answer the inevitable question – “Do I need a probiotic?”

First, what is a probiotic?

Probiotics are living bacterial organisms present in our gut, mostly in our large intestine. These organisms (along with other microorganisms) are commonly referred to as our gut microbiome. It’s a complex community made up of as many as 10,000 species and 8 million genes! That’s a lot of culture y’all.

We rely on probiotics and other organisms for a number of functions including energy and vitamin metabolism, digestive health, disease mediation, and development of the immune system. Factors like diet, medications, stress, and activity level have been linked to alterations in the gut microbiome.

And since we are starting to unravel the first few layers of understanding in the gut microbiome, probiotics have come to the forefront of many health conversations. It’s also important to note that anytime research comes out about a substance (think omega-3s, calcium, vitamin D, etc), you’ll start to see more manufacturers cashing in on this supplement opportunity. It’s neither good nor bad but important to keep in mind that a business may not have your actual health in mind. They might, but they might not too.

So, what do probiotics do?

Generally speaking, probiotics help support the growth and populations of potentially beneficial bacteria to “crowd out” the “bad” or potentially harmful bacteria. I say “bad” because most bacteria aren’t inherently good or bad but some organisms are pathogenic and would cause a lot of dybiosis (think severe GI issues and various metabolic conditions).

Many of the probiotics you may be more familiar with (including the Bifidobacterium and lactobacillus families) have been associated with an improved immune systems in studies after consumption. The specific mechanisms are not entirely clear as this gut microbiome world is about as complicated of a world as a hormonal teenage girl who just broke up with her boyfriend and is headed off to college in some far off city and has no idea what she wants to do with her life. That’s the kind of complicated we’re talking about with gut microbiome but x100 and that type of complexity takes time to unravel.

Can I get probiotics through diet?

Yes, of course! And you know, being a dietitian I definitely take a “food first” type of mentality when it comes to supporting our well being.

There are 2 main things you can do to support beneficial bacteria populations and a healthy gut microbiome:

  1. Consume prebiotic fibers the organisms love to feed off of.
  2. Consume the living organism in fermented foods.

First things first, when I talk to people about their gut, the absolute number one thing they can do to support a healthy gut microbiome is consume a high-fiber diet. Many of these “good” bacteria love (like really love LOVE) to feed off of fiber. So if you feed your body these foods, the organisms can feed off the fiber and everyone is happy.

There are particular types of prebiotic fibers that help leverage this probiotic community: fructooligosaccharides (FOS), Galactooligosaccharide (GOS), inulin, and resistant starches. If that sounded like a lot of science to you, it is BUT I’m here to help make that science a bit more digestible. 😉

Think about eating more of these foods to support your gut microbiome:

Foods with FOS: onion, garlic, leeks, chicory root, Jeruselum artichoke, whole wheat

Foods with GOS: chickpeas, lentils, green peas, kidney beans, all the beans basically

Foods with inulin: leeks, asparagus, onions, garlic, whole wheat

Foods with resistant starches: oats, bananas (especially if more green), beans/lentils, whole grains, potato starch, cooked and cooled rice/potatoes

If you chose to consume the probiotic aka the live bacteria, consider consuming these fermented foods:

Yogurt (dairy and non-dairy options), kefir, water kefir, fresh sour pickles, fresh sauerkraut, any pickled/fermented fruit or vegetable, kombucha, kimchi, and tempeh

So can you get enough probiotics through your diet?

Perhaps. Consume a high fiber diet with fermented foods a few times a week to everyday and it’s possible for some of us. Plus, with high fiber foods, you’ll get so many other health benefits from aside from supporting a healthy gut.

Now, if the thought of eating a high fiber diet rich in the foods mentioned above sounds like GI issues waiting around the corner, a probiotic may be helpful. If you’re consuming probiotic containing foods regularly but having digestive issues, a probiotic may be helpful.

In general, if your GI tract has been compromised from a chronic condition (such as Celiac, Crohn’s, or Inflammatory Bowel Disease) or antibiotic use, I definitely think a probiotic supplement is helpful.

Also, if you are introducing potentially pathogenic bacteria (think traveler’s diarrhea) or you’ve come down with the flu and your immune system is compromised, I think it’s advantageous to consider a probiotic supplement.

Now, not all probiotics are created equal.

What probiotic should I take?

Honestly, it depends on any symptoms or conditions you may be experiencing but remember that we are focused on supporting the overall community instead of one organism. I say this because depending on our unique gut microbiome and our symptoms, different strains will be potentially more or less helpful.

The best probiotic guide I’ve found is the one published by the International Scientific Association of Probiotics and Prebiotics. You can find it here, but essentially the probiotic guide is a systematic literature review of specific probiotic strains and outlines which brands have which strain and when it may be helpful but also the strength of evidence to support the claim. It’s a comprehensive list and may be a good place if you’re already taking a probiotic or if you’re wondering about a particular brand. While there is evidence to support probiotics in some conditions, the overall demand and availability of these products is growing tremendously …as you can see from the guide but also just your local grocery store’s yogurt aisle or the probiotic section.

When it comes to GI related issues, the highest grade of evidence (1) that supports probiotic use is in:

  • overall symptoms and abdominal pain with IBS
  • prevention and reduction of antibiotic associated diarrhea
  • overall symptoms in IBS-D
  • bloating/distention in IBS

When it comes to non-GI related issues (anxiety, stress, weight management, etc), there is less research based evidence to support these claims. That doesn’t mean it can’t be potentially helpful, it just reiterates the fact that more research is needed (but very much underway).

Things to Consider When Taking a Probiotic Supplement

  • The amount you’d need varies depending on condition and strain (constipation vs IBS) but for truly symptomatic individuals, the therapeutic dose level is around 80-100 live active organisms.
  • Take your probiotic first thing in the morning or in between meals – basically not with food.
  • Aim for multiple strains to support that overall community – diversity is a good thing!

My advice to you

Eat more fiber. If you are experiencing GI upset or your immune system has been compromised, consume probiotics. If you’re taking an antibiotic, take probiotics.

Aim for food first with fermented foods like kombucha, tempeh, unsweetened yogurt, and sauerkraut. If your immune system IS compromised, it’s likely you’ll need more of the potentially beneficial bacteria and a probiotic supplement should be considered. Also, if you’re consuming fermented foods regularly without any other underlying issue, consider probiotics.

Ultimately, it takes practice but learn your body and listen in to what your gut is telling you.

Comment below – do you consume probiotics? If so, in what form? Let’s get cultured y’all!

Also, I should mention, if you have specific questions about probiotics and whether or not they’d be a good fit for you, or another question I may be able to help with, head over to my shop and Ask a Dietitian – 15 minute sessions made to help you answer some of those burning questions!

Do You Need a Probiotic?

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