Whether it was through washing our hands thoroughly or scrubbing surfaces clean. Now we know that “good” bacteria exists and is crucial to maintaining our health and we have named them “probiotics” which literally translates to “for life”.
An example where good bacteria is important was discovered in studies that consistently found that children who are exposed to microorganisms before their first birthdays are less likely to develop asthma or allergies in the future than those who are brought up in highly sanitised environments from birth. In addition to this, C-section babies have been found to have more than double risk of developing food allergies and asthma by their third birthdays than babies born vaginally. This is because they miss out on the exposure to bacteria from passing through the birth canal in a process known as “microbiome seeding”. This all suggests that exposure to germs, dander and allergens help stimulate and train our immune systems’ responses, very early on in life. So we can see how certain bacteria and yeasts are important in shaping our immune system and continue to play a role as we age.
Probiotics also play an important role in our gastrointestinal health. Trillions of these “good” bacteria of different species live all over our body: on our skin, in our mouths and highly populate our digestive tracts. Without a healthy balance of “good” and “bad” microbiota, we are prone to conditions such as diarrhoea, irritable bowel disease, eczema and UTIs, and so on. When we fall sick, there is more bad bacteria inhabiting our bodies so we need good bacteria to eliminate the bad to maintain a heathy equilibrium in our digestive system.
Probiotics are naturally present in fermented food e.g. in sauerkraut, miso, kombucha etc. or live cultures can be added during preparation of foods e.g. in probiotic yoghurt or fermented milk drinks (Yakult). They are also available as dietary supplements in capsule, tablet or powder found at pharmacies, supermarkets and health stores. The optimal dosage of probiotics is difficult to determine as it depends on the strain and the product but many research articles suggest a daily dose of 10-20 billion Colony Forming Units (CFU) is adequate for probiotic benefits.
So what effect can probiotics have on the musculoskeletal system? Recent research has found that microbiota of the gut has key roles in bone metabolism, regulation of hormones and as we already know, development of the immune system. In bone metabolism, Vitamin D and Calcium are crucial nutrients for maintaining healthy and strong bones where deficiency in these can lead to osteoporosis, osteoarthritis, and increased risk of bone fractures. Gut microbiota produce short chain fatty acids (SCFAs), such as butyrate and propionate, that increase absorption and activation of these nutrients which indirectly increases bone density and strength. Alternately, Vitamin D and Calcium help maintain the epithelial barrier and translocation of microbial metabolites to the person so without each other, homeostasis of the gut will be disturbed.
Bone disease is more common in women over 50 years old due to the drastic drop in oestrogen (the female sex hormone) post-menopause. Gut microbiota has been found to regulate levels of oestrogen through secretion of an enzyme called β-glucuronidase that changes oestrogen into its active form. With lower diversity of microbiota in the gut, there is less oestrogen being activated, leading to breaking down of bone thus decreased bone density.
The gut is continuously exposed to a range of microorganisms coming from our environment and diet which can disrupt the equilibrium of good and bad bacteria, leading to increased “leakiness” of the intestinal barrier. This allows bacterial toxins to cross into the person’s circulation, stimulating unfavourable systemic inflammation. This can lead to developing autoimmune inflammatory conditions such as Rheumatoid Arthritis and Spondyloarthritis where the risk is further increased if you are not exposed to bacteria in early childhood. Additionally, the high rate of self-medicating with NSAIDs and paracetamol to treat pain further compounds this problem where probiotics can maintain intestinal barrier integrity by modulating “bad” microbiota that encourage gut inflammation.
The two primary genera of probiotics that can help improve your health are lactobacillus and bifidobacterium. Within these genera are different strains which may serve varying roles in different musculoskeletal and gastrointestinal conditions therefore the ones you should be taking will be dependent on what you are trying to treat. They are also generally safe as many microbiota you can ingest already exists in your gut.
However, as some probiotics can trigger allergic reactions, cause digestive discomfort and increase risk of infection in certain people it is always important to consult your healthcare provider to determine the strain and CFU before starting a probiotic supplement.
Ask at your next physio appointment if Probiotics can be helpful for you!
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