Teaser Excerpt from The Paleo Approach: Probiotic Supplements
February 18, 2013 in Gut Health, Supplements, The Paleo Approach Excerpts
Last week I posted a teaser excerpt from The Paleo Approach about the importance of including probiotics (while the book is written from the perspective of autoimmune disease, the benefits of probiotics extend to all health conditions and human health in general). However, there are many people who don’t do well with fermented foods (reasons might include a yeast sensitivity, which is common in people with gluten intolerance, or a histamine sensitivity) or who just plain old don’t like them. So, it’s no surprise that that post prompted a series of questions about probiotic supplements. I have decided to share another excerpt from the book with you to help answer the question of probiotic supplements.
I should probably mention that both of the specific brands of probiotics mentioned in this section are ones that I take myself (and chose after a great deal of research). I’ve been taking these for 4 or 5 months and really like both of them. I also heard Chris Kresser rave about Prescript-Assist in his most recent podcast (just in case you were looking for a second opinion!).
This excerpt is from Chapter 8 (the supplements chapter).
As mentioned in Chapter 6,different strains of probiotics confer different effects on your body. However, from the vast array of different probiotic bacteria (approximately 35,000 species), only a handful have been characterized.
As previously mentioned, probiotic supplementation was shown to be beneficial for the management of every autoimmune disease in which it has been tested, including: inflammatory bowel disease, autoimmune myasthenia gravis, celiac disease, rheumatoid arthritis, multiple sclerosis, and autoimmune thyroid disease. However, it is important to note that there is also some conflicting information. In fact, there is convincing evidence that both bifidobacterium and lactobacillus probiotic bacteria (the two most common bacterial genera in probiotic supplements) are a source of autoantibody formation through molecular mimicry in autoimmune thyroid disease (discussed in Chapter 2). Furthermore, there have been reports of severe eosinophilic syndrome—a condition characterized by elevated eosinophils (a type of white blood cell important for the innate immune system) in the blood with damage to cardiovascular system, nervous system, and/or bone marrow—directly attributable to the use of probiotics (both in people with a history of autoimmune disease but also in completely healthy individuals).
What does this mean? If you do not tolerate fermented foods, probiotics are definitely worth trying. The majority of the evidence in the scientific literature supports their potential benefits; however, some caution is advisable. Just as in the case of fermented foods, probiotic supplements can be added after following The Paleo Approach for several weeks (at least 3) in the case of people with severe gastrointestinal symptoms or known bacterial overgrowth.
Which probiotics should you take? Probiotic supplements fall into two categories:
Lactobacillus/Bifidus: Lactobacillus and bifidobacterium are the two most heavily studied genera of probiotic bacteria. They are also the most commonly found in supplement form. It is important to note that even though the majority of scientific studies show health benefits of these strains, these are also the strains that may contribute to autoantibody formation and to severe eosinophilic syndrome in some people.
If you choose to take a lactobacillus and bifidobacterium supplement, look for a brand with as many different strains as possible (for greater probiotic diversity). However, be cautious: dairy ingredients are common in these types of supplements. Look for a bottle that specifically brands itself as dairy-free, gluten-free, soy-free, corn-free, wheat-free, egg-free, peanut-free, and tree nut-free. Also look for one that is yeast-free if the reason you are taking a probiotic supplement instead of eating fermented foods is yeast sensitivity concerns. One high-quality brand to look for is Kirkman.
Start with a low dose, even breaking open a capsule and sprinkling a small amount in your food or in a small cup of water. Alternatively, you can take your probiotic supplement every 2 or 3 days. Over the course of several weeks, work your way up to the suggested dose on the bottle, taken daily. Some probiotic supplements recommend taking with food while other recommend taking them on an empty stomach. It is typically best to follow the specific recommendation of the brand you are using. If your probiotic supplement does not have directions regarding whether or not to take it with food, first try taking it on an empty stomach. After several weeks, switch to taking with food and see if you notice any improvement.
Soil-Based Organisms: While not as extensively studied as probiotics from the lactobacillus and bifidobacterium genera, soil-based organisms hold extreme promise for modulating the immune system and correcting gut dysbiosis. They have been shown to have extreme therapeutic potential in Irritable Bowel Syndrome and provide probiotic organisms that are routinely missing from our modern, over-hygienic lifestyles yet are normal residents of a healthy gut.
One brand to look for is Prescript-Assist which contains 29 different strains of soil-based organisms and is also dairy-free, gluten-free, soy-free, corn-free, wheat-free, egg-free, peanut-free, tree nut-free and yeast-free (also none of the strains included in Prescript-Assist come from the lactobacillus or bifidobacterium genera, or indeed any of the strains typically found in fermented foods). Prescript-Assist has one of the best diversity of any probiotic supplements available. Soil-based organisms seem to be better tolerated than lactobacillus and bifidobacterium, although extensive comparisons have not been made.
It is typically recommended to take two capsules daily (divided into two doses) for thirty days, followed by one capsule once or twice per week as a maintenance dose. Because the strains in soil-based organism probiotics are different from the probiotic strains typically found in fermented foods, it is worth strongly considering taking a soil-based probiotic even if you are eating fermented food or taking a lactobacillus and bifidobacterium-based probiotic supplement.
