OPS CORE September 2021 by Wayne David Clark

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CORE September 2021

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September 2021

OPS CORE September 2021 ISSUE PG 2

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Do Probiotics Really Work?

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This issue... This month we take a moment to acknowledge all the athletes who participated in this years games, with a special shout out to our Hong Kong Athletes, as they return home from what will be one of the most memorable Olympic Games to date. The Olympic Games is the one event that can highlight and showcase the strengths and mental abilities of the human body to the extreme, and anyone with a passion for sport or health and fitness will be motivated and inspired by these amazing talents. Even people that aren't physically minded can be motivated by watching so many awesome achievements.

The games are also that one event that can unite countries and races, and for a brief moment make us feel that everything is alright with the world. So we thank everyone involved in making these games so special especially in this environment. Here at OPS we are slowly getting back into full swing, with the implementation of our Face To Face workshops. Of course as always keeping strict government safety guidelines in place. Finally this issue will feature new products that have just arrived, giving you something extra to add to your personal training arsenal.

Editor OPS Core www.opstudiohk.com

As the curtain falls on the 32nd Olympic Games in Tokyo, capturing two-and-a-half weeks of competition may we congratulate all the athletes, coaching staff, medical support teams, parents, spouses who persevered during the lead up and at the games in Tokyo. CONGRATULATIONS on all your achievements. These games will certainly go in the books as one of the most unique and challenging of all times. To the country of Japan, the city of Tokyo and outlying supporting cities, thank you for hosting a truly magnificent Olympic games under pandemic situations. To all the volunteers who made the games safe, you can be extremely proud of your achievements. To all the athletes representing Hong Kong, 46 in total, competing in 13 sporting events, congratulations on your personal achievements, a truly remarkable performance by all. I was most inspired reading an article in the Standard and statement by Shen Jinkang, coach of cycling queen Sarah Lee Wai-sze who stated.... The Olympics are just a big game, and the experience and lessons learned are far more meaningful than a medal. To all the athletes, in particular those in Hong Kong, thank you for your sacrifices in representing your country, wearing the SAR colours. As we tend to focus on medal results, let us not forget everyone who sacrificed in the lead up to, and preparing for the Tokyo Olympics. At the closing, the IOC President, Thomas Bach called the Tokyo Olympics the “Games of hope, solidarity and peace” amid the coronavirus pandemic. For the first time, the entire world came together reunited through sport. The stage is set now for the Paralympic Games, may we continue to inspire the next generation of athletes from around the world to pursue their dreams!

Managing Director OPS

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Featured Article By

Derek Ng

By Derek Ng

Playing sport for fun is one thing, playing competitive sport is a whole other ball game. As a competitive squash player the nature of the game changes from a casual afternoons ball game, to an aggressive competition. This in itself creates a certain type of stress, which can be both a blessing and a hindrance, depending on how you allow it to affect your performance. Like most competitive sports there are many factors that come into play. As the saying goes being in the zone usually means that you are focused and in-tune with yourself, this can bring about a sense of superhuman abilities resulting in exceptional performance. especially when playing in a team. OPS CORE September 2021 ISSUE PG 17

Playing an individual sport brings this to another level entirely, as everything falls on you. From defence to offence, you are singularly responsible for every single thing that happens on the court. As such, mental preparation becomes even more crucial, as you have to strike a very precise balance between aggressive and composed. Too much aggression, and you might unnecessarily open up the court or make unforced errors, too little and you become too passive and reactive, allowing your opponent to dictate the game. At the upper echelons of the game, where skill and fitness are oftentimes close enough that they don’t make or break a match’s outcome, the ability to find and maintain that balance often becomes the key distinguisher between a champion and the rest. At the end of the day, you can be the fittest person in the world, or have the best skills and ball control in the world, or have the patience and composure of a monk, but none of it will mean anything if you can’t get them to work in harmony. Each of the three pillars need to be well balanced and in tune with each other for you to have your best performance. Think of it as a three sided pyramid, if even one side is weaker and collapses, it’ll take the whole thing with it. OPS CORE SUMMER 2019 ISSUE 6

I’ve always believed that there are three essential pillars for any athlete. The physical fitness aspect, the skills aspect, and last but not least, the mental aspect. As mentioned earlier, most top athletes often have the first two dialled in near perfection, and so the mental aspect is what separates the greats from the legends. However, mental strength and composure is not the easiest thing to train, and is a much more nebulous process than strength or skills training. It’s also a very individual thing, as different people need different mindsets that work for them. This is why there has been a big push towards sports psychology, and why a lot of top athletes have started working with sports psychologists. Another thing that has been proven to help is listening to music before games, the sort of music however, is again very individual and really just depends on the person. At the end of the day, you can be the fittest person in the world, or have the best skills and ball control in the world, or have the patience and composure of a monk, but none of it will mean anything if you can’t get them to work in harmony. Each of the three pillars need to be well balanced and in tune with each other for you to have your best performance. Think of it as a three sided pyramid, if even one side is weaker and collapses, it’ll take the whole thing OPS CORE September 2021 ISSUE PG 19 with it.

