Transcription:
Probiotics in Gastrointestinal Conditions

Melanie Cole (Host):  From supplements to yogurt to granola bars, probiotics or showing up on labels everywhere and they claim to improve digestive health and a number of other ailments. But what exactly are they? In this great segment today, my guest Dr. Jatinder Pruthi, he’s a board certified physician in gastroenterology and a member of the medical staff of Palmdale Regional Medical Center is here to tell us all about them. So, Dr. Pruthi, welcome back. Always a pleasure to have you on with us. What are probiotics and how do they work in the body? What are they intended to do?

Jatinder Pruthi, MD, FACG, CPI (Guest):  Probiotics are a good bacteria. Good microbes. Normally, our intestinal tract is a host to a vast variety of microbes. So that are a necessity for health but sometimes also have potential to contribute to the development of a disease process. Now probiotics are the good bacteria. Those are the friendly bacteria which when we consume in adequate amounts, they have beneficial properties for us.

Now most commercial probiotics that are available are derived from food sources like cultured milk products and yogurt and stuff and they contain these lactic acid bacilli. Those are the bacteria which are good for us.

Host:  Okay so, they are available in food but there are supplements everywhere Dr. Pruthi. So, tell us a little bit about the different types of probiotics. We’ve even heard the word prebiotic and from a GI perspective; what are you doing? What are probiotics doing in our gut? Are they fighting the bad bacteria with the good bacteria? Are they the little armies in there? How are they helping us?

Dr. Pruthi:  Probiotics are common I mean we can get from the food products also. But now the majority of the probiotics which are consumed by a lot of people are commercially available products which are derived from these food products though. The most commonly available probiotics include VSL#3, Align, Culturelle, DanActive, NutraFlora Florastor, Ortho Dophilus, Bifidobacteria. There are so many of them. And these are friendly bacteria.

Now how do they work? When we consume the probiotics, somebody is taking the supplements, so what they do in our body is they suppress the growth of harmful or pathogenic bacteria. So, we are consuming probiotics, good bacteria, good microbes in large numbers so they try to outgrow the bad guys. Secondly, they improve the intestinal barrier function. So, normally when we eat food or anything that goes into our system, the intestinal lining cells are tightly knit together, and they work as a barrier. So, they don’t let the bad stuff get into the body. Pro bacteria they help to strengthen that barrier function.

Then they also modulate the immune system. Several probiotic species or their products induce productive cytokines. Those are the protective chemicals that our body secretes. Or sometimes these bacteria secrete these protective chemicals, and this suppresses the inflammatory cytokines or bad chemicals. Then many of them also modulate our pain perception in patients with IBS with pain and sometimes we have seen that they say the pain is better also.

So, these probiotics work in a variety of ways to help us.

Host:  Such important information. So, do refrigerated probiotics work better? Compare them to shelf-stable or probiotic drinks like Kombucha. Is there any difference between them?

Dr. Pruthi:  So, all of them they have their own different kind of positives and negatives. The shelf-stable bacteria are a different kind of bacteria. They have some preformed positive characters in them and on the other hand, the bacteria which are not shelf-stable, they refrigerate them this way at a particular temperature so it depends on under what circumstance and what particular condition that we are recommending the probiotics to a particular person. Both have their own preferences, own place in the system.

Host:  So, how much should we be taking everyday and is it okay for children to take probiotics as well? Is there anything you want us to be concerned about and how much should we be taking?

Dr. Pruthi:  Probiotics we are taking in adequate numbers. Normally, our intestinal system has different levels of normal bacteria in the body. Stomach doesn’t have many bacteria because acid kills them. The small intestine bacteria numbers go up in millions per gram of the material in there. And the colon they go in billions. So, if we are focusing on the colon part of it; then we will take in large numbers for the consumer considering taking probiotics for constipation and we want to improve the number of bacteria in the colon; then we have to consume large numbers, large amount.

So, that those large bacteria can overcome - the large numbers can overcome the existing large numbers particularly a couple of billion and many billions sometimes we are to consume. And these capsules or the commercially available products come in with – they come with certain number. These have so many billion microbes per cubic – whatever the weight is on there. So, depending on the condition that we are treating; or we are considering to alternate then we consume that amount.

Now the question about children. Children are very delicate. Normally what I would prefer to give them naturally, natural products like foods containing probiotics rather than high volume of supplements. Like let them eat yogurt or cultured milk products and everything like that.

Host:  Yeah that’s so important Dr. Pruthi to point out and our kids love yogurt. We can get them to eat yogurt and get it other ways. So, as we wrap up, what would you like us to know about probiotics, maybe interaction with any medication or medical condition. Really what would you like us to know about the benefits of probiotics and how people can be taking them and really notice a difference.

Dr. Pruthi:  Probiotics are useful in so many gastrointestinal conditions. And the data is in support of their benefit for ulcerative colitis, diverticular colitis, pouchitis, radiation enteritis, Clostridium difficile infection, infectious diarrhea, collagenous colitis, constipation, IBS, hepatic encephalopathy, and some patients with allergy too. So, these are the medical conditions that we can try to modulate with probiotics.

And the other thing that we did not talk about is prebiotics, Melanie. And you mentioned at the beginning. So, prebiotics are the products, or these are the fermented things which increase or enhance the probiotic effect. Prebiotics are dietary substances which are mostly non-starch polysaccharides and oligosaccharides and they are commonly found in food ingredients like biscuits, cereal, chocolate, dairy products also and wheat, onions, bananas, honey, garlic, leeks, chicory root. So, these are some of the prebiotics which will enhance the effect of probiotics and they are available commercially also like Inulin, lactulose. These are the commercially available products which are prebiotics and they work in connection with probiotics and help the bacteria grow and establish better.

Now, we have to be careful. Everything is not rosy. Now patients who are on immunosuppression medicines, who are on chemotherapy or there are other medications which suppress the immune system, you don’t want to give them too many probiotics even though these are the friendly bacteria but when their immune system is down in a particular host or a particular patient; these have the potential to establish or grow and cause disease process. So, generally, I’m very, very careful in patients who have immunosuppression and they have some serious condition medically that is going on so always consult their own physician before they start the probiotics and all probiotics are not the same.

And everybody does not need probiotics either. So, it’s important to talk to your physician and get advice and recommendations whether your particular condition that you are treating is amenable or may be helpful for probiotics or not.

Host:  It’s great information Dr. Pruthi, as always, thank you so much for your expertise and for coming on and sharing with so many people that don’t know what probiotics are or what they are intended to do. Thank you for that great information. And that wraps up another episode of Palmdale Regional Radio with Palmdale Regional Medical Center. You can head on over to our website at www.palmdaleregional.com for more information and to get connected with one of our providers. If you found this podcast informative and I know that you did, share it with your friends, share it on social media. We all have questions about probiotics. We’ve heard so much about them and Dr. Pruthi just answered so many of those questions for us here today. And don’t miss all the other interesting podcasts in our library.

Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. Until next time, this is Melanie Cole.