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You have heard that yogurt is good for you and that it is high in protein; but do you know why it is good for you? Have you ever wondered what some of those long unpronounceable words in the ingredients list are and how they could possibly be safe to put in your body? Did you ever think that bacteria could be good for you? This article will help answer these questions and many more. 
 

Let’s start by defining probiotics which is a relatively new word meaning “for life?. The definition, as adopted by the Food and Agriculture Organization (FAO)/ World Health Organization (WHO), is “live organisms which, when consumed in adequate amounts, provide measurable health benefits to the host.? In other words, probiotics are one way to help keep your gut happy and healthy. The gut or digestive tract includes the mouth, esophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Probiotics, also called friendly or healthy bacteria, survive passage through the digestive tract and interact with other bacteria in the intestine. A normal digestive tract contains approximately 400 different types of friendly bacteria that reduce the growth of harmful bacteria and promote a healthy digestive system.
 

Probiotics are also claimed to be found in food items such as fermented and unfermented dairy products, some infant formulas, miso, tempeh, soy beverages, granola bars and cereals. They are also available as dietary supplements packaged as powders, capsules, tablets, wafers and beverages. Without a doubt, of all the probiotic-containing foods sold in the U.S., yogurt is the most familiar. Yogurt is usually made from milk inoculated with probiotics like Streptococcus thermophilus and either Lactobacillus acidophilus or Lactobacillus bulgaricus. There are those long unpronounceable words. The good thing is that you don’t need to know how to pronounce them; you just need to know where to find them.
 

It is not completely understood how probiotics work because there are so many different types and each person’s mix of bacteria is different. In general, probiotics positively change the pH of intestinal content, which helps prevent harmful bacteria from multiplying and maintains a healthy balance in the intestines. Friendly bacteria are vital to proper development of the immune system for protection against microorganisms (tiny living organisms such as bacteria) that could cause disease, and to the digestion and absorption of food and nutrients.
 

The major benefits of probiotics are impressive and include: alleviating digestive disorders by decreasing gas, cramping, and diarrhea; enhancing synthesis of B vitamins; improving absorption of calcium; protecting against infection; improving lactose intolerance; reducing tooth decay and periodontal disease; reducing vaginal infections; and reducing cholesterol.
 

For example, let’s say that you were placed on an antibiotic. The antibiotic will kill the unfriendly bacteria in the gut while fighting the infection, but it will also kill the friendly bacteria along with it. Probiotics can be consumed to try to replace the friendly bacteria and to offset the side effects from antibiotics like gas, cramping, or diarrhea. Similarly, they can be used to ease symptoms of lactose intolerance—a condition in which the gut lacks the enzyme needed to digest significant amounts of the major sugar in milk, and which also causes gastrointestinal symptoms. As many of you know, lactose intolerance is not uncommon post bariatric surgery. 
 

A recent article published in the Journal of Gastrointestinal Surgery (J Gastrointest Surg. 2009;13:1198–1204) reported that probiotic supplementation may improve weight loss and other outcomes after Roux-en-Y gastric bypass surgery (RXYGB). "In this novel study, probiotic administration improves bacterial overgrowth, vitamin B12 availability, and weight loss after RNYGB," the study authors write. Although this was a small study, it did show favorable results for the bariatric population.  
 

Not all probiotic products are the same. Five factors should be considered when choosing a probiotic, especially for dietary supplements.

Genetically one strain can be more effective than others. Just remember that more does not always mean better; follow the dosage guidelines. Buy single-strain probiotics so that one does not negate the other and thus leaving one of the strains ineffective.

You may see this listed as CFU or Colony Forming Units. It’s a scientific term for “number of organisms or bacteria?. Pick a probiotic that has at least one billion organisms per gram and aim for 10 billion live cultures daily post bariatric surgery. The most common probiotic products are Lactobacillus acidophilus and Bifidus longum with FOS, Bifidus infantis and Lactobacillus acidophilus with (FOS). Read product labels carefully, look for a statement that the product contains "live and active cultures?.

Yogurt that has sat on the shelf for several days will not have the same effect as homemade yogurt that can be consumed fresh. Products that are not refrigerated lose effectiveness first and are not as potent as refrigerated products. Similarly, liquid supplements will not last as long when stored as will powders or capsules.

4.  Is the product pure or does it contain contaminating or ineffective bacteria?
For example, processed foods, pesticides & chemically contaminated foods, chlorinated water and antibiotics. Choose probiotics that are uncentrifuged. This method actually destroys cells and makes the living bacteria useless.

5. Is the product able to survive in the intestine and produce beneficial effects?
Look for a product with an enteric-coat. This helps to ensure that the bacteria won’t be exposed to harsh stomach acids which could reduce their ability to survive.
 

American consumers have spent millions of dollars on products containing probiotics. We have accepted the idea of friendly bacteria despite minimal regulation and manufacturer evidence. In 2007, the U.S. Food and Drug Administration (FDA) passed regulations requiring dietary supplements to be produced in a quality manner, to be free of contaminants or impurities, and to be correctly labeled. At this time, the U.S. Food and Drug Administration (FDA) has not approved specific health claims for probiotics. Many products like energy bars, frozen yogurt, cereal, cookies, and beverages can continue to claim that they contain “beneficial cultures", but don’t meet the criteria listed above. Like many products, “you can’t judge a book by its cover? and may not be getting what you are paying for. Contact the manufacturer for product information. Don’t just stop there; ask what studies have been done on the specific product and what health benefits should be expected.  Consumers should be proactive and diligent about products that they are purchasing to consume for their “beneficial properties?.
 

Although more research is needed, there is encouraging evidence that probiotics are friendly bacteria and beneficial to bariatric patients, especially within the first 6 months post-operatively. Most people can safely add probiotic foods to a healthy diet. If you're considering taking probiotic supplements, double check with your doctor to make sure the supplements are right for you.

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Stacy Paine, RD, LD has been a Registered Dietitian for 11 years and worked with bariatric patients for the last five years. She is co-president of Oconee Nutrition Consultants and can be reached at [email protected].