I’ve shared this quote a few times since hearing Professor Fasano speak at a symposium back in 2016 and was fortunate to have a personal conversation with him for clarity after. While everything he shared was extremely valuable, the 2 things that have stuck with me and unfortunately have been ignored particularly by many of my medical and naturopathic colleagues is that gluten does NOT need to be avoided by everyone and his concern around the arbitrary use/prescribing of probiotics.
I’ll speak to the gluten issue in another post.
I have shared about this quote before here however I think a step back to explain microbiomes, the gut microbiome in particular, as I understand them, might be helpful. This is a very basic and simplistic explanation. Like most areas of health, there are always variables due to humans being unique, dynamic and thus constantly changing - just like our microbiomes actually…
The microbiome from the Greek words mikrós - small and bíos - life, is an environment consisting of a community of micro organisms existing together. Bacteria, viruses, fungi, parasites and yeasts are some of the very many micro organisms living in our gut. They all perform important functions to ensure our body is functioning optimally. We have microbiomes in various parts of our bodies including nasal passages, in our skin folds like armpits and groin, in genital areas and in our large intestine or gut. The gut one is the microbiome most determinate of our overall health.
Each of these microbiomes have their own ideal balance of micro organisms and when in balance all is well for the larger organism ie the human body. Problems arise when these micro organisms are either out of balance of find themselves in microbiomes not native to them.
It used to be thought that at delivery is the first time a baby is exposed and inoculated with micro organisms, however we now believe that this exposure commences in utero which is one of the many reasons preconception preparation is essential.
It is generally accepted however, that the major starting point for a microbiome, particularly the gut microbiome, is at birth ideally via the birth canal.
In our modern world there is much that can affect the optimal functioning of microbiomes eg the food and drink we consume, particularly the quality and the way it is grown and produced, chemicals and toxins in our environment that we knowingly and unknowingly inhale, touch, wear and apply, medications and supplements, stress, age, intimacy, exercise, travel… The re emergence of fermented foods and more specifically the discovery off supplemental probiotics and the resulting rampant consumption, is now being acknowledged as a major contributor to an imbalance in the gut microbiome and what Professor Fasano is speaking to. We now know that the horse had already bolted in the case of the realisation that the almost casual use of antibiotics has been detrimental in our health collectively, due to their effect in essentially wiping out microbiomes and the development of antibiotic resistance making many antibiotics ineffective. Professor Fasano is committed to trying to get the warning out about indiscriminate use of probiotics and the negative effects on the gut microbiome, before the damage we are starting to see gets out of hand.
Just like antibiotics, probiotics are a valuable tool in health care when used correctly. Remember that probiotics are relatively new and we are still learning about their potential uses and adverse effects. Over 2 decades ago when I was at university learning about probiotics we really only knew of the genus Bifidobacteria or Lactobacillus, and the most common species of them for example L.acidophilus. Today we have discovered that when using probiotics therapeutically the strain is also vitally important - one strain of L.acidophilus can have a completely different effect than another and not confer any benefit or worse… This is one of the many reasons that probiotics should only be taken on advice of a health practitioner well versed in probiotic genus, species AND strain. With what we know now, I would be extremely concerned if a strain is not specified on the probiotic you are taking and that strain needs to be specific for the reason you are taking it.
I often shudder when seeing social media posts asking for help with a condition and, I’m sure well meaning, people randomly commenting their recommendation or the one that worked for them of a supplement or probiotic.
Further to that is the underlying message of popping a pill regardless of whether ‘natural’ or not as a magic bullet cure.
From my research and experience and in keeping with traditional naturopathic practice, it is essential to address diet and lifestyle BEFORE supplementing. Considering that diet and lifestyle are the major causes of imbalances in the gut microbiome it unequivocally makes sense to have these areas as the initial focus. In my experience, when diet and lifestyle changes are made, the expense of supplements is often not required.
Finally, if probiotics are indicated, taking them for a limited time and then being reviewed by your prescribing health practitioner is of paramount importance. Remember that the gut microbiome is made up of an elegant balance of a variety of micro organisms. It is presumed that you have been prescribed a probiotic as your symptoms are indicative of an imbalance of one or some of these micro organisms. After taking them for a period of time you may feel better. This does NOT mean that you should continue to keep taking them to stay feeling better . It could be a sign that you now have a level of balance in your gut and can maintain it with good diet and lifestyle habits. At this point a review with your prescribing practitioner is indicated. By continuing to take them when your symptoms have been relieved, you risk throwing out the balance of micro organisms in your gut by having too many of the bacteria of the probiotic you were taking. Old and new symptoms may re occur and so the cycle continues.
The human body has an innate intelligence to be well and in a state of balance (homeostasis). Apparently the state of the gut microbiome is a major contributor to this balance. There can be situations out of our control or knowing that can alter this balance. As slow and tedious as it may be, scientific and anecdotal evidence shows that tweaks to diet and lifestyle is the most effective way to return the balance. For the occasions when these tweaks are not enough we are fortunate to have supplements like probiotics that MAY assist in regaining that balance, lets learn our lessons from our disrespectful use of antibiotics and minimise our use of probiotic supplements and only utilise them as required.