Reader Question: Probiotic Predicament

Reader Question: Probiotic Predicament

I have another reader question post for you, this time dealing with probiotics and gut health. This is a follow up to the previous reader question post about Candida. The person emailed me with follow up questions to that post.

Since the email is a bit long, I broke it up in pieces and answer each piece individually. But the main issue is probiotics. How to make sense of the confusing opinions and conflicting information about probiotics? How to know which supplements are helpful and which are useless?

I’ll do my best to shed some light to these questions.

Thanks for your blog post, it was extremely helpful. I’m glad you knocked some sense into me, because you were right about my logical leap. I guess blaming my acne on candida made me feel comfortable, but being logical and patient will reward me in the long run.

I totally get this. When you are suffering with something, you want to know what it is. Getting diagnosed is the first step in getting over the problems, because now you know what the problem is and you can start doing something about it.

This is where you need critical thinking and to keep a calm head. Otherwise it’s easy to start charging full steam to the wrong direction! And you especially have to be careful with information coming from forums and other not so reliable sources.

As a rule, most people suck at critical thinking. It goes against what the brain naturally does (i.e. find patterns and jump to conclusion, see patternicity). Critical thinking is a skill of stepping back and logically examining the conclusions your brain is steaming towards. It’s a skill you have to learn and practice, and feels very unnatural at first.

Making sense of probiotics

But I digress.

Anyway, moving straight to the point. Today, I went to kaiser and now my doctor is going to run a blood and stool test for me, that is when she’s done researching my symptoms. Before I left, my doc advised me to take lactophilus. Here’s where I need your advice.

I’m still reading your informative posts, but in a particular one you say probiotic supplements are generally useless because they may not have the strain we need for acne reduction?

I wouldn’t go as far as to say that probiotics are useless. There are studies that show reduction in acne from probiotic supplements. The problem is that our understanding of the bacteria that live in the digestive track (gut microbiota), their effect on health, and what we can do to correct problems is still at infancy.

Think of probiotics like vitamins. There are many different vitamins, each with different function in the body. Giving vitamin A to a person who is deficient in vitamin E doesn’t help. Consequently, giving a ‘wrong’ strain of probiotic to a person may not help – and in some cases could even be harmful.

This is an incredibly complex subject and it will probably take another 5 to 10 years before science comes up with answers we can really rely on. Sucks, but there you have it. In the meanwhile we just have to make do with what we have. That’s why I say probiotics and bit of a hit and miss.

You just have to try something and see what happens. I would also recommend keeping a close eye on your gut. Monitor your bowel movements and look for changes in symptoms. And be open to the possibility that probiotics make your situation worse.

Problems from fermented foods?

Anecdotally, I’m starting to think eating yogurt is not good for my gut. About 4 months ago I was eating yogurt (homemade) regularly, and had been doing that for the past 8 to 12 months. Around that time I also noticed onions give me gut problems, and eating them usually led to a breakout on my scalp. For some reason (can’t remember why) I stopped eating yogurt. Overtime I noticed that when I accidentally ate onions, they didn’t cause such noticeable symptoms anymore. I still noticed symptoms but much milder than before.

Last week I decided to make yogurt again and have it on breakfast. I noticed that within 30 minutes of eating yogurt my gut started rumbling, and I had to visit the bathroom. My guess is that yogurt contained bacterial strains not normally found in my gut, and introducing those foreign bacteria disturbed the ecosystem.

I also suspect that earlier, when I was eating more yogurt, constantly introducing probiotics from yogurt caused some bacteria to migrate up the digestive track to the small intestine (that’s usually relatively sterile), and that caused some problems with onions. Small intestine bacterial overgrowth (SIBO) is quite a common feature in some gut problems.

This is of course speculation, so take it for what it’s worth. And even if my speculation is correct, it only applies to my own yogurt. Different fermented foods have different strains of bacteria and thus may have different effects.

But, since the supplement my doc wants to give me is actually lactophilus and not just labeled “probiotics” would that still qualify as a blind shot?