Bittner AC, Croffut RM & Stranahan MC, Prescript-Assist probiotic-prebiotic treatment for irritable bowel syndrome: a methodologically oriented, 2-week, randomized, placebo-controlled, double-blind clinical study, Clin Ther. 2005 Jun;27(6):755-61.
Bittner AC, et al., Prescript-assist probiotic-prebiotic treatment for irritable bowel syndrome: an open-label, partially controlled, 1-year extension of a previously published controlled clinical trial, Clin Ther. 2007 Jun;29(6):1153-60
Jirillo E, Jirillo F & Magrone T, Healthy effects exerted by prebiotics, probiotics, and symbiotics with special reference to their impact on the immune system, Int J Vitam Nutr Res. 2012 Jun;82(3):200-8
Kiseleva EP, et al., The role of components of Bifidobacterium and Lactobacillus in pathogenesis and serologic diagnosis of autoimmune thyroid diseases, Benef Microbes. 2011 Jun;2(2):139-54.
Klaenhammer TR, et al., The impact of probiotics and prebiotics on the immune system, Nat Rev Immunol. 2012 Oct;12(10):728-34
Kverka M & Tlaskalova-Hogenova H, Two faces of microbiota in inflammatory and autoimmune diseases: triggers and drugs, APMIS. 2012 Oct 24.
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Do you have any brand recommendations for people in Europe? Prescript Assist will not be shipped to Germany, neither does (tried to order it some weeks ago) e.g. Syontix Probiotics. I guess it is a question of package insert or so.
I have crohns disease and am very sensitive to just about everything new I try (whether it be a new food or Rx). A doctor at a CCFA seminar told us to use just regular yogurt for a probiotic. I cannot tolerate yogurt at all for some reason. Even when I am in remission with my crohns two tsp of yogurt will set off my stomach. So if I am reading your post correctly I should try the soil-based and see how that goes? Why do you think I respond so badly to yogurt when so many others with crohns swear it works for them? Thanks for any info.
Dairy proteins have very similar effects to gluten in the gut and diary intolerance is extremely common in autoimmune disease. So, it might just be the fact that it’s yogurt made from cow milk (which is what I’m assuming). Either way though, yes, I think soil-based would be a good thing to try.
Hi! I was wondering about bifidobacterium and lactobacillus being “a source of autoantibody formation through molecular mimicry in autoimmune thyroid disease”. I have ai thyroid disease and I take a probiotic with those two strains (BioKult) but I’ve only just starting taking the probiotic (4 weeks now) and I’ve had ai thyroid disease for at least 6 years. I didn’t take any probiotics before this. Well, some yoghurt on occasion but that’s it. I’m just wondering if the probiotic only causes the molecular mimicry or if it also continues it. I’m following a cross section of GAPS/AI Paleo right now, hence the BioKult. I’m googling now for more information but if you have any links to studies, I’d love to see them. Thanks! Jen
The study is in the references. All the study was able to say was that the antibodies formed in autoimmune thyroid disease also bind to proteins specific to those bacteria. So, basically, if you have a leaky gut and you have those bacteria in it (either from probiotics or normally), proteins from those bacteria are a source of autoantibody formation. But, taking those probiotics shouldn’t on their own perpetuate autoantibody formation–that’s more about having a leaky gut and eating foods that stimulate inflammation or rev up the immune system.
Thanks! and Duh! I just skimmed over the references without reading them – bad Jen. Just read the abstract and that is very interesting. I may have to reassess my probiotics. I’ve only been taking them for a month but I’ve been consuming ferments for about 6.
One more Q: Do you know specific these strains are? For example, BioKult has Bifidobacterium bifidum PXN 23 while the study references Bifidobacterium bifidum 791. Do the numbers make much of a difference or would the whole family be part of the molecular mimicry phenomenon? That’s just one example, all of the strains they mention (except Bifidobacterium adolescentis) are in BioKult but none of the numbers at the end match up.
Thanks again, can’t wait for the book!
When it comes to molecular mimicry, there will be an incredible similarity between those strains that it likely doesn’t make a difference, but at the same time, the only hard conclusions can be drawn from the stains studied.
Hi, firstly congratulations and thank you for all this excellent free content. I’m looking forward to the book.
I’m wondering what your thoughts are on the safety of soil-based organisms. A quick search reveals lots of articles suggesting that propagation via spores can be dangerously effective. Could Prescript-Assist start a colony of bacteria that grows out of control?
I know I’m allergic to some (if not all) mould. Is it possible I will also have a problem with soil-based organisms?
The issue of possible overgrowth is not at all limited to SBOs. It’s possible for any bacteria to overgrow if you aren’t eating the right foods, aren’t sleeping well and aren’t managing stress. But, I think what you are referring to is that early SBO formulations contained the strain Bacillus licheniformis which has since shown to be pathogenic/toxic. Prescript-Assist does not contain that strain (actually, I think that most if not all manufacturers have removed that strain from their formulations). Prescript-Assist is the only SBO to publish a peer-reviewed longer-term study on its use, so I do feel comfortable recommending it.
