Holistic Performance Nutrition 2: Complete Guide To Probiotics, Essential Strains for Athletes, and Healing Reoccurring SIBO

On episode 2 of Holistic Performance Nutrition (HPN) with Julie McCloskey, registered holistic nutrition coach, and Tawnee, we take a deep dive into your gut health and the use of probiotics from why you need then to what brands and how to take them: Gut dysbiosis & Leaky gut What is dysbiosis: an imbalance in […]

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On episode 2 of Holistic Performance Nutrition (HPN) with Julie McCloskey, registered holistic nutrition coach, and Tawnee, we take a deep dive into your gut health and the use of probiotics from why you need then to what brands and how to take them:

Gut dysbiosis & Leaky gut

What is dysbiosis: an imbalance in the gut microbiome, specifically a decrease in gut microbial diversity.
What is leaky gut: increase intestinal permeability and contents of gut leak into the bloodstream (probiotics help prevent this).
How/why do things go wrong in the gut?

Diet that’s high in processed food, sugar and starch.
Not enough of the right fiber and prebiotics.
Too many drugs (like antibiotics, acid blockers for reflux, anti-inflammatories, hormones, etc).
Stressors (toxins, hard exercise, overtraining, chronic stress, etc)
Study: High intensity running increases gut permeability.

Gut is a garden

More than 500 species make up gut flora….equating to 5-8lbs worth!
Different types of bacteria:

Essential/beneficial (good)
Opportunistic (bad)
Transitional (from environ that we take in; can damage in absence of good guys)

People with IBD have less gut diversity by up to 25%.
Aim to just pick the weeds from the garden, and not wipe out the whole thing with aggressive treatments.

Disease/illness

Gut health affects your overall health and risk for many diseases.
Gut bacteria are out of balance → you increase risk of getting sick.
70% of immune system in gut; when out of balance susceptibility to illness increases including URTI and common colds. Athletes hate being sick.
State of gut health can influence depression, weight, skin conditions, etc.

Probiotic basics

Help to populate your gut with good bacteria for normal functioning and lower inflammation.
Beneficial strains that help our native good guys, control the bad guys and protect us from invaders.
Protective barrier for your gut (key for athletes).
Manufacture vitamins B3, B5, B6, B12, biotin, folate, Vit.K – crucial for energy and metabolism.
Not all probiotics will be right for you.
Study showing the benefits of probiotics for athletes.

 

Good strains for athletes

Lactobacillus (genus) — So many benefits: estrogen metabolism, liver function, fights H pylori infections, immune function, leaky gut repair, repopulate the small intestine with good guys, digestion, reduces inflammation, increases GABA, helps with bloating, can reduce diarrhea, etc. Certain strains are good and safe for SIBO. Most popular strain: lacto acidophilus
Bifidobacterium — Produces the short-chain fatty acid butyrate, which supplies energy to your colon cells to keep them functioning optimally. Good for IBS/IBD. Can ease constipation. Help intestinal barrier function. Can decrease carcinogenic enzymes in large intestine.

Without adequate SCFA and butyrate, we increase risk of colonic disorders. Butyrate is an energy substrate i.e. fuel for colonocytes. Can also get in diet via fiber and resistant starches.

Saccharomyces boulardii — Protects the gut lining from the effects of antibiotic-induced dysbiosis leading to leaky gut syndrome. S. boulardii can also outcompete other unfriendly yeast. Actually is a healthy yeast not bacteria.
Prebiotics — Non-digestible and goes through small intestine where it’s fermented, which feeds beneficial bacteria. basically a boost to your good guys but if there’s bad overgrowth these might need to be saved for later. In probiotics they’ll be things like FOS and GOS on label.

