Marketing Myth of Capsules for Probiotics

When I started my microbiome journey, I heard, and believed “You need special capsules so that stomach acid does not kill all of the probiotic — otherwise you are wasting your money!“

Then I hit Symbioflor-1 and Symbioflor-2 probiotics. These probiotics are in water and drops are added to a glass of water to take. More impressive, there have been studies that these specific strains makes it to the gut but typically persists for 18 weeks!

I started using Custom Probiotics single species probiotics. Originally, they sold only powder (eventually they added capsules because of customers’ request). Their instructions below.

I have since added two additional single species probiotics sources to my providers:

BulkProbiotics
Maple Life Sciences

Not only are these in powder, they are massively cheaper than capsuled probiotics at health food stores and more likely to be alive. See Probiotics — what is advertised may not be what you get post.

Use as a mouth rinse, gargle then swallow!

Recently there has been growing numbers of studies associating bacteria in the oral cavity (i.e. mouth and nasal passages) with conditions such as UC

Yesterday I had a conversation with someone that had SIBO, was successfully treated with rifaximin and was clear for a few months, then the “cat came back”, i.e. SIBO returned. I asked him, where did the bacteria come back from? My answer was simple, gravity and eating moved them from the oral cavity back to the small intestine. My suggestion was doing the above probiotic rinse a few times a day — my suggests were one of (or rotate every two weeks of):

I have not yet found any studies on using these as an oral rinse for SIBO — so these are modelled suggestions.

Stomach Acid — the facts

Stomach acid levels change in response to eating. When you eat, your stomach produces more acid to help break down the food. The pH ranges for one study are shown below — for the non-science types, a pH of 7.0 is neutral water.

Diurnal variation of intraoral pH and temperature

This leads to a simple suggestion: take the probiotics about 1 hour prior to eating. This keeps the threat of stomach acid low (if there is any acid!). Other facts:

  • Acid resistance: Many probiotic strains, particularly Lactobacillus and Bifidobacterium, have evolved robust cell walls that can withstand low pH environments. This intrinsic acid resistance allows them to survive in acidic conditions for limited periods.
  • F1F0-ATPase proton pumps: Probiotics can regulate their internal pH by using F1F0-ATPase proton pumps. The reduction of these pumps’ activity in low pH environments contributes to probiotic survival.
  • Upregulation of stress response genes: Under acidic conditions, probiotics upregulate certain genes to enhance their survival. For example, the hisD gene involved in histidine biosynthesis is upregulated during acid adaptation in some Lactobacillus strains.
  • Membrane fatty acid modulation: Some probiotic strains, like Lactobacillus rhamnosus GG, upregulate the cfa1 gene, which is involved in modifying membrane fatty acid composition to enhance acid resistance.
  • Glucose-mediated protection: The presence of glucose can significantly enhance probiotic survival in acidic conditions. For instance, Lactobacillus rhamnosus GG showed up to 6-log10 enhanced survival in simulated gastric juice at pH 2.0 when glucose was present.
  • Strain-specific adaptations: Different probiotic strains have varying levels of acid resistance. For example, Lactobacillus gasseri ATCC 33323 showed high intrinsic acid resistance even without glucose at pH 2.01.
  • Cross-protection mechanisms: Adaptation to moderately acidic conditions can provide cross-protection against other stressors, such as improved survival during lyophilization.

Profitable Marketing of Capsules?

Company selling probiotics are doing it for profit. People will pay for the convenience of capsules (instead of powder) but more important, you can drive sales to your product by claiming superior capsules. It works for sales! It may actually be less healthy because of the late release of the probiotics.

Bottom Line

It has become the norm in this household to use powders mixed with warm water and rinse the oral cavity before swallowing. We want to address the root source of the bad bacteria, not the down stream manifestations.

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