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In light of concerns with the side effects associated with the traditional pharmaceutical interventions for osteoporosis, including Denosmab (Prolia) and bisphosphonates, are probiotics a potential therapy for osteoporosis and bone loss? Is the health of our bones influenced by the health of our gut microbiome? How can we optimize our microbiome?
In this blog post, we examine the most recent scientific and clinical developments on probiotic therapy and osteoporosis, as well as research related to osteoporosis and the gut microbiome in order to answer these questions.
Article Summary
This article explores the role of the gut microbiome and probiotics in the treatment of osteoporosis. As a result, the post is rather lengthy and not everyone has time to read it in its entirety.
For those of you only interested in the main points, here is a brief summary of the the article.
- Targeting probiotic strains at a specific medical condition, including osteoporosis, requires skilled hands and is best done under the guidance of a trained health professional.
- The gut microbiome plays an essential role in our overall health, including the health of our bones. A healthy gut microbiome will absorb, metabolize and activate nutrients and minerals. A disrupted microbiome is unable to perform these tasks and can cause a leakage of toxins into the bloodstream and around the body.
- Probiotics potentially accelerate recovery of our microbiome. However, their effects are limited without changing diet and including soluble fibre.
- Diet is the path to a healthy gut microbiome. The right diet plan can reset the microbiome.
The balance of the article explores these points in more detail.
Probiotics for Osteoporosis
Two key research studies indicate that probiotics are a potential therapy for osteoporosis and bone loss. Both of these pieces of research come out of Sweden.
Osteomicrobiology Research: Gut Microbiome and Bone Health (2018)
The first research has been done by Dr. Claes Ohlsson, Professor, Chief Physician and Head of the Department of Internal Medicine and Clinical Nutrition at the Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden.
At the American Society for Bone and Mineral Research in Montreal in October, 2018, Dr. Ohlsson presented his research in the field of osteomicrobiology — the rapidly emerging research field of the role of the microbiota in bone health. (1)
During an interview with MedPage Today, Dr. Ohlsson explained that osteomicrobiology bridges “the gap between bone physiology, gastroenterology, immunology, and microbiology”.
Scientists first hypothesized in 2009 that the immune system can regulate bone mass. Studies using probiotics initially started on rodents. From there, research graduated to the study of older postmenopausal women. Dr. Ohlsson’s study, presented at 2018 ASBMR in Montreal, looked at the use of probiotics and its affect on the bone health of early postmenopausal women. Later in the post I provide a detailed summary of this study.
Probiotic Therapy Treatment Research (2019)
The second, and more recent research, has been conducted by Dr. Per-Anders Jansson, Dr. Ohlsson and colleagues. Their study examines probiotic treatment using a mix of three Lactobacillus strains for lumbar spine bone loss in postmenopausal women (2). Their research was published in November, 2019 in The Lancet and found that “no bone loss was observed in the” group that took the probiotic mix.
The authors state that: “Probiotic treatment using a mix of three Lactobacillus strains protects against lumbar spine bone loss in healthy postmenopausal women.”
While in its early innings, this research is an encouraging development for people with, or at risk of developing, osteoporosis and who want an organic, non-pharmaceutical way to improve their bone health.
Before we go further, I briefly comment on the world of probiotics and why you should use exercise caution before purchasing and consuming probiotics, in general.
Please note: MelioGuide has no relationship with BioGaia AB (the probiotic supplier in the study), any other probiotic company, or any of the research teams.
Not All Probiotics Are The Same
Like the calcium supplement industry, the probiotics industry is unregulated and there is little oversight or accountability. With the hype around the benefits of a healthy microbiome, the probiotics industry has become a high-growth, multi-billion dollar industry.
Claims being made by the industry players can be difficult for the scientific community to test and verify. I encourage you to exercise caution before consuming probiotics, especially if the reason you are taking probiotics is to benefit your gut microbiome as well as your bone health.
I encourage you to listen to a 16 minute audio post on CBC’s Quirks and Quarks entitled “Probiotics probably aren’t making you well, and they could make you sicker.”
The audio segment covers in detail what scientists are learning about the benefits of probiotics, as well as the challenges they present. The host interviews Dr. Eran Elinav, an immunologist at the Weizmann Institute of Science in Israel and one of the authors of a recent study published in the scientific journal, Cell.
Do Probiotics Help Healthy People?
On one study (3) Dr. Elinav and his team looked into whether probiotics given to healthy people had an affect on their health. They found and reported that the group of healthy people broke into two subgroups, roughly of equivalent size.
The first subgroup is the “permissive” subgroup. In this subgroup, administered probiotics were:
- Accepted into the gut microbiome.
- Allowed to co-exist and colonize with the existing bacteria.
- Helped modify their microbiome profile.
The second subgroup, which he called the “resistant” subgroup, barred the colonization of the administered probiotics. The host’s microbiome did not detect the probiotics. Further, the probiotics passed through the system without anything happening.