Learn the real bene ts of probiotics, what they can help with, and what it truly means to have a “healthy

ARTICLE

OPS CORE SUMMER 2021 ISSUE PG 20

Do probiotics really work?

JOHN BERARDI PHD, CSCS, CO-FOUNDER Dr. Berardi (a.k.a. “JB”) is a co-founder of Precision Nutrition, which has become the world’s largest online nutrition coaching and certi cation company. He’s an advisor to Apple, Equinox, Nike, and Titleist, and was recently selected as one of the 20 smartest coaches in the world.

I’ve devoted my entire career to making health and tness something that’s achievable and attainable for every type of person, from every walk of life.

OPS CORE SUMMER 2021 ISSUE PG 21

Do probiotics really work By Gabrielle Fundaro, PhD, CISSN, CHC Should I take a probiotic?” Some people say probiotic supplements are the answer to whatever ails you: digestive complaints, brain fog, immune system problems—even cancer. And then there are those who liken probiotics to multivitamins: a sure re method of creating very expensive urine—or in this case, poop. The truth is, taking a probiotic can be worth it. But any potential bene ts depend on factors like: Who’s taking the probiotic? Under what circumstances? And for what goal? In fact, even though I’m a coach with a PhD in this area, most of my clients don’t take probiotics. That’s not because they don’t ever work. It’s because we only know they work in certain situations. That’s why in this article, I’ll guide you through: What “gut health” actually means and how probiotics could support it Why we have so many unanswered questions about probiotics The bene ts of probiotics, based on the scienti c evidence How to choose a probiotic, when to take it, and how to tell if it’s working The two best things you can do to support your gut microbes, no supplements required.

Ready? Let’s learn all about these little bugs.

What are probiotics? According to the World Health Organization (WHO), probiotics are “live microorganisms, which when administered in adequate amounts, confer a health bene t on the host.”1 A simpler de nition would be: Probiotics are bacteria (and sometimes yeasts) that o er health bene ts. Probiotics come in supplement form and are also found in various fermented dairy products. Fun fact: Based on the current evidence, fermented dairy, such as yogurt and ke r, is the only food that can be considered probiotic. Other fermented foods like kimchi, sauerkraut, kombucha, natto, and miso may have health bene ts, but aren’t probiotic because they don’t contain the types of bacteria that t the de nition above. Also, pickled foods don’t t the de nition either (sorry!), though they’re certainly delicious. There are dozens of strains of probiotics. They often have long names that may seem di cult to remember and even harder to spell. I’ll mention quite a few of them in this article—not to make your head hurt, but because speci c health bene ts depend on speci c strains. The full name of each strain includes its genus, species, subspecies (if applicable), and an alphanumeric designation that serves as an identi er. Unless you’re a scientist, you’ll mostly hear strains referred to by just their genus and species (i.e. Lactobacillus reuteri or Bi dobacterium longum). Occasionally, you’ll also see the speci c strain included by name and/or numeric identi er.2

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These distinctions can be important because, in some cases, di erent strains of the same genus and species have very di erent e ects. For example, Escherichia Coli Nissle is probiotic, but Escherichia Coli Shiga (sometimes shortened to just E. Coli) is pathogenic, meaning it’ll make you sick.

To put this into real-life terms, at the genus level, we’re talking about the di erence between a dog and a wolf. When we get down to the strain level, it’s like specifying between a dog and a dingo. In the chart below, you can see how the probiotic taxonomy compares to that of an animal.

