I recently had the privilege of sitting down with one of New Zealand’s most sought after Medical Research Consultants, Corene Humphreys.
I invited Corene to come speak with us about the benefits of Probiotic supplements and how they work, with the end goal of finding What is New Zealand’s Best Probiotic Supplement, that meets all of Corene’s criteria.
View the transcript below. I encourage you to place comments at the bottom of the page also.
We are here today with Corene Humphreys to learn about probiotics.
Corene is a registered naturopath who graduated from the South Pacific College of Natural Therapeutics, here in Auckland, with a Diploma in Naturopathy, Medical Herbalism and Homoeopathy. As well as this she recieved, from the Charles Sturt University, a Bachelor’s degree in Health Science and Complementary Medicine.
For a number of years Corene operated a multi-disciplinary practice, specializing in Functional Medicine. She also served as a clinical consultant for a number of specialty diagnostic companies which lead her to immigrate to the USA in 2001.
During her role with the American company Genova Diagnostics, Corene was instrumental in developing a Comprehensive Gastrointestinal Profile, along with other specialty gastrointestinal and metabolic profiles. She also served as an educational resource for physicians, consulting to thousands of practitioners in the US and overseas. Corene has lectured extensively on numerous medical topics throughout the world and authored a chapter in the Textbook of Natural Medicine on the topic of Intestinal Permeability.
When she returned to New Zealand in 2006, she founded a research company which sees her developing natural evidenced based formulations for a number of health conditions. Corene regularly travels abroad attending medical conferences to keep abreast of the latest research in the field of Complementary and Alternative Medicine and has a special interest in probiotics.
Thanks Leanne – it’s great to be here today.
Corene, what made you so interested in the field of probiotics?
My initial training was in the field of medical microbiology where I worked in both private medical laboratories and public hospitals in NZ and England, so I have a good understanding of microbes on a biochemical level. Then when I was in private practice, I predominately specialized in gastro-intestinal health issues and would regularly send samples overseas to specialty laboratories to assess gut microbes - because labs in NZ don’t test for probiotics. As a result, I was able to see which probiotics I gave my patients were effective and which ones did not colonize the gut.
Given my combined background of microbiology and Naturopathy, I was invited to be the medical specialist for the Gastroenterology division at Genova Diagnostics. This was a wonderful opportunity and allowed me to help develop novel diagnostic tests to assess GI function and beneficial bacteria in a non-invasive way. In this role, I regularly attended microbial conferences to keep abreast of the latest knowledge and now that I am back in NZ, I still continue to attend probiotic conferences in the US and Europe. For me it is such a fascinating field and it is a real honour to hear first hand from the researchers, the latest developments in the field of probiotics – it is such a rapidly growing industry. It is the information from the researchers along with scientific papers that I use to source evidenced-based probiotic supplements.
So, Corene, can you tell us what a probiotic actually is?
Probiotics, as defined by the Food and Agriculture Organization of the United Nations and the World Health Organisation, are “Live microorganisms which administered in adequate amounts, confer a health benefit on the host”
The key words (to me) in this definition are “live” and “adequate” – a probiotic supplement containing bacteria that are not viable (or alive) at the time of use is not a probiotic.
And, having a probiotic in an adequate amount is also very important.
Do we need to take probiotics on a regular basis or just when our gut flora has been altered as is the case when we take antibiotics?
I believe we should take probiotics on a regular basis. This is because our diet has changed so much over the years. Historically, fermented foods (that contained bacteria) were part of our diet because we didn’t have fridges and we needed to preserve our food. These days’ things like sauerkraut or lactic acid broths are not part of most people’s standard diet.
We actually have 10 times more bacterial cells in our gut than we do tissue cells forming our entire body. To give a sense of numbers, it is estimated that we have approximately 100 trillion bacteria in our gut. For this reason, some researchers consider our gut bacteria an organ in its own right.
Probiotics or beneficial bacteria also perform a number of important roles in the body including immune regulation so it’s important that we do have adequate amounts of beneficial bacteria in our gut.
Can you give us some specific examples of what beneficial bacteria do in the gut?
