Everything You Need to Know About Gut Health & Probiotics
Special Interview with the co-founder of Biohm and the author of ‘Total Gut Balance’ Dr. Mahmoud Ghannoum
What is ‘gut health’ and why should you pay attention to your gut health?
Gut health refers to the optimal physical function of our digestive system. When you have a healthy gut, your organs all work together in harmony to allow you to eat and digest food without discomfort and unwanted gastrointestinal symptoms. Recent discoveries have shown that having a healthy digestive system is dependent on harboring a balanced gut microbiome. The microbiome is defined as the collection of bacteria, fungi, viruses, and parasites that live on and in our bodies (specifically the bacterial and fungal communities residing in our gut). Bacteria and fungi, when in balance (in homeostasis or equilibrium), work together for our benefit to break down food and turn it into small nutrients that our body can use to provide us with energy and macronutrients (proteins, carbs, fat, etc.). These macronutrients enter the bloodstream, distribute to different organs and tissues, and support the growth of our cells. Like society, some of these microbes are “good guys” and some are “bad” ones. The good news is that the good guys keep the bad guys under control. Some good examples are probiotic strains such as the bacteria Lactobacillus and the yeast Saccharomyces boulardii, which keep Candida (a pathogen that can cause disease) under control. Having a balanced microbiome will not only improve gut health but also these microbes exert influence beyond the gut to improve/maintain overall physical and mental wellness.
A healthy gut with a balanced microbiome will positively impact overall health. Balance is a beautiful thing; it brings calmness to life and calmness to the gut, too. When this balance is disrupted (a situation we call dysbiosis), problems can take root and ripple throughout the whole system. Dysbiosis is the result of complex interactions between fungi and bacteria residing in our gut. An uncorrected gut imbalance will result in disease and dysfunction.
Microbial imbalance puts your beneficial microbial communities at risk and gives the pathogens a foothold, often causing uncomfortable symptoms for you and even potentially serious disease health issues, including gastrointestinal inflammation that we see in patients with Crohn’s disease. Recent research-based discoveries are starting to show the association between gut microbiome imbalance and a wide array of health issues such as bad breath, bloating, constipation, concentration problems, diarrhea, and neurodegenerative concerns such as depression, anxiety, autism, and Alzheimer’s disease.
That is why you need to maintain a healthy, balanced gut. Your aim is to keep different members of your gut microorganisms in balance, where the good guys are present in high enough numbers to keep the bad guys under control.
Having a balanced gut is completely in your hands. Think of your gut as a garden. If you want roses in your garden to bloom, give them food, and keep the weeds at bay. You can do the same to keep your fungal and bacterial gut communities balanced.
What are the signs you need probiotics?
Let us start by defining “probiotics.” Probiotics are live microorganisms that, when taken in adequate amounts, can provide health benefits to both humans and animals. The most widely used bacteria in probiotics belong to the genera Lactobacillus and Bifidobacterium. Besides bacteria, the yeast Saccharomyces boulardii is also used as a probiotic. It is particularly good at fighting off Candida.
Probiotic supplements are nutritional supplements that are intended to provide beneficial bacteria and fungi that will support our microbiome and help restore and maintain microbiome balance.
What are the signs that you need a probiotic? Listen to your body and ask yourself:
Do I have bloating, gas, constipation, heartburn, diarrhea, stomach pain, nausea, loose stools, or vomiting?
Do I suffer from leaky gut, Irritable Bowel Syndrome, small intestinal bacterial overgrowth (SIBO) or small intestinal fungal overgrowth (SIFO), Inflammatory Bowel Diseases like Crohn’s Disease and Ulcerative Colitis?
Do I suffer from depression or anxiety?
Do I have food allergies?
Do I have skin issues, such as eczema and other rashes, acne, or rosacea?
Do I have an autoimmune disease? Autism?
Did I recently take an antibiotic?
If the answer to any of these questions is yes, then you know that something in your gut isn’t working as it should be, that your microbiome is likely imbalanced, and that taking a probiotic will be helpful. The balance is often restored after a short time, but if the symptoms become chronic, you should consult your physician who will help you with a diagnosis and can treat your condition.
