With all the microbiome research in the past few years, we have more information about which specific probiotic strains can best be used for specific conditions. Yet, all the companies and products available make it so confusing! That begs the question, which probiotic should I take, lactobacillus, SBO’s or spores?
We host about 400 – 500 species of microorganisms in the gut of which only 80 species have been identified. There is so much to investigate involving the different strains and their appearance, as well as their structure and function.
Importantly, there is research about how they behavior as a single strain and how they interact with each other in communities, because in the human gut there is never just one strain.
They all interact.
With new technologies such as Multilocus Sequence Analysis, DNA Typing using PCR, Pulsed Field Gel Electrophoresis, and others with even more complicated names, researchers can identify the different strains, tag them, study what they do, what bio-chemicals they secrete, how they affect the microbiome and ultimately how they affect human health.
Furthermore, once they are identified and their behavior is studied, they may be used as therapeutic interventions which are targeted to very specific conditions.
This is HUGE!
There is good evidence that probiotics are effective for acute infectious diarrhea, antibiotic-associated diarrhea, C diff-associated diarrhea, hepatic encephalopathy, ulcerative colitis, irritable bowel syndrome, functional gastrointestinal disorders, and necrotizing enterocolitis – along with advise or treatment from an appropriate health care provider.
Probiotics are safe for infants, children, adults, and older patients, but caution is advised in immunologically vulnerable populations.
Probiotics are officially defined as,
Live organisms that, when administered in adequate amounts, confer a health benefit on the host
by the Food and Agriculture Organization (FAO) of the United Nations, via the WHO.
It used to be simple, with just acidophillus and bidfidus strains. Now we have combinations with multiple strains and different types of bacteria.
One of the most marketed features of a probiotic is the number of cfu (colony forming units) per dose.
Is more probiotic better?
Is there more value in 100 billion over 50 billion or even 10 billion?
The answer is not as always obvious as it seems.
For some people, more is not better.
In fact, more bacteria may be too many bacteria if the person has a serious health condition like Crohn’s disease or ulcerative colitis. The same can hold true for people with irritable bowel syndrome, people with gluten sensitivity, and frankly, anyone with leaky gut.
It can be a shock to the GI system to introduce too many bacteria of too many strains, as this can cause an exacerbation of all the person’s usual symptoms.
The most historically used and the most common probiotics are made with lactic acid based strains of acidophillus and bifidus.
These are sold as live strains and much is made about using strains that survive the acidic environments of the stomach and the bile salts in the small intestine.
Many companies require refrigeration in order to keep them alive, while others seem to have formulated them to survive at room temperature.
Studies show which strains actually survive these challenging environments.
There are, in fact, strains of lactobacillus that survive stomach acids and bile salts, or at least function well in those conditions.
L. plantarum is one such strain.
L. rhamnosus is another.
These strains are a favorites of mine as I have found them to be safe and effective.
In recent years there has been a trend towards soil based organisms or spores.
Soil based bacteria or soil based organisms (SBO’s) are simply the bacteria we find in the soil. They are also known as HSO’s (homeostatic soil organisms). SBO’s are not necessarily spore forming bacteria and spores are not necessarily found in the soil in their active form.
In the past, we were exposed to these particular strains from food that came directly from the soil. Produce was pulled from the ground with all the soil around it, brushed off and brought to market.
Today, we have produce that is triple washed and packaged. We grow food in a depleted soil, with fewer bacteria and more chemicals.
Consequently people have less of these soil based bacteria in their gut.
Soil based bacteria are important because they may help regulate our immune systems, protecting us from an over reactive immune response. They may also provide protection against bacterial and fungal overgrowth in our intestines and they do a lot of other tasks.
However, there is not a lot of published research around the strain of SBO’s used in some probiotics.
There is also some controversy about the safety of taking soil based organisms and they are confused with spore forming bacteria.
Spore bacteria are in a different category from soil based organisms.
While many clinicians have jumped on the bandwagon of spore forming bacteria, some have not.
One benefit of spore forming bacteria is that, due to the endospore, they can survive stomach acid and bile salts and actually arrive in the large intestine, emerge from the spore alive, then multiply and stay around for a while – or stay dormant until the right conditions occur.
It is this exact benefit that causes some to take pause.
Those against, say that due to the endospore, these bacteria would be very, very difficult to eradicate should they ever turn against their host and become opportunistic pathogens. (See my explanation about gut commensals a little further down that disputes this).
The opposers say that there is not enough research to validate usage of some of the endospore strains particularly, bacillus licheniformis, which one particular writer states is known to cause opportunistic infections in humans or can cause severe health issues, some worse than others.