Lactobacillus is one genus (like bacterial race) among so-called probiotic bacteria, but within that genus there are over 180 different strains. It’s hard to say how well those different strains play along, and whether you can swap one strain to another and still get the same benefits. That said most probiotic studies use lactobacillus and/or bifidobacterium. So if I were to take a supplement, I would take something advertising those. Unfortunately that’s about all I can say about this, and you have to ask someone with more hands of experience.

So I’d say that the supplement your doctor prescribed is probably a bit of a blind shot, but I would trust the doctor.

Chiropractor delivers a steaming pile of turd and bad advice

Also, I read an article from one of my favorite blogs, the sock-doc, and he claimed that probiotics are practically useless in healing the gut because they’ll just killed off by the harmful bacteria or yeast thriving inside the gut. Thus it’s important to eliminate the bad bacteria first. Here’s a link to his article so you see where I’m coming from:

When I read that article, I kept thinking how badly derailed the doctor was. I couldn’t believe any serious doctor would write that. After clicking to the ‘about the doc’ page it became clear. We aren’t talking about a real doctor, but a holistic, chiropractic ‘non-dr.’

I can’t speak of his other articles, but this one was really, really bad. Full of usually alt-med oversimplifications and conspiracy drivel. Some of the more ridiculous points:

  • Doctors and medical scientists aren’t interested in probiotics. What a steaming pile of turd. This is a very active area of research, and probiotics are studied for many conditions. The difference between science and alt-med is that scientist don’t willy-nilly recommend treatments with unknown safety and efficacy. While supplements seem benign, we can’t really say they are safe until they have been studied. Take vitamin E and selenium as an example. Several smaller studies suggested they can reduce some cancers. But a large and well-controlled study showed taking vitamin E and selenium increased the risk of prostate cancer by 17%.  One thing I so hate about alt-med practitioners is how they substitute confidence for evidence. They confidently prescribe supplements to patients without really understanding the effects of their recommendations.
  • Fermented foods are healing foods. Well, they may, or they may not. The good doctor doesn’t really know. It’s certainly possible fermented foods help, but it’s also possible they cause problems for some people.
  • Bashing fecal transplants. Scientific medicine uses fecal transplants because they are one of the treatments that have actually been shown to work. It involves taking a fecal sample from a family member (usually) and then transplanting it to the patient.  Because family members tend to have similar gut bacteria, it makes this treatment far more targeted and likely to work than blindly prescribing probiotics. Imagine that, those evil doctors using a simple, one-off and relative cheap treatment. But don’t let facts stand in the way of good conspiracy mongering, doctor.

Anyway, getting back to the point that harmful bacteria kill good bacteria. Yes, some bacteria don’t get along well, and when you introduce foreign bacteria into the gut there will be some fighting. But this doesn’t only apply to the harmful vs. helpful bacteria. I’m fairly certain that even different probiotic bacteria don’t get along. That’s why I say it’s possible that taking probiotics can cause problems.

The way I understand it is that the bacterial composition in the gut depends largely on your diet. Different foods leave different substrates available for bacterial fermentation. Basically, different foods feed different bacteria. And when you change your diet, then the bacterial composition also shifts.

That’s why I believe healthy diet is one of the best treatments for gut problems. Nothing too complicated; fruits and vegetables, healthy fats, animal foods and avoidance of most processed crap. Of course some people have problems with FODMAPs and may have limited tolerance for fiber, so you have to monitor the effect diet has on your gut.

Take-away points

This turned out little bit of a ramble, but hope I answered most of your points. Here’s what I’d like you to take home from this post:

  • Science doesn’t understand gut microbiota and probiotic bacteria nearly well enough to make good recommendations. Therefore you have to do some experimentation and monitor your results. And be open to the possibility that popular treatments that ‘make sense’ may make your situation worse.
  • It’s impossible to say which probiotics help and which don’t. Try something and see what happens. I would take something with lactobacillus and bifidobacterium.
  • In some cases fermented foods are probably helpful, but they also need to be judged on a case by case basis.
  • Keep a food journal and monitor your gut, as outlined here. This should help you to figure out which foods are good for your gut and which may not be.

I wish I would have more concrete and useful answers, but it is what it is.

