Q: I have been diagnosed with irritable bowel syndrome (IBS). When I take probiotic supplements, my bloating is much better for some weeks, then it seems the probiotics will abruptly stop working. Why would this happen?
A: Irritable bowel syndrome is a disorder characterized by bloating, abdominal pain, cramping, constipation and diarrhea. It’s fairly common, affecting as many as 20 percent of the adult population, and occurs more often in women than men. Probiotic supplements, which contain beneficial bacteria to offset harmful gut bacteria, offer relief for many people, and recent insights into gut physiology may explain your changing symptoms.
Researchers estimate that the gut contains 500 different species of bacteria with 30 to 40 species predominating; the total number of bacteria, 100 trillion, can weigh up to four pounds. The majority of these bacteria are beneficial and perform a host of important functions, including keeping bad organisms out of the gut, detoxifying the body, digesting food, providing certain nutrients, balancing immune function and protecting against cancer.
The internal ecosystem is complex because each bacterial species has its own preferred niche or microclimate. Unfortunately, current research is limited because many strains simply won’t grow outside the gut in a lab setting. Bacterial DNA testing, however, is now able to detect bacteria accurately and internally. This new research implementing DNA testing has greatly expanded our understanding of the gut’s bacterial ecosystem and its complexity. One interesting finding is the prevalence of different gut bacteria in people from different cultures. Using bacterial DNA testing, researchers found that a person’s gut bacteria physiology falls into one of three distinct groups, categorized as Enterotype 1, 2, or 3. Just as our blood types fall into different groupings (A, B, O), so do our gut bacteria profiles.
This discovery brings up many questions: If we knew which Enterotype we had, could we select the most beneficial probiotic to support it? Should a person with Enterotype 1 eat differently than a person with Enterotype 2? Should she take different vitamins and minerals? Do antibiotics affect enterotypes? Does a person’s enterotype change over time?
Although we do not currently know the answer to all these questions, THIS research suggests an answer to your question. You should stick to the probiotic brand that works best for you because it most likely contains a blend of bacteria that support your particular Enterotype. Compare the product that works well for you with other products to see if your product has more of a certain species. Commercially available probiotic blends include bifidobacter, lactobacillus, and streptococcal species. In Canada and Europe, you can get therapeutic E. coli. There is also a therapeutic yeast probiotic called saccromyces boulardi.Look for dairy-free products to avoid aggravating your gut, and be sure you’re getting enough bacteria; many probiotic supplements do not contain the recommended therapeutic dose of 50 billion to 500 billion organisms per day.
Bacterial DNA testing can provide other valuable information about an individual’s gut ecosystem. Stool DNA analysis offers more detail of the bacterial ecology and the presence of other organisms than traditional under-the-microscope methods. In our office, since we instituted the use of DNA testing of stools, we have found and treated a variety of worms and parasites that simply are not found with simple microscope lab methods. Getting rid of worms can improve gut symptoms in many people with chronic gut problems. It certainly could be true in your case that your symptoms vary from the waxing and waning of abnormal bacteria, parasites or worms.
Your commercial probiotic helps, but only to a point. Find an integrated physician who can offer DNA stool analysis; this may lead to an end of your frustrations and your varying gut feelings.
Nexus March/April 2012