Kelsey Kinney: So the way that I think about gut maintenance, and what I assume you mean by that is if somebody had some sort of gut infection whether that’s just general kind of dysbiosis or SIBO or pathogens, parasites, anything like that, you’ve already cleared that out, and now you’re trying to make sure that somebody’s gut stays healthy. They don’t get any more infections for hopefully for the rest of their life. That’s how I think about gut maintenance. That’s the goal here is that we’re trying to keep the gut very healthy because we’ve done all this great work clearing out these infections and kind of getting that bacterial balance to a place that looks really good, and now we want to maintain that.
In terms of probiotic and prebiotic foods and supplements, I’m a big fan of both, especially if somebody has a history of gut infections. Those two things, I feel, are very important to think about when it comes to gut health maintenance. In terms of probiotics, when somebody’s clearing out infections, you might choose a particular probiotic to kind of help clear particular infections out. A lot of times, for example, I’m using something like Florastor or Saccharomyces boulardii to help clear out bad bacteria during that antimicrobial process.
Then afterward, once we’ve figured out that that infection is gone and we’re focused more on creating a healthy balance of good and bad bacteria in the large intestine, that’s when I might start to think about other probiotics. Typically I am choosing probiotics that have a particular purpose for some kind of other — if this person has other health conditions that they’re dealing with, I might choose a particular strain that’s going to match up and has been shown to be really helpful for that particular condition because when it comes to actually balancing out good and bad bacteria in the large intestine, probiotics become a little bit less important. I only say that because they pass through the large intestine transiently, so they might colonize for a couple weeks, but that’s about it.
It’s not like, I think it’s easy to think about probiotics as in like, “Okay, I’m taking a good bacteria like Lactobacillus. That’s supposed to be in high counts in my large intestine, so when I take this probiotic, it’s just going to go to my large intestine and stay there. It’s going to raise my counts of good bacteria.” That’s not entirely how it works. That particular probiotic that you take might, like I said, colonize for a couple weeks, but then it kind of goes through, and more so, it affects the immune system. That’s sort of how it’s really helping to balance out good and bad bacteria.
It is still very, very useful to take probiotics to keep a healthy balance of good and bad bacteria in the large intestine, but the mechanism is a little bit different than a lot of people think, so I just wanted to clarify that first. Another, like I was saying, another reason why you might use a particular strain of probiotic over another is that somebody has got a particular health condition that’s been shown to be helped or has a therapeutic benefit by taking a particular strain of probiotics. For example, there are some particular strains of probiotics that help anxiety or help blood sugar regulation, things like that.
I really do try to tailor it as much as I can to the other things that this person is dealing with. If you guys want a great resource for determining what kind of strains are helpful for different conditions based on the research that’s available, I really would recommend checking out a website called ProbioticAdvisor.com. Let me post that in the comments here. It was actually created by one of my professors at the University of Western States who teaches a gut health course. He’s just essentially put all of the research that he’s done, finding all these studies and everything, to look at what particular strains are helpful for different conditions, and he’s put it into a database. I think it’s a yearly fee that you have to pay for that, but it’s very inexpensive. Great resource.
If you don’t want to have to be searching PubMed or Google Scholar every time you’re looking for what strains might be helpful for somebody, this is a great resource. You can just type in the condition that you’re looking for, and he’s got a great chart of the different research studies that have been done on particular strains of probiotics for that condition, and he rates the quality of the evidence as well. You can make an informed decision on whether or not a particular strain is actually, has the potential to be useful for somebody, for a particular condition.
I really like to use that in terms of a particular probiotic strain. Then in terms of just actually getting probiotics in on a daily basis, I prefer that people, if they can tolerate fermented foods, that they eat those as opposed to taking a supplement. Now I have nothing against supplements whatsoever. General probiotic supplements I think can be very useful, especially if somebody either doesn’t like probiotic foods, fermented foods or can’t eat them for whatever reason. Maybe they’re histamine sensitive for the time being, and they just can’t tolerate that kind of stuff.
If that’s the case then yes, probiotic supplements can be great, and you can just—there are plenty out there that have a variety of different probiotic strains that can be very useful, so I definitely use stuff like that. Occasionally you can use VSL #3, or there’s one from Garden of Life. Now I’m blanking on the name of it. It’s a Garden of Life. I think it’s called Garden of Life Colon Care is what it is. That has a couple different strains. I like that one. It’s sort of a general probiotic to use for people who just need a maintenance type of probiotic supplement.
I also think there’s benefits to switching up the probiotics over time as well if that’s all somebody is doing as for a maintenance probiotic supplement. Maybe for a couple months, they’ll take one, and then they’ll switch to another just to kind of give some variety in the strains that they’re getting. I think that’s a good option, but really I prefer if at all possible for somebody to just include fermented foods in their diet to get their probiotics in their everyday life for their gut health maintenance.
