Probiotics After Antibiotics? | 5 Probiotic Myths

Via the author- @nickbelden

In today’s gut, supplement, and health food industry, no product seems to be more beloved than probiotics. You’re seeing them now in candy bars, cookies, and cereal. Everyone’s telling you to take them for IBS, Irritable Bowel Disease, and even to take probiotics for obesity and type two diabetes. I’ve even written several articles and several posts on my Instagram that are tailored to what you should look for in probiotics and what kind of conditions probiotics can help support.

Probiotic manufacturers sometimes make some pretty lofty claims. Along with that, a lot of misinformation has made its way into the general public. We’re going to discuss 5 probiotic myths that I’ve heard being thrown around quite often over the past several years.

Myth #1: Probiotics Colonize the Gut.

You hear people say: “Oh, you know, I’m not feeling great, so I need to take some probiotics just to ‘re-seed’ my gut bacteria”. Actually, science tells us that’s not exactly how it works. First, our stomach is one of the most acidic environments on the planet. What that means, is it doesn’t favor the growth of many organisms. A lot of times, especially if you take low quality probiotics, they can’t even survive the stomach environment. You’d want probiotics making it past the stomach and at least into the small intestine, and ideally into the large intestine. That’s why one of the things you want to look for in a probiotic on the ingredient label is “enteric coated capsule” because that’ll help it to survive the really acidic, really low pH environment that is the human stomach.

The other reason is probiotics have more of what’s called a transient effect in the gut. They serve most of their role, not by re-seeding the gut, but when they pass through, they release antimicrobial peptides or they themselves act as prebiotics for the good gut bugs that are present. There’s trillions and trillions of bacteria within our gut and if you look at most probiotic supplements, a serving is anywhere from five to fifty billion colony forming units (CFUs). 50 billion into multiple trillion, that’s a drop in the bucket. That’s really not enough of a dosage or enough bacteria to make a change. Along with that, most supplements only have between 2–10 different species of bacteria and there are hundreds of species of bacteria within the human gut (1). Trying to influence that environment in this manner with only 0.4% (2/500) of what’s there seems like a pretty tall task.

Myth #2: Taking More Is Better

This myth builds off the first one. As I just mentioned, there’s trillions of bacteria within our gut. Rationally, some people think of the idea of just increasing the dosage until it gets into the trillions. If only it were that easy. The bacterial counts within our gut stay within a very tight range, called homeostasis. The existing microbiome fights really hard to keep itself within that range, resisting colonization by any external pathogen, or external probiotic (see Myth #1). If you overwhelm the system with too high of a dose of probiotics, you’re probably going to get some adverse side effects, namely diarrhea, abdominal pain, and probably bloating. Not to mention you’re probably not going to be able to get the same beneficial effects from probiotics if you’re taking too much of them. You’re basically just wasting your money.

Myth #3: Take Probiotics When You’re Taking Antibiotics

This is one that I believed for the longest time. Now, based on what we’ve already talked about as myths in the probiotic landscape, think about why that wouldn’t really make sense? People used to think this because they thought that probiotics re-seeded or colonized our gut; like we talked about in the beginning, they don’t. People thought: “Hey, antibiotics are killing things off, let’s just make it equal and re-populate the gut with the probiotics.” Most of the time, antibiotics are stronger and more potent than any probiotic that is currently on the market. If you’re taking antibiotics, hopefully your doctor is trying to kill a specific organism. At that point, it may not be beneficial to try and favor the growth of the current bacterial environment. There’s something harmful growing in there, so you want to go off and kill that particular organism.

This is what I’ve started to formulate with taking antibiotics: many of them are given for strep throat, an ear infection, or some sort of sinus infection. Many times, it’s just a 10 to 14 day course of antibiotics. It’s really not worth your money to try and megadose with probiotics during that same period. Let the thing die that’s trying to be killed. Now, this whole paradigm changes if you’re going to be taking antibiotics for multiple months (topic for another article).

If I were to take antibiotics, what I would do is just keep my normal dietary patterns over that time period. Then, after I’m off antibiotics, I would incorporate some different things to support my inevitably leaky gut (2). Then I would also try to incorporate a greens or a red juice, because there’s so many different types of plant material and plant fibers, that it’s going to favor the growth of good bugs. Good bugs that have been subsided, haven’t been allowed to grow, or have been killed off from the antibiotics. We really want to start trying to regrow the good guys. One of the best ways to regrow beneficial bacteria, is to eat as diverse a diet as possible. But you have to be careful, because some people actually develop dysbiosis associated with taking antibiotics. Like we’ve talked about in previous articles, some people with dysbiosis can’t handle a wide array of fruits and vegetables. That’s where things get really nuanced, and care becomes highly individualized. That’s why it’s important to work with an experienced clinician that knows how to incorporate different support strategies for your gut after/with antibiotics.