Sure, probiotics make certain B-group vitamins (for example Vitamins B2, B12, folic acid and biotin) and vitamin K in the gut. They also produce short chain fatty acids, which provide up to 5-10% of our total body energy requirements. And as I mentioned before, they help regulate our immune system. They do this by stimulating the maturation and balancing of the immune system at birth and then go on to stimulate and prime the immune system throughout life. This enables us to have a correct response to dietary and environmental allergens and also tolerance to our normal flora (i.e. so we can differentiate friend from foe). Priming the immune system allows our body to react quickly to potentially harmful challenges like pathogenic bacteria.
Most people aren’t aware that about 70% of our immune system resides in our digestive tract (known as GALT or Gut Associated Lymphoid Tissue).
What are some of the misconceptions about probiotics?
There are 3 main misconceptions from a consumer stand point and these relate to the quantity of probiotics in a dose, the belief that multiple strain formulations are better, that we need to take probiotics AWAY from food and that all probiotics must be refrigerated.
Let’s start with the first misconception about probiotics – that of quantity.
Some probiotic companies have misleadingly educated the public that “more is better” in terms of the number of colony forming units (CFU) of probiotics in each capsule. Now many companies are competing to have higher and higher amounts of probiotics in each capsule.
It is a fallacy that more is better. This can only be determined or proven from researching a particular strain, or a strain combination at a defined dose and assessing the outcome. What science has demonstrated, is that the beneficial effects of a probiotic are dose specific and strain specific.
At this point, it is probably best if I take a step back here and define “What a probiotic strain is”. Most people have heard the name Lactobacillus and know this organism to be a form of beneficial or ‘friendly’ bacteria. There are in fact a number of different types of lactobacilli, for example Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus bulgaricus and so on. If we just use the word Lactobacillus, when have identified the genus. If we say for example Lactobacillus rhamnosus, we have identified the genus and the species (‘rhamnosus’ is the species). We can also further define a probiotic by identifying the strain which is done with genetic typing using sophisticated methodology (such as pulse field gel electrophoresis). For example, there is more than one type of lactobacillus rhamnosus and when we identify the strain e.g. Lactobacillus rhamnosus GG, we have further characterised the organism.
It may help if I give you the analogy of this using makes and models of cars. If someone said they owned a Toyota (this would be equivalent to the genus), it could be a number of different cars or even a 4WD. They could further define what type of car by sharing the model e.g. Toyota Hilux-Surf (the equivalent of the species of an organism). We now have a far better idea of what type of car this person has, but there are still a number of different types of Toyota Hilux Surf’s which can be further defined by the year and the particular type of model (or in bacterial terms, the strain). If someone said they had a Toyota (genus) Hilux-Surf (species) SSR-G, 1995 (strain), we now know exactly what type of car the person has and if we were to review the manual (or with probiotics, the research papers), we would know exactly what features it has for example, a turbo engine, ABS brakes, runs on diesel etc.
Just as cars are different from one another, so are bacterial strains. We can’t for example say all Toyota’s have 4 wheel steering – that is specific to the type of model, just as the health benefits of a probiotic are specific to the particular strain. We can’t say all lactobacilli reduce the incidence of respiratory infections because that would depend on what strain we were using. So one pearl is to look for probiotic supplements that cite not just the genus and species of an organism on the label, but also the exact strain.
So getting back to the misconceptions surrounding probiotics, we have also been misleadingly taught “the more the merrier” – that is, multiple strain formulations are better than single or two strain formulas.
Many companies combine a number of probiotics and in super high doses. These types of products are often cheaper to produce (because there are no studies to fund) and sound impressive, but don’t always have the desired beneficial results.
Certain bacteria, for example, may compete with one another, or reduce the efficacy of another strain or even negate the beneficial effects altogether! For example, some strains help stimulate the immune system and in this capacity are great for colds and flu’s, where other strains help tone down exaggerated immune responses, as is the case with rheumatoid arthritis. If these strains are combined in a formula, we don’t know what the overall effect will be on the immune system. We can only determine this if we perform robust clinical trials.
For this reason, it is far better to have a few proven and well studied probiotics, in sufficient quantities, than a whole bunch of probiotics with little research to support their use – either in isolation or in combination with other strains.
That clarifies things a lot – thanks. Now what about when to take a probiotic and whether or not we need to refrigerate probiotics?
