Scott Webb (Host): There are many health benefits to probiotics, but what are they and how do we get them into our bodies? And joining me to answer these questions and more is Dr. Jasmine Vayalil. She's a board-certified family medicine physician with Franciscan Health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's great to have you here today. I was telling you I want to find out more about probiotics. Like I see that word, I hear that word and I'm like, "What are probiotics?" So, we're going to talk to you today about the pros of probiotics, if you will. So, let's just start there. Like, what are they and what's their primary role in our nutrition?

Dr. Jasmine J Vayalil: So, I guess just to start out with what are probiotics, probiotics are live, friendly bacteria and yeast that can benefit your health, especially your digestive system. So while we often think of bacteria as harmful, your body is actually home to trillions of helpful bacteria. So, probiotics are similar to these good bacteria that naturally live in your gut. So as far as how they work, your gut contains a large community of tiny organisms called your gut microbiome. So when this community is out of balance, for instance, after taking antibiotics, during illness, or due to a poor diet, it can lead to digestive problems and other health issues.

So, probiotics then can help by restoring the balance of that good bacteria in your gut. They can break down food more efficiently, improve the absorption of vitamins and minerals, crowd out harmful germs by competing with them for space and nutrients, support your immune system to help your body fight off illness, and strengthening the gut lining, which acts as a barrier to keep those harmful substances out of your bloodstream.

Host: Sure. Yeah. So obviously, a lot of benefits to probiotics and makes me wonder then naturally like, well, when should we have probiotics? When should we take them or drink them or however we get them into our bodies and why?

Dr. Jasmine J Vayalil: One of the most common reasons that I recommend probiotics is during or after antibiotic use, and to help prevent antibiotic-associated diarrhea. Antibiotics kill harmful bacteria, but they can also wipe out good bacteria, so the probiotics can help restore that balance. It can help prevent infections like C. diff that people can get while taking antibiotics. In people with irritable bowel syndrome, probiotics can help with improving symptoms like bloating, gas, abdominal pain, and then just overall general digestive wellness, so to support everyday kind of digestive comfort.

Host: Yeah. Yeah. And you touched on this a little bit, but I want to drill down on some of these individual areas, if you will. So, how do they help then with digestive health? Like, we know we don't have any diagrams or things for you to use to point to today, but do the best you can. Like, how do they help with digestion?

Dr. Jasmine J Vayalil: So, probiotics help restore the balance with your gut bacteria. So, helping replenish the good bacteria in your gut, especially after illness or antibiotic use, like we just talked about earlier. Strengthening the gut barrier, so the probiotics help keep the lining of your intestine strong and intact, preventing harmful substances from leaking through. They help fight off those harmful germs helping crowd out germs that make you sick by, you know, competing for the space and the nutrients in your gut. And then, reducing gas and bloating by helping how your body breaks down food. They may reduce uncomfortable symptoms like gas, bloating, irregular bowel movements. And they can produce helpful substances like short-chain fatty acids that can just help nourish the lining, the cells lining your gut and reduce inflammation.

Host: Okay. It does sound like if we were on a sort of a regular course of probiotics, that it would probably help with our immune support, if I'm hearing that right.

Dr. Jasmine J Vayalil: Right. So, there's different types of probiotics that you can take orally as supplements. Lactobacillus, bifidobacterium, there's a yeast called Saccharomyces boulardii, sorry if I'm butchering the name. There's various different strains. So essentially, the moral of the story is, you know, you should consult with your healthcare provider or pharmacist or both, regarding what's appropriate for your specific condition, because different ones are effective for different conditions. You can get them through your diet, but also through, like, oral supplements that you can take.

So, about 70% of your immune system is located in your gut, and probiotics can support your immune health by boosting antibody production. So by producing those antibodies, it can help fight off infections. And then, reducing inflammation, so promotes anti-inflammatory signals and calming overactive immune reactions. By regular probiotic use over prolonged periods of time, it's shown to potentially reduce the frequency and duration of common upper respiratory infections like colds. So, that's neat. And then also, just interacting directly with immune cells in your gut to help them respond effectively to threats like bacteria and viruses and so on.

