Ask a Doctor: The Truth About Probiotics
07.22.16
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We also asked a doctor about sugar.

I’m not sure I’ve been more exposed to a word without actually understanding it than “probiotics.” It pops up on yogurt containers and proverbial soapboxes everywhere but, since I tend to side-eye health trends that feel of-the-moment (still waiting for the other shoe to drop on this whole “sugar is bad” myth), I’ve willingly chosen the path of probiotic ignorance. Recently, though, the fingers in my ears have started to feel silly. An increasing amount of research is proving that probiotics are more than a flash in the pan and that I ought to start listening.

OKAY! FINE! But also, show me the receipts, you know? So I asked two experts to tell it to me 5th grader-style. Dr. Rupy Aujla is a general practitioner and the founder of The Doctor’s Kitchen, where he researches and creates recipes with health benefits. Dr. Roshini Raj is a gastroenterologist and the founder of TULA, a health-driven beauty brand with products that contain probiotics and other superfoods.

Both of them know a thing or three about probiotics, so I asked them everything.

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1. What are probiotics and why should I care about them?

Dr. Rupy Aujla: A little context: The study of the microbiome (the microbes that live in or around the body) has accelerated in scientific journals over the last two decades with good reason. We’re learning so much more about the symbiotic relationship we live in with these foreign organisms. They protect us from pathogens, release nutritional content from our food, create neurotransmitters, maintain immune functioning and allow us to break down molecules we’re unable to digest. People are calling the microbiome “the forgotten organ.”

Probiotics are ingestible products that include live bacteria of varying strains and concentrations that are thought to enhance a healthy microbial population. They come in many forms including tablets, drinks, yogurts and fermented foods. I think in the future we’ll rank “gut health” as important as ensuring adequate exercise, hydration and alcohol moderation.

But it’s still an early field of research without specific recommendations for conditions.

Dr. Roshini Raj: Our bodies contain 300 to 500 different strains of bacteria and these make up 95% of the total cells in our body – on a cellular level we are more bacterial than human! By maintaining a healthy bacterial balance in the gut, probiotics can reduce overall body inflammation that may cause skin sensitivity, or even acne and rosacea.

2. What would you say to someone who claims they are just the next health fad?

Dr. Rupy Aujla: I would say the notion of eating a probiotic food with every meal isn’t a fad but actually a return to how we’ve eaten for centuries. In Japan, pickled ginger is consumed with sushi and rice and miso broth is prepared before large meals. In India, they drink fermented yogurt-based drinks (‘lassi’) before meals and eat a range of pickles including mango (my fave) with curries. In the Middle East, they have Kefir, Nordics have smörgåsgurka and Koreans have kimchi. Even in England, tartar sauce used to be traditionally fermented and we have that with fish ‘n chips!

Through experimentation and continually passing down practices from generations, we have evolved to have always had a ‘probiotic’ with meals. An unfortunate byproduct of globalization and fast-paced city living is that lot of modern products are now homogenized, which kills the bacteria off, so they don’t have the same qualities.

However, despite the burgeoning popularity of probiotic supplements, I suggest the taking of supplements with caution. First, no probiotics are created equal. There have been studies that show the actual content of probiotic strains in supplements is vastly different from its packaging claims. Currently, probiotics are not regulated with the same rigor as pharmaceuticals and thus the actual content could vary immensely.

3. Would everyone benefit from taking probiotics or just people with specific issues?

Dr. Roshini Raj: Studies show that probiotics provide a wide range of benefits, from supporting the immune system, helping to prevent obesity and relieving depression to reducing body and skin inflammation, and improving digestive function. Thus, everyone would benefit from taking probiotics as a way to maintain a healthy lifestyle.

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4. What are the different kinds and what do they each do?

Dr. Roshini Raj: While there are thousands of different strands of probiotics, the two most common ones are Lactobacillus and Bifidobacterium. The Lactobacillus strain is oftentimes called the “superstar” of probiotics, as it can be beneficial to us by simply thriving within us. These probiotics can cause other helpful microbes present in our intestines to magnify their own benefits. They also ferment carbs in the gut, which results in the production of lactic acid. More lactic acid means more absorption of vital minerals such as iron, calcium and copper. The Bifidobacterium strain is the second most widely studied and praised for its health benefits. Like Lactobacillus, these probiotics also produce lactic acid in the intestine and have immense health benefits on the immune and digestive systems.

Dr. Rupy Aujla: There are thousands of species living in our gut and most supplements contain only a handful of varieties. There are studies that demonstrate, for example, the impact of better glycaemic control in diabetics and reduced incidence of common infectious disease in children with some probiotics, but most of the meta-analyses conclude that we don’t know which strains are responsible and further research is required.