In a nutshell, half of the healthy people accepted the administered probiotics into their community and the other half completely rejected them. The conclusion was that your acceptance of an external probiotic depends on the acceptance profile of your microbiome. Figuring that out is beyond the reach of most people and requires the attention of a skilled health professional.
Do Probiotics Rebuild the Gut After Antibiotics?
In a second study (4), Dr. Elinav looked at the usage of probiotics for people who recently had taken anti-antibiotics. He wanted to see if the administered probiotics rebuilt the gut colony — a narrative promoted aggressively by probiotic marketers.
Dr. Elinav’s study found the opposite effect. Probiotics inhibited the reintroduction of the native strains. They also slowed the reconstruction of a gut microbiome stripped of its colony by antibiotics. This suggests that you should be cautious about using probiotics to rebuild your gut microbiome after taking antibiotics.
The Future of Probiotics
Later in the CBC audio interview, there is a discussion with Dr. Brett Finlay, a leading microbiologist at the University of British Columbia. Dr. Finlay has done significant research in the area of probiotics, including making breakthroughs in the use of fecal transfers.
I won’t go into all of the discussion with Dr. Finlay but he does make one important point that relates to the research happening in the area of bone loss and probiotics.
Dr. Finlay has reservations about the current probiotic offering on the market today. He sees great opportunity in next generation therapeutic bacteria probiotics targeted at specific medical conditions. These applications need scientific testing and validation.
With that, now is a good time to discuss the state of science as it relates to probiotics, osteoporosis, bone density and the gut microbiome. Our discussion will start with research done in 2012 that examined the relationship between gut microbiome health and bone mass in mice.
Bone Mass in Mice
In 2012, researchers Klara Sjogren, Cecilia Engdahl and colleagues studied the relationship between the gut and bone mass in mice. The research team demonstrated that gut microbiota (responsible for modulating host metabolism and the development of immune status) is a major regulator of bone mass in mice. (5)
Professor Sjogren’s study of mice showed “that the gut microbiome modulates bone homeostasis in mice, potentially by regulating the immune system and osteoclast formation”. Further, the research suggested “that modulating the microbiome and/or inflammatory tone may provide means to modulate bone mass and prevent osteoporosis.”
Mice are not people so we cannot conclude that the same effects will translate to humans. However, that changed with the publication of a number of studies in this area on humans. Let’s start with a twelve month study done between 2016 and 2017 on probiotic use in older postmenopausal women and the effect on bone mass loss. After that, we will cover the recent research done by Dr. Ohlsson on probiotics, bone loss and younger postmenopausal women. Finally, we will look at the research published in late 2019 by Dr. Per-Anders Jansson and his colleagues.
Probiotics and Bone Density: Older Postmenopausal Women
During a twelve month period between May 2016 and May 2017, Dr. A.G. Nilsson and colleagues at the Geriatric Medicine Unit at Sahlgrenska University Hospital in Molndal, Sweden, conducted a trial to investigate if lactobacillus reuteri ATCC PTA 6475 (L. reuteri 6475) affects bone loss in postmenopausal older women with low bone mineral density (BMD). (6)
Lactobacillus reuteri ATCC PTA 6475 is a microbe found naturally in the human gastrointestinal system. One of its benefits is its anti-inflammatory effects. This is important for bone health since inflammation leads to accelerated bone loss due to stimulation of the development of osteoclasts and increased bone resorption.
The research team at Sahlgrenska University Hospital wanted to determine if L. reuteri 6475 supplementation could reduce bone loss in humans — in this case a group of postmenopausal older women.
The study was called “Effects of lactobacillus reuteri on Bone in Older Women” or ELBOW.
The Study Participants
The trial was a double-blind, placebo-controlled study. Ninety caucasian women were recruited from the Sahlgrenska University Hospital Prospective Evaluation of the Risk of Bone fractures, also known as SUPERB.
The researchers screened 329 of 969 candidates.
The following were some of the medical conditions that eliminated a candidate:
- A T-score < -2.5 at spine or total hip.
- Untreated hyperthyroidism.
- Rheumatoid arthritis.
Fewer than half of the women were osteopenic. None of the women were classified as osteoporotic.
Of the group of 329 people, 253 women were contacted, 157 declined, and 6 met the exclusion criteria. This yielded a group of 90 women for the study.
Of the 90 study participants, 70 completed the study. Thirty four of the 70 women used the probiotic and the remaining 36 used the placebo. The age range of the women was 75 to 80 years old, with an average age of 76 years.
All of the women in the study had low BMD. This was determined by a T-score <= -1 standard deviation for BMD at either the spine, hip or femoral neck. The researchers used DEXA to measure BMD.
No study participants began osteoporosis medication during the period of the study.
The Study Procedure
The twelve month study started on May 9th 2016 and ended on May 24th 2017.