Host: Nice. Yeah. So, you give us a sense of how we get these probiotics into our bodies and some of the benefits there when it comes to, you know, fighting off illnesses and that kind of thing. And, Doctor, I've heard this before and I'm stretching the resources of my memory here, but I've spoken with experts at Franciscan Health about the gut-brain connection, and I wanted to ask about mental health. Like, do probiotics—is it possible that they also help with mental health?

Dr. Jasmine J Vayalil: Correct. So, you're right about that. So with the gut-brain axis, your gut and your brain are constantly, talking to each other through this kind of communication highway that we call the gut-brain axis. So, this connection uses nerves, hormones, immune signals, and chemical messengers to send information back and forth.

And like we said, your gut is home to trillions of bacteria, collectively called the gut microbiome, and these bacteria play a surprisingly important role in this conversation between the gut and the brain. In fact, your gut actually produces about 90% of your body's serotonin, which is a chemical that helps regulate mood, sleep, feelings of wellbeing.

So when your balance of bacteria in your gut is disrupted by stress, poor diet, illness, antibiotics, et cetera, it can affect this communication and may contribute to symptoms of anxiety, depression, poor sleep, difficulty concentrating, and so on. So, there's emerging research that suggests that certain probiotic strains, again, like I said, you want to consult with your healthcare provider because not all probiotics are going to help with these things, right? There's certain probiotics that are meant for anxiety, stress, sleep, et cetera. So, these specific, you know, probiotic strains are sometimes called psychobiotics, can help reduce symptoms of anxiety, stress, improve mood, emotional wellbeing, support better stress resilience, calm the body's stress response system.

An important caveat being, you know, the research is promising, but it's still evolving. This is not meant to be a first-line treatment. It's a complementary approach. So, probiotics are not a replacement therapy, medication, or professional mental health treatment. It's just meant to be an adjunct treatment. So like, you know, do not stop your medication to try the probiotics instead. It's more like to take them hand in hand. And again, you know, discuss that if you're taking prescription medications with your healthcare provider and/or pharmacist.

Host: Of course. Yeah. Rely on the experts, if and when possible. Certainly. I think I read this, Doctor. I wanted to find out, obviously, probiotics have so many benefits. Do they also help with skin health?

Dr. Jasmine J Vayalil: Right. They do. So, kind of similar to we talked about a gut-brain axis, there is something scientists also call the gut-skin axis. So, it's a two-way communication system between the bacteria in your digestive tract and the health of your skin. So when these bacteria are out of balance, it can trigger inflammation throughout your body, including in your skin. And that has the potential to worsen conditions like eczema, acne, psoriasis. So, probiotics can help restore this balance and support skin health from the inside out.

For example, for families with a history of allergies, certain probiotics given during pregnancy and/or infancy may reduce the risk of eczema in children. These are typically started during the last trimester of pregnancy and continued in the infant for the first six months of life. However, you know, obviously discuss timing and dosing with your doctor. And then, along with that, so kind of along the same lines with eczema, some studies show that certain probiotics can reduce the severity of eczema especially in children.

One clinical trial found that 12 weeks of oral probiotics reduced eczema severity and possibly even the need for a steroid cream. So, that's neat. And then, as far as like acne, early research suggests that probiotics may help reduce acne-related inflammation, and then just overall general skin health by reducing overall inflammation and supporting immune balance, just kind of promoting healthier, calmer skin in general.

Host: Yeah. It does sound like probiotics are kind of magical in a way. Like, they help with so many things. And course, we should consult with, you know, our healthcare providers and all of that. I guess I'm wondering specifically about diet. Like, how do probiotics benefit our diet in general?