When to take a probiotic and whether we should refrigerate is really dependant on three things:
1) The type of strain we are using
2) Whether or not we have used any special encapsulation technology
3) The type of packaging
How about I first share the journey of a probiotic in the gut, as this will help explain these last two misconceptions?
That would be great.
Probiotics undergo quite a mammoth journey to get to the colon – they first have to survive the stomach acid which has a very low pH, (as low as 1.4), then once in the small intestine, the pH radically increases (up to 6.5) and there are also harsh bile acids to content with. All these factors can easily kill the bacteria. Stomach acid is after all Mother Nature’s Antibiotic, to help protect us from harmful bacteria in our environment.
One way to overcome these challenges, is to select strains that have demonstrated acid and bile tolerance – this can be assessed in the laboratory, or we can perform human studies to see if the probiotics can be recovered from the stool – that way we know the specific strains can survive the acid and bile AND reach the intestine, still live.
Another way is for companies to use a specialized gel matrix coating on the bacteria themselves or to have special enterocoated capsules which allow the probiotics to get past the stomach and then hydrate in the intestine.
Companies should be able to provide scientific evidence of the organisms’ ability to tolerate stomach and bile acid and share if they have utilized any special encapsulation technology.
If they do have acid and bile resistant strains and/or a protective matrix coating or enterocoated capsule, it really doesn’t matter if the probiotics are taken with or away from food. For this reason it is best to adhere to the instructions on the particular supplement, rather than just assume that all probiotics should ideally be taken away from food.
This is very helpful – now to the last misconception, why do some products say to refrigerate and other probiotics seem to be fine at room temperature?
Probiotics as we have already established, are live microorganisms. Before there were specialized drying techniques, encapsulation technology and novel packing systems, it was best to keep the bacteria cold to reduce moisture and degradation. Think of having a bowl of fruit on the table in the sun vs. having a bowel of fruit in the fridge – it is the refrigerated bowl that will last a lot longer because there is less moisture and heat.
Nowadays, we have far more sophisticated methodologies and laboratory procedures to protect probiotics during the manufacturing process. For example, freeze drying the probiotic helps preserve them and having temperature and humidity controlled manufacturing rooms helps control the moisture content – it is exposure to moisture and oxygen that decreases the viability of probiotic bacteria.
There are also specialized packaging systems that can protect the probiotics from exposure to oxygen and moisture once they have been encapsulated.
Manufacturers should be testing their probiotic as soon as it has been cultured, at the time of packaging and throughout the product’s shelf life to ensure there are viable cells and they can meet the label CFU (colony forming unit) claim.
Why would someone want to take a probiotic and what kind of benefits could someone expect from taking one?
You could (as mentioned earlier) take a probiotic daily to ensure a regular supply of beneficial bacteria in the gut. Taking a probiotic for a short time doesn’t mean we continue to harbour that organism in our gut once we have stopped ingesting. Depending on the particular strain, it may not be recovered from the stool a few weeks after or even a few days after we stop taking the supplement. What we do know, is that regular ingestion (of a viable probiotic) ensures we do have an ongoing supply of friendly bacteria.
We can also take probiotics for specific conditions, for example health care professionals may recommend probiotics for digestive disorders like diarrhoea, constipation, lactose intolerance, gas, irritable bowel syndrome or inflammatory bowel disease or even Helicobacter pylori infection. Other times when probiotics are recommended are with yeast infections, following antibiotic therapy or for immune support.
As the research continues, I expect we will see a lot more probiotic supplements that are condition specific – for example probiotics for high cholesterol, probiotics for diabetes, probiotics for respiratory infections and so on.
What should people look out for when choosing a probiotic?
As I mentioned, make sure the probiotic has strain specific organisms and that it is a formula with research to support its effectiveness. If it is a combination formula, then ideally, it should have documentation or studies that show the strains are still effective when taken together.
The dose should be expressed in CFU’s and the manufacturers should perform stability testing on each batch throughout the product’s shelf life to ensure the probiotics remain viable until or even beyond the expiration date.
Probiotics should also be packaged in such a way, so as to protect them from exposure to light, oxygen and moisture - as all these factors can affect the viability of the bacteria.
