When I first learned about probiotics I was frankly somewhat disgusted at the thought of ingesting a pill filled with millions of bacteria. Fast forward 20 years, and probiotics are now part of many treatment programs to heal disease. But what is a probiotic and why are they important for our health? Let’s explore the world of probiotics and why I use them for eczema.
Humans have had somewhat of a love-hate relationship with bacteria over the last 200 years. Although it turns out bacteria have been one of the best friends humans will ever have, when we first began learning about bacteria it was a rocky start.
The Story of Semmelweis
The year was 1846, and the center of our story was a Hungarian doctor named Ignaz Semmelweis. At this time in Vienna, physicians had begun to consider themselves scientists and began performing more autopsies and collecting data. So when the young Semmelweis showed up for his first day of work in the maternity clinic at the Vienna General Hospital, he began looking for a research project of his own. The first thing he noticed was that large numbers of women were dying on the maternity ward from a disease known as childbed fever—now known to be an aggressive bacterial infection.
Semmelweis set out to determine why so many previously young, healthy women were dying. He studied the two maternity wards in the hospital. One was staffed by all male doctors and medical students, and the other was staffed by female midwives. And he counted the number of deaths on each ward.
When Semmelweis crunched the numbers, he discovered that women on the wards staffed by doctors and medical students died at a rate nearly five times higher than women on the midwives’ ward. He started to look at the differences between the two wards to determine what possible factor could be causing so many more women to die under the care of the male surgeons and students.
He examined any possible difference he could find. He looked at things like birth position- side versus back- and found no difference. Finally he landed on the key major difference. The male surgeons and students were routinely performing autopsies on all the women who had died, then would walk upstairs from the morgue and deliver babies – without washing their hands!
To test his theory he had all the male surgeons and students begin sterilizing their hands with chlorine (I don’t recommend chlorine, I do recommend hand washing) and voila – women stopped dying. Unfortunately, Semmelweis berated and embarrassed surgeons for this oversight and was ultimately fired. He died in a mental asylum at the young age of 47. Don’t worry, our probiotic story has a happier ending.
For many years bacteria were thought to be only harmful to humans and most treatments were aimed at killing bacteria. In the early 1900s Elie Metchnikoff, a Russian scientist, found a group of Bulgarian people who routinely lived into their 90s and felt it was due to their daily intake of fermented yogurt products containing lactobacilli. Despite this early revelation, it would take nearly 90 years for the term probiotic to mean what it does today.
The Human Microbiome
We have come a long way since the days of Semmelweis and Metchnikoff in our understanding of our relationship with bacteria. Did you know that for every one human cell we have ten bacteria cells in and on our bodies? Were you aware that 3-4 pounds of an adult’s weight is bacteria weight? Our intestinal tract, affectionately known as our gut, is home to the largest portion of our bacterial guests.
We refer to the intestinal soup of bacteria in each person’s gut as their microbiome. Each individual’s gut microbiome is unique, like a fingerprint or a retina, and family members tend to share very similar microbiomes. Traditionally, it has been thought that babies simply adopt their parent’s microbiome, as these bacteria are passed to the growing fetus. The reality is each baby will progressively develop their microbiome over the first few years of their life and likely hundreds of factors affect the diversity. Evidence is mounting that the overall composition of any individual’s microbiome is a significant predictor of disease risk and health issues, and correcting a sick microbiome (termed dysbiosis) is the goal of most holistic treatment regimens.
There is a continuous interplay between beneficial versus potentially harmful bacteria inside our digestive system. When the balance of power shifts to the more harmful bacteria, a sick microbiome results and autoimmune diseases such as eczema, asthma, diabetes, and psoriasis develop. Taking unnecessary antibiotics for ear infections or a cough can devastate the balance of power between those bacterial groups and lead to an autoimmune disease beginning.
Also, remember that antibiotics are lurking in many of our foods. The largest recipients of antibiotics in the United States are the cattle we eat, thus eating grass fed (antibiotic free) beef will help spare your precious gut bacteria.
One of the most important determinants of whether you have more beneficial or harmful bacteria is how you treat those guests. Think of your gut like an Airbnb for bacteria. If the condition of your Airbnb is run down, grimy with damaged furniture and appliances, the type of guests you may attract may damage the place even more. If you have a nice clean rental with pristine floors, new paint, clean linens, etc, then you will attract much better guests.
The number one factor determining which bacteria stay in your gut is your diet. Different bacterial strains have very different diets – some love sugar and processed foods while others love fibers and healthy fats. To continue our metaphor, the diet you choose to feed your AirBnb guests will determine which guests stay and how they behave. Generally, sugar and convenient processed foods attract the hoodlums which tend to cause a lot of damage in the form of eczema, asthma, diabetes and so on.