I also came out with a checklist (I call it Dysbiosis Risk Checklist) that can help you know whether your gut microbiome is imbalanced. The following conditions/situations can put you at a greater risk for microbiome imbalance:
Check all the items that apply to you:
□ Were you a C- section baby?
□ Were you ever hospitalized as a child?
□ Were you fed with a bottle rather than breastfed?
□ Did you have colic as a baby?
□ Did you take antibiotics multiple times as a child?
□ Did you grow up in a home without any animals?
□ Did you grow up in an exceptionally clean, hygienic environment?
□ Did your family always use a dishwasher rather than washing dishes by hand?
□ Have you taken antibiotics multiple times as an adult?
□ Did you ever have a C. difficile infection?
□ Do you or did you ever have asthma and/or allergies?
□ Do you have a diagnosed autoimmune disease, such as Crohn’s disease, ulcerative colitis, rheumatoid arthritis, lupus, psoriasis, or celiac disease?
□ Are you or were you ever very overweight?
□ Do you eat a high- sugar diet?
□ Are you under a lot of stress for prolonged periods of time?
□ Would you describe yourself as mostly sedentary during the day (like working at a desk or spending many hours at home sitting)?
□ Are you over 50 years old?
If you checked more than three, you are at greater risk for dysbiosis. It doesn’t mean you have it right now. You may have suffered from dysbiosis in the past that has resolved.
What happens in the gut when you start taking probiotics?
Now that you decided to take a probiotic, what should you expect when you first start taking them? Everyone is different. This includes our microbiome, where each individual has a unique gut microbial profile. Consequently, one size does not fit all. In other words, what happens in our gut when we start taking a probiotic will depend on each person. Some individuals may feel great from the get-go, while others might actually feel a bit under the weather at first, but this soon passes. This is not a surprise, as we are introducing live beneficial microorganisms to our gut to rebalance the microbiome. These friendly strains work hard to crowd out the bad bacteria and fungi in your gut. During this cleansing process, the dying pathogens can sometimes release toxins/mycotoxins much quicker than your body can wash them out. At the same time, your immune cells are recruited to participate in the cleansing process to eliminate the pathogens which are accompanied by some inflammation symptoms. During these cleansing activities, you may experience some temporary discomfort such as bloating, aches and pains, gas, alterations in the regularity and texture of bowel movements, and even some skin irritations.
The good news is that these symptoms are temporary and as your microbiome rebalances, you will start feeling the benefits of taking the probiotics. You can help alleviate these symptoms by drinking lots of water throughout the day. If you are having difficulty tolerating taking the probiotic then ease into it by cutting back on the amount of probiotic you are taking, and gradually increase the dose as your body gets used to it. Our studies show that your microbiome starts to restore itself within two weeks, and by week four, the gut reset should be complete.
Research has demonstrated that probiotics contribute to health in the following ways:
• Improve digestive function
• Enhance immune function
• Reduce antibiotic-associated diarrhea
• Reduce the development of allergies
• Improve lactose intolerance
• Manage the relapse of some inflammatory bowel conditions
• Decrease Helicobacter pylori colonization of the stomach (the bacteria that can cause stomach ulcers)
• Help reduce the risk of certain acute common infectious diseases (such as infections caused by C. difficile)
• Reduce crying time in colicky babies (talk to your pediatrician)
When is the best time to take a BIOHM Probiotic Supplement?
Although the pH of the gut is generally considered to be highly acidic (i.e., pH<3.5-5), studies have shown that following a meal, the pH of the stomach can rise to a range of 4.0 – 6.0. Approximately two hours after eating, the pH then returns to pre-ingestion levels. Our data show that S. boulardii and L. rhamnosus can survive while passing through the stomach at the fasting pH of 1.5. Moreover, our study showed that both Lactobacillus acidophilus and Bifidobacterium breve are able to survive in the stomach at a pH that would be typical following a meal (between 3.5 and 6.0.). Thus, not only has the BIOHM probiotic been shown to deliver effective levels of probiotic strains when taken within 30 minutes following completion of a meal, but it also provides the advantage of a beneficial yeast organism with greater acid resistance than some other commercial products.