5. If I’m not taking them for a specific reason (say, maybe I feel fine but just want to take them to be healthy), then how do I know they are working?

Dr. Rupy Aujla: It’s an interesting question and you could apply that to everything we choose to do despite feeling healthy already. If you’re already happy with your figure, why exercise, why eat certain foods, etc.? I guess it comes down to how health-conscious and risk-averse you are.

However, when you begin to understand how pivotal the gut microbiome is in the functioning of the human body, you may notice small things like skin improvement, perhaps less bloating after meals, a reduced propensity to catch common illnesses like the flu, more regular bowels, a better mental attitude, and less fatigue. Neurologists, psychiatrists and endocrinologists are looking at gut-focused treatments for a range of conditions we never thought were related.

6. Can I get probiotics through food? What kinds?

Dr. Roshini Raj: Yes, in fact the most effective way to reap the benefits of probiotics is by eating foods containing these good bacteria. Fermented foods are great examples of natural sources of probiotics that you can easily include in your diet.
• Yogurt: most well-known probiotic source
• Kombucha: this fermented tea is packed with good bacteria
• Miso: this fermented soy product is rich in probiotics
• Fermented vegetables: examples include sauerkraut, kimchi and pickles
• Fermented cheeses: like gouda, cheddar and swiss
• Kefir: this drinkable yogurt is known for its probiotics
• Tempeh: this is a fermented, probiotic-rich grain made from soy bean

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7. How often should I be getting them?

Dr. Rupy Aujla: Probiotics ideally are taken with every meal in varying forms, but some nutritionists advise a concentrated supplemental pill which can have bacterial populations between 5-25 billion of varying strains depending on the brand of supplement.

8. How much do I need? Would you recommend a specific pill?

Dr. Rupy Aujla: What I would stress is that taking a pill in isolation is not going to improve your microbiome one bit. These aren’t wonder drugs.

Probiotics will only have an effect in the context of a healthy and mindful lifestyle. Taking a tablet in isolation and having a high sugar diet, an imbalance of macronutrients, low nutrient dense food, excess alcohol, etc. is not going to make much of a difference to anything!

There are so many other mechanisms to take into account when determining how to improve our microbial health. These include varying our diet, cutting out processed foods, organic produce, antibiotic avoidance, exercise and prebiotics (the indigestible fibers that our microbes feed on). This entity is more complicated than people give it credit for. It’d be quite naïve of people to assume that introducing a pill into their daily routine is going to somehow miraculously rejuvenate their digestive tract.

Dr. Roshini Raj: The science on the benefits of probiotics is exploding right now and we are learning more and more about them every day. That being said, it is difficult to say how much and what strains a person should take without knowing their individual health situation. So, for example a person with irritable bowel syndrome may require a different probiotic than a person trying to strengthen immunity. There are a few pill probiotics that seem to offer general health benefits to most people: Align, Florastor, and Culturelle. And if pills are not your thing, Goodbelly offers some probiotic drink options.

This interview has been edited and condensed. 

Photographed by Krista Anna Lewis; creative direction by Juliette Kang.

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  • Hilary

    THANK YOU FOR THIS! I’ve been confused for ages about the purposes of, and practices for effectively taking, probiotics. Thanks for doing the research for us lazies out here who never bothered to look it all up. (Also, always glad for an excuse to eat more pickles.)

  • libs

    I love probiotics! I have a disgusting tendency to get a cold every six weeks, and after a horrible bout of flu at the end of January I started taking a probiotic supplement. Having roped my research nurse mum into scoping out Any med journal articles on them, I figured it was worth a go at to take a daily supplement and I haven’t had any real colds or grotty illness in nearly six months now (including some trips abroad and a stressful exam period, both often ‘triggers’ for my relatively weak immune system). So, purely anecdotally, probiotics worked for me, and I’m so pumped to see more proper scientific research into WHY.

  • Orexata

    Nounos Greek Yogurt is by far the best yogurt. I tried it while I was on a business trip in NY. I cant wait until it becomes available in SF.

  • sparris

    Also, don’t forget PREbiotics! Feed the microbiome you have!

  • Cutting back sugar + good quality probiotic had an amazing effect on my skin. What I considered hormonal acne became far less aggravated, and I feel if I had’ve kept it up I could have cleared it all together. But, the siren song of pop tarts calls..

  • Actually it may be better NOT to ask experts who have a horse in the race and instead find an unbiased medical expert.