For both probiotics and animals, di erences at the strain or subspecies level can be more important than you might expect. Some of the most common probiotic strains come from following genera (not to confuse you more, but genera is the plural of genus): Lactobacillus Bi dobacterium Saccharomyces (these ones are actually yeast!) Streptococcus Enterococcus Escherichia

Bacillus

Lastly, some probiotic supplements contain multiple strains. Often, these are given a special product name, such as VSL#3, a multi-strain probiotic with Lactobacillus, Bi dobacteria, and one strain of Streptococcus that you’ll learn more about later in this article. Why are probiotics a thing? A lot of times, people hear “bacteria” and think, ‘Oh, that’s the stu that makes you sick.’ But our bodies are actually packed with di erent types of bacteria and other microbes—especially our gut. That’s what we mean when we talk about the gut microbiome, the complex ecosystem of microbes (and their genetic material) that live in our GI tract. These microorganisms are with us when we’re born, and they do more than just freeload. When everything’s working properly, they: help ferment undigested nutrients to produce bene cial compounds, in some cases (those are called postbiotics) prevent harmful bacteria and yeast from overpowering the gut by starving them out or actually attacking them (cool, right?!) play a part in regulating immune responses to infections and potential allergens in uence energy balance and potentially body composition may (potentially) in uence mood, behaviour, and cognition. As you can see, our GI microbes have several important and wide-ranging jobs. So it’s understandable that people want to prioritise their gut health. Thus, the interest in probiotics.

But what are we actually talking about when we use the term “gut health”? It depends on the context. But usually, when we talk about having a healthy gut, we mean: Having a diverse gut microbiome with a wide array of di erent types of microbes and microbial genes. Diversity is crucial, because it prevents one niche group of microbes from overpowering the rest of the population, which could make you sick. It’s also important because we know our gut microbes have key metabolic and immune functions related to their genetic material. Except… we don’t totally know which microbes do what. So a wider variety of microbes means more genes to perform a variety of functions to support our health. When there isn’t a wide enough array in a person’s gut, it’s called dysbiosis. You might hear people saying gut dysbiosis is bad and scary, and that you need probiotics to “ x” it. You may also hear that dysbiosis causes leaky gut, also known as intestinal permeability. (You can read more about leaky gut later in this article, but long story short: There’s no agreed-upon way to diagnose leaky gut, and it’s not something you need to worry about.) It’s true that dysbiosis can cause problems or signal there’s a problem in your gut, and that probiotics might help. But not always. That’s because…

There’s no single “healthy” gut pro le. A healthy person’s gut pro le (or the di erent types and amounts of microorganisms they have in their gut) could look completely di erent from another healthy person’s gut.

The same goes for people with various diseases: two people with the same GI disease, for example, may have vastly di erent gut pro les. So while probiotics can help in certain situations), there’s still a lot we don’t know about how our gut works and what probiotics can do. And when it comes to gut health overall, I often say we’re being sold a problem so we can buy a solution.

That’s why it’s important to keep your eyes and ears open for disinformation and sales tactics related to gut health. In particular, watch out for anyone/anything claiming that: gut dysbiosis, gut imbalance, or leaky gut is the cause of any disease they can diagnose, treat, cure, or prevent dysbiosis or leaky gut you need supplementation, detoxing, or any sort of “gut reset” they can design a speci c diet for you based on the microbes in your gut there’s a speci c pro le of a “healthy” gut or dysbiosis they have the ability to directly modify your gut microbiota in a speci c way studies from rodent or cell culture are directly representative of the human gut microbiome The bottom line: There’s still so much we don’t know about the gut microbiome that it’s impossible to de ne “good” or “bad” gut health. What’s more… The bene ts of probiotics aren’t a sure thing. At most, we have moderate evidence that certain probiotic strains might help alleviate certain health issues. Turns out, it’s very tricky to do research and draw conclusions on the bene ts of probiotics. That’s because:

There are hundreds of known strains of gut bacteria. And potentially hundreds or thousands more that we haven’t been able to identify yet. It’s going to take a while to sift through them all and understand their e ects.

Designing high-quality research is tough. There’s no standardisation in: Probiotic strains Dosage for trials Treatment time So when we look at the outcomes of di erent studies, they may not be comparable due to how the research was designed. That can make it di cult to draw conclusions.

Much of this research is done on animals. These studies are useful in telling us how things might work in the gut, but we can’t extrapolate the ndings to humans.

There may be some bias in which strains get studied. Certain strains tend to come up more often in research than others. When scientists see that a certain strain seemed e ective in one study, they might (consciously or unconsciously) select it for another study. Also, some research may be funded by commercial entities (for example, a speci c brand of yogurt), which a ects which strains are studied.

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Ultimately, this all means we have less information about some strains, and more information about others.