About Me

Hi, I am Acne Einstein(a.k.a. Seppo Puusa). I'm a bit of a science nerd who is also passionate about health. I enjoy digging through medical journals for acne treatment gems I can share here. You can read more about my journey through acne and how I eventually ended up creating this.


6 thoughts on “Reader Question: Probiotic Predicament”

  1. Wow, thanks again for such a scholarly reply!
    Yeah, this is embarrassing, yet amusing to admit…but, I checked out your link to that balogone test kit. And, let’s just say when I did, I saw the sock-doc in a different view. He can come off a little too bias in the majority of his articles.
    Ahh, and you say I should probably trust my doctor. It’s just that I’m a little uneasy, because 1) this was the first time I met her and 2) I thought it’d be better if I would hold off until I get to take my stool and blood test…but…I’ll just take the chance…
    Oh and, I think I’m doing pretty well with my diet. I pretty much follow a low-FODs diet, because a few months back, I found out fruits were giving me massive bloating issues…
    Anyway, words can’t express how thankful I am for your knowledge and critique! Please take care! And, if another question appears, I know who to come to! (If you don’t mind haha)

    • I’m sure the sock doc has a lot of good info on his site. The problem with many alt-med practitioners is that they freely mix evidence-based information with total nonsense, and sometimes it’s hard say where one ends and the other begins.

      I don’t understand what are you afraid will happen if you trust your doctor and take those probiotics. I think it’s highly, highly unlikely they cause any long-term harm. If they don’t agree with you, most likely you’ll just notice bloating and increase in other GI symptoms. Those should resolve once you stop the probiotics. At least that’s what happened with me and yogurt.

      Anyway, happy to hear if you are becoming more skeptical. It’s perhaps the best thing that happened to my health. Gives you freedom to say BS to a mountain of nonsense without having to try it out for yourself first.

  2. This is a really cool subject, but like Seppo said, I don’t believe that researchers really, completely understand what any *specific* strains of bacteria are doing in human guts at the moment. It is a complicated subject, given how complicated our symbiosis with microbiota really is. However, fecal transplants have shown that gut bacterial communities (the key word here is “community”) are very important for “normal” digestion.

    We, as humans, are born with specific communities of bacteria – these communities consist of thousands of species and strains – many of which scientists have not characterized at this point – that change over time and environments. So, why would only one strain or species be relevant to acne and other diseases? Seems too simple to me unless someone has shown a direct association. It’s possible that probiotics would help, but I don’t think that taking any one probiotic will completely solve any acne issue. Acne is a mixture of inflammation (immune response, essentially), hormones, genetics, and bacteria in your skin. So, bacteria is only one part of the equation, and no one has really shown that “good” bacteria (“probiotics” – which is such a relative term, to begin with) can actually affect acne. Though, it would be really awesome if they found a strain of bacteria that outcompeted the bacteria that cause acne, without causing any symptoms itself.

    • There is some evidence that probiotics can help with acne. It’s not what you would call strong evidence, but there are studies that suggest it. I can’t remember now if there have been studies using probiotic supplements, but there’s at least one Korean study that found a positive effect from a fermented dairy drink. There’s also indirect evidence showing people with skin problems (acne included) have more disturbances in the gut microflora. But you can’t really conclude from that that taking probiotics help with acne.

      I’m also not sure that taking a single strain would do much of a difference. Some doctors’ blogs I follow make the analogy of planting a few fields of corn into rain forest and expecting it to change the whole ecosystem. Perhaps taking a mixture of probiotics would have a different effect. Perhaps they just temporarily hold off the harmful bacteria in the gut and thus allow the ‘native’ probiotics in the gut to recover. It’s too early to say much. I guess we have to wait until the human microbiome project finishes to understand this better.

  3. I started making Milk Kefir a few weeks ago. And normally my stomach would always growl and make noises when I started to eat. But it stopped doing that after I started eating Milk kefir, so I guess that it’s a good sign since nothing bad has happened? Although… I’m not sure if it’s because of the Kefir or not but I have been slightly constipated lately and I dunno if it’s because of the kefir or not..

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