However, there is actually tons of research that supports the use of spores.
There is another category of spores that are called gut commensals.
These spores are native to the gut – that is – the gut is their natural home. Just by virtue of that information we know that they are safe.
The four strains used in Just Thrive are gut commensals. They travel through the digestive tract, but are excreted out after about 3 to 4 weeks.
Along the way, they clean up their environment (your gut) and then exit.
They are perfectly safe.
Kiran Krishnan has written an extensive rebuttal regarding the alleged safety issues with certain spores.
I will present some of the highlights regarding the safety of spores as used in probiotic supplements. Megaspore is the product that contains the additional spore, B. licheniformis as well as the four other species that are also in Just Thrive.
These are quotes compiled from the rebuttal:
The Bacillus species used in Megaspore and Just Thrive are the most widely researched and used in the world. There are currently more than a dozen prescription or OTC products marketed around the world through primary care that utilize strains found in MegaSpore. The strains found in the product are the most widely used and researched among bacillus.
The company that produces Megaspore did not do any of the work on bacillus Indicus HU36 and its ability to colonize and produce 7 of the most bio-available carotenoids. This was done by the large, European Colorspore Consortium project. This project included 8 different research institutes, 50 researchers and had over 5 million Euro of funding. It is all done by the most highly regarded research institutes in the world.
Regarding the safety of B. lichenformis:
Published studies that have reviewed the reported cases of adverse events with licheniformis have concluded that in NONE of the cases it was determined that licheniformis was the causative agent. In addition, ALL reported cases were in severely immunocompromised individuals or individuals with trauma. Lastly, licheniformis was only associated with infection and never determined to be the cause of the infection as this species is not naturally infective. The most comprehensive safety review on licheniformis was done by the Environmental Protection Agency (EPA) and they concluded, at the end of their detailed report, that “B.licheniformis is not a human pathogen nor is it toxigenic.
Bacillus licheniformis is a GRAS (Generally Recognized as Safe) organism in the U.S. by the FDA standard for safety and toxicity of bacterial strains and it has QPS (Qualified Presumptionof Safety) designation in the E.U. There isn’t a single case report where licheniformis was determined to be the primary causative agent in an infection and all case reports of adverseevents are in subjects that are severely immunocompromised and/or had significant trauma.
Regarding the manufacture of Megaspore/Just Thrive.
We have microbiologists and M.Ds on our scientific committee and advisory board. We also work with and have derived our strains from London University, where we work with a renowned team of microbiologists and biochemistry researchers who have dozens of scientific publications, text book authorships and scientific committee appointments on their CV. We are conducting human clinical trials in collaboration with Universities and doctors in the U.S. We have thousands of people from doctors, medical practices, health practitioners, etc. that routinely use the product with great success with no reported adverse events.
I am so glad I received this information by Kiran Krishnan!
I feel so much better about the safety of the spore products! As noted below in more detail, I have been using them very great success as well!
B. subtilis is one of the most researched spores that we have known about – discovered in the 1870’s.
Bacillus subtilis, or B. subtilis, is found in many places such as soil, water, air, and decomposing plant material. It is also the spore that creates natto, the fermented soybean that the Japanese have been eating for centuries.
This particular microbe has many strains with genetic differences, some of which are toxin producers.
For this reason it is very important to know the actual strain used in the probiotic.
Be warned that some manufacturers simply list B. subtilis on the label, when other bacillus species may be used that produce toxins (such as B. cereus). So be careful to note exactly which Bacillus strain is in the product.
The 2 safe strains used in probiotics are:
B. subtilis is generally thought of as beneficial (except for the individual mentioned above) and is included in the spore probiotic Just Thrive.
In a study using a Continuous Model of the gut, researchers studied the HU58 strain of B. subtilis.
This study was completed at a 3rd party independent research company called ProDigest. They specialize in digestive studies.
The Continuous Model of the gut allows researchers to study the effects of the probiotic over long periods of time – not just one dose. This sheds light on the effects of the probiotic in all areas of the digestive tract.
This study was commissioned by the producers of Just Thrive Probiotic and is available to read here.
The researchers found some very exciting results about B. subtilis HU58:
Butyrate is a powerfully protective substance that most of us do not have enough of. Just the benefit of increased butyrate alone would cause me to want to take this probiotic!
Butyrate is a critical energy source for the colonic cells, which protects the cells from uncontrolled growth (tumor growth). Butyrate is also known as an immune system modulator, which can help tamp down an over-active immune system in the gut.
Find out more about the benefits of butyrate here.
Another strain included in Just Thrive is B. indicus HU36. Here again, the manufacturers commissioned a study of a similar kind (as the one for B. subtilis HU58).
