Heartburn is a burning sensation in the chest that can extend to the neck, throat, and face. It is often worsened by bending over or lying down. It is the primary symptom of gastroesophageal reflux disease (GERD), which is the movement of stomach acid into the esophagus. GERD is caused by frequent acid reflux, the backup of stomach acid into the esophagus. When swallowing, the lower esophageal sphincter which is a circular band of muscle around the bottom part of the esophagus, relaxes to allow food and liquid to flow down into your stomach. Then it closes again. However, if
Many people believe that the health of the digestive tract reflects the health of the rest of the body. This makes sense given that the gastrointestinal tract is our first line of defense against many infectious agents; it is responsible for building our immune system; it breaks down, produces, and absorbs nutrients; and it is a major pathway for toxin elimination. If any imbalance occurs within the digestive tract, many aspects of our health will be negatively affected.
Keeping Your Gut Bacteria Happy: All Probiotics are Not Created Equal
The human body contains 10 times more bacteria than human cells, and somewhere between 400-500 different bacterial species1. These bacteria are responsible for producing essential nutrients such as vitamin K, biotin, folic acid, and short chain fatty acids such as butyric acid. An imbalance in these bacteria, known as dysbiosis, has been linked to an increased susceptibility to infections, nutrient deficiencies, bone loss, altered immunity, and gastrointestinal disorders such as constipation and diarrhea1. Dysbiosis has even been linked to changes in mood2. Understandably, much attention has been given to probiotic blends that may be able to improve the balance of this complex microbial community or “microbiome” that lives within our digestive tracts.
The problem is that probiotics often tend to get lumped into one category, viewed as equally effective or “good enough to do the trick”. This couldn’t be further from the truth. When choosing a probiotic blend, many people assume that a higher number of bacterial strains and a larger dose indicates better efficacy. In fact, it is not uncommon to see products advertising a high dose such as 50 billion colony-forming units (CFU) per capsule, with 10 or more different strains of bacteria. This may sound impressive on the surface, but what do we really know about the interactions between bacterial strains within the body? What about the relationship between the 10 different strains in one capsule? Perhaps one strain feeds off the other nine and ends up killing them, for example. Unfortunately, we often don’t have enough research data to definitively say how these combination probiotics interact with each other.
Additionally, there are certain strains that have been studied for specific conditions and circumstances. It’s crucial to choose a probiotic that has clinical data to support its claims for specific health conditions. For example, the same probiotic that relieves irritable bowel syndrome (IBS) does not necessarily help with eczema. Instead, it’s best to target the treatment and use a probiotic that is specific to the health concern in question.
Introducing BIO-Three Probiotic
Bio-Three is a unique probiotic blend from Japan and a prime example that you don’t need extremely high doses, or a huge variety of strains, to have an effective probiotic supplement. Bio-Three contains a total of 48 million CFU and three different strains per capsule. Yet, it is one of the most well-studied and beneficial probiotics available on the market, according to over 60 years of research in over 30 clinical studies. Bio-Three contains the following three strains that work synergistically to improve digestive health:
- Enterococcus faecium T-110 – part of a normal healthy microflora andcapable of decreasing the pH of the GI tract to ensure all other beneficial bacteria can thrive.
- Clostridium butyricum TO-A – important because humans don’t have enzymes to break down fibre. This bacterium breaks down fibre in the gut to produce butyrateand butyric acid which keeps the cells of the colon healthy, reduces intestinal permeability and improves nutrient absorption. This probiotic strain is difficult to find in most supplements in Canada.
- Bacillus mesentericus TO-A – supports the growth of the two aforementioned bacteria and the growth of the most common bacteria in the large intestine: the Bifidobacterium species.
Despite only having three strains and 48 million CFU, Bio-Three has been shown to improve digestive discomforts such as bloating and constipation, but also a wide variety of health concerns. Here are some highlights:
Ulcerative Colitis (UC): A 2007 study looked at 20 UC patients that were unresponsive to conventional medical treatments such as mesalamine and sulfasalazine3. Remission or improvement in UC symptoms and endoscopic imaging was seen in 55% of patients after only four weeks of Bio-Three supplementation. This is a significant improvement given that the “standard” medical approach did not show any improvements for these individuals. A 2015 study evaluating the efficacy of Bio-Three in UC patients confirmed these findings, showing only a 9% relapse rate after six months in the treatment group versus a relapse rate of 26% in the placebo group4.
Gastrointestinal Infections: Two studies have found that Bio-Three can effectively reduce the duration of infection and decrease the length of hospital stay in children with acute infectious diarrhea5,6. A separate study found that supplementation with Bio-Three reduced post-surgery infection rates7. Moreover, the combination of these three specific bacterial strains has been shown to not only accelerate the growth of Bifidobacterium, but also inhibit the growth of E.coli8,9.