It doesn’t matter how many probiotics you take, if you don’t feed them the correct diet they will die and you will just make expensive poop. Simple as that.
The other factor is the location of your Airbnb. You may have a beautiful house (diet) but it’s built on top of an earthquake fault line. No guest wants to experience continual earthquakes. Stress in your life represents those earthquakes. Changes in cortisol and other hormones associated with stress have a negative effect on your gut bacteria.
It’s imperative to correct your diet and lifestyle before taking probiotics – otherwise it’s a waste of money.
Eczema and the Microbiome
There is a clear connection between microbiome disruption (termed dysbiosis) and the development of eczema. This is evident in the significant increased risk of eczema in kids born via c-section. C-section is a known disruptor of the microbiome due to a number of reasons which I have written previous blog posts on and which I discuss in more detail in my upcoming book – The Eczema Epidemic.
An abnormal gut microbiome during infancy has been linked to increased risk of developing acute and long-term inflammatory diseases, such as colic, asthma and allergies, eczema, type 1 diabetes, obesity, and celiac disease. This is supported by studies which provide strong evidence that alterations in the gut microbiome composition contribute to abnormal development of the immune system and can lead to greater risk of the onset and progression of various autoimmune and allergic diseases.
Hopefully I have convinced you that providing an hospitable environment is key for maintaining a healthy gut microbiome. That’s why in my eczema program we start with gut healing by correcting diet, stress, and micronutrient deficiencies first.
As the gut is beginning to heal I then add digestive enzymes to help the intestinal cells and resolve leaky gut. Finally, once we have healed the gut and created the ideal bacterial environment, we start probiotics. Again, starting probiotics before addressing the diet is a waste of time and money.
**NOTE – You can’t supplement your way out of a bad diet!
When choosing a probiotic there are a number of considerations. First and foremost, only buy probiotics that are third party tested! The price point of probiotics is high compared to other supplements, so you want confidence that the pill actually contains what the manufacturer claims.
Probiotics are largely divided into lactic acid producing bacterial strains or spore producing bacterial strains.
Lactic Acid Probiotics
These are probably the most well known of the probiotics and include bacteria such as lactobacillus and bifidobacterium. Through the fermentation process, they all produce lactic acid by eating lactose, sugar, and carbohydrates. The acid produced lowers gut pH (more acidic) and, therefore, limits the growth of pathogens and Candida.
These bacteria are transient, so they do their work while they pass through the gut rather than setting up shop longterm. They are also sensitive to light and heat, and the acid in your stomach so how they are manufactured and stored is important. Another reason to use third party tested supplements.
The bacteria in spore probiotics are able to form protective capsules, called spores which protect the bacteria under harsh conditions. Much like the seed of a plant, it waits for the perfect conditions to begin to sprout. These are colonizing bacteria and set up long term residency in the gut. They can also go dormant until optimal nutrients are available.
One concern with spores is that they can be opportunistic and cause issues in certain environments. If your child is immunocompromised, or has a seriously weakened microbiome, these guys could take over as they colonize and cause a bigger issue.
The bacterial strains that are spore forming typically start with bacillus as in bacillus coagulans, bacillus subtilis and bacillus clausii.
Which one to Choose…
Current studies do not suggest one is better than the other. My eczema transformation protocol utilizes a lactic acid probiotic which contains 2 strains that have been studied extensively in kids and pregnant mothers. There are as many studies which show a beneficial reduction in eczema as there are that show no change. The problem with many of the studies is that the only intervention is starting probiotics. In other words, taking probiotics without changing the diet does not make much difference in a lot of studies.
As I explained above, introducing probiotics to a sick and leaky gut is likely to be a losing proposition. That’s why healing the gut first is so important.
Once the gut is healed, I firmly believe probiotics are beneficial to rebalance the microbiome. Here is what i use:
My Choice for Kids in Chewable Form
My Choice for Babies in Powder Form
My Choice For Teens/Adults…
Take Home Points
- You must take the time to correct diet and environmental issues before starting probiotics
- Both lactic acid and spore probiotics are beneficial for eczema, my preference is lactic acid.
- You can’t supplement your way out of a bad diet
- Only buy probiotics with third party testing that can confirm bacterial counts (beware of Amazon – we don’t know how the probiotics are stored, have been returned, or if the bottle actually contains the advertised ingredients. Amazon is not a certified seller of medical grade products)
In Good Health,
Drs Ana-Maria and John Temple