Response to probiotics is highly individual. A supplement might work wonders for one person—but o er no bene t to another—due to di erences in gut pro les and other factors. What’s more, some people appear to be resistant to supplementation. One study had a group of people take a Lactobacilli supplement.3 Then, researchers sedated each volunteer and then inserted a long, exible tube into their intestines to see if the probiotic strains had successfully enriched their gut. (If this sounds hauntingly like your last colonoscopy, you’d be right on.) Researchers also asked volunteers to hand over their feces for analysis. The results? The scientists found remnants of the probiotic in everyone’s poop. But during the colonoscopies, they discovered some participants’ guts weren’t enriched with the probiotic strains. For these people, the probiotics essentially passed right through them. So… Finding #1 was that people responded di erently to the probiotic strains. Finding #2: Faecal counts were not a reliable measure of how well a probiotic “worked” in this study. And most studies use faecal counts as their main measure of how well a probiotic “worked.” Which leads us to…

Measuring whether probiotics “work” is tricky. Just because you pooped out microbes doesn’t mean they took up residence and started multiplying in your gut, as evidenced by the study mentioned above. But taking samples from a person’s gut requires, well, getting a tube stuck into your intestines. And it’s not always easy to nd enough people who are willing to endure that in the name of science.

Check out the chart below to see the health concerns probiotics are shown to help with. After that, I’ll delve deeper into each issue individually.

The bene ts of probiotics: When is a supplement a good idea?

One thing I need to get out of the way: There’s no probiotic supplement that works like a multi-cooker—solving ve di erent problems all at once. Instead, probiotics work more like a bread maker with a persnickety on-o switch. They only do one thing, and they only do that one thing… sometimes. Probiotic supplements are both strain-speci c and population-speci c. So there’s no need to pop them the way you would a multivitamin. You have to be taking the right strain for the right job, and there has to be some evidence that the strain can actually do that job. Even then, there’s no guarantee a probiotic will help solve the problem. So a crucial rst step in deciding which probiotic to take is to ask yourself: Why do I want to take a probiotic? Because based on what we currently know, probiotics may help in just a few speci c situations. Taking a probiotic may be helpful if:

You’re taking antibiotics. Antibiotics kill o some of your gut’s microbes, which can cause a form of dysbiosis. (Remember, dysbiosis is when you don’t have enough diversity in your gut.) This type of imbalance provides opportunities for pathogenic bacteria (the nasties that make you sick) to multiply and take over. That’s why some people get diarrhoea while taking antibiotics.

One example: Clostridium di cile (often called C. Di ) normally hangs out in your gut. But it doesn’t cause problems, because the rest of the microbes in your gut keep it in check. Except, when you take antibiotics, C. Di might get the opportunity to thrive, which can make you really sick. So if you have to take antibiotics, taking probiotics alongside them may help reduce the risk of antibiotic-associated diarrhoea.4 Lactobacillus rhamnosus GG and Saccharomyces boulardii seem to work best. But you may want to wait and see if you actually get diarrhoea before starting a probiotic. Why? Starting a probiotic too soon can back re when it comes to getting your gut back to normal. One study dug deeper into this by looking at a healthy group of people who were taking antibiotics.5 Some participants took Lactobacillus rhamnosus GG, some took the antibiotics only, and some got a transplant of their own pre-antibiotic poop after nishing their antibiotics (also known as an autologous faecal transplant). The people who got back to their baseline fastest? The ones who got the faecal transplant, followed by the ones who took the antibiotic alone. Some participants took Lactobacillus rhamnosus GG, some took the antibiotics only, and some got a transplant of their own pre-antibiotic poop after nishing their antibiotics (also known as an autologous faecal transplant). The people who got back to their baseline fastest? The ones who got the faecal transplant, followed by the ones who took the antibiotic alone. In last place: the group that took a probiotic.

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The researchers theorized that the probiotic overpowered the participants’ native microbes, making it take longer to recover.

The takeaway? Since getting an autologous faecal transplant isn’t an option (they’re not FDA-approved for this purpose and, well, they’re a little inconvenient), the next best things are: • Do nothing, and only use a probiotic if you get antibiotic-associated diarrhoea • Take Saccharomyces boulardii along with your antibiotic, which has been shown to help, but doesn’t seem to have the same overpowering e ect as Lactobacilli strains

You have infectious diarrhoea. Got a stomach bug that’s causing diarrhoea or traveler’s diarrhoea? Taking Lactobacillus rhamnosus GG or Saccharomyces boulardii might help. There are di erences between what works best depending on the cause of diarrhoea, as well. For instance, Lactobacillus rhamnosus GG seems to work better for diarrhoea associated with C. Di infections than it does for general infectious diarrhoea.6 If you’re not sure which to try, consult your doctor or pharmacist for their advice.

