Page 69 - Demo

68 DIGESTIVE HEALTH FROM PAGE 67 The role of probiotics Probiotics are live bacteria that people consume in such products as yoghurt, in the belief that they reach the bowel and provide some sort of functional benefit, whereas a prebiotic is dietary fibre that is food for the bacteria already present in the large bowel, says Dr Belobrajdic. He highlights that the large bowel is complex, with more than 1000 species of different bacteria. A probiotic food or supplement typically only has a small number of different microbes, with clinical evidence still limited in supporting whether currently available probiotics provide functional benefits for improving gut health, he adds. Dr Belobrajdic says it’s important to keep in mind that to maintain higher levels of specific bacteria species in the gut, a person must consume probiotics every day and/or dietary fibre, which is the food needed for the beneficial microbes to flourish. Mr Webster says he has noted that more people are becoming aware of the importance of their microbiome for good health and the need to eat more insoluble dietary fibre as well as soluble fibre, cereals (low sugar), natural yoghurt and fermented food among other foodstuffs to feed their microbiome. Fermented dairy products such as yoghurt are generally advocated for improving digestion because they contain probiotics such as Lactobacillus bulgaricus and Streptococcus thermophiles. Claims are made that these probiotics: trigger changes in colonic bacteria and decrease the onset of Crohn’s disease, type-2 diabetes and irritable bowel syndrome; avoid inflammation of the gut and simulate antioxidants, which can ward off disease; help generate healthy short-chain fatty acids in the colon; and provide vitamins E and C while counterbalancing unfavourable bacteria associated with pain, bloating, gas and diarrhoea. Mr Webster underscores, though, that caution should be applied when many claims are made around probiotics and that it should be kept in mind that “dairy products are problematic for the majority of the population”. He also cautions against the widespread belief that all fermented foods contain probiotics, and that if people consume probiotics they’ll enjoy good gut health. “Some fermented foods have been sterilised, which means that the ingredient list has to be checked to see if live microbes are in the product,” he said. “Then there’s also confusion around strains of probiotics, some of which can cause ill health in individuals. “We’ll often hear about Lactobacillus or even Lactobacillus acidophilus, but it’s not meaningful unless we’re specific and state that it’s Lactobacillus acidophilus NCFM \\\[for instance\\\] – a strain, ie, a critical part rather than just a species. “So, it’s all well and good for people to try to increase the amount of good bacteria in their gut by consuming natural probiotics \\\[live bacteria\\\] from sources such as kefir and kombucha, as well as prebiotics.” Mr Webster highlights, though, that consuming these foodstuffs is beneficial as long as pharmacists and their patients remember that the restaurant of the gut is not “by invitation only”, meaning that both bad and good bacteria can thrive in it. “It’s always important to keep in mind that one size doesn’t fit all and that while there might be benefit for some individuals, it doesn’t mean that fermented dairy is the panacea for gut issues,” he said. “There are many people who cannot tolerate dairy, and the problem isn’t just with the lactose, but also the casein. I’d agree that there are some benefits to using fermented foods, but fermented dairy isn’t the only broom in the closet.” Gut queries for all conditions The gut can also play a part in a person being sick and listless, as the gut wall contains around 70 per cent of the cells that comprise the immune system, but there are many other reasons that could also cause these conditions. “Chances are there will be issues with the gut wall,” Mr Webster said, adding that discerning the link can be tricky, however. “Yes, it seems simple, but it’s so complicated, which means there must always be the inquiry as to what’s going on with the gut when it comes to any condition. “And also remember that if somebody has an issue, it often took a long time to get there, so it might take a long time to get better, and if someone’s been in a particular frame of health, it might take a long time to reframe their health.” He says that acne, dry and inflamed skin and eczema can be symptoms of a bacteria imbalance in the microbiota, and that an inextricable link exists between gut health and mental health. “We know this because we say things like, ‘I just followed my gut’, or ‘It didn’t feel right in my gut’,” Mr Webster said. At the pharmacy level, he says, he is keen not to simply sell an OTC remedy, “which isn’t easy, as patients often just want a tablet”. “It can also be problematic when I talk to people about sitting up at a table and chewing their food properly, because there are no teeth after their mouths,” he said. Overall, he says the best way he can assist patients is by helping them to get a good understanding of their digestive issues and to take it from there. “That approach is really crucial for pharmacists – getting to the root of the issue rather than taking the patient at their word,” he said. “That includes getting a good patient history and asking some questions, such as whether it’s the first time they’ve experienced the discomfort, what else was going on when they experienced the symptoms, whether the symptoms come and go, and what makes the gut discomfort better or worse. “And when they think they’ve asked enough questions, they should ask a few more, such as what their symptoms are, how they started and how long they’ve had them. “The biggest mistake a pharmacist can make is to grab something off a shelf without asking at least 10 questions.” RETAIL PHARMACY • JUL 2020