Module 3.3: Consume Probiotic Foods

Probiotics are defined as live microorganisms which confer a health benefit to the host, and they are what largely compose the GM (21). Probiotic consumption is a way to directly improve the composition of the gut microbiome by simply increasing the number of microorganisms that perform vital beneficial functions relating to physiology and immunology. Probiotic microorganisms regulate the Tight Junction proteins that regulate intestinal permeability, which has a direct impact on the immune system, and thus inflammation (2,3,4,5,12). Probiotic therapy is known to improve the GM and increase rates of remission in patients with IBD.

A double-blind study published in the Korean Journal of Gastroenterology tested the effects that probiotic yogurt consumption had on the GM of IBD patients. 105 patients with IBD and 95 healthy individuals were given 250 g of probiotic yogurt per day for 8 weeks, while another 105 patients with IBD were given 250 g of placebo per day for 8 weeks. The results of the study revealed that IBD patients receiving the probiotic yogurt had a significant increase in Lactobacillus and Bifidobacterium, well known probiotic bacteria, and a slight decrease in Bacteroides, which are bacteria that become pathogenic in certain circumstances (22,23). It’s important to know that even patients with IBD will see an increase in probiotic microorganisms within the GM if they consume probiotics. It’s important because it’s known that probiotic microorganisms, specifically Lactobacillus and Bifidobacterium, are able to decrease pathogenic microorganisms by competitive exclusion (12).

This means that, even in patients with IBD, probiotic therapy improves the GM composition by directly increasing probiotic microorganisms which can then begin to competitively exclude, and thus decrease, pathogenic microorganisms over time.

Not only do probiotics improve the GM, they increase rates of remission. A meta-analysis of 23 randomized controlled trials with a total of 1763 participants found that patients with active UC treated with probiotics had significantly higher rates of remission than UC patients treated with placebo (24).

Bottom line, probiotic therapy is known to improve the GM and increase IBD remission rates. So we definitely want to consume probiotics, however, introducing probiotics can be tricky initially because they can cause what’s known as the Jarisch-Herxheimer reaction. The Herxheimer reaction can occur when some sort of microbiological agent, such as antibiotics, antimicrobials, or probiotics, begins to kill pathogenic microorganisms (25,26). When these pathogenic microorganisms die, their cells burst open, which allows their toxic contents to be released into our bodies, which then triggers an inflammatory response from our immune system (26). For IBD patients, the symptoms most commonly experienced on an anecdotal basis as a result of the Herxheimer reaction are increases in the already present or normal IBD symptoms such as diarrhea, frequency, urgency, bleeding, gas, mucus, etc.

So this leaves us with two questions. Number one, why would we want to consume probiotics if they might induce the herxheimer reaction and cause symptoms to flare up or worsen? The reason we want to consume the probiotics is because we have to target the dysbiosis or imbalance in the gut microbiome. We need to establish a new level of homeostasis, aka eubiosis, in the GM where the probiotics are back in control so that they can perform all of their necessary functions that keep our bodies and digestive systems healthy. Question number two, how can we approach the introduction of probiotics so that we hopefully avoid a severe herxheimer reaction? Start low and slow. Starting out with a high volume of probiotics in the form of food or supplements could cause a significant amount of pathogenic microorganisms to die-off in a short amount of time, leading to a significant inflammatory response and increase in symptoms. But, if we start with a low amount of probiotic foods and supplements, that should theoretically cause a lower amount of pathogens to die-off at a slower rate, and thus lessen the intensity of the inflammatory immune response. This will allow us to slowly increase the volume of probiotic foods and supplements each week, as long as the Herxheimer reaction symptoms are not severe, until we are able to tolerably consume a high enough amount of probiotics each day that will correct the dysbiosis within the GM and bring it back to eubiosis.

This is often a game of give and take where each individual has to increase and decrease probiotic consumption based on the fluctuation of symptoms. The exact philosophy that I recommend using in order to do this will be explained in Module 5 before you are able to access the daily routines. Probiotics are very important, but it is also very important how they are implemented. That being said, here are my favorite sources of probiotic foods and supplements:

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