You have irritable bowel syndrome (IBS). Bi dobacterium and Lactobacillus probiotics appear e ective for reducing symptom severity in people with IBS.7,8,9 Caveat: Because some of the research uses quality of life scores and most of the strains seem to o er the same e ect, there may be a placebo e ect at play. Still, if you have IBS, it may be worth it to give probiotics a try. Some research suggests taking a single strain on a short-term basis (8 weeks) is most helpful.10 Other research notes that a combination of Bi do and Lactobacillus works best, particularly if constipation is a problem.11 (Remember how I mentioned it’s tough to draw conclusions from probiotics research? This is a good example of that.)

So if you’re thinking of taking a probiotic for IBS, consider checking in with your gastroenterologist or a registered dietitian experienced with GI disorders about which strains to try.

You have ulcerative colitis. Ulcerative colitis, a form of irritable bowel disease, may respond well to certain probiotic strains. In particular, VSL#3, which is a combination of several di erent strains, may induce remission and prevent ares. Unfortunately, researchers haven’t seen the same consistency in treating people with Crohn’s disease.

You’re being treated for an H. pylori infection. Heliobacter pylori is a type of bacteria that can live in your digestive tract and cause ulcers. Certain strains (Lactobacillus reuteri, Lactobacillus rhamnosus, and Saccharomyces boulardii) may have a synergistic e ect with conventional treatment. And if you’re being treated with antibiotics, it could reduce any associated diarrhoea.12

You want to reduce your cholesterol/ improve heart health. File this one under: Probiotics might help, but certainly shouldn’t be the primary thing you do to improve your cardiometabolic health.

Some evidence indicates that certain strains can improve lipid pro les, meaning we see reductions and either total or LDL cholesterol, as well as improved insulin sensitivity.13,14 In the case of cholesterol, the ndings were speci c to fermented dairy (think: yogurt) rather than a supplement.

Before you read on… I’m about to tell you about a bunch of situations when taking a probiotic isn’t going to help. You might respond to some of these by thinking something like: “But I saw a study/article/documentary saying probiotics help with [ ll in the blank]!” That’s great! This is an exciting and emerging area of research, and we’re learning new things about probiotics every day. But scientists don’t consider one or even a few studies showing a positive e ect to be high-quality evidence. In order to draw a conclusion, a given e ect needs to be repeated in several studies, and ideally reviewed and analysed in a systematic review or meta-analysis. So, for the health situations below, this may mean that: There hasn’t been research on probiotics and this health issue. There has been research, but not enough to draw a conclusion. There has been research, but the e ects observed are inconsistent, negative, or non-existent. We may eventually discover that probiotics DO help with some of these health concerns. But at the moment, there’s not enough evidence for health professionals to make recommendations they can stand behind. Phew. [Deep breath.]

Probiotics are unlikely to help if:

You’re dealing with depression, anxiety, or another mental health concern. Yes, the gut-brain axis is a thing. But we still have a lot to learn about it. Much of the mainstream discussion around using probiotics for mental health revolves around the idea that if your gut produces more serotonin (sometimes called the “happy hormone”), you’ll have better mental health. While it’s true that 95 percent of your body’s serotonin is produced outside the brain (including in the gut), this isn’t the exact same serotonin that makes you feel happy.15 Serotonin produced in the gut doesn’t cross the blood-brain barrier, meaning it won’t impact your mood. Why am I pointing this out? The science simply doesn’t support the idea that having more serotonin in your gut means you’ll have better mental health. And overall, the evidence for using probiotics to help treat the following mental health issues is weak:16 Depression: It looks like probiotics might have an antidepressant e ect, but there’s not enough evidence to say that de nitively.17 Anxiety: Preclinical studies in rodents show a bene t, but, so far, these bene ts haven’t been observed in humans. Mood: In general, it seems probiotics may have an e ect on mood. But researchers are careful to note that at the moment, we don’t know enough to make recommendations. Importantly…

Probiotics should never be used in place of traditional mental health treatments, (Seriously) And even if you’re considering probiotics as something to try alongside therapy or medication, it’s probably not worth it.