Women’s health: The use of Bio-Three intravaginally for three days in women with bacterial vaginosis and vaginitis resulted in complete eradication of symptoms in 44% of cases. Vaginal discharge, redness, and pH were all reduced significantly10.
Immune Function: Bio-Three has been shown to modulate immune function and the inflammatory response after only two weeks by increasing the production of the anti-inflammatory cytokine, IL-10, and downregulating the pro-inflammatory cytokine, TNF-alpha11. It has also demonstrated potential for reducing allergies.
As a consumer, perhaps the most important aspect of Bio-Three is its demonstrated stability at room temperature and ability to survive the high acidity of the stomach. This means refrigeration is not necessary when storing the capsules. These factors, in combination with the solid clinical research, makes Bio-Three a particularly attractive probiotic blend for a wide variety of conditions. It is important to seek out evidence-based strains when choosing a probiotic.
Every Great Probiotic needs a Great Prebiotic
The term “prebiotic” refers to a fiber or carbohydrate that is used as a fuel to feed good bacteria. Prebiotics are often paired with beneficial probiotics inside a capsule. However, the most common prebiotics such as fructo-oligosaccharides, galacto-oligosaccharides, inulin, and raffinose are typically not provided in high enough amounts to result in effective growth of beneficial bacteria in the intestines. Even worse, these prebiotics have been reported by many individuals to have negative side effects such as gas or bloating12. This is because many prebiotics promote the growth of both good and bad gut microflora – they are not selectively feeding the good bacteria!
Xylo-oligosaccharide (XOS) is a different type of prebiotic fiber used to promote bowel regularity and digestive health. XOS selectively promotes the growth of only beneficial microflora and can actually inhibit the growth of harmful bacteria13. To be more specific, research has found that XOS supports the digestive tract through the following mechanisms:
- Improving bowel regularity by normalizing stool consistency and enhancing peristalsis, the slight muscle contractions of the bowel wall which help move stool through the GI tract14,15
- Promoting the growth of healthy bacteria, especially Bifidobacterium13, while decreasing the growth of potentially harmful bacteria such as Escherichia coli, Campylobacter jejuni and Salmonella enteritidis16
- Reversing changes commonly found in the microflora during the development of diabetes17
- Supporting epithelial cells that line the mucosal wall of the digestive tract and lowering intestinal pH in order to create an inhospitable environment for harmful bacteria to live18
XOS has also demonstrated the ability to improve metabolic parameters by reducing triglyceride production in the liver, increasing the excretion of cholesterol in the feces, improving nutrient absorption, and improving immune function13,18.
These actions are all quite desirable for overall health, but of greater interest to most people is that XOS can prevent or relieve constipation and diarrhea. Clinical research has shown improvements in stool frequency, fecal quantity, and fecal consistency in those with constipation at the low dose of 0.4 grams of XOS per day19. Further research on pregnant women has found that 4.2 grams of XOS per day, for a period of only four weeks, was effective in relieving severe constipation15. This same study showed normalization of stool consistency and decreased occurrence of loose stools in these women.
When it comes to safety and tolerability, no significant side effects have been noted in all of the aforementioned clinical trials and even at doses as high as eight grams per day13. Nevertheless, lower doses of only 1.4 – 2.8 grams per day for a duration of eight weeks, have been sufficient to raise Bifidobacterium counts and positively influence the gastrointestinal microflora20. This low dose makes XOS highly desirable as a prebiotic or, at higher doses, as a significant source of dietary fibre to benefit cardiovascular, metabolic, and cellular health. Ultimately, XOS is considered to be one of the most beneficial prebiotics because it is highly effective at improving the gastrointestinal ecosystem compared to other prebiotics.
Advanced Repair: Inflammatory Bowel Disease
If the digestive tract has become overwhelmed by stress, injury, infection, or immune dysregulation, inflammatory bowel disease (IBD) can result. IBD is a blanket term that includes both Crohn’s Disease (CD) and Ulcerative Colitis (UC) and, although the two diseases have important differences, they both share a few common factors:
Stress: Consistent evidence shows that psychological factors such as stress and depression can impact the course of IBD21. Many individuals with UC or CD report that high stress often coincides with or precedes disease flare-ups. Keeping this in mind, it stands to reason that anything that will support the body’s stress response may be useful in controlling IBD symptoms. Indeed, this is the case. One herb that has been found to be quite effective for managing stress is Withania somnifera, commonly known as ashwagandha.
