Episode 91: What are the health benefits of probiotics?

Summary by Ellie Roberts

This episode is sponsored by Symprove.

Continuing from last week, Dr Bahijja Raimi-Abraham delves deeper into the health benefits of probiotics with Professor Simon Gaisford, Chair in Pharmaceutics at University College London School of Pharmacy.

A bit more about Professor Gaisford and his research…

Professor Gaisford uses a technique called calorimetry which measures heat. Like any living organism, bacteria emit heat, so calorimetry can be used to study probiotics.

Together with a student, Professor Gaisford investigated the content of several different probiotic products that were readily available to consumers. They wanted to know whether the label truly reflected what was actually in the product – for example, whether it contained certain species, or how many live bacteria were present. They also wanted to investigate the best way to take probiotics, such as together with water, or drinking a water-based probiotic directly. Using an in vitro “artificial stomach” replicating the actual stomach environment, they were able to produce a set of guidelines as to how a probiotic should be chosen.

So, what is the best way to take probiotics?

“I think a liquid probiotic is better than a solid probiotic […] and also I think it’s better to take a product in a fasted state” – Professor Gaisford

When you eat something, your stomach starts to produce acid to degrade the food – most bacteria are not very tolerant of a low pH, and stomach acid (hydrochloric acid) is a very strong acid. So, it’s best to take a probiotic before eating for maximum efficacy.

Bacteria should be full of water, however, to be formulated into a capsule or tablet, probiotic bacteria must first be desiccated and stripped of internal water, which is already a big ask. Following this, the probiotics must survive being swallowed, be able to sit in the stomach acid, and then replace the water they lost in order to fully recover before they are able to grow and have any beneficial effect.

On the other hand, when taking a liquid probiotic, the bacteria have not undergone desiccation and are in a suitable environment. So, all they have to do is warm up inside the body and then they’re good to go.

Liquid probiotics should always be chilled. Probiotics grow best at 37°C, the temperature of the human body, so if you were to store a liquid product at 37°C, there would be a lot of internal growth. However, this is undesirable as this may cause some to die within the product, and probiotics should grow inside the body. Chilling them down puts them in a state of suspended growth.

How can probiotics help with Parkinson’s disease?

Scientists have now been able to sequence the bacteria present in an individual’s gut using stool samples. This has enabled the understanding of what types of bacteria are prevalent in those with certain conditions, and it has been found that the balance of good and bad bacteria in the gut is consistently different to healthy subjects.

“We’ve seen quite an improvement, I think, in Parkinson’s patients who are taking probiotics” – Professor Gaisford

One of the earliest symptoms of Parkinson’s disease is constipation – those who are developing Parkinson’s are likely to have had long-term issues with gut health. It has been suggested that some of the proteins involved in the development of Parkinson’s are produced in the gut. The gut wall usually prevents unwanted things from entering the bloodstream, but because many Parkinson’s patients have suffered with chronic constipation, the gut wall is weakened due to the pressure caused by the build up of faecal matter in the gut. The gut wall is comprised of a single-cell layer, so this pressure can cause the cells to come apart, allowing things to pass between the cells and enter the bloodstream. Proteins from the gut can begin circulating around the body and transfer to the brain.

Professor Gaisford has been investigating the use of probiotics to combat the progression of Parkinson’s through preventing constipation and damage to the gut wall. Even after gaps have been formed in the gut wall, once faecal matter is able move smoothly through the gut, the cells can come together again.

“Probiotics can help improve gut health, improving gut health then improves other conditions” – Professor Gaisford

Probiotics for inflammation and wound healing

Professor Gaisford was recently involved in a research project investigating the effects of probiotics on wound healing. They looked at 3 conditions: ulcerative colitis, Parkinson’s disease and liver sclerosis. Stool samples were taken from patients with these conditions and combined with a medium, allowing the bacteria to grow, ultimately producing a beaker full of bacteria that the patient would have had in their colon. They added probiotics into the stool samples to observe the effect that they would have on the native bacteria.

Many gut conditions are inflammatory – to investigate inflammation, a model of the cells lining the gut was exposed to bacteria in order to observe what sort of compounds are released by the cells – sometimes they would release those which are a sign of inflammation. To investigate wound healing, cells were put on a plate and scratched, causing them to split. This would replicate having some sort of cut or ulcer on the gut wall. The time taken for the wounds to heal through the cells coming together again was then recorded.

The outcome of the study showed that by adding the probiotics, the balance of gut bacteria improved, inflammation was reduced, and the rate at which the wound healed increased.

The development of your microbiome

“At the moment of birth, everyone is the same” – Professor Gaisford

Everyone is born the same in the sense that they are sterile, so by adulthood, the content of your microbiome has been hugely influenced by your environment: what you ingest, what you touch, anything that helps you populate your gut. During birth, those who are born naturally (as opposed to caesarean birth) ingest Lactobacilli from the lining of the vagina, contributing to the microbiome population. Similarly, when drinking breast milk, Lactobacilli and Bifidobacteria are ingested. Cultural background will also affect your gut flora – people from different cultures will generally have different diets, and the food that you eat influences the content of your gut microbiome.

Is it best to eat the food you grew up on?

Gut bacteria are tightly bound together in groups called biofilms as a form of protection, producing a sticky mucus which makes them hard to displace. So, if your gut flora have survived on a particular diet for 20-30 years, a week on a different diet will not produce any change – many years of consistently eating a different type of diet are needed.

The gut bacteria which lived on the food you consumed as you grew up will demand the same type of food, causing issues when dietary changes are attempted. Eating different things will feed different bacterial populations, and the absence of the same type of food for a given population can cause problems such as excess gas and bloating.

How can you improve your gut health?

“Eat healthy things to encourage your gut bacteria to grow” – Professor Gaisford

As mentioned previously, it’s good to eat food that your bacteria will digest. In general, heavily processed foods should be avoided, while consuming vegetables and high-fibre foods is encouraged. Fibre provides a framework for faeces to be built around, and aids gut motility.

Professor Gaisford’s take home message

Although probiotics are often viewed in pharmacy as being part of ‘homeopathic remedies’, Professor Gaisford strongly believes that probiotics are a good idea. Some people are not aware of their potential gut issues, such as bloating – they may not realise if they are bloated all of the time. If you find that probiotics don’t seem to work for you, try out different products and observe how you feel. It could be the case that you don’t have much imbalance in the first place, or you aren’t able to physically detect any change.

“There’s a lot going on in your gut that you can’t feel” – Professor Gaisford

Don’t forget to check out Professor Gaisford’s YouTube Channel Pharma Drama, addressing issues concerning the pharmaceutical industry and healthcare.

What to find out more? Check out these links:

Gut Inflammation and Parkinson’s Disease - https://www.psychiatryadvisor.com/home/topics/neurocognitive-disorders/gut-inflammation-linked-to-the-development-of-parkinson-disease/

Probiotics in Wound Healing - https://www.medicalnewstoday.com/articles/318765

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