The women who received the probiotic followed this protocol:
- Orally receive BioGaia AB (the brand name of the probiotic) probiotic drops L. reuteri 6475 in doses of 5×10 (to the 9) colony-forming units (CFU) mixed with maltodextrin powder.
- The dosage was taken twice daily, yielding a total daily dose of 1×10 (to the 10) CFU.
During the study trial, the placebo group received the maltodextrin powder only.
The research team used a standardized questionnaire to collect information on smoking habits, calcium supplementation, alcohol intake, medical history, medications, and physical activity.
Volumetric BMD (vBMD) and bone microstructure were recorded at the baseline, or beginning, of the study. After 12 months, high resolution peripheral quantitative computer tomography (HR-pQCT) was used on the distal tibia to determine the following metrics:
- Total volumetric BMD.
- Cortical thickness.
- Cortical volumetric BMD.
- Trabecular bone volume.
During the study, subjects visited the clinic every third month to collect their dosage and assess adherence and adverse events.
The Study Sponsor
BioGaia AB is a Swedish developer and marketer of probiotic products. They provided the L. reuteri 6475 used in the trial and sponsored the study.
The research team indicated that the sponsor, BioGaia, had no role in “design and conduct of study, collection, management analysis and interpretation of the data, review or approval of the published study manuscript.”
BioGaia states that the dose used during the study was very large — likely well beyond administered in day to day probiotic use. They likely did the large dose during the study to avoid under-dosing and to ensure that they were able to see results.
Further, BioGaia states the L. reuteri 6475 is unavailable in Canada for general consumption.
Please note: MelioGuide has no relationship with BioGaia AB (the probiotic supplier in the study), any other probiotic company, or any of the research teams. We do not receive any benefit from publishing this article other than the satisfaction of sharing it with you, our reader.
Outcomes
The research team examined two outcomes, a primary and several secondary outcome.
The primary outcome the research team targeted was relative change after 12 months in tibia total vBMD.
The secondary outcomes targeted by the research team were relative changes after 12 month in the following areas:
- The aBMD (areal BMD) measured at the hip and spine.
- Trabecular bone volume fraction.
- Cortical vBMD.
- Cortical thickness.
- Bone turnover serum markers.
- Inflammation serum markers.
- Serum HbA1c.
- Body composition (total fat and lean mass).
Reported Key Findings
The research team reported that supplementation with L. reuteri 6475 for 12 months lead to a 50% reduced loss of tibia total vBMD (bone loss) in older women with low bone density compared to the placebo group. This is a significant finding since rapid bone loss can increase the risk of fracture.
Similar but smaller effects were seen in the secondary outcomes, however, the differences were not statistically significant.
Further, the research team reported that the probiotic treatment was “well tolerated and did not produce more side effects than those experienced by women who received the placebo.”
In an interview with Scientific News, team member Mattias Lorentzon stated: “Treatment with probiotics can be an effective and safe way to prevent the onset of osteoporosis in many older people in the future.” (7)
Exercise Recommendations for Osteoporosis
Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.
But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?
A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.
I cover important topics related to osteoporosis exercise including:
- Can exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis exercise program.
- Key principles of bone building.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength important if you have osteoporosis?
Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.
Probiotics and Bone Density: Younger Postmenopausal Women
At the October 2018 session of the ASBMR in Montreal, Dr. Claes Ohlsson of the University of Gotheburg in Sweden, presented the results of a study. The study was similar to the one described above with two differences:
- Younger postmenopausal women were studied.
- He used three strains of probiotics. (8)
Dr. Ohlsson and the research team set out to determine if “a combination of three bacterial strains protects against the rapid lumbar spine bone loss occurring in early postmenopausal women.”
The Study Procedure
The researchers performed a multi centre, randomized, placebo-controlled, parallel group, clinical study to evaluate the efficacy on lumbar spine bone mineral density (LS-BMD) and safety of a probiotic treatment consisting of three lactobacillus strains. The three strains used in the study were: L. paracasei DSM 13434, L. plantarum DSM 15312, and DSM 15313.
A daily dosage of 1×10 10 CFU/capsule was administered for the full 12 month duration of the study to the probiotic-treated group.
A total of 234 healthy, early menopausal women participated in the study. This study group was almost two and half times larger than the study of older postmenopausal women described above.
The following were the main characteristics of the total group of women studied in the trial:
- A lumbar spine bone mineral density (LS-BMD) T-score >-2.5.
- 2 to 12 years after menopause.
- Average age of 58.6 years.
- Average BMI of 24.0 kg/m2.
The group of 234 women was broken into two sub-groups:
- Placebo group.
- Probiotic-treated group.
The researchers used lumbar spine DEXA (LS-DEXA) to record bone density scores. The team measured the women at baseline and again 12 months later at the conclusion of the study. The primary outcome the research evaluated was the percentage change from baseline in LS-BMD after 12 months.
