Review 003: Seed: Probiotics, Prebiotics & Symbiotics

Why Should I Care? 🤷‍♂️

In 2019 over 5 million people in the U.S. (>2%) have used probiotics or prebiotics in the last 30 days! We’re going to cover why you should care where you purchase your probiotics, and what’s in them.

An Amazon merchant, for example, in 2019, sold dupes of genuine probiotics made by Align, a Procter & Gamble brand. That begs the question, so what the fu$% was in those pills? Maybe a few steroids, antidepressants, viagra, or Pseudomonas aeruginosa (a highly infectious bacteria mostly found in a hospital setting) as reported by FDA and Wired news. How could the FDA allow such things you say? Or these other companies? Well, since these are labeled as “dietary supplements” NOT drugs, it’s up to the producer to test for impurities.

So now you decided against over-the-counter probiotics and are going straight to the source. You decide to buy some yogurt, great, it has “Lactobacillus bulgaricus and Streptococcus thermophilus”. Will these bacteria make it through all the body's mechanisms and survive? That can be highly variable and differ on the individual and strain. Don’t give up hope though the amount of research into probiotics is significant and there is evidence specifically looking into atopic dermatitis, pediatric acute infectious diarrhea, antibiotic-associated diarrhea, inflammatory bowel disease, irritable bowel syndrome, hypercholesterolemia, and obesity. This article will not delve into specific diseases, but I suggest you visit your gastroenterologist and nutritionist for additional advice.

Fancy Definitions

• Probiotic (probios, for life): live microorganisms which when administered in adequate amounts confer a health benefit on the host. Common known foods include bacteria-fermented foods, such as sauerkraut, kombucha, yogurt, and kimchi. Specific strains of bacteria vary depending on the product.

• Dysbiosis: Reduction in microbial diversity and a combination of the loss of beneficial bacteria.

• Symbiosis: An interaction between two species. People generally think of mutualistic relationships such as E. coli that relies on intestinal contents for nutrients, and humans derive certain vitamins from E. coli, particularly vitamin K, which is required for the formation of blood clotting factors.

• Prebiotics: Typically complex carbohydrates (such as inulin and other fructooligosaccharides) that microorganisms in the gastrointestinal tract used as metabolic fuel. So, when you consume carbohydrates that are not digestible by your body, they pass through the digestive system to become food for the bacteria and other microbes.

• Dietary Ingredients: as a vitamin; mineral; herb or other botanical; amino acid; dietary substance for use by man to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of the preceding substances. Unlike drugs, supplements are not intended to treat, diagnose, prevent, or cure diseases. That means supplements should not make claims, such as “reduces pain” or “treats heart disease.” Claims like these can only legitimately be made for drugs, not dietary supplements.

• Colony Forming Units (CFU): The way probiotics are measured, indicates the number of viable cells. Higher CFUs does not mean it’s better. To be useful, the probiotics must contain at least 5 to 10 billion per dose viable CFUs per gram to be able to survive digestion and exert positive effects in the body. Important to note depending on the shipping conditions and storage, the CFUs can be variable. People should be using AFU.

• Punicalagins: A polyphenol in pomegranate juice is a potent antioxidant. Read more about it here. The amount of research into this drug is insane. Read this article by natureshowing it could prevent cardiac metabolic disorders.

• Active Fluorescent Units (AFU): It’s measured with flow cytometry, a process where probiotic cells are tagged with fluorescent ‘markers’ and counted by a laser as they pass through a tube. That way, they can calculate a more precise measurement of all viable cells, including ones that are efficacious but not necessarily culturable (and therefore would not be counted in a traditional plated CFU measurement).

Probiotics Recommendation

These recommendations were made on probiotic units, storage, price, safety, science, and websites functionality. I’m going to predominately focus on seed probiotics, given it is the only one that passed all the prerequisites.

Seed Probiotics

Photo byCDC/Unsplash

• Production: Has prebiotic outer capsule formulation consists of punicalagins concentrated from Indian pomegranate. The probiotic inner capsule is the good stuff.

• Formulation: 53.6 billion AFU and with each strain under each subsection with the AFU including digestive, dermatological, cardiovascular, and micronutrient.

• Simulator of the Human Intestinal Microbial Ecosystem (SHIME®): Earlier we talked about the variable digestive possibilities with probiotics, including yogurt and other fermented foods. Well, seed developed a model that created physiological conditions and biological processes. While impossible to recreate entirely, this is impressive!!

• Quality Control: In addition to the QC/QA they follow the FDA, global quality standards outlined by Foods for Specified Health Use (Japan), and the European Food Safety Authority.

• Research: Seed's Scientific Advisory Board is impressive and includes MDs, PhDs, and other prolific leaders from the NIH’s Human Microbiome Project. The FDA has also authorized Investigational New Drug (IND) application for DS-01™ (Seeds Daily Synbiotic) inpatient living with irritable bowel disease. 

• Future: This company is impressive in all aspects, although I wish I was getting paid to promote this company 😪. They currently have randomized control trials in various aspects of health at reputable hospitals, including Massachusetts General Hospital. It appears current ongoing studies include recurrent UTIs, bacterial vaginosis, spontaneous preterm birth, major depressive disorder, and Hypercholesterolemia.

What about the others?! 🤔

• What about align, NewRhythm, Garden of Life, Renew Life, Ancient Nutrition SBO, nurish by Nature Made Multi Strain, HUM Gut Instinct, and Florastor.