Based on our studies, the best time to take BIOHM, or any probiotic for that matter, is within 30 minutes of a meal. I personally take BIOHM after my morning breakfast. Others may prefer to take it after dinner. We received feedback that taking it at dinner time may help in achieving better sleep.
How many times should we take BIOHM Probiotic Supplement in a month/year? What is its frequency?
BIOHM Probiotics are safe to take one capsule per day. This dosing regimen is generally recommended for probiotic nutritional supplements. It is important to mention that probiotics are a natural supplement and not a medicine. Therefore, we strongly suggest talking to your physician or pharmacist about whether probiotics might help you. This is particularly important if you are immunocompromised (have an immune deficiency) as cancer or transplant patient.
Can probiotics cause weight gain?
The relationship between the microbiome and obesity is well documented. Therefore, it is not surprising that some ask if probiotics cause weight gain. A number of studies conducted in humans have shown that the gut microbiome composition is significantly different between obese and lean individuals. Based on this evidence, manipulation of the gut microbial communities with probiotics has been suggested as a possible approach to prevent and treat obesity. However, additional studies are needed to gain more insight into whether probiotics can be used to prevent and treat obesity. These studies should investigate the dosage, duration of administration, and long-term effects of probiotics on weight gain/loss. Until more convincing data is available regarding whether probiotics can help you lose weight, I recommend that in addition to taking a probiotic you should also follow a dietary and a lifestyle approach to maintaining optimal weight.
Do probiotics make skin and hair better? How?
The influence of probiotics on the skin were discovered more than 70 years ago when Stokes and Pillsbury first proposed a gastrointestinal mechanism for the overlap between a probiotic strain and a number of health issues including skin conditions. Among the remedies advocated by these authors were Lactobacillus acidophilus cultures. Additionally, Sugimoto examined whether oral administration of live Bifidobacterium breve, a typical probiotic strain, could exert photoprotective effects in hairless mice. Their data suggest that oral administration of probiotic B. breve has the potential to prevent UV-induced skin damage, supporting the hypothesis that probiotics are beneficial not only to the intestine but also to the skin.
These effects were reproduced in human clinical research. After taking Lactobacillus brevis SBC8803 oral supplements for 12 weeks, human subjects had significantly decreased transepidermal water loss. In a separate placebo-controlled human study, bacterial supplementation was shown to have a positive effect on the skin barrier function. Volunteers who took Lactobacillus paracasei NCC2461 supplements for two months had decreased skin sensitivity and transepidermal water loss, an effect attributed to an observed increase in circulating transforming growth factor-beta, a cytokine known to have a favorable effect on barrier integrity.
The mechanism of how probiotics affect our skin appears to be related to the modulatory effect of these beneficial microorganisms on our immunity. Certain gut microbes and their secreted small molecules (retinoic acid, for example) promote anti-inflammatory responses. Other beneficial compounds secreted by probiotic strains are called Short Chain Fatty Acids, including propionate, acetate, and butyrate. These compounds are believed to play a pivotal role in determining the predominance of certain skin microbial communities, which subsequently influence cutaneous immune defense mechanisms. These findings provide supportive evidence for a functional interactive mechanism between gut and skin.
Can you tell us a little bit about your book ‘Total Gut Balance’? Can we take it as a guide to health?
I developed the Total Gut Balance diet as a new way of eating that specifically promotes gut health and targets fungi and its nature for rapid change, as well as the beneficial bacteria whose job it is to keep fungi under control. I tried to take the best elements from the paleo, low-carb, vegetarian, and Mediterranean diets while leaving behind the aspects of each of these diets that have specifically been proven to increase pathogenic fungi and/or decrease beneficial bacteria and fungi that maintain balance in the human gut. This way, the diet keeps your gut working for you and not against you. It teaches you to sustain those positive changes and manage your fungal community by:
• Limiting the growth of pathogenic fungi with a diet designed to stifle its growth: 1. vitamins A, B, and C, 2. low-carb, and 3. a good balance of plant-based protein and fatty acids.
• Enhancing the growth of beneficial bacteria by providing prebiotic food (vegetables, fruits, and whole grains, especially those containing resistant starches) for them to grow and flourish, thereby keeping fungal growth under control and at the same time crowding out pathogenic bacteria that cooperate with pathogenic fungi in their biofilm-making efforts.