Source of the Probiotics Strains for Bone Loss Study
Each of the three strains are produced by Probi AB —a bioengineering company located in Sweden. A posting (9) on PLOS One (a web publishing platform for researchers) identifies Probi AB as the main applicant for a patent on the strains (pending patent application SE 1351571-3).
The posting also states: “The authors Klara Sjögren and Claes Ohlsson are included in the patent application as inventors but are not further involved in the activities of Probi AB.”
The posting further states that Probi was not involved in the study of mice by Dr. Ohlsson (where the same three strains were used). We could find no statement on Probi’s involvement in the study on post menopausal women.
Outcomes and Key Findings
After 12 months, the research recorded the bone density scores of the participants and compared the results of the placebo and probiotic-treated groups to see if there were marked differences in loss of bone mass.
At the ASBMR meeting in Montreal, Dr. Ohlsson reported two key findings.
- First, the lumbar spine bone mineral density (LS-BMD) loss was significant in the placebo group but the same metric was not significant in the probiotic-treated group.
- Second, the most noticeable protective effect of probiotic treatment was observed “for women below the median of 6 years from menopause. For these women, the LS-BMD loss was clearly less pronounced in the probiotic treated group compared with the placebo group.”
The research team concluded “probiotic treatment using a mix of three lactobacillus strains protects against lumbar spine bone loss in healthy early postmenopausal women. These findings indicate that the pronounced lumbar spine bone loss occurring during the first years after menopause is reduced by specific probiotic treatment.”
In an interview with MedPage Today, Dr. Ohlsson indicated that there were no changes in BMD at the hip or trochanter, and only slight reductions in bone loss at the femoral neck.
In the same interview, he went onto state that “the protective effect seems to be site-specific, and further studies will be needed to determine the mechanism of possible bone site-specific effects”. (10)
Probiotic Treatment Using a Mix of Three Lactobacillus Strains for Lumbar Spine Bone Loss in Postmenopausal Women
A publication in The Lancet in November 2019 studied the effects of probiotic treatment using a mix of three Lactobacillus strains for lumbar spine bone loss in postmenopausal women (2).
A group 249 postmenopausal women received a treatment consisting of three probiotic Lactobacillus strains: Lactobacillus paracasei DSM 13434, Lactobacillus plantarum DSM 15312, and Lactobacillus plantarum DSM 15313.
The research team measure the percentage change from baseline in lumbar spine bone mineral density (LS-BMD) at 12 months of probiotic treatment.
They reported “Lactobacillus treatment reduced the LS-BMD loss compared with placebo. The LS-BMD loss was significant in the placebo group, whereas no bone loss was observed in the Lactobacillus-treated group.”
Summary of Probiotic Therapy for Osteoporosis Research
The studies described above identify several probiotic strains that appear to improve bone health and are a potential therapy for osteoporosis. While this is encouraging, there are several important issues that I would like to point out:
- The probiotics used in the studies were specific strains, with lactobacillus reuteri ATCC PTA 6475 (L. reuteri 6475) being one of the more successful strains. It is improbable that a general probiotic will deliver the same results as these strains.
- These strains are only available from specific manufacturers and are not available in all countries. As a result, you might not be able to access either of these strains even if you wanted to.
- These therapies are generally not available through clinics and I encourage you to work with a qualified health professional if you want to pursue this therapy option.
- The probiotic dose levels administered during the studies were quite large — probably not advisable unless managed by a qualified and skilled health professional.
- The reduction in bone loss was restricted to the lumbar spine in each instance and was not seen in other parts of the skeletal system. Consider where you are experiencing bone loss before pursuing probiotic therapy for osteoporosis.
Scientists are in the early stages of understanding the relationship between probiotic strains and bone health and it is likely too early to consider it a therapeutic option for the treatment and management of osteoporosis.
Gut Microbiome and Osteoporosis
Probiotics are only one part of the therapy for osteoporosis and bone loss. A healthy gut microbiome contributes significantly to your overall health and, specifically, to the health of your bones.
Several recent studies (11, 12, 13) point to the microbiome as a source for (or at least a key contributor to) bone health. A research team at Michigan State (11) found that: “studies have clearly demonstrated that the intestinal tract can profoundly influence the health of the bone. One way this occurs is through the regulation of mineral absorption which is required for healthy bone and includes calcium, phosphorous and magnesium. In addition, endocrine factors that influence the absorption of these minerals as well as gut-derived factors such as incretins and serotonin can also influence bone turnover.”
Another study published in 2020 in the journal Aging and Disease by a team of researchers in Soochow University, Changzhou, China stated that “gut microbes can increase bone mass and improve osteoporosis by inhibiting osteoclast proliferation and differentiation, inducing apoptosis, reducing bone resorption, or promoting osteoblast proliferation and maturation. However, the therapeutic effect of gut microbes on osteoporosis remains to be further proven.”