Thank you for your response, much appreciated. I’m going to give it a try.
I clicked on the link for Prescript Assist because I would like to try it but the picture on amazon that comes up is different than the one on you post? Are they different? Is the one that is linked OK to order from? PS I can’t wait for your book.
They’ve changed their label. It’s the same stuff though.
Awesome, thank you!
Why do you recommend starting slowly with probiotics?
Some people have very dramatic reactions to probiotis. Plus, if you have a severe overgrowth, they can actually make the problem worse, which is why I advise adding them in after a few weeks.
Hi Sarah (this is a continuation of Melissa’s question above) – I’ve been on probiotics for years now but still having gut problems (I’ve commented on the AI post and the SIBO posts…). My question has to do with treating SIBO and/or dysbiosis in general (too much bad bacteria) – while I’m “proactively” treating this, should I HOLD OFF on ALL gut repair and reinoculating steps? This would be stopping the l-glutamine, quercitin, zinc and DGL (I’m also considering colostrum as well), as well as ALL probiotics?? I’ve been taking the l-glutamine and probiotics for a while now (a couple of years). My out-of-state ND wants me to try a combo of SIBO treatments: neomycin, berberine complex and oregeno oil, plus a low fodmaps diet (I’m also going to do maybe a combo of your SIBO/fodmaps protocols? I tried the treatment as prescribed for a few days (drugs and pills) but think I had a pretty severe allergic reaction, so I’m actually hesitant to try those again and would prefer to kill off the bad guys with diet only and perhaps some caprylic acid/lauricidin supplements. I think, if I’m reading your post on probiotics correctly, that you DO advise to NOT take probiotics for 2-3 weeks while initially treating SIBO or any form or gut dysbiosis to ensure any overgrowth (good or bad) is killed, right? Thanks in advance!
For some people, taking probiotics can actually make overgrowths worse, depending on the probiotic. You might not need to stop (although that’s still a good option to consider for a couple of weeks), but might find that switching brands, especially switching to a soil based probiotic, might be very helpful. You’ll also get much more diversity in microorganisms from fermented foods, so that’s another way to go. Also, quercitin and DGL are immune stimulators, so depending on exactly what’s going on in your body, they might not be helping (they only stimulate certain cell types which is thy they can be useful is some situations; colostrum is similar). You might have had a severe die-off reaction as opposed to an allergic reaction (they can be similar, rashes and diarrhea being the most common symptoms of diet-off). It can really help to support liver function while going through die-off, which means lots of organ meat, fish, and cruciferous veggies (sticking with the ones that are also low FODMAP–I do think that makes sense).
Hi Sarah, thank you for this information! Honestly, I don’t know EXACTLY what is going on (it’s been chronic for years and years…), so it’s been a trial and error process. I like your idea of switching to a soil based probiotic (which is one thing I have not tried). It could have been die-off, but it started literally within 24 hrs of the treatment (that said, the rash, swelling – all around my eyes – last for a couple of weeks and JUST went away hence my reluctance to go back to such a harsh approach). I really want to tackle any overgrowth, so I’m going to move forward, probably removing quercitin, dgl, colostrum etc initially and start off more slowly with the antibacterial meds and continue to take milk thistle for liver support (which I’ve been taking daily for a couple of months). Thanks again for all of your support and information – it’s pretty scary and intimidating trying to figure out and tackle all of this on my own – your site, balanced bites, chris kesser, et al have all been wonderful sources of information! Have a great weekend, and I will be on the lookout for your book – can’t wait!
Is there a soil based probiotic for children? I give both my kids probiotics in powder form currently off a spoon.
I don’t know.
What are your opinions on probiotic supplements while pregnant? I’ve taken various probiotics on and off through the years. Do you feel that either of your recommendations are safe to add while pregnant? What other things can I do to improve my gut flora before giving birth?
Yes, I feel that both would be safe during pregnancy. But, I will say that you will get greater probiotic diversity from lactobacillus and bifidobacter type strains with fermented vegetables. The other thing you can do to improve your gut flora is to eat tons of vegetables (non-starchy and starchy) and to be very mindful of your omega-3 intake (specifically, the ratio with omega-6) and I’m assuming you are already eating a paleo diet. Insoluble fiber and omega-3 fats are the two biggest influences of the numbers and types of bacteria growing in your gut once you remove the factor of excess sugars that are difficult to digest (basically, one you stop eating grains and legumes).
I have been dealing with leaky gut and Candida all my life and now,thanksto you, understand the roleauto-immunity plays. I have taking SBO Bacillus Coagulans from Thorne for about 1 month and Prescript Asssist for about 2 weeks. What an amazing difference!!! I can now eat fruit as well as paleo friendly starches like root veggies and plantains in moderation without the candida coming back!!! Doing the AIP, I progressed in a month what I hadn’t in 2 years. I started incorporating back in what I eliminated and have fond I am not ready. I am so grateful your website and information. I can’t thank you enough. Btw I have tried some of your recipies like the mofongo. Awesomeness!!