• Breaking down existing digestive plaque using particular kinds of vegetables, fruits, garlic, apple cider vinegar, and that spice celebrity, turmeric. Some probiotic strains shown to break down biofilms formed by bacterial and fungal pathogens are also included.
• Fostering and nourishing beneficial fungi to crowd out Candida and solve uncomfortable gastrointestinal symptoms.
• Reducing overall inflammation that weakens the immune system with potent anti-inflammatory and antioxidant foods rich in targeted vitamins, minerals, and other beneficial constituents.
In addition to a healthy diet, adopt a healthy lifestyle that includes moderate exercise, reducing stress (through meditation and yoga practice for example), and maintaining good sleep habits. The result is making all your good-health efforts (including dieting for weight loss and exercising for fitness) more effective.
Here are some tips that will ensure you are on your way to a healthy gut and overall wellness:
1. Carbs aren’t bad. Certain kinds of carbs in certain amounts provide essential nutrition for your most beneficial gut microbes.
2. Don’t fear dairy. Low-fat dairy products actually improve microbiome health, if you tolerate them.
3. Cut down on refined sugar. Refined sugar is the fuel for the trouble maker Candida yeast which could cause serious health problems from severe digestive problems to joint pain.
4. Go for a walk. People who either exercise less or are chronically stressed tend to have more microbiome imbalance, even when they eat a good diet.
5. Try plant protein. High-fat meat products increase gut bacteria that promote inflammation. High-fat plant foods do not have this effect.
6. Say “yes” to soy. Organic non-GMO versions are great microbiome food, in moderation.
7. Play outside. If you are too clean, you will have a less diverse and healthy microbiome. A little dirt can be a good thing, especially for children.
8. Pile up on sauerkraut. Cabbage is a powerful gut-balancing food. Other gut-balancing foods include lentils, brown rice, blackberries, and pistachios.
9. Eat garlic to dissolve biofilms. Bacteria and fungi can work together to form harmful biofilms in your gut, but the right foods (such as garlic and apple cider vinegar) can actually dissolve those biofilms and restore your gut health.
10. Get a dog. Kids who grow up with animals are more likely to have healthier microbiomes and are less likely to have asthma and allergies.
What transformational outcomes should people expect?
To determine whether adhering to the Total Gut Balance will impact your health, I conducted a clinical trial where we showed that:
• Overall, adhering to the Total Gut Balance does indeed lead to positive shifts in fungal and bacterial communities in your gut, and that these shifts typically result in reduced GI distress symptoms, healthy weight loss, decreased fatigue, increased energy, more restful sleep, and fewer cravings for empty-calorie foods.
• Being on the diet, you will have dramatic improvements in your gastrointestinal symptoms.
• You will start losing weight (up to 10 pounds) over four weeks.
• You will dramatically feel higher energy levels and reductions in fatigue.
• You will have a better night’s sleep with less waking during the night.
• You will have a reduction in hot flashes.
In the first week, your body will start adjusting to the diet.
The two-week timeline is when you will clearly see the difference being on the diet.
This “feeling good” coincides with an improvement in your microbiome where we see a decrease in the level of harmful bacteria and fungi and an increase in the beneficial ones. Differences include:
• You will start having more energy
• You will feel much better waking up
• After the first two weeks, your craving for sugar and carbs will subside
• Your gastrointestinal symptoms will start to slowly improve
By three weeks, your GI symptoms will improve significantly. Your energy level will go up and you will feel better than you have in months.
By week four, you will start to notice weight loss and improvements in GI symptoms including bloating, diarrhea, and constipation.
What the Total Gut Balance diet can do?
In conclusion, when people learn about the fungi within them and how their own behavior (diet and lifestyle) directly affects the control fungal species that impact health, they conquer health issues that they hadn’t been able to before. Over the years, I have seen many people suffering from gastrointestinal disorders, low energy, overall poor health, and unhappiness. By implementing dietary and lifestyle changes that address fungi, I’ve seen people become more energetic, with massive improvements in digestive health and mood. This is my goal for you in creating the Total Gut Balance diet.