Kent MacLeod: Gut Microbiome
To learn more about the relationship between the gut microbiome and osteoporosis, I turned to Kent MacLeod, CEO and Clinical Pharmacist at NutriChem and the author of Biology of the Brain: How Your Gut Microbiome Affects Your Brain.
During his many years of practice, Kent has observed that there is usually a reason behind “unexplained” serious bone loss. One of the overlooked causes is a history of significant gastro-intestinal disturbances and usage of medications.
Therapeutically, his objective is to resolve these digestive issues and use probiotics and prebiotics that are proven to improve bone density. Kent also encourages a targeted exercise program and a precise nutrition plan. He believes that the natural “trifecta” that triggers anabolic bone health includes:
- Microbiome (food, prebiotics, probiotics).
- Targeted exercise.
- Precise nutrition.
For his clients, Kent reviews and recommends proper hormones that have significant benefit to reduce risk for bone and overall health.
In cases where the bone loss is significant and the risk of this condition affecting quality and quantity of life is elevated, he encourages clients to consider more aggressive therapies such as the related medications Forteo and Tymlos. The objective is to get a new baseline for the microbiome so the other therapies can do their job.
Definition of the Gut Microbiome
The gut microbiome is a two- to five-pound biomass made up of a combination of bacteria, fungi, and other microorganisms. While the microbiome is distributed around the body, Kent notes in his book that its principal “headquarters” is located in the large intestine.
The gut microbiome consists of four distinct groupings of bacteria:
- Firmicutes.
- Bacteroidetes.
- Actinobacteria.
- Protobacteria.
Kent has developed a “Microbiome Map” (available in his book) that identifies the different species in each major grouping as well as the recommended prebiotic “fuel source”.
Your ability to absorb, metabolize and activate nutrients and minerals is dependent on the health of your microbiome. In other worlds you could eat nutrient rich foods, take all the supplements for bone health, but if your microbiome is compromised, your body will not be able to absorb the nutrients.
For example, Kent points out that magnesium is a critical nutrient for overall health. It helps regulate (and participates in) hundreds of biochemical reactions, including the structural development of bone.
In his book, Kent explains the “not all magnesium sources are equal”. Some magnesium sources are poorly absorbed in the gut, while others are more successful. Choice of magnesium source therefore matters and a healthy microbiome is essential to the overall absorption of magnesium, as well as other nutrients.
Short Chain Fatty Acids (SCFAs), Soluble Fibre, Prebiotics and Gut Microbiome Health
Kent explains that one of the most important metabolites for your gut are short chain fatty acids (SCFAs). These are produced when gut bacteria digest soluble fibres (as known as prebiotics).
Unfortunately, prebiotics are often overlooked and under appreciated but they play a critical role in “protecting the gut lining, reducing gastrointestinal inflammation, and act as important signalling molecules.”
Microbiome Disruption
Kent has a whole chapter dedicated to the threats that can lead to microbiome disruption. These include alcohol, stress, opioids, Proton Pump Inhibitors (PPIs), antibiotics and more. If you consume any of these or experience stress, then your microbiome might be disrupted and need attention.
However, in the absence of using these, how do you know if your microbiome is disrupted? Self assessing your microbiome health can be a challenge. Kent points out that there are two conditions in the gut that can lead to the release of toxins into the bloodstream:
- Leaky gut.
- Inflammation.
Leaky Gut and the Microbiome.
A gut is “leaky” when the intestinal lining is compromised and toxins are not naturally contained and are free to spread into parts of your body. A leaky gut is the direct result of your diet, environment, drug use, stress level and other factors. A leaky gut can lead to a number of problems including Irritable Bowel Syndrome (IBS) and many more conditions. Kent describes these in detail in the book. He describes the leaky gut in detail and identifies what you could be doing to cause the condition.
In a nutshell, if your gut is leaky, your microbiome is disrupted and needs fixing.
Inflammation and the Microbiome.
Kent points out that inflammation is the body’s way to fight back invaders. However, chronic inflammation (like the found in a compromised gut) is problematic. An inflamed gut can spread to the rest of the body, can cause a wide range of problems and needs attention.
To pinpoint whether you have chronic inflammation, you will likely need the attention of a qualified health professional. However, a good starting point is to be aware of the issue.
At NutriChem, Kent’s clinic in Ottawa, he offers a Body Chemistry Balancing (BCB) Test. This test protocol thoroughly goes through your body chemistry, identifies the presence and causes of a disrupted microbiome, and determines corrective action.
How to Fix a Disrupted Gut Microbiome
Once you know you have problems with your gut microbiome, Kent recommends you revisit and revamp your diet. He recommends that you eliminate processed foods from your diet — those that include sugars and preservatives, as well as foods that have been subject to pesticides, antibiotics, growth hormones and artificial flavours. Kent states that a 30 day shift in diet can have dramatic effects on the health of the microbiome.