When it comes to prebiotic foods or supplements, I am a huge fan of prebiotics. I think probiotics get all the love these days, and prebiotics are definitely gaining traction, but they’re very much less talked about than probiotics at this point. I love prebiotics because that’s actually what’s going to increase the counts of good bacteria in somebody’s microbiome, which is a really, really great thing to do, of course, if you’re trying to keep somebody’s gut healthy and prevent future infection. You really need those high counts of good bacteria to kind of push out the bad bacteria or prevent pathogens or parasites from being able to take over.
I think they are really, really useful when it comes to a therapeutic benefit, and I really like FOS or GOS as my prebiotic supplement recommendation. GOS stands for galacto-oligosaccharides, and FOS stands for fructo-oligosaccharides. Now I think Jarrow used to make a GOS syrup that was just GOS, but I think it’s discontinued, unfortunately. Right now, I use Galactomune from Klaire Labs. It’s got a little bit beta glucan in it, but I think it’s mostly GOS. Most people tolerate it just fine, but you do want to be a little bit careful with that just because if somebody is really sensitive to some types of prebiotics that other one can sometimes cause symptoms.
That’s what I use right now for GOS supplementation if I choose that. The FOS I use it’s just called FOS. It’s called actually FOS powder from NOW Foods. The benefits of that are that it’s a really inexpensive supplement, and it tastes really good. It’s very sweet. I just have people for both of those just put it right in their mouth. You don’t necessarily even need to mix it with water or anything, sort of let it dissolve on the tongue mixed with saliva. It kind of glues up a little bit and gets a little bit sticky. But the FOS powder, I think, I would say it tastes like cotton candy, so it’s one of my favorite supplements to take personally. All my clients really like it for that reason too.
As for supplements, those are what I recommend. When it comes to food for prebiotics, I mean, if you have a digestive health client, and they come to you for digestive symptoms originally. You cleared out infections. You kind of balanced out their microbiome. Ideally, they should at that point be able to tolerate more FODMAP foods. FODMAP foods are prebiotics. If you’re eating a higher FODMAP diet, that diet is going to have more prebiotics in it. If somebody’s got active GI symptoms and they can’t really tolerate FODMAPs, a lot of times they can’t even tolerate a whole lot of carbs, fibers, all that stuff is generally going to be problematic for that person at that point, so that’s a very low prebiotic diet, which, of course, can be useful for a time when you’re figuring out active digestive issues.
But once you’ve cleared all that stuff out, you’ve balanced everything, most people are going to be able to tolerate at least a much higher prebiotic diet than they could before, so that’s where I really try to focus this whole idea of gut maintenance on is just getting somebody to the point where they can eat a really varied diet within healthy means and a Paleo or real food ancestral-type diet. They’re getting lots of different colors in their vegetables. They’re getting lots of different types of vegetables. They’re eating lots of different types of fibers because they’re eating lots of different types of vegetables. It’s really like the plant matter that matters the most here and the variety is so, so key. I’ve written an article for Chris about polyphenols and their prebiotic effect in the microbiome. Just to summarize that in one sentence here, essentially polyphenols act like or have prebiotic properties, so you want to get as many different kinds of polyphenols as you possibly can in your diet because they each sort of feed different types of bacteria.
The more variety, the more diversity you have in your microbiome is generally considered a good thing. The more diversity we see in the bacteria that you have, the better your health is in general. So variety is really key, I think when it comes to gut health maintenance, and you want to encourage your patients to eat as many different colors or as many different types of plant matter as they can. You can kind of gamify that a bit. Give them a goal every week to focus on, like try to eat 10 different types of vegetables this week, see if you can meet that challenge, and then you can even increase it from there. But, in general, that variety I think is one of the most important things when it comes to gut health maintenance.
Then usually I do just add a prebiotic supplement on top of that because for most people it’s not a huge deal to incorporate that into their diet and their supplement regimen, especially for something like FOS. It tastes really good, not that the GOS doesn’t taste good, but the FOS just, in my opinion at least, tastes a lot better. It’s a really easy thing for a lot of people to incorporate. Even if they’re not doing it every single day, but they’re doing it relatively regularly, I think it’s a great idea to kind of keep somebody’s gut healthy.
I know that was a long answer, but I hope that helps to sort of clarify what a healthy gut maintenance protocol looks like. I think the two key things to consider here is what other conditions somebody has and kind of tailor the supplement recommendations to those conditions. Then from a diet perspective, if you can have somebody on a lot of different types of fermented foods, that’s great. For prebiotics I think a prebiotic supplement is a great idea for most people, and then from a food perspective, just variety — as much variety as possible, especially when it comes to plant matter — is really, really important.