One double-blind, randomized control trial found that subjects with a history of chronic stress showed significant reductions in stress and anxiety scores after 60 days of supplementing with ashwagandha22. Additionally, a 28% reduction in blood levels of the stress hormone cortisol were found at the end of the trial, relative to only an 8% reduction in the placebo group. A meta-analysis reviewing five clinical trials for ashwagandha’s effects on stress and anxiety showed overall favorable results as well23.
Vitamin D3: It has been noted in the scientific literature that patients with CD and UC often have low levels of serum vitamin D324. Animal models have found that the vitamin D receptor also appears to have a critical role in the control and response of the colon to chemical injury25. Therefore, vitamin D3 may play a significant role in the prevention and treatment of IBD.
Bacterial Imbalance: The balance of good and bad gut bacteria has been found to be disrupted in both CD and UC patients26. For example, a decrease in healthy Bifidobacteria species and an overall less diverse gut flora has been found in CD patients27. Some research even suggests a high incidence of small intestinal bacterial overgrowth (SIBO) in CD patients28. The importance of treating dysbiosis in cases of IBD is also evidenced by the aforementioned efficacy of the Bio-Three probiotic in improving UC remission and relapse rates3,4.
Another therapeutic option is Saccharomyces boulardii, a non-pathogenic yeast most commonly known for its ability to treat diarrhea in those traveling or using antibiotics. However, it has also demonstrated powerful anti-inflammatory actions in the digestive tract through the modification of various cytokines29. Human clinical trials have found benefits for both CD and UC. For example, one trial found only a 6% relapse rate of CD in those taking Saccharomyces boulardii versus a 38% relapse in the placebo group30. Similarly, 68% of patients with mild to moderate UC flare-ups found clinical remission with the combination therapy of mesalazine and Saccharomyces boulardii31.
Inflammation: As the name implies, inflammatory bowel disease presents with severe inflammation throughout various areas of the gastrointestinal tract. Boswellia serrata is an herb well known for its anti-inflammatory effects, and clinical trials have obtained promising results in IBD patients. One study found that a higher percentage of UC patients (82%) achieved remission while using boswellia than those using the pharmaceutical drug sulfasalazine (75%)32. Boswellia has also been found to improve CD to a similar degree as the standard treatment, mesalazine, according to a standardized rating scale for disease severity34. Results like these may explain why 36% of German IBD patients surveyed use boswellia as part of their treatment protocol33.
When it comes to IBD, clearly there are many factors to consider and inflammation is only a small piece of the puzzle. A multi-targeted treatment approach is best for controlling symptoms, treating the root cause of disease, and generating long-lasting relief in both UC and CD patients.
- Yarnell E (2011). Natural approach to gastroenterology. Seattle [Wash.], Healing Mountain Pub. pp 51-52.
- Zheng P et al. Gut microbiome remodeling induces depressive-like behaviors through a pathway mediated by the host’s metabolism. Mol Psychiatry. 2016 Jun;21(6):786-96.
- Yukiko Tsuda. Clinical effectiveness of probiotics therapy (BIO-THREE) in patients with ulcerative colitis refractory to conventional therapy. Scandinavian Journal of Gastroenterology, 2007; 42: 1306-1311
- Yoshimatsu Y. Effectiveness of probiotic therapy for the prevention of relapse in patients with inactive ulcerative colitis. World J Gastroenterol. 2015 May 21;21(19):5985-94.
- Huang YF et al. Three-combination probiotics therapy in children with salmonella and rotavirus gastroenteritis. J Clin Gastroenterol. 2014 Jan;48(1):37-42
- Chen CC et al. Probiotics have clinical, microbiologic, and immunologic efficacy in acute infectious diarrhea. Pediatr Infect Dis J. 2010 Feb;29(2):135-8.
- Nomura T et al. Probiotics reduce infectious complications after pancreaticoduodenectomy. Hepatogastroenterology. 2007 Apr-May;54(75):661-3.
- Seo,G., et al.: Microbios Letters, 40, 151-160, 1989
- Lino, H., et al.: Biomedical Letters, 48, 73, 1993
- Chimura T. [Ecological treatment of bacterial vaginosis and vaginitis with Bio-three]. Jpn J Antibiot. 1998 Dec;51(12):759-63.
- Hua MC et al. Probiotic Bio-Three induces Th1 and anti-inflammatory effects in PBMC and dendritic cells. World J Gastroenterol. 2010 Jul 28;16(28):3529-40.
- Olesen M and Gudmand-Hoyer E. Efficacy, safety, and tolerability of fructooligosaccharides in the treatment of irritable bowel syndrome. Am J Clin Nutr. 2000 Dec;72(6):1570-5.