In the book he goes into quite a lot of detail on diet and walks the reader through the different layers of diets you can employ. My suggestion is that you clean up your diet before you spend money on consulting services since they will likely start with that step anyway. In other words, clean up your diet and gut, and work with a skilled practitioner to eliminate the difficult and hard-to-find bugs in your gut.
Probiotics and the Microbiome
Kent dedicates a full chapter to probiotics and the gut microbiome. It is well worth the read.
Unfortunately, there is a misconception that you can solve your gut microbiome problem by loading up on probiotics or even targeting certain conditions with specific probiotics. This is not true.
The problem is that the introduction one strain of probiotic to address a specific health issue could, under certain circumstances, trigger an unexpected negative reaction.
Kent states: “You can only do so much with a probiotic when there is a disrupted microbiome”.
Instead he emphasizes that “diet is the real backbone of a microbiome shift. Probiotics accelerate recovery, but their effects are limited without changing diet and taking soluble fibre.”
Kent goes on and explains that there are potential side effects of taking probiotics, including anxiety or aggravation of existing symptoms.
In other words, you should exercise caution when consuming probiotic supplements. This guidance also applies to the probiotic strains listed in this post that are used for osteoporosis. You might want to consider working with a health professional if you want to pursue this path.
Probiotics that are part of your diet are encouraged. Sources include kefir, yogurt, kombucha and other foods.
Prebiotics and Gut Microbiome
Kent defines prebiotics (soluble fibres) as the “fuel of the microbiome” that “feed healthy probiotic bacteria.” The are great for a healthy gut microbiome.
Prebiotics, however, are likely not appropriate with a disrupted microbiome since they feed both the good and the bad bacteria.
Kent recommends that you fix your microbiome (through diet) and then employ prebiotics to maintain gut health.
In the following three interviews with Kent, I explore the gut microbiome, bone density and osteoporosis.
Microbiome Health and Osteoporosis
This is Part 1 of a three part series on the Microbiome Health. In this first part, Kent defines the microbiome, microbiome health, how a healthy gut microbiome improves your energy, and discusses the benefits of a healthy microbiome for your body and your bones.
What is the microbiome and where is it in our body?
The microbiome is essentially the microbes or the bugs that live on and inside our body. Most microbiomes are found in our gastrointestinal system. We have over a hundred trillion of these bugs which has a mass of about, in the average human, four or five pounds.
A healthy microbiome has many benefits including improved liver and kidney function, reduced inflammation, better immunological balance, and better bone health.
What is the relationship between our microbiome and our hormones?
There is an epidemic of hormone-related problems in humans: infertility, pre-menstrual problems, endometriosis, breast cancer, and polycystic ovarian syndrome.
In Kent’s clinic they treat a range of hormone issues. However, when they treat the microbiome, they see significant improvements to all hormone-related health issues because the microbiome is intimately involved in hormone metabolism.
For example, when your microbiome is unhealthy, you recycle estrogen. Your estrogen levels will go higher and higher and tend to make unhealthier estrogens. Women who are menstruating are still creating their own hormones.
We need to understand how an imbalance in the microbiome may impact bone density and ability to lay bone. Today, compared to years ago, we won’t give hormones to a woman yet until we are confident that the woman has a healthy microbiome.
Many women come to us for hormonal issues and want hormone replacement therapy. Often, after we improve their microbiome, the hormonal issues diminish. However, they still may need some hormones to maintain their bone density and health.
How to Get a Healthy Microbiome
This is Part 2 of a three part series on the Microbiome Health. In this second part, Kent discusses microbiome health, microbiome diet, identifies the process of building a healthy microbiome and how to get healthy microbiome. Kent also discusses bone health and the microbiome.
What makes a healthy microbiome and what causes a microbiome to be unhealthy?
Kent states that prebiotic soluble fibres contribute to a healthy microbiome. A prebiotic enhances the structure of the natural bacteria in the gut microbiome. Probiotics also contribute to a healthy gut microbiome.
A diet consisting of high concentrations of sugar, processed foods, and pesticides (in fruits and vegetables) as well as antibiotics in substances we eat contribute to an unhealthy microbiome.
The problem, Kent points out, is that most people, including medical and health professionals, do not know how crucial these items are and how much of the healthy stuff people need to consume for a healthy gut microbiome.
Probiotics and Osteoporosis
Generally, foods such as yogurt and fermented foods are good for the microbiome. However, to get a specific probiotic for a particular health issue, such as osteoporosis, you need to look at research into specific probiotic species (often manufactured by companies). Kent’s firm, NutriChem, designs probiotic mixes that consider available data and choose optimal configurations.
In the discussion Kent references a study that looked at one species of probiotic, lactobacillus reuteri ATCC PTA 6475 (L. reuteri 6475). In that study, a group of women, over a period of one year, took lactobacillus reuteri ATCC PTA 6475 and experienced 50 percent less bone loss than the group who weren’t using the probiotic (they were on placebo).
