We really are doughnuts. I know you do not want to hear that description, but it’s true. From the mouth on down humans are colonized by microbes. For most, “normal flora” describes a symbiotic relationship and represents our bodies in balance. Since diet, lifestyle, immune competence and environmental influence all differ between individuals, so too do our gut flora. Probiotics are a growing segment of the dietary supplement market about which you should be knowledgeable.

Human culture has long known that a healthy gut is vital to our health. The first examples of probiotic use originate in the tradition of eating fermented foods, such as yogurt, miso, sauerkraut, whey-fermented vegetables, unpasteurized kefir and buttermilk. Today, the most successful application of probiotics has been in the treatment of diarrhea, limiting the severity of symptoms in Crohn’s disease and irritable bowel syndrome. Probiotic treatment is also proving helpful in maintaining urogenital health. Healthy bowel flora appears to play an important role in our ability to fight infectious disease, providing a front line in our immune defense. And acid-producing lactobacilli and bifidobacteria increase the bioavailability of minerals.

Increasingly probiotic supplement labels containing the ingredient fructooligosaccharides (FOS), a ‘prebiotic’. A prebiotic is a food source for our own beneficial bowel flora. Many prebiotics are found in herbs and foods containing mucilage, polysaccharides and FOS, including artichokes, onions, bananas, asparagus, leeks and grains. Humans cannot digest or absorb FOS. Apparently, the net effect of including FOS with probiotics is improved nutrient absorption and reduced bowel inflammation.

An emerging application of probiotics involves co-administration with herbal medicine. Several herbal antioxidants are found in the plants we ingest attached to sugars (glycosylated). Bowel flora breaks down the sugar portion as a source of energy, leaving behind a more active and absorbable form of the molecule (aglycone). Similarly, our gut bacteria also converts glycosylated phytoestrogens, used as an alternative to Estrogen Replacement Therapy, into an active form. Although most medical practitioners agree that the ecology of our gut flora may not be mutable to wholesale change, temporary alterations can occur through probiotic supplementation and that the resulting condition may alter how we absorb medicinally active molecules.

An excellent scientific review of our current understanding of probiotics can be found here, although it provides limited information on how probiotics interact with herbal medicine or pharmaceutical drugs.

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• Well: Probiotics: Looking Underneath the Yogurt Label (nytimes.com)