- Childs CE et al. Xylo-oligosaccharides alone or in synbiotic combination with Bifidobacterium animalis subsp. lactis induce bifidogenesis and modulate markers of immune function in healthy adults: a double-blind, placebo-controlled, randomised, factorial cross-over study. Br J Nutr. 2014 Mar 24:1-12.
- Aachary AA and Prapulla SG. Xylooligosaccharides (XOS) as an Emerging Prebiotic: Microbial Synthesis, Utilization, Structural Characterization, Bioactive Properties, and Applications. Comprehensive Reviews in Food Science and Food Safety, Vol 10, Issue 1, pp 2-16, January 2011
- Tateyama I, Hashii K, Johno I, et al. Effect of xylooligosaccharide intake on severe constipation in pregnant women. J Nutr Sci Vitaminol (Tokyo). 2005 Dec;51(6):445-8.
- Fooks LJ, Gibson GR. FEMS Microbiol Ecol. In vitro investigations of the effect of probiotics and prebiotics on selected human intestinal pathogens. 2002 Jan 1;39(1):67-75
- Yang J et al. Xylooligosaccharide supplementation alters gut bacteria in both healthy and prediabetic adults: a pilot study. Front Physiol. 2015 Aug 7.
- Jain I et al. Xylooligosaccharides: an economical prebiotic from agroresidues and their health benefits. Indian J Exp Biol. 2015 Mar;53(3):131-42.
- Iino T, Nishijima Y, Sawada S, Sasaki H, Harada H, Suwa Y, Kiso Y. Improvement of constipation by small amount of xylooligosaccharides ingestion in adult women. J Japan Assoc Diet Fibre Res 1997 1:19–24.
- Sydney M. Finegold et al. Xylooligosaccharide increases bifidobacteria but not lactobacilli in human gut microbiota. Food Funct., 2014, 5, 436.
- Maunder RG and Levenstein S. “The role of stress in the development and clinical course of inflammatory bowel disease: Epidemiological evidence”. Curr Mol Med, 8(4): 247-52, 2008.
- Chandrasekhar K et al. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration fullspectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med. 2012 Jul;34(3):255-62.
- Pratte MA, Nanavati KB, Young V, Morley CP. An Alternative Treatment for Anxiety: A Systematic Review of Human Trial Results Reported for the Ayurvedic Herb Ashwagandha (Withania somnifera). Journal of Alternative and Complementary Medicine. 2014;20(12):901-908.
- Jahnsen J, Falch JA, Mowinckel P, and Aadland E. “Vitamin d status, parathyroid hormone and bone mineral density in patients with inflammatory bowel disease”. Scand J Gastroenterol, 37(2): 192-199, 2002.a
- Froicu M, Cantorna MT. Vitamin D and the vitamin D receptor are critical for control of the innate immune response to colonic injury. BMC Immunol. 2007 Mar 30;8:5.
- Scanlan PD, Shanahan F, O’Mahony C, and Marchesi JR. “Culture-independent analyses of temporal variation of the dominant fecal microbiota and targeted bacterial subgroups in crohn’s disease”. J Clin Microbiol, 44(11): 3980-88, 2006.
- Dicksved J, Halfvarson J, Rosenquist M, et al. “Molecular analysis of the gut microbiota of identical twins with crohn’s disease”. ISME J, 2(7): 716-27, 2008.
- Castiglione F, Rispo A, Girolamo ED, et al. “Antibiotic treatment of small bowel bacterial overgrowth in patients with crohn’s disease.” Aliment Pharmacol Ther, 18(11-12): 1107-12, 2003.
- Kelesidis T, Pothoulakis C. Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders. Therapeutic Advances in Gastroenterology. 2012;5(2):111-125.
- Guslandi, M., Mezzi, G., Sorghi, M. and Testoni, P.A. (2000) Saccharomyces boulardii in maintenance treatment of Crohn’s disease. Dig Dis Sci 45: 1462–1464.
- Guslandi, M., Giollo, P. and Testoni, P.A. (2003) A pilot trial of Saccharomyces boulardii in ulcerative colitis. Eur J Gastroenterol Hepatol 15: 697–698.
- Gupta et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. 1997 Jan;2(1):37-43.
- Gerhardt H et al. [Therapy of active Crohn disease with Boswellia serrata extract H 15]. Z Gastroenterol. 2001 Jan;39(1):11-7.
- Joos S, Rosemann T, Szecsenyi J, Hahn EG, Willich SN, Brinkhaus B. Use of complementary and alternative medicine in Germany – a survey of patients with inflammatory bowel disease. BMC Complementary and Alternative Medicine. 2006;6:19.