The important issue, Kent points out, is not to get too focussed on foods or strains specific to bone health and make sure that you are eating foods and species that promote an overall healthy microbiome.
Medications and the Microbiome
This is Part 3 of a three part series on the Microbiome Health. In this third part, Kent discusses how medications and drugs can disrupt the microbiome. He specifically covers proton pump inhibitors (PPI) , boron bone healing, and strontium.
Medications that disrupt the microbiome.
Proton Pump Inhibitors (PPI) are prescribed for digestive problems (heart burn, reflux) and are very disruptive to the gut microbiome. In the video, Kent explains how the PPI disrupts your gut and intestinal area and provides recommendations for people on PPI’s and how to address the issues this medication creates.
Conclusion
While in its early stages, probiotics appear to be a promising way to slow bone loss and osteoporosis. This is an encouraging development but it does not mean you should replace your exercise program, medications or nutrition with probiotics. We all should take heart and monitor developments in this promising research area.
Researchers in the growing field of osteomicrobiology are working hard to determine the link between the health of your gut and the health of your bones.
A few more points to consider:
- First, the choice of probiotic strain for a specific medical condition matters as does the dosage, and researchers have not nailed either of these down yet.
- Second, Dr. Elinav’s research indicates that acceptance of an external probiotic depends on your microbiome profile, something we hope will be generally available sometime in the future.
- Third, you should attend to the health of your gut microbiome since it can influence your overall health as well as that of your bones.
- Fourth, work with a skilled and qualified health professional if you decide to pursue this treatment option.
Hopefully, in the near future researchers will be able to provide us clear, evidenced-based direction on how we can use probiotics to reduce bone loss and battle osteoporosis. We would all benefit from the application of stringent, scientific standards to this health category.
Exercise Recommendations for Osteoporosis
Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.
But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?
A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.
I cover important topics related to osteoporosis exercise including:
- Can exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis exercise program.
- Key principles of bone building.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength important if you have osteoporosis?
Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.
References
- Ohlsson C, Sjogren K., Osteomicrobiology: a new cross-disciplinary research field. Calcified Tissue International, 2018 Apr;102(4): 426-432. EPUB 2017 Oct 27.
- Jansson, Ohlsson, et al. Probiotic treatment using a mix of three Lactobacillus strains for lumbar spine bone loss in postmenopausal women: a randomised, double-blind, placebo-controlled, multicentre trial. The Lancet. VOLUME 1, ISSUE 3, E154-E162, NOVEMBER 01, 2019
- Elinav, E. et al. Personalized Gut Mucosal Colonization Resistance to Empiric Probiotics Is Associated with Unique Host and Microbiome Features., Cell. September 6, 2018.
- Elinav, E. et al. Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT., Cell. September 6, 2018.
- Sjogren K, et al, The gut microbiota regulates bone mass in mice, Journal of Bone Mineral research, 2012 Jun 27(6): pp 1357-67
- Nilsson A.G., Sundh D., Backhed F., and Lorentzon M., Lactobacillus reuteri reduces bone loss in older women with low bone mineral density: a randomized, placebo‐controlled, double‐blind, clinical trial, Journal of Internal Medicine, September 2018, Volume 284, Issue 3, pp 307-317; first published 21 June 2018
- Probiotics can protect the skeletons of older women, June 21, 2018. https://www.sciencedaily.com/releases/2018/06/180621101329.htm
- Ohlsson C, Curiac D, Sjogren K, Jansson PA. Probiotic Treatment Using a Mix of Three Lactobacillus Strains Protects Against Lumbar Spine Bone Loss in Healthy Early Postmenopausal Women. ASBMR. Montreal QC. October 2018 presentation.
- Probiotics Protect Mice from Ovariectomy-Induced Cortical Bone Loss. https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0092368
- ASBMR: Probiotics Mediate Bone Loss in Women. https://www.medpagetoday.com/meetingcoverage/asbmr/75470
- Collins F. et al. The Potential of Probiotics as a Therapy for Osteoporosis. Microbiology Spectrum. Aug 2017. vol. 5 no. 4 doi:10.1128/microbiolspec.BAD-0015-2016
- Ding K, et al. Gut Microbiome and Osteoporosis. Aging and Disease. Volume 11, Number 2; 438-447, April 2020
- Zhang J, et al. The impact of the intestinal microbiome on bone health. Intractable and Rare Diseases Research. 2018 Aug; 7(3): 148–155.
Osteoporosis Guidelines
For more information, check out my Osteoporosis Guidelines.
Comments
November 13, 2018 at 8:51pm
Pat Anderson
Thanks for this, Margaret.
I have been trying to eat more fermented foods, thus consuming probiotics through food instead of taking them as a supplement.
November 15, 2018 at 8:27am
Richard Martin replies
Hi Pat: Thanks for sharing your thoughts on this topic.