• None of these made the list. The websites of ALL these products gave precursory non-clinically backed information. With the majority selling on amazon. I am not against selling supplements on amazon per se but the quality suffers and can become an issue as discussed earlier. Some of these probiotics have reasonable quality control metrics but lack in comparison to seeds.

Covid-19 and Probiotics

No real evidence yet, but we can make some inferences. COVID-19 affects almost every single body system, causing a cascade of damage. Probiotics can have potential anti-inflammatory and antiviral effects, as they act by suppressing cytokines production. For example, two randomized controlled trials showed that critically ill patients on mechanical ventilation who were administered probiotics had significantly less ventilator-associated pneumonia compared with placebo.

One system that is impacted is the gastrointestinal system, causing gut dysbiosis. While probiotics may not cure or treat COVID-19, I’m going to start using them as an adjunct for prevention and its complications.

Final Takes 

The gut microbiome is complex and intertwined with every single other system in our bodies, including the brain-gut-microbiome. Taking probiotics isn’t a panacea but does contribute in some fashion to almost every aspect of one's life. This supplement is also gluten, dairy, soy-free, vegetarian friendly, and does not require refrigeration. Offered as a monthly subscription service, this company is backed by a group of certified scientists, doctors, and entrepreneurs who believe this supplement can be used to improve digestive health. Try it and tell me what you think.

References

1. Ozen M, Dinleyici EC. The history of probiotics: the untold story. Benef Microbes. 2015;6(2):159-165. doi:10.3920/BM2014.0103

2. Giovanni G, Fiorenza B, Annagiulia G. Probiotics History, Journal of Clinical Gastroenterology: November/December 2016 - Volume 50 - Issue - p S116-S119 doi: 10.1097/MCG.0000000000000697

3. National Center for Complimentary and Integrative Health. Probiotics: What You Need To Know. https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know. Updated August 10th, 2019.

4. Pace, F, Macchini F, Castagna VM. Safety of probiotics in humans: A dark side revealed?, Digestive and Liver Disease, Volume 52, Issue 9, 2020, Pages 981-985, ISSN 1590-8658, https://doi.org/10.1016/j.dld.2020.04.029.

5. Santacroce L, Inchingolo F, Topi S, et al. Potential beneficial role of probiotics on the outcome of COVID-19 patients: An evolving perspective. Diabetes Metab Syndr. 2021;15(1):295-301. doi:10.1016/j.dsx.2020.12.040

6. Cunningham M, Azcarate-Peril MA, Barnard A, et al. Shaping the Future of Probiotics and Prebiotics,Trends in Microbiology,2021. https://doi.org/10.1016/j.tim.2021.01.003.

7. Louise M. Amazon Warns Customers: Those Supplements Might Be Fake. Wired Web site. https://www.wired.com/story/amazon-fake-supplements/.

8. Car Reen Kok, Robert Hutkins, Yogurt and other fermented foods as sources of health-promoting bacteria, Nutrition Reviews, Volume 76, Issue Supplement1, 1 December 2018, Pages 4–15, https://doi.org/10.1093/nutrit/nuy056

9. Viktoria Yonkova Marinova, Iliyana Kirilova Rasheva, Yoana Krasimirova Kizheva, Yordanka Dimitrova Dermenzhieva & Petya Koitcheva Hristova (2019) Microbiological quality of probiotic dietary supplements, Biotechnology & Biotechnological Equipment, 33:1, 834-841, DOI: 10.1080/13102818.2019.1621208

10. Chen B, Longtine MS, Nelson DM. Punicalagin, a polyphenol in pomegranate juice, downregulates p53 and attenuates hypoxia-induced apoptosis in cultured human placental syncytiotrophoblasts. Am J Physiol Endocrinol Metab. 2013;305(10):E1274-E1280. doi:10.1152/ajpendo.00218.2013

11. Cao, K., Xu, J., Pu, W. et al. Punicalagin, an active component in pomegranate, ameliorates cardiac mitochondrial impairment in obese rats via AMPK activation. Sci Rep 5, 14014 (2015). https://doi.org/10.1038/srep14014

12. Akour A. Probiotics and Covid‐19: Is there any link? Letters in Applied Microbiology. 2020;71(3):229-234. doi:10.1111/lam.13334. https://sfamjournals.onlinelibrary.wiley.com/doi/10.1111/lam.13334

Disclaimer:

The materials on this site are provided for general medical education purposes only and are not meant to be applied rigidly and followed in all cases. Use of this information in a particular situation remains the professional responsibility of the practitioner. In no event will any editor or contributors of this website or its contents be liable for any decision made or action was taken in reliance upon the information provided.

This information pro­vides gen­eral infor­ma­tion and dis­cussion about med­i­cine, health, and related sub­jects. The words and other con­tent pro­vided in this page and its contents, and in any linked mate­ri­als, are not intended and should not be con­strued as med­ical advice. If the reader or any other per­son has a med­ical con­cern, he or she should con­sult an appropriately licensed physi­cian or other health care worker.

Never dis­re­gard pro­fes­sional med­ical advice or delay in seek­ing it because of some­thing you have read on this blog or in any linked materials. If you think you may have a med­ical emer­gency, call your doc­tor or 911 immediately.

The views expressed on this blog and web­site have no rela­tion to those of any academic, hospital, practice or other insti­tu­tion with which the author is affiliated.