While most doctors generally agree that taking a probiotic is good for your health, not much direction besides that is given by most medical professionals. But scientific research in the last 20 years has discovered so much more about these beneficial bacteria. Scientists have found that certain strains of bacteria seem to be particularly helpful for different medical conditions. So, while the general rule of “just take a high-potency multi-strain probiotic” is often still good medical advice, patients may be able to get a lot more benefit from their probiotic if they take the correct one. Today I’m going to break down for you some of the best probiotic strains based on your medical condition. This will be the first article in a series as the research in this area is plentiful.
SIBO:
Small intestinal bacterial overgrowth is a very common medical condition that occurs when pathogenic (bad) bacteria colonize the upper intestinal tract. One distinguishing feature of untreated SIBO is that these patients often feel significantly worse when taking probiotics. Why is this? The first reason why is most probiotics also contain something called prebiotics (food for the probiotics). The problem with prebiotics if you have SIBO is that these compounds will also feed pathogenic bacteria. This leads to a worsening of existing bacterial fermentation, causing gas, bloating, and upper intestinal pain. Additionally, the strains Lactobacillus acidophilus and Bifidobacterium lactis have the potential to produce excess gas for some SIBO sufferers as these bacteria can also ferment carbohydrates. As the majority of probiotics contain these two strains, most people who suffer from SIBO need to avoid generic probiotics until their infection has been adequately treated.
While regular probiotics are out, SIBO patients often respond very well to spore-based (also known as soil-based) probiotics. With spore-based probiotics, the bacterial strains are encased in hearty endospores, which give them extra protection from stomach acid. These bacteria are much more likely to survive the difficult journey from your stomach all the way down to your large intestine, thus bypassing the small intestine altogether (1). In the early phases of treatment, I always recommend spore-based probiotics to my SIBO patients for these reasons.
IBS:
IBS is a tricky topic because this diagnosis is often a catch all for “doctors don’t know what’s wrong with you”. In fact, research is catching up to this fact. A research review published in Gut and Liver in 2017 found that up to 78% of patients with IBS had underlying SIBO infections, compared with up to 40% of patients who did not have IBS (2). So, for those IBS patients whose symptoms are actually caused by SIBO, all my above recommendations still apply. Other IBS patients have large intestinal dysbiosis, which may be improved by a generic probiotic. Often these patients need antimicrobial treatment though before replenishing the colon with probiotics in order to see the greatest level of symptom relief.
One probiotic that has considerable research supporting its efficacy in treating IBS is Saccharomyces boulardii. This organism is actually a probiotic yeast, and not a bacteria at all. But there is evidence that Saccharomyces boulardii decreases a pro-inflammatory cytokine called interleukin 8 and increases the anti-inflammatory cytokine interleukin 10. It is through this mechanism and likely others that accounts for this yeast’s ability to reverse damage to the intestinal lining (3). Research shows that IBS patients taking Saccharomyces boulardii had less abdominal pain, abdominal distention, and stool frequency, especially in IBS-D (diarrhea) patients (4).
For patients with IBS with constipation, studies suggest that the probiotic strain Bifidobacterium lactis BB-12 may be the best choice. A recent study that included 1200 subjects from Germany, France, and the UK showed significant improvement in bowel movement regularity when this probiotic was taken regularly (5).
Depression and Anxiety:
There has been a lot of research done in the world of mental health in the last 20 years. Studies support that lactobacillus and bifidobacterium species show the greatest effectiveness in modulating the neurotransmitters that improve mood. Specifically Lactobacillus. paracasei PS23, Lactobacillus helveticus NS8, Bifidobacterium longum, and Lactobacillus rhamnosus were associated with increased serotonin activity. Lactobacillus plantarum PS128 has been shown to elevate serotonin and dopamine activity. Bifidobacterium infantis was associated with decreased noradrenaline levels. Bifidobacterium strains seem to be the most significant contributor to GABA production, followed by Lactobacillus strains. Specifically, Lactobacillus plantarum 90sk and Bifidobacterium adolescentis 150 have been shown to be as effective as Prozac in increasing GABA levels with similar anti-depressant effects (6).
Dr. Katie Nuckolls is a naturopathic physician and owner of Thrive GI: Natural Digestive Medicine in Vancouver, Washington. She currently sees patients that live in Washington, Oregon, and Arizona using telemedicine. For more information, visit our contact page or schedule a free 15-minute consultation online.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770835/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347643/
- https://www.sciencedirect.com/science/article/pii/S0011393X23000309https://www.sciencedirect.com/science/article/abs/pii/S1043661822002365#:~:text=Clinical%20evidence%20has%20confirmed%20that,12%5D%2C%20%5B13%5D.
- https://www.sciencedirect.com/science/article/pii/S0011393X23000309
- https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/effect-of-the-probiotic-strain-bifidobacterium-animalis-subsp-lactis-bb12-on-defecation-frequency-in-healthy-subjects-with-low-defecation-frequency-and-abdominal-discomfort-a-randomised-doubleblind-placebocontrolled-parallelgroup-trial/C5AE26FCBEEE3F687E4A3793B3AF757D
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053794/#:~:text=Most%20pharmacological%20treatments%20in%20MDD,2%2C26%2C129%5D.