Discover Probiotic-Rich Low FODMAP Foods
Once available only from health food stores, probiotics are now big business. Market reports predict the global probiotics industry will be worth $57.4 billion by 2022. Are probiotics simply marketing hype, or could they be the answer to our health problems? And, most importantly, should probiotics be consumed on a low FODMAP diet?
Probiotics are live microorganisms (like bacteria and yeast) that multiply in the gut and improve the balance of the bacteria in the digestive system. These “good” bacteria are important. “Nutritional factors including several B vitamins, vitamin K, folate and short-chain fatty acids are produced by these bacteria,” explains gastroenterologist Dr Matthew Ciorba. “Up to 10 percent of an individual’s daily energy needs can be derived from the by-products of bacterial fermentation.”
Fermented foods like yoghurt, kimchi and kefir contain natural probiotics. “Natural food sources of probiotics and prebiotics (fibres which feed our health-promoting bacteria) are incredibly important for maintaining health,” explains Belinda Reynolds, dietitian and education manager
Probiotic supplements that are available in powder, tablet and liquid form also contain ‘good bacteria,’ but these have been cultivated in a lab. “Probiotic supplements are still natural, living microorganisms,” says Reynolds. “The difference is they have been cultured in a lab, having often been selected for inclusion within supplements due to certain benefits they have the potential to provide.”
If you’re unsure whether you should go natural or man-made, Reynolds believes there’s a time and place for both. “Both supplements and food sources of bacteria have an important role to play in health,” she says. “The key difference is that what is found in a supplement is often a higher dose than what is found in food.”
Unfortunately, not all probiotic strains can be cultivated in labs. “The key limitation with probiotic supplements is that not all beneficial species/strains suit being grown in a lab and encapsulated for commercial supply,” says Reynolds. “For that reason, a supplement cannot possibly provide all that you require. Furthermore, if you wish to promote the survival of the microorganisms that you take, it is important to continue to feed them with a good, fibre-rich diet.”
HOW DO THEY WORK?
“When you take a probiotic, you allow the good bacteria to repopulate your gut, which helps control the bad bacteria that may have taken hold,” explains nutritionist Samantha Gemmell. “Gut bacteria can affect everything from how many nutrients you absorb, to what neurotransmitters and hormones you produce, to the strength of your immune system.”
Probiotics vary in type and strength and this is essential for their effectiveness. “Different strains of bacteria have different effects on the body because they produce different compounds, digest different compounds and are all very individual,” says Gemmell. Consequently, the probiotic that is right for you might not be suitable for other family members.
CAN PROBIOTICS HELP WITH IBS?
Researchers have linked IBS symptoms to certain changes in the gut flora and it is thought that probiotics may work by replacing missing strains of beneficial bacteria, or competing with, and excluding unfavourable strains. To date, researchers have identified 10 probiotic strains that might aid in enhancing overall IBS symptoms. Nonetheless, additional research is necessary, given that the existing studies have been relatively small-scale, of limited duration, and have yielded varying outcomes. This isn’t surprising as probiotics are not a one-size-fits-all solution.
ARE PROBIOTICS LOW FODMAP?
“I recommend avoiding probiotics in the elimination or challenge phase of the low FODMAP diet, unless under the guidance of a specialist dietitian,” says Joanna Baker from Everyday Nutrition in Melbourne. “These phases of the low FODMAP diet are about finding out how your body reacts to FODMAPs in food and probiotics can skew the results.”
“Probiotics may need to be taken for up to four weeks to see an effect,” explains Baker. “If after this time, you think they are helping, stop taking them to see what happens without them. If things stay the same, they probably weren’t doing much more than a placebo, however, if things deteriorate, they were probably helping.”
HOW DO YOU CHOOSE PROBIOTICS?
Colony forming units (CFU) measure the strength of a probiotic supplement. The CFU describes the number of live, active microorganisms in each serve and should be displayed on the packaging.
According to Adelaide-based naturopath Danielle Archer the CFU listed on packaging may differ greatly from the reality in products of poorer quality. “There is also a question around the quality of probiotics that some brands sell,” she says. “If the quality is poor, then what might say 2 billion CFU per capsule may actually be much, much less and as a result may provide little to no therapeutic benefit.”
Joanna Baker targets the probiotic to symptoms when recommending probiotics to her patients. “I use specific probiotics to address specific symptoms the same way you would use Panadol for pain and antibiotics for infection or the pill for birth control,” she says. “You’d never grab Panadol and expect it to prevent pregnancy and probiotics are the same. Specific strains appear to work for specific situations.”
If you’re taking probiotics to treat a specific health problem or to manage your IBS symptoms consult a Monash FODMAP trained dietitian who is up to date on research and can recommend a relevant product.
ARE PROBIOTICS THE WAY OF THE FUTURE?
With all the exposure probiotics are getting you’d be forgiven for thinking they are the answer to all of our health problems and while there is plenty of research to support their use, they’re certainly not a magic pill. “Healthy levels of gut bacteria are crucial to our health and wellbeing as humans,” says Archer. “However, I believe that they are never the full solution. Addressing why there is a problem with bowel flora, as well as treating other aspects of the person’s health holistically are essential to long-term health.”
The results are in…..
“There is a huge amount of research available in the field of probiotics however, the results are mixed and we are still learning” says Reynolds. “Certain strains have shown their benefit in assisting in the management of certain health conditions, whilst a loss of microbial diversity appears to be the key contributor to illnesses which respond to probiotic therapy.”
Research shows probiotics are effective for treating:
Diarrhoea caused by antibiotics and infection
Studies have looked at the use of probiotics in the prevention and treatment of acute infectious diarrhoea. While their preventative ability has shown to be modest, the results are much more positive when it comes to treatment.
When it comes to diarrhoea as a result of antibiotic use, probiotics have been found to have a positive preventative outcome in both children and adults. “The preventative effect of probiotic use remained significant regardless of species used, adult versus child populations, study quality score and antibiotic administered,” says researcher Dr Elizabeth Videlock, who conducted meta-analysis on their effectiveness. “The preventative effect of probiotics is also apparent during combined antibiotic treatment for H.pylori eradication.”
Ulcerative colitis – preventing relapse and pouchitis post surgery
A number of studies have shown probiotics to be beneficial in the management of Ulcerative Colitis (UC). “These studies have examined induction of remission and maintenance of remission typically by comparing the probiotic with oral mesalamine or adding the probiotic to standard therapy,” says Dr Ciorba. Pouchitis is a complication affecting 10 to 20 percent of patients undergoing surgery to treat UC. Studies have found that certain probiotic strains can help prevent reoccurance.
Reducing the length and severity of colds
Studying university students in the United States, researchers at the University of Medicine and Dentistry of New Jersey found that probiotic supplements may be useful in reducing the length and severity of colds and upper respiratory infections. “We know that certain probiotic strains support immune health and may improve health-related quality of life during upper-respiratory infections,” says dietitian Tracey Smith. “This double-blind study assessed how probiotic supplementation affects the duration and severity of symptoms, and the impact of symptoms on the daily life of infected students.” The study found that the students taking probiotics had colds that were of shorter duration and experienced less severe symptoms, than the participants not taking probiotics.
“L. plantarum (HEAL 9) & L. paracasei (8700:2) strains have clinically shown to reduce frequency and duration of colds,” says integrative health pharmacist Tania Tan.