Are there probiotic formulas on the market that meet all these requirements?
A new formula that has recently been launched on the NZ market is a product called Clinicians™ MultiFlora. This probiotic formula does meet all the criteria that I mentioned.
It contains two strains – Lactobacillus rhamnosus GG and Bifidobacterium animalis BB12. These are two of the most studied and scientifically researched strains in the world1 and when combined, these strains have demonstrated synergistic effects – that is the addition of one (BB12) enhances the presence of the other (LGG).2
Research has shown that Lactobacillus rhamnosus GG and Bifidobacterium animalis BB12 can be used for a number of gastrointestinal conditions including diarrhoea, Constipation3 and Irritable Bowel Syndrome.4
Is CliniciansTM MultiFlora good for a specific type of diarrhoea?
Studies show that the strains in Clinicians MultiFlora are effective for many types of diarrhoea including infectious diarrhoea, traveller’s diarrhoea, antibiotic-associated diarrhoea and diarrhoea of viral aetiology (e.g. rotavirus). It is also is considered a beneficial adjunct to conventional triple therapy for the eradication of Helicobacter pylori.5
That’s impressive! Can you use MultiFlora for any other conditions or diseases?
Yes, other applications that have been studied include atopic eczema in children and infants. It helps prevent eczema and can also reduce the severity of an outbreak.6 And, CliniciansTM MultiFlora is safe to take during pregnancy to help prevent early atopic disease in newborn babies especially when there is a family history of eczema.7
It is also an ideal supplement to support immune function and can help reduce the incidence of respiratory infections in children.8 Studies have shown that B. animalis BB12 can help improve overall immune function in both the young and the elderly.9
If you suffer from pollen allergies it is a good probiotic to consider as there is research to show that LGG can increase our body’s immune response (through increased IgA levels) to help protect against birch pollen allergies.10
Research also indicates that CliniciansTM MultiFlora may help protect against colon cancer by improving the composition of the bowel flora and favorably altering cancer biomarkers in the gut.11
Given its many indications and demonstrated protective effect on the gut, it can be used as a “condition specific probiotic” and a probiotic for general well being – it’s the one I take every day.
How about the stability of this product and the packaging?
Clinicians TM MultiFlora has research to show it can survive stomach and bile acids. As well as this, it also has a specialized polysaccharide encapsulation technology to ensure the strains reach the intestine intact. Vegetable capsules are used to further reduce the moisture content which also makes this product suitable for vegans and vegetarians.
With regard to packaging, CliniciansTM MultiFlora is packaged in special Alu/Alu blister packs that enable the bacteria to remain viable in room temperature environments. As well as this, stability studies are performed over the product’s shelf life to assess the CFU’s and moisture content. Each MultiFlora capsule is individually packaged with easy tear-off perforations so you can conveniently take with you when travelling; without the need for refrigeration.
Are the probiotics in Clinicians MultiFlora safe for everyone to take?
Both strains have demonstrated safety in general. There are studies to show they are safe for all age groups, from infants as young as one month old to children, right through to adulthood and the elderly.12-15 Women can also take it during pregnancy and while breast feeding.
Probiotics are generally considered safe and well tolerated however, there are certain situations that require caution.
You should consult your physician before using probiotics if you have recently had radiation therapy, oral or gastrointestinal surgery (particularly short bowel loop) or if you are immunosuppressed (such as those with HIV). Under such circumstances, there is increased susceptibility of bacterial translocation across the gut wall which can increase the risk of infections.16
What dose would you advise to take for general well being and how much MultiFlora would you take for a specific health complaint?
At the time of manufacture, there are over 7 billion CFU’s in Clinicians MultiFlora or greater than 3.5 billion CFU’s of each strain per capsule.
For adults, if they are taking this for general well-being, the dose is one capsule once or twice a day with food. The dose in clinical trails varies between 5-40 billion CFU’s/day and is dependant on the particular health condition.
For example, to increase immunity, doses have varied between 4-40 billion CFU’s per day. For skin conditions, good results have been demonstrated at 20 billion CFU’s per day (which is 3 capsules). 20 billion CFU’s is also a suitable dose following antibiotic therapy. When used alongside triple treatment medication for H. pylori eradication, studies have shown that 12 billion CFU’s per day reduces the antibiotic side effects such as bloating and diarrhoea and improves overall tolerance to the medication.