Brands

SOUND — Formula based on research with strains that will benefit athletes.
VSL #3 — Very high potency, 450 bill live species.
KlaireLabs — Their “Lactoprime Plus” is safe for SIBO w/o inulin and prebiotics; and their “Ther-Biotic Complete” is a great all-around probiotic.
Garden of Life Primal Defense — Contains soil based probiotics.
Equilibrium — 115 strains including strains not found in other products.
Ortho Biotic by Ortho Molecular — Contains S. boulardii.
Genestra HMF Forte
Thorne Flora Sport

More on your probiotic

A multistrain probiotic is ideal, including strains from the genera listed above.
DOSAGE: Taken either 30 minutes before food or with the meal itself, the fat content of food tends to help it along.
Sometimes probiotics can irritate symptoms of other gut issues like SIBO or candida. In those cases a special kind of prob is recommended or holding off on probiotic for a while depending on the case. I wouldn’t avoid probiotics forever though, and they’ve been shown to be beneficial in treating SIBO. Read more on this by Chris Kresser. 
You can combine different probiotics. Tawnee says she always has Sound in the mix even when not training, and also loves Equilibrium.
Even if they don’t colonize they will still have a beneficial effect. They still have significant changes in gene expression in the gut, aid digestion, and probably above all else, enhance our immune systems.

Gut testing

Testing can help you determine deficiencies and strengths in your gut microbiome, leading to learning what you may need to supplement with and what probiotic to choose.
Two tests that Tawnee recommends:

GI effects—great snapshot of microbiome, shows us the relative concentration of 20+ different species. Includes, also, markers of digestion and intestinal inflammation. 
GI Map—the “Microbial Assay Plus” to take a deep dive into microbiome including the state of your good guys, all kinds of pathogens, parasites, bacteria, fungi, and other cool things like gluten sensitivity markers, autoimmunity markers, markers that can indirectly indicate SIBO, markers that can indicate leaky gut and other forms of dysbiosis. More info on what the GI MAP includes and tests for here.

Fermented foods

Sauerkraut
Kimchi
Kombucha
PrEbiotics—non digestible carbs e.g. artichokes, onions, garlic, green bananas, leeks, asparagus, dandelion greens, apples, seaweed, etc.

Study: “Beneficial effects on host energy metabolism of short-chain fatty acids and vitamins produced by commensal and probiotic bacteria.”

Eating a varied plant heavy diet is a great way to increase your diversity.

Reoccurring SIBO – How to Heal?

Kathryn says: “I’ve tried Low FODMAP and LOW GI, while also being Gluten free, dairy-free, soy-free, alcohol free, and yeast free. Have tried supplements, and two rounds of antibiotics. Working out 6 days a week. Was training for a tri. Changed to Orangetheory 2x week, barre 3x week and one long run, since I am time-strapped and in a busy season for work.”  

Troubleshooting

Have you eased up on the protocol that you found relief with? Perhaps you eased up too soon? Could take months (60-90+ days).
SIBO recurrence after antibiotic therapy
Further gut testing and hiring a qualified functional practitioner.
Need to find out: what the underlying cause is and address that. Some triggers include:

Low gastric acid production and taking PPIs.
Modern SAD . 
Damage to the nerves or muscle cells in the gut.

Scar tissue from surgeries, crohn’s, endometriosis.
Ileocecal valve malfunction.

Autoimmune disease, IBS, or recurrent antibiotic use.
Poor Motility → During periods of fasting, a migrating motor complex (MMC) develops approximately every 90–120 minutes to sweep residual debris through the GI tract. Several studies have demonstrated that abnormalities in the MMC may predispose to the development of SIBO.19-21
Taking the wrong probiotic could “fuel the fire” (and certain foods and other supplements may contain the following as well):

Watch for inulin, dairy/lactose, soy, starches, FOS, GOS, chicory root in probiotics, supplements and foods.
Start taking prebiotics after initial round of treatment and symptoms improve.

Treatment considerations

Biofilm disruptors (antimicrobials) – such as: Klaire Labs Interfase Plus.
Smaller meals, rest the gut.
Herbal therapy.
Make sure you’re confident it’s actually SIBO and not just GI flare-ups or another gut issue (testing with GI MAP or GI Effects helps with this).
Prescript-Assist Study.
Soil-based Probiotic Supplement Recs from Dr. Ruscio.
If you have slow motility, try Bifobacterium Lactis.
Add in a prokinetic agent to help with stronger motility if that’s part of the cause

Supplement suggestion for this is: Iberogast

Vagus nerve stimulation for motility (thus addressing stress levels and managing that is key).

Supported in research:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665597/  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017164/