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14 August 2006
Bacterial Bloat
by Serena Mackesy

Everybody's bloated these days. Have you noticed? Ten years ago, bloating was something you associated with overeating (or possibly having been dead for a couple of days). And now? We've all got it! Women particularly, it seems. You can barely get through a day without one of your colleagues clutching at her stomach and declaring how bloated she feels. "Bloating" is a Noughties buzzword, like "Axis of Evil" or "Joined-up Government".

So what's happened? What's changed about our lifestyle that's caused this epidemic? Has human physiology gone through some major alteration in the last decade, so we can no longer digest our food? And why does this new bloating seem to affect the health-conscious - the salad-munchers and gym-rats - more than it does the sort of person whose idea of a balanced diet is a side order of fries with their bucket-o-fat?

Part of the answer is this: however well-read they are, however much they like to feel that they are making informed consumer choices, the health-conscious among us are as much suckers for advertising as any couch potato. In some ways like being drawn to novelty in the form of "scientific advances" - they are even more credulous. One of the big changes in recent years is the mass-production and promotion of probiotic food supplements. And, whether they do what they claim on the bottle or not, they've certainly added another stratum to our ever-increasing neurosis about our wellbeing. Do I feel bloated? Why, yes I do, sometimes, and I never really noticed it before. Oh, dear. I saw something on TV about that. It must be a problem. I must find friends for my Friendly Bacteria! Look! In the chiller cabinet alongside the Sunny Delight! I'll try some of that!

So: what's the straight dope, then? Well, there is no doubt at all that our guts are, indeed, home to many Friendly Bacteria. Around 400 different types, in fact; and around a hundred-trillion of them in each and every digestive system. To supposedly complement and reinforce our natural population of little critters, marketers are pushing lactobacilli and bifidobacteria, though there are others; among them, amazingly, the much-feared E. Coli and that anti-Christ of the alternative health world, the evil Yeasts. According to probiotic true-believers, these concoctions of germs will aid digestion, produce vitamins and minerals and conduct an ongoing war with all the pathogens - Unfriendly Bacteria - that we inevitably take in as a consequence of day-to-day existence.

Scientists are beginning to discover that the human digestive system is much more than a poop factory. A surprising large piece of your immune system is based in your intestines. Ditto for great chunks of your endocrine (hormonal) system. Ghrelin, the magic-bullet weight-loss hormone discussed last week, is a gastro-intestinal hormone. And your guts play a big role in neurotransmitter production. That stomach lurch you get when something frightening happens? It's serotonin busting out of your enterochromaffin cells to back up the Prozac in your brain, honey, and making your gut contract as it goes. And we don't yet know the whole story. Research conducted at Dundee University with ulcerative colitis patients, for instance, revealed that they had very low levels of probiotics, and there are certainly strong links between arthritis and immune system problems.

So, a good strong probiotic bacterial population in your guts is undoubtedly a Good Thing, and in some circumstances this population can be disrupted. Antibiotics, for instance, will kill off roughly 10 percent of your "good" bacteria along with the Thing that was killing you, and there's evidence that your gut population gets sparser in old age, so obviously it's a good thing to encourage them to thrive.

But the thing is, as to the claims made for oral probiotic supplements, well, the best that can be said for the trials so far is that they are inconclusive. Some trial subjects have shown improvement in conditions as wide-ranging as Crohn's Disease and eczema, and some simply haven't. A recent round-up of all the trials to date found, for instance, that, of the five studies on irritable bowel syndrome (IBS), some were positive and others negative. The problem is not so much that probiotics don't work full-stop, but that we simply haven't got enough data to back up all the claims made for their miraculous properties.

How come the manufacturers can get away with the claims they bandy about on television? Well, two things. Firstly, ad-speak. Back to the bloating. If I asked you this question: would your rather be a) bloated or b) not bloated, I bet you'd plump for b), wouldn't you? But what exactly is bloating? What does it feel like? What does it look like? Is it really harmful? Is there an actual, medical definition for it, or is it something that varies perceptually from person to person? Or is it just a nice, nebulous concept, like "feeling a bit off-color", that can't actually be quantified in any real sense? And, because we're human beings and like to find cause-and-effect in everything, and the likelihood is that, as it's been suggested to you, you'd try a probiotic when you were feeling a bit bloated, the likelihood would also be that you might well feel that, when the bloating went away, it was the probiotic that made it do so. It's the same thing that made people swear that half an onion under their pillow made their cold go away.

The other thing is this: probiotics - the drinks, the pills and the powders - are classified, quite rightly, as foodstuffs, not as medicines. And the rules governing claims for foodstuffs are a lot laxer than those for medicines. That's how come A Mars A Day Helps You Work, Rest And Play. The probiotic claims themselves are pretty unspecific, if you look at them closely. "Feel the difference or your money back"; "can help digestive discomfort"; "that bloated feeling's just gone." There's the odd claim that's laughable. One manufacturer claims that certain anaerobic bacteria (i.e - ones that cannot survive when they come into contact with air) will "import oxygen" into your body. Mmm. Hot air, maybe - oxygen, no.

And then there's the specific products themselves. A recent study at the Royal Free Hospital, London, showed that, where over-the-counter probiotic products are concerned, some are definitely more equal than others. Only a third, for instance, contained the "billions of bacteria" their labels claimed they did. One tablet from a major British health-food chain claimed to contain a lactobacillus that doesn't even exist. Words like "biocultures" are so vague as to be effectively meaningless.

Furthermore, as you're taking them orally and they have to pass through the high-acid environment of your stomach before they get anywhere near where they're aiming for, the vast majority of these bugs will not survive to breed anyway. Of 39 products tested, only one - Multibionta tablets, which has a coating that enables its contents to get through the stomach unharmed - fulfilled all the criteria (safety for human consumption, containing living organisms capable of surviving gastric juices, having clinically proven health benefits, being clearly labeled with their contents clearly defined and "shelf stability") set by the testers, and 13 more were judged "satisfactory". The rest were useless.

So, the beneficial effects of probiotics are still very much going through the process of debate. In many Asian countries, probiotics are routinely given with antibiotics, and it may well be that there's good sense in the habit. OK, so longevity levels in many Asian countries are not exactly up there with the centenarian Bulgarian yoghurt-eaters who sparked off the original interest in probiotics, but there might be something to it. But if you're going to spend your hard-earned on these supplements, do so with a vigorous dose of good sense. Take the Multibionta, or stick to the major drink brands such as Yakult, Activia or Muller Vitality, which have at least had to pass enough tests to satisfy the Advertising Standards authorities (it's worth remembering that all of these products have quite high sugar levels). It's possible that you will, indeed, see health benefits from these products, and in any case, they're probably a lot less harmful than some of the other health fads we've endured of late.

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