As I write this, a multi-state lottery prize has exceeded 500 million dollars. Would you like to win?  That certainly is quite a number. Here is an even more extraordinary one: the healthy human gut is home to trillions of bacteria, and gut flora has up to 800 times more genes than our own genome. These are tiny organisms that colonize a healthy colon, and our relationship with this gut flora is a mutually beneficial one.  As you no doubt already know, these bacteria are essential for healthy digestion and absorption of the food we take in. The old adage ‘you are what you eat’ might just as well have been ‘you are what you absorb’, because without absorption, what we eat does not get into our blood stream.

Intestinal bacteria can synthesize substances such as the essential vitamins biotin and folate that can be absorbed into our bloodstream. Intestinal bacteria are also essential for protecting us against pathogens.  A deficiency in intestinal bacteria leads to a poorly regulated immune system and gut function, and is associated with a number of autoimmune and inflammatory conditions, including Clostridium difficile colitis (C.diff) and Irritable bowel syndrome (IBS), both common digestive disorders in the Western world. In fact, human fecal microbiota transplants (FMT) from healthy donors are now often used to treat patients who have recurrent C. diff infections and studies are underway to examine the role of FMT in treating IBS.

Consider also the role of gut bacteria in obesity. Our intestine breaks down the bulky food we ingest into smaller pieces to facilitate absorption. Typically, only a fraction of this food is absorbed, and the rest is eliminated as waste material. Some bacteria are more effective and efficient at breaking down food than others. In other words, some bacteria can increase the number of calories we absorb into our blood stream, potentially causing us to gain weight. Theoretically, if our gut has more of those “procaloric” bacteria, it should be harder to lose weight. Scientific studies support this premise. For example, when bacteria are transferred from the guts of obese mice into lean ones, the skinny mice get fat, and vice versa. A study also showed that a fecal sample from an obese human transplanted into lean mice caused the mice to gain weight. However, researchers observed no weight gain with a similar transfer from the donor’s lean twin. Obviously, these scientific observations suggest the potential for human FMT to treat obesity. Those studies are in progress.

This brings us to the world of probiotics. Probiotics are live microorganisms, like the healthy bacterial flora in our gut. Supplementation with probiotics helps recolonize our gut with good bacteria that are beneficial to our digestive health.  As with our previous article on supplements, there is a bewildering range of options for supporting gut flora, and all too many companies that want to sell you their supplements to produce super healthy intestinal function and abundant gut flora. However, probiotics are not a one-size-fits-all; it’s important to realize that not all probiotics are the same; specific strains of bacteria seem helpful for some conditions, while additional strains are useful for others.  For example, extensive studies indicate that several Lactobacillus strains treat inflammatory and allergic diseases such as colitis, while other Lactobacillus strains treat atopic dermatitis (allergic inflammation of the skin).

While there are pills that promise probiotic benefit, many of the supplements in this category are fermented food products, like kombucha, kefir and sauerkraut. Many yogurt brands are now fortified with live bacterial cultures. This is certainly an appealing claim, but the challenge is to get those live microorganisms to the lower GI tract in quantities sufficient enough to confer a benefit.

Because probiotics must consist of live bacteria, freshness is a pertinent issue. If you choose to supplement, select a reputable brand with airtight packaging, and make sure the expiration date is as current as possible. Avoid probiotic supplements that do not display an expiration date.  Lastly, if you have concerns about your gastrointestinal health and wish to explore the possibility of adding probiotics to your diet, it may be reasonable to speak to your doctor about it.

Dr. Yousif A-Rahim, M.D. Ph. D.

Chief Medical Officer: Covenant Surgical Partners

Dr. A-Rahim works with our Medical Advisory Boards, our Medical Directors, and our quality assurance programs to oversee improvement of clinical outcomes for our patients. He also organizes and leads Company efforts to measure and improve clinical outcomes for all centers and the Company as a whole. Dr. A-Rahim earned his medical and doctorate degrees from the Pennsylvania State University and completed a residency in Internal Medicine and fellowship in Gastroenterology at Beth Israel Deaconess Medical Center, Harvard Medical School. As a physician, he is known for his expertise in interventional endoscopy and minimally invasive treatments for gastrointestinal disease. He has authored several articles published in medical journals and has delivered presentations to fellow physicians around the country, including at his alma mater, Harvard Medical School.

Dr. A-Rahim is currently a Lecturer in Medicine at Harvard Medical School and practices gastroenterology at the VA Boston Healthcare System West Roxbury Campus in Massachusetts, and at Pacific Endoscopy Center, an ASC he co-founded in 2008 in Pearl City, Hawaii.

Dr Yousif A-Rahim – “ASC Leader to Know” Covenant Surgical Partners Chief Medical Officer

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