Interestingly, researchers have found that beta-carotene is almost totally degraded by gastric juices as quickly as 10 minutes.
However, they also found that bacillus derived carotenoids have very little degradation. This leads to the survival of the carotenoids past the stomach acids via the spores.
In 2017 a ground-breaking study was published in the World Journal of Gastrointestinal Pathophysiology by a group at the University of Texas.
I will note that in the conflict-of-interest statement, the authors say that the study was partially funded with a grant from Microbiome Labs – which is the parent company of Just Thrive Probiotic. However, they also state that the funding was not direct and that there is no conflict-of -interest.
This study was a measure of post-prandiol endotoxemia.
Oh that is a mouthful!
What this means is that after eating, many people experience an increase in inflammatory markers (like LPS), because of a disruption in intestinal permeability (leaky gut) or perturbations in the gut microbiota, or both.
Chronic, transient increases in inflammatory markers after each meal may increase a person’s risk for disease.
According to these researchers,
Our laboratory and others have demonstrated that consumption of a single, high fat, high calorie meal was associated with an increase in serum endotoxin, triglycerides, metabolic biomarkers, inflammatory cytokines, endothelial microparticles, and monocyte adhesion molecule. The postprandialtime course varies for each biomarker, but generally the transient changes occur during the first five hours ofthe post-prandial period. Given the direct link between nutrition, microbiota, GI permeability, and disease risk, our laboratory and others have speculated that these changes represent an appropriate treatment target for a probiotic intervention.
In summary, the key findings of the present study demonstrate that 30d of spore based probiotic supplementation resulted in a blunting of dietary endotoxin, triglycerides, and potentially systemic inflammation. To our knowledge, the present study is the first to report that a short term sporebased probiotic intervention altered dietary endotoxemia in human subjects, although the effect has been widely reported in mice.
Due to limitations associated with using human subjects, it was not possible to directly measure gut permeability in the present study. Despite this, it is reasonable to speculate that the underlying cause of the observed reductions in postprandial endotoxemia may be due to changes in the gut microbiome, gut permeability, or a combination of the two. Future research is needed to determine if a longer course of treatment with a spore based probiotic results in additional health improvements.
Needless to say, the folks at Microbiome Labs (also producers of Megasporebiotic) are thrilled with these results.
If you want to start with just one strain of a spore probiotic, Schiff’s Digestive Advantage is a good place to start. It contains Bacillus coagulans GBI-30 (B. coagulans is also included in Just Thrive but the specific strain is not indicated).
I will note that there are also some other ingredients in Digestive Advantage that are not so great, like titanium dioxide – but it has been shown to be effective for some folks for abdominal pain and diarrhea.
Now that I have you excited about spore based probiotics, let me say a few words about the traditional lactobacillus probiotics we have been using for years.
As mentioned above, many formulations are now in the many billions. For most people that works. For those with digestive or autoimmune issues, that may be an issue.
In these cases, I generally recommend starting with a single strain, low dose lactobacillus such as L-rhamnosus. This is a well researched strain that reduces inflammation in the lungs, and reduces peanut allergies.
See more benefits of L-rhamnosus here.
L-rhamnosus is found in the product Culturelle.
Another great lactobacillus is L-plantarum. It is usually the first listed probiotic in many of the multi-strain products.
Donna Gates from Body Ecology has written a great deal about L-plantarum.
I like Women’s Care Probiotic by Flora as it is a multi-strain with a nice selection of lactobacillus and bifido bacteria and it is shelf stable – no refrigeration needed. Note, I did receive a month supply of this brand to try and I liked it.
I personally take (and recommend to my patients) and rotate probiotic strains whether they are lactobacillus or spores. You can do this by switching every other day or take a bottle of one type for a few weeks and then switch to another type. This way, you are getting a larger variety of strains.
See more about some of the researched brands of probiotics available over-the-counter here.
As a clinician, I do favor many of the brands available only to clinicians, because these are usually high quality and also researched. Therefore, if you have a practitioner that you trust, go with their recommendations after you do your research as to which strains you want to take.
Obviously, a great (and cheap) way to get lots of lactobacillus every day is to start introducing fermented foods into your diet. Here are a few of my favorite fermented foods you get easily and cheaply make at home.
I will note that I have been using Just Thrive for several months now and have received free product. However, that is not the reason for this article. I have also used some of the other probiotics mentioned here. I have found great benefits from taking Just Thrive!
In my practice and on my blog, I have made it my mission to never recommend a treatment or supplement to anyone that I have not personally tried. If I have not tried it, I disclose that.
Over the years in practice, this has served me well.
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