Who Needs a Probiotic and Why: A Practitioner’s Perspective

Dr. Tori Hudson, ND

As practitioners, I imagine that most of us have at least a rudimentary understanding and awareness of the basics of probiotics. Not unlike other areas of medicine – and life – there are more advanced and nuanced issues relative to probiotics that impact the specificity and effectiveness of their clinical impact. 

Let’s make sure we are all on the same page first, to answer the question of who needs a probiotic, why and how to target their use in clinical practice for better outcomes.

The International Scientific Association for Probiotics and Prebiotics defines probiotics as “live microorganisms which when administered in adequate amounts confer a health benefit on the host.” These microorganisms consist mainly of bacteria but also include yeasts. Naturally present in fermented foods, they can also be added to foods and, of course, are available as dietary supplements. 

Pre-, Pro- and Post-biotics

Probiotics are not the same as prebiotics. Prebiotics are usually complex carbohydrates (such as inulin and other fructo-oligosaccharides) that microorganisms in the gastrointestinal tract use as metabolic substrates. Synbiotics are products that contain both prebiotics and probiotics. Then there are post-biotics. This term refers to the waste left behind after the body digests both prebiotics and probiotics. Healthy post-biotics include nutrients such as vitamins B and K, amino acids, short chain fatty acids and antimicrobial peptides that help to slow down the growth of pathogenic or disruptive bacteria. 

Probiotics are identified by their specific strain, which includes the genus, the species, the subspecies (if applicable) and an alphanumeric strain designation. There are seven core genera of microbial organisms that are most often used in probiotic products: Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, Escherichia and Bacillus.

Why Probiotics?

Oral probiotics transiently colonize the human gut mucosa. Their influence depends on the baseline microbiota and the probiotic species/strain/potency. The mechanisms of their effects are both nonspecific and genus-, species- and strain-specific. 

These mechanisms include inhibition of the growth of pathogenic microorganisms in the gastrointestinal tract, production of bioactive metabolites such as short-chain fatty acids and reduction in the pH of the colon lumen. Other species specific mechanisms can include the synthesis of vitamins, intestinal barrier effects, bile salt metabolism, enzyme activity and the neutralization of toxins. Strain-specific mechanisms include cytokine production, immunomodulation and effects on the endocrine and nervous systems. 

Probiotics have wide-ranging prevention and intervention effects and potential including gastrointestinal, gynecological, mental health, skin, immunity and autoimmunity.

Who Could Benefit from a Probiotic?

The research for probiotics is vast and expanding, but obvious clinical uses include patients with irritable bowel syndrome, inflammatory bowel syndrome, infectious diarrhea, antibiotic-associated diarrhea, atopic dermatitis, hypercholesterolemia, obesity, vaginitis (especially chronic bacterial vaginosis) and cystitis (especially chronic or chronic recurring cystitis)

One could also consider a daily broad-spectrum probiotic for most any patient to optimize gastrointestinal health, urogynecological health, general immunity, neuro-endocrine homeostasis and mental health.

Probiotics stand amongst the primary pillars of dietary supplementation for a clinical practice of naturopathic, integrative and functional medicine practitioners. 

Probiotic specificity can be utilized as part of a treatment strategy, choosing the specific genus/species/strain and potency depending on the clinical goals for that patient. 

Formulas to Consider

Probiotic products can be standalone formulations, but they can also be used as part of multi-ingredient formulation for specific impact. Here are a few examples: 

While it doesn’t contain probiotics, GI + Biome Complex promotes a healthy balance in the small and large intestine microbiome, while supporting the epithelial lining’s integrity.^ Prebiotic fibers in ButyraGen® work synergistically to promote butyrate-producing bacteria in the gut, while reducing occasional gas.^ Lipase supports butyrate’s release, Livaux® golden kiwi provides dietary fiber and PepZinGI® zinc carnosine helps rebuild mucosa.^ The formula also promotes healthy motility.^

Complete Digestion provides gentle digestive enzymes with probiotics.^ With Thera-blend® enzymes and 8 diverse strains of shelf-stable probiotics (125 million CFU per capsule).^ It’s excellent for use in those who need assistance in macronutrient digestion, for mild digestive discomforts and for those with occasional gas and bloating.^

Critical Digestion combines the highest-potency digestive enzymes with guaranteed-potency probiotics.^ Thera-blend® enzymes work synergistically across the diverse pH range of the GI tract.^ This formula also contains 8 diverse strains of shelf-stable probiotics at 1.25 billion CFU per capsule.^ It relieves occasional gas, bloating and indigestion, and increases energy and nutrient absorption and offers maximum strength digestive support.^

SubCulture™ Probiotic for Women includes 50 billion CFU live strains specifically chosen to support women’s health, including Lactobacillus rhamnosus GR-1™, Lactobacillus reuteri RC-14™, Saccharomyces boulardii and Bacillus subtilis.^ These strains have been extensively studied and featured in several clinical trials.^