Dr. Jasmine J Vayalil: Right. In kind of a number of different ways. So, overall helping with nutrient absorption, so they help your body get more vitamins and minerals from the foods you eat. Improve digestion, like we talked about earlier. I think probiotics help break down fiber and other complex foods, making digestion smoother and more comfortable.

Eating probiotic-rich foods adds a more variety to your gut bacteria, which is, you know, like we discussed, helps with better overall health. There's even some research that suggests that probiotics may help with blood sugar regulation and cholesterol levels. So, kind of a lot of ongoing research and just figuring out even more ways that probiotics are just beneficial to our overall wellbeing.

Host: Yeah. And despite the fact that they've been around for a while, it does seem like research is ongoing and we're learning more and more about them and the benefits. But also makes me wonder then, Doctor, like what are maybe some of the risks, drawbacks, maybe some negative interactions with certain medications? Like, are there any downsides, so to of probiotics?

Dr. Jasmine J Vayalil: That's a good question. That's important to address. So, probiotics are generally considered safe for most healthy people. However, there are some things to be aware of. I guess just kind of, you know, generally as far as side effects goes, there's mild side effects, which are usually temporary, but that can include gas and bloating, mild stomach discomfort, loose stools, or change in bowel habits.

These symptoms often improve within the first few days to weeks as your body adjusts, but just kind of as an FYI to be aware of. More serious concerns, like rare, but in, you know, potentially can cause serious infections in people with severely weakened immune systems, those who are critically ill, with central venous catheters and so on.

So obviously, like can't stress enough how important it is. Even though we think it's something that's benign, it can cause interactions with medications and in certain conditions. So, do always consult with your healthcare providers, like we said. In the United States, most probiotics are sold as dietary supplements, not medications, meaning that they're not always held to the same strict quality standards as a prescription drug, so quality, potency, purity can vary between brands. So again, important to see what would be like the best one for you.

And then, just in general, people who should be cautious, those with weakened immune systems, organ transplant recipients, those on chemotherapy, those who are critically ill, premature infants, et cetera.

There's one more specific medication interaction I wanted to mention, for people who should be especially cautious, taking probiotics, like those with weakened immune systems or organ transplant recipients.

If you are organ transplant recipient or on immunosuppressive drugs like tacrolimus, everolimus, there is some recent research that suggests that certain probiotic organisms may break down the immunosuppressive medications in the gut before they can be absorbed. And this can make these medications less effective, which is especially dangerous for organ transplant recipients. So, that is a group that really needs to be kind of aware of that and really consult with their providers before, you know, considering starting anything like this.

As far as antibiotics as well, like I said, that's one of the more common indications that I'll recommend people take probiotics while they're on antibiotics to help prevent antibiotic-associated, you know, diarrhea and GI discomfort. While the probiotics are often taken alongside, antibiotics may kill the probiotic bacteria. So of note, it's generally recommended to take the probiotics at least two hours apart from the antibiotics to get the maximum benefit.

Host: So then, doctor, how do we get started with probiotics? Do we ease our way into it, right? And like, what's the best way to get started and then also to continue on?

Dr. Jasmine J Vayalil: Right. Like I said, you can get it from foods, you can get it from supplements foods are generally preferred for everyday health because they also provide other nutrients like protein, calcium, vitamins, fiber. They're also a natural, affordable, and enjoyable way to kind of support your gut health.

So, some examples of probiotic-rich foods are yogurt with live active cultures, unpasteurized sauerkraut, kimchi, kombucha, some cheeses like Gouda, cheddar, cottage cheese, pickles that are naturally fermented. Supplements are useful when you need a specific strain or a higher dose. They're convenient and easy to take, may be recommended by your doctor for a specific condition like I mentioned earlier.

