Probiotics for physical and mental health - your questions answered

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What are probiotics?

Probiotics are everywhere these days. So many kinds, so many brands, so many forms - pills, drinks, or natural fermented probiotic foods. You may be wondering: What are the benefits of probiotics? What should you look for when shopping? And what the heck are these probiotics anyway?

Probiotics are beneficial bacteria that we can use to replenish what should, but may not be, in our gut (intestines). We have a symbiotic relationship with such bacteria. We ideally provide them a nice place to live, good food to eat, and they provide us with benefits in turn. Bacteria in our gut help us digest our food, they help our immune systems work optimally, and they contribute neurotransmitters and even "talk" to the brain via the vagus nerve. They also keep the integrity of the wall of the small intestine so it is impermeable to incompletely digested food. Without beneficial bacteria we are more prone to "leaky gut" which can cause food allergies and autoimmune disorders. In the large intestine, beneficial bacteria keep us eliminating well.

**Fun fact: Our bodies contain approximately 10 times as many cells that aren't "ours" (like bacterial cells) as the ones that are.

**Ancient medical systems recognized that, as Hippocrates said a few thousand years ago, "all diseases begin in the gut". Western medical science grew away from that basic assumption, but interestingly, it appears that science is beginning to come back around and validate the foundational importance of gut health to overall health and in particular, mental health.

What do we know from science?

Much of what we know, as covered in the second paragraph, is from animal studies, although recently there have been a few high profile clinical studies on humans. For example, women who took probiotics lost more weight on a diet than women who did not, even after they stopped taking the probiotics. In other examples, "infusion of fecal microbiota" (yes, pretty much a poop transplant) from healthy individuals to those with health problems improved insulin sensitivity in diabetics and reduced neurological symptoms in patients with multiple sclerosis.

A few other studies on humans show reduced levels of depression, anger and, most reproducibly, anxiety upon ingesting probiotics. Levels of the stress hormone cortisol also decreased. One double-blind study showed that probiotic yogurt caused changes in brain activity as shown by functional magnetic resonance imaging (fMRI). We also know from human research that probiotics can benefit both over- and under-active bowels, and this is borne out by hundreds of probiotic product reviews on Amazon from people confirming improvements in irritable bowel syndrome (IBS) or constipation.

Human research may yet bear out other benefits observed in rodents, such as anti-nociceptive (pain reduction) activity and improved cognitive functioning.

Do I need to buy commercial probiotics or can I just eat some yogurt?

Fermented foods containing active bacterial cultures have long been a dietary staple in cultures worldwide. If you are making your own yogurt or sauerkraut, high five to you; that will be ideal. However, it's unlikely that the probiotic foods you buy in the store pack enough of a bacterial punch to make it to, let alone thrive and multiply in, your gut. They will be sluggish compared to a probiotic of aggressive live strains that is needed to supplant the suboptimal gut flora you already have.

What is the best commercial probiotic to take?

This is a tough question because a) it has not been investigated scientifically and b) the answer might be different depending on what the rest of your diet is like. Even the effectiveness of the probiotic may depend on what else you are eating, as was observed in rodents.Generally, though, it is best to take a probiotic containing a diversity of bacterial strains. So take one that contains both lactobacilli (L. somethings) and bifidobacteria (B. somethings). Some believe the higher the colony count the better, but also important is including a prebiotic fiber along with the probiotic. Human research shows that a prebiotic alone increased fecal amounts of bifidobacteria as well as decreased patients' anxiety. This probiotic fits all these requirements and is a standout in the reviews on Amazon.

Does taking a probiotic reduce skin picking and other BFRBs?

This is another difficult question to answer! The answer I would give is, "maybe". I do recommend that most of my clients take a probiotic, especially because most of them do experience anxiety, which we know a) contributes to picking and b) has been shown to lessen with probiotics. The reason I can't say whether they help decrease picking is that at the same time they are taking probiotics, I am also having them do other actions that reduce anxiety and decrease picking. So it's impossible to determine the contribution from probiotics. I am a coach now, not a scientist, so it is more important to me to help people reach their goals as quickly as possible than to determine the exact effectiveness of probiotics on skin picking or hair pulling. (Anybody who does the experiment on themselves, please let me know the results!)

How long should I take a probiotic?

Most studies have shown a short-term benefit, but have not measured whether a long-term benefit continues after stopping probiotics, and for how long they need to be taken. I recommend that once you use up the bottle, you can wait and see, noticing the effects on yourself and if any of the beneficial effects start to dwindle. If so, then the bacteria have not established a stable colony within the wall of your small intestine, and you will probably want to use another bottle or two before testing again. Again, a probiotic containing prebiotic fiber can help to more quickly establish a stable population inside your gut.

As a final note, any time you take a course of antibiotics, always follow up with a run of probiotics.

Love and support,

Annette

p.s. Have you downloaded my free "Freedom Kit"? It comes with a written and audio report, "Why you pick your skin and how to finally stop," a video on "how to stop skin picking urges in two minutes flat," and my "Live Free" newsletter in your inbox each month. Learn more here.

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Treating scarring caused by skin picking: guest post by dermatologist Dr. Sasi Attili