For children 3 years and over, the recommended dose is ½ to one capsule a day with food – the 2 piece hard-shell capsules can easily be twisted opened and the contents mixed with milk or water (not fruit juice – as you want something with a neutral pH). Make sure the liquid is not warmed.
The dose for infants 1 month to 3 years is ½ a capsule daily, mixed in with milk or water.
Corene, this has been invaluable, thanks SO much for your time today.
You’re most welcome.
Corene has provided a number of references and abstracts for the MultiFlora strains so for those of you that would like further information on this probiotic, you can find these below.
1. Salminen S, Benno Y, de Vos W. Intestinal colonisation, microbiota and future probiotics? Asia Pac J Clin Nutr. 2006;15(4):558-562.
2. Juntunen M, Kirjavainen PV, Ouwehand AC, Salminen SJ, Isolauri E. Adherence of probiotic bacteria to human intestinal mucus in healthy infants and during rotavirus infection. Clin Diagn Lab Immunol. Mar 2001;8(2):293-296.
3. Vendt N, Grunberg H, Tuure T, et al. Growth during the first 6 months of life in infants using formula enriched with Lactobacillus rhamnosus GG: double-blind, randomized trial. J Hum Nutr Diet. Feb 2006;19(1):51-58.
4. Kajander K, Myllyluoma E, Rajilic-Stojanovic M, et al. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota. Aliment Pharmacol Ther. Jan 1 2008;27(1):48-57.
5. Myllyluoma E, Kajander K, Mikkola H, et al. Probiotic intervention decreases serum gastrin-17 in Helicobacter pylori infection. Dig Liver Dis. Jun 2007;39(6):516-523.
6. Betsi GI, Papadavid E, Falagas ME. Probiotics for the treatment or prevention of atopic dermatitis: a review of the evidence from randomized controlled trials. Am J Clin Dermatol. 2008;9(2):93-103.
7. Kalliomaki M, Salminen S, Poussa T, Arvilommi H, Isolauri E. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet. May 31 2003;361(9372):1869-1871.
8. Hatakka K, Savilahti E, Ponka A, et al. Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. Bmj. Jun 2 2001;322(7298):1327.
9. Schiffrin EJ, Rochat F, Link-Amster H, Aeschlimann JM, Donnet-Hughes A. Immunomodulation of human blood cells following the ingestion of lactic acid bacteria. J Dairy Sci. Mar 1995;78(3):491-497.
10. Piirainen L, Haahtela S, Helin T, Korpela R, Haahtela T, Vaarala O. Effect of Lactobacillus rhamnosus GG on rBet v1 and rMal d1 specific IgA in the saliva of patients with birch pollen allergy. Ann Allergy Asthma Immunol. Apr 2008;100(4):338-342.
11. Rafter J, Bennett M, Caderni G, et al. Dietary synbiotics reduce cancer risk factors in polypectomized and colon cancer patients. Am J Clin Nutr. Feb 2007;85(2):488-496.
12. Guandalini S, Pensabene L, Zikri MA, et al. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J Pediatr Gastroenterol Nutr. Jan 2000;30(1):54-60.
13. Saavedra JM, Abi-Hanna A, Moore N, Yolken RH. Long-term consumption of infant formulas containing live probiotic bacteria: tolerance and safety. Am J Clin Nutr. Feb 2004;79(2):261-267.
14. Szajewska H, Mrukowicz JZ. Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized, double-blind, placebo-controlled trials. J Pediatr Gastroenterol Nutr. Oct 2001;33 Suppl 2:S17-25.
15. Larsen CN, Nielsen S, Kaestel P, et al. Dose-response study of probiotic bacteria Bifidobacterium animalis subsp lactis BB-12 and Lactobacillus paracasei subsp paracasei CRL-341 in healthy young adults. Eur J Clin Nutr. Nov 2006;60(11):1284-1293.
16. Reid G, Sanders ME, Gaskins HR, et al. New scientific paradigms for probiotics and prebiotics. J Clin Gastroenterol. Aug 2003;37(2):105-118.