And so, general tips for getting started, start slowly. Introduce one probiotic or food, or a low-dose supplement and and gradually increase based on, you know, kind of your clinical response and tolerability. Look for products that list specific bacterial strains and number of colony-forming units. Store probiotics as directed. Of note, some of them do need to be refrigerated, so that's something to be mindful of. And then, pair probiotic with prebiotic-rich foods, so bananas, onions, garlic, oats, asparagus to help the good bacteria thrive.

One way to think of it is probiotics are the plants, like the live beneficial bacteria that you add to your gut garden, and then prebiotics are like the fertilizer. So, like the special types of fiber that feed and nourish the good bacteria that already live in your gut. So, the best way is to take both of them together, like to work together to keep your digestive system healthy, support your immune system and promote overall wellbeing.

Host: Right. I was hoping you were going to say coffee. Drink a lot of coffee, that's really good when it comes to probiotics. But, you know, as you said, it's ongoing. Research is ongoing. You never know.

Dr. Jasmine J Vayalil: Yeah.

Scott Webb: So then, Doctor, how do we know that a probiotic is working? What are the signs, if you will, that, hey, this thing, this is the right thing for me?

Dr. Jasmine J Vayalil: Okay. So, what are signs that a probiotic is working? It typically takes two to four weeks of consistent use to notice benefits. Though some people may notice changes sooner. Signs might include more regular bowel movements, less bloating and gas, reduced stomach discomfort or cramping, improved stool consistency, fewer episodes of diarrhea or constipation, better overall energy, well-being, improved skin appearance, again, over a longer period of time. And then, the fewer colds or infections, again, over a longer period of time. Keep in mind that some bloating or gas in the first few days is normal and usually goes away in some time. If symptoms worsen or do not improve after four to six weeks, you want to talk to your healthcare provider. You might need a different strain or dose if you're taking an oral supplement and like I said, not all probiotics work in the same way. Different strains have different health benefits, and that's why you want to consult with an expert first before starting.

Host: Of course. Well, it's been great to consult with an expert, if you will, today and have your time and your expertise. Really helpful, really educational. Just give you a chance here at the end, Doctor, final thoughts, takeaways. We teased this as the pros of probiotics. So, maybe go back over things.

Dr. Jasmine J Vayalil: Yeah. So overall, we discussed that, you know, probiotics have a lot of benefits in multiple kind of systems in our body that can help with digestive health, immune health, mental health, skin health, and so on. One of the other areas that I did want to just briefly touch on is with women's health.

I've heard this anecdotally from, you know, some patients that I see in clinic. But there are some studies that suggest that some probiotics support vaginal health by maintaining a healthy balance of bacteria. So, that might help prevent, you know, recurrence of yeast infections, urinary tract infections, and also help prevent recurrence of bacterial vaginosis.

Bacterial vaginosis is the most common vaginal infection in women of reproductive age. It occurs when the balance of the vaginal bacteria shifts away from the protective, bacteria toward the harmful bacteria. And it often comes back after antibiotic treatment. So, the probiotics can help in that regard by, you know, using it after the antibiotic treatment. It can help restore the good bacteria and reduce the chance of recurrence. , So kind of also to help reiterate, you know, probiotics are not a substitute for medical treatment. So, always follow your healthcare provider's advice. It is really kind of a complementary approach to kind of help with your overall wellbeing in addition to the traditional, you know, medications or wellness plan that you're recommended to follow.

Like we've discussed, they offer a plethora of benefits. You know, it doesn't replace a healthy diet rich in fruits, veggies, whole grains, and fermented foods that are the foundation of good gut health in general. So, always keep that in mind and at the forefront.

Host: Yeah. Like I said earlier, they do sound sort of magical, but they aren't magic. We still have to do our part. So, behavior, lifestyle, diet, exercise, all those old chestnuts, you know, come into play as well. So again, appreciate your time and your expertise. Thanks so much.

Dr. Jasmine J Vayalil: Yeah. Thank you for having me.

Host: And for more information, visit franciscanhealth.org and search gut health. And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.