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Should I Start Eating Probiotics?

Girl Eating Yogurt

Mrs. Patty G writes in asking Dr. Zora about Probiotics…

I’ve been researching why I’ve become sugar and fat intolerant. I’ve been following a gluten free diet for 15 years now. I just read in several places on the internet that when Celiac Disease is in remission that you need to take two different probiotics: Lactobacillus Rhamnosus and Lactobacillus Reuteri so that the pancreas will secrete the enzymes you need to keep you from becoming sugar and fat intolerant. I read that without gluten in your diet the pancreas will not secrete these enzymes. What do you know about probiotics and this problem?
Sincerely,
Mrs. Patty G

Hi Patty, let’s first start with the probiotics—until relatively recently, mainstream medicine was rather dismissive of the importance of the gut bacteria for health.  They were there but it was taken as an accepted factoid and not much else—an interesting example of symbiosis for high school biology classes.  What naturopathic medicine has been saying for decades (sorry—couldn’t resist the little atta-girl there…) is that the gut bacteria are an essential part of immunity and proper GI function.

These bacteria function to aid in proper absorption of nutrients, protect against infection (both by outgrowing bacteria that don’t belong in the gut and by “teaching” the immune system what to respond to) and to provide a physical barrier and helping to prevent “leaky gut syndrome”1 .  It has also been shown that in animal models of gluten sensitivity, probiotics strains can break down gluten2 .

In humans, probiotics have been shown to decrease the incidence of allergies in at least some children3, improve GI function1, provide therapeutic options for a number of GI disorders, including celiac disease4,5,  and be beneficial for a host of other disorders6.   So, I would definitely recommend probiotics for just about anyone—my preferred “delivery method” is by an organic yogurt with active cultures.  These bacteria should be added back after pasteurization.

My second favorite is by taking a supplement—make sure it is in the refrigerated section of the health food store—bacteria go into a sort of hibernation, but they “sleep” and survive better when it is cold—so the refrigerated products, on the whole, deliver the most probiotics bacteria for your dollar.  I also like to see included in the probiotics something abbreviated as FOS (Fructo-oligosaccharides) or inulin—this provides the bacteria with an initial food supply and tends to allow for better growth.

Most probiotics on the market will contain a mixture of Lactobacillus, Bifidobacterium and sometime a fungus—Saccharomyces boulardii.  As long as it’s a quality product, I don’t find that the exact strain is crucial.

To get to another part of your question, I didn’t find any studies linking pancreatic secretion of enzymes to probiotic use, and I would have some doubts that the pancreas somehow requires gluten for proper function. On the other hand, celiac disease is an autoimmune disorder that can be associated with conditions connected to proper pancreatic function—like type-1 diabetes and autoimmune thyroid disease.  Celiac can also be associated with antibodies produced against the pancreas and other organs as well, so it is quite possible that a decrease in the production of pancreatic enzymes is responsible for your sugar and fat intolerance.

Another approach you might consider is using a digestive enzyme supplement to “pre-digest” your foods.  These are usually taken about 15-20 minutes before a meal (they can be taken afterwards if you forgot…I know I forgot lots of times!!) Also, digestive enzymes have been shown to be effective in treating disorders where inflammation is an important component7,8, — that list of disorders is a very long one—but it includes any autoimmune disorder like celiac disease and food intolerance like gluten sensitivity.

References:
1Mennigen R; Bruewer M., Effect of probiotics on intestinal barrier function.  Ann N Y Acad Sci – 01-MAY-2009; 1165: 183-9
2Clark, KJ., et al, Identification of Probiotic Strains Capable of Gluten Peptide Degradation. Journal of Allergy and Clinical Immunology – Volume 127, Issue 2 Suppl (February 2011).
3Kuitunen M; Kukkonen K; Juntunen-Backman K; Korpela R; Poussa T; Tuure T; Haahtela T; Savilahti E., Probiotic prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort. J Allergy Clin Immunol – 01-FEB-2009; 123(2): 335-41
4Quigley EM., Bacteria: a new player in gastrointestinal motility disorders–infections, bacterial overgrowth, and probiotics.  Gastroenterol Clin North Am – 01-SEP-2007; 36(3): 735-48, xi
5Quigley EM. The use of probiotics in functional bowel disease. – Gastroenterol Clin North Am – 01-SEP-2005; 34(3): 533-45, x
6Sanders ME., Probiotics: definition, sources, selection, and uses. Clin Infect Dis – 1-FEB-2008; 46 Suppl 2: S58-61; discussion S144-51.
7Biziulevicius GA., Where do the immunostimulatory effects of oral proteolytic enzymes (‘systemic enzyme therapy’) come from? Microbial proteolysis as a possible starting point. Med Hypotheses – 01-JAN-2006; 67(6): 1386-8.
8Leipner J; Iten F; Saller R., Therapy with proteolytic enzymes in rheumatic disorders.  BioDrugs – 01-JAN-2001; 15(12): 779-89
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