Myth #4: Fermented Foods Are Probiotics

I often hear people say: “Oh I started eating kimchi and drinking kombucha to get my probiotics.” There’s a very specific definition of what constitutes a probiotic that supplemental probiotics have to meet. Probiotics have to be live microorganisms that, when administered in adequate amounts, confer a health benefit to the host (3). Now, what does all that actually mean? Live microorganisms, meaning they need to be alive at the time that you take the product, in adequate amounts, meaning the amount that’s listed on the product has been verified in some sort of research lab or study. Lastly, conferring a health benefit to the host. That means the probiotic strains being used have been studied and have shown to have a benefit on human health. There’s many clinical trials on supplemental probiotics, but there isn’t convincing data on fermented foods like kombucha and kimchi (4).

The microorganisms that are added to these fermented foods, hopefully listed on the ingredient label, aren’t always the amount you’re actually ingesting (5). That’s the amount that was added to the fermentation process. Like we talked about earlier, the stomach’s environment is so acidic that it’s not going to allow a lot of things to survive it, basically meaning some of those organisms that have been added to fermented foods aren’t going to make it through the stomach still intact.

If you’re looking for gut health benefits from eating fermented foods, I think that’s a good idea in practice and it has good intentions behind it. I also think fermented foods can be a nice piece of a well-rounded diet, but they’re not the same thing as probiotics. Don’t eat them thinking they’ll have the same effect. Not to mention, some people who have histamine intolerance may not be able to handle fermented foods well because fermented foods are very high in histamine. These are people that after drinking kombucha or having some fermented yogurt get really bloated and a really distended belly.

Myth #5: Probiotics Can Fix Any Gut Issue

This is one that I think is the most important myth that needs debunking and addressing. I’ve heard it everywhere from chiropractic school, to patients that come to me, and conversations with my friends back home. It goes something like this: “I’m bloated. Do you think I should take a probiotic?” Or they come to me having already been diagnosed with IBS and they say: “Yeah, I didn’t really change my diet, I just took a probiotic and it didn’t really help.” Shocker.

Probiotics can’t mask a suboptimal lifestyle. If you’re not sleeping well, if you’re not eating a nutrient-dense diet, if your stress is really high, if you’re not exercising, or you’re exercising the wrong way, taking the world’s best probiotics isn’t the ideal approach. In probiotic research, what you’ll find is that they work really well when they’re coupled in tandem with a dietary intervention (6). For example, in people with IBS, taking probiotics combined with a Low FODMAP diet can do wonders for some people’s digestive woes.

Don’t buy into any of the hype that you can just walk into any health food store, and buy any probiotic, without actually changing your diet, without addressing stress, without addressing these foundational lifestyle elements. Again, this is why it’s really important that people seek out experienced clinicians, or a Functional Medicine provider. At The HIVE Natural Health Center, we have knowledge of the probiotic space, we’ve worked with people to make tailored nutrition strategies and tailored supplemental regimens, and we really know the nuances and can sift through a lot of the B.S. that’s out there in the supplement industry.

This wasn’t a poo-poo, no pun intended, on probiotics. I think probiotics are a wonderful product. When you find the right one for you, they can do wonderful things. I just wanted to address, and dispel, some of the things that I’ve seen that are causing people to spend way too much money on the wrong types of products, especially when there’s tried and true strategies that can work really well to help address someone’s underlying gut issues.

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As always, Trust in Your Gut.

Disclaimer: The contents of this article are for educational purposes only, and are not intended to diagnose or treat any condition. Do not apply any of the information in this article without first speaking with your doctor.

References

  1. Rinninella E, Raoul P, Cintoni M, Franceschi F, Miggiano GAD, Gasbarrini A, Mele MC. What is the Healthy Gut Microbiota Composition? A Changing Ecosystem across Age, Environment, Diet, and Diseases. Microorganisms. 2019; 7(1):14. https://doi.org/10.3390/microorganisms7010014
  2. Rao R, Samak G. Role of Glutamine in Protection of Intestinal Epithelial Tight Junctions. J Epithel Biol Pharmacol. 2012;5(Suppl 1-M7):47–54. doi:10.2174/1875044301205010047
  3. Reid G, Gadir AA, Dhir R. Probiotics: Reiterating What They Are and What They Are Not. Front Microbiol. 2019;10:424. Published 2019 Mar 12. doi:10.3389/fmicb.2019.00424
  4. Dimidi E, Cox SR, Rossi M, Whelan K. Fermented Foods: Definitions and Characteristics, Impact on the Gut Microbiota and Effects on Gastrointestinal Health and Disease. Nutrients. 2019;11(8):1806. Published 2019 Aug 5. doi:10.3390/nu11081806
  5. Kok CR, Hutkins R. Yogurt and other fermented foods as sources of health-promoting bacteria. Nutr Rev. 2018;76(Suppl 1):4–15. doi:10.1093/nutrit/nuy056
  6. Xie Y, Zhou G, Xu Y, et al. Effects of Diet Based on IgG Elimination Combined with Probiotics on Migraine Plus Irritable Bowel Syndrome. Pain Res Manag. 2019;2019:7890461. Published 2019 Aug 21. doi:10.1155/2019/7890461

Educating, Optimizing, & Empowering Fitness Enthusiasts To Trust In Their Gut. Doctor of Chiropractic. Instagram: @drnickbelden. LinkedIn: Nicholas Belden