November 13, 2018 at 10:00pm
Sheila Allum
Thanks for this. It has been around for a little while on some of the FB groups that I belong to. I am considering probiotics but my concern with this article is that it was sponsored by BioGaia who have patented the particular strain so unless you buy their products which are not available everywhere and expensive you cannot get that strain.
November 14, 2018 at 8:37am
Richard Martin replies
Hi Sheila: This article was not sponsored by BioGaia. We do not have a relationship with them or any other probiotic company. We receive no financial gain from writing and publishing this piece. The article was written to share the state of research into bone loss and probiotics with our readers.
November 14, 2018 at 7:47am
susan irene skoda
Further research is required with those people who already have Osteoporosis but not severe for fractures. There are so many different strains and quantities in probiotics and they are not regulated by the FDA in the US. Until there is more trials and evidence-based results, I will continue with natural sources of all nutrients, follow my physicians advise to take Calcium/Magnesium and Vit D supplements and perform weight-bearing exercises daily and avoid falls with balance techniques.
November 14, 2018 at 8:37am
Richard Martin replies
Hi Susan: Thanks for sharing your thoughtful comments.
November 14, 2018 at 1:15pm
Steve
Hello, and thank-you for this informative blog post. The microbiome is a recent hot research topic. What researchers are finding out is that the microbiome is much more diverse and complex than originally thought, and that it adapts rather quickly to dietary changes. This implies that diet may be an even more effective method of developing a bone-healthy microbiome than taking a small variety of specific probiotic strains. Perhaps all we need to do is eat more veggies to improve our bones. Time will tell.
November 14, 2018 at 2:02pm
Richard Martin replies
Hi Steve: Thank you for sharing your thoughts on probiotics, the bone healthy microbiome and their role in bone loss.
November 14, 2018 at 8:12pm
Sheila Allum
Hi Richard - I may not have put it quite right - the original study and article that came out I understand was sponsored by BioGaia. I did not mean to imply that your article was sponsored by them or that you had any financial or other reason to gain from sharing it so that we can make decisions about our bone health. Sheila
November 15, 2018 at 7:54am
Richard Martin replies
Hi Sheila:
Thank you for clarifying this. My apologies if my response was taken the wrong way.
The study is a peer-reviewed published in the Journal of Internal Medicine. The researchers explicitly state that BioGaia was the sponsor but that they had no role in the “design and conduct of study, collection, management analysis and interpretation of the data, review or approval of the published study manuscript.”
Unless there is evidence proving that this is not true, one can only assume that the statement is accurate.
The second study by Dr. Ohlsson used three different strains. For example, one is L. paracasei DSM 13434. This product is available from a different manufacturer, Probi AB.
https://www.ulprospector.com/en/eu/Food/Detail/13290/354034/Lactobacillus-paracasei-87002-DSM-13434
Probi AB provided the other two strains of probiotics in the bone loss study.
If probiotics turn out to be an effective way to treat bone loss in people with osteoporosis, it appears that there will be several manufacturers competing in the space. At this point it is premature to identify the combination of probiotics that will do the trick.
Our goal with our article was to "lay it all on the table" for our readers, especially in light of the encouraging progress that has been made of recent. However, we did caution that we are not there yet, there is much to be done and we should all monitor the progress in this space.
Thank you again for your insights and thoughts.
July 16, 2019 at 8:36am
Nancy Fortune
Margaret, I can't find the article you wrote on hormones and bone health. Didn't you write about this somewhere or was it only in our discussion?
July 16, 2019 at 8:58am
Richard Martin replies
Hi Nancy. You can find the article here. http://melioguide.com/osteoporosis-prevention/bioidentical-hormone-replacement-therapy/
August 26, 2019 at 7:05pm
Dragana Skokovic-Sunjic
Interesting review. Still too early to use probiotics as an intervention to prevent bone loss. Few points made in the article I really appreciate are: strain specificity for probiotics, and looking at different sides of the spectrum of opposing opinions. Elinav study has been criticized by many researchers including Dr Gregor Reid (ISAPP). Dr Finlay does point to Clinical Guide to Probiotic Products as a great resource for guiding evidence-based decision when choosing probiotic. There is so much more we all need to learn. At this point we need to do our best to make an educated guess, if anything, when if comes to taking probiotic supplements. Food and prebiotics (fibre) should support our own bacteria in their count and diversity. Probiotics should be used as an intervention, usually short term.
February 3, 2021 at 8:59am
Cindy Federan
Hello Margaret, I have found the MelioGuide very helpful over the years. I was diagnosed with osteoporosis in 2016. After going to various doctors over the years late last 2020 I was diagnosed with hyperparathyroidism which causes too much calcium in your blood. I have not noticed any discussion regarding this disease. It can lead to osteoporosis, kidney stones (which I now have) and other conditions within the body. Thorough my research I did find a very helpful website parathyroid.com. I apologize if I missed this within your guide. If not I thought I would pass it on.
February 13, 2021 at 12:18pm
Richard Martin replies
Thank you for sharing.