Autism and probiotics: Can they help? People with autism tend to report a range of GI symptoms, such as abdominal pain, diarrhoea, and constipation. This leads some experts to wonder: Is an imbalance in gut ora to blame? Unfortunately, we still have more questions than answers. In several studies that included people with autism, GI and behavioural symptoms sometimes worsened while they were taking probiotics.19 There’s also been lots of buzz about the promise of faecal microbiota transplantation (FMT) in people with autism. (You can read more about FMTs below!) One study did show behavioural symptoms improved over time when people with autism received FMTs, but there was no control group, or a group of people who didn’t receive FMT treatments.20 So while the ndings seem promising, it’s impossible to say whether improvement could be attributed to FMTs without a control group.

You want to lose weight. It’d be so nice if probiotics could help us lose fat. Unfortunately, there’s no compelling evidence that probiotics can help with fat loss. Some studies have shown a reduction in waist circumference or BMI, but the e ects are too inconsistent to draw conclusions.

You have a rash or acne. As of now, probiotics are not recommended for eczema, atopic dermatitis, acne or any other skin complaint.

You have GERD. For those experiencing discomfort related to gastroesophageal re ux disease, probiotics may seem like a nice alternative to conventional medications. Unfortunately, while some early study results have seemed promising, they’ve been inconsistent. So there’s not enough evidence to show that probiotics can help in this situation.24

You have occasional gas or other digestive issues. If you’re wondering if probiotics can help with intermittent gas or stomach upset, the answer is no. Research shows probiotics don’t help with indigestion that has no speci c, diagnosable cause.25

You’re concerned you have a leaky gut. Though intestinal permeability, aka “leaky gut,” has been associated with various diseases and certain medications, it’s not something that can be diagnosed as a health problem (despite what Instagram “experts” may say). When a person does have intestinal permeability, they won’t have any outward symptoms of that issue speci cally—though it’s possible they may have other digestive complaints.

And regardless of whether you believe leaky gut is a “thing,” there’s no evidence probiotic supplements help repair the gut lining in people with intestinal permeability.

You have a yeast infection or recurring UTIs. People often look for natural alternatives to treating these issues, but probiotics are unfortunately not proven to help with yeast infections or prevent recurring urinary tract infections.26,27

You want to be the healthiest person on your block. You’re better o making lifestyle changes to support your overall health than taking a probiotic.

You want to “boost” your immune system. We know that probiotics can play a role in enhancing immunity in certain speci c situations. For example, when you take a probiotic to help with infectious diarrhoea, that’s a function of immunity. And one study showed probiotics might reduce the severity of upper respiratory tract infections in athletes.28 That said, for overall immune health—something a lot of people are interested in now given the pandemic—there are quite a few other changes you can make that will have a greater impact. (To learn what they are, check out this infographic on how to optimize your immunity.)

Faecal transplants: Are they evidence that probiotics work? Sometimes, people cite the success of faecal transplants as evidence that probiotics work. But what is a faecal transplant, exactly? The technical term is faecal microbiota transplantation (FMT). Basically, a healthy person’s stool is mixed with saline and then inserted into the patient’s colon. So yes, we’re talking about poop transplants here. We don’t know exactly how or why FMTs work, but they’ve been shown to be 80-90 percent e ective in helping people with C. Di infections that don’t respond to other methods of treatment.29 It’s thought that FMTs might help these patients by repopulating their gut with microbes that edge out C. Di . These results made scientists wonder about their other potential applications: In people with Crohn’s disease, ulcerative colitis, autism, obesity, and more. Despite great hopes for FMTs, results have been mixed in trials using them in patients with Crohn’s disease and ulcerative colitis.30 And in trials with people with obesity, no e ects were observed on body weight or composition.31,32 At the moment, faecal transplants are only approved by the FDA for treating C. Di after other treatments haven’t worked. And does the success of FMTs underscore the e ectiveness of probiotics? Not really. Probiotics contain a much smaller number of strains and a much lower total microbial content than FMT preparations.

So essentially, just because FMTs seem to work in people with C. di does not necessarily mean everyone should be taking probiotics.

Taking a probiotic 101: The most common questions, answered

Question #1: How do I choose a probiotic? You’ll need to consider several factors. Factor #1: Species, strain, or multi-strain probiotic The species or strain(s) that will make the most sense for you depends on the reason you’re taking a probiotic. Refer to the chart above to see which speci c probiotics are relevant for you. Factor #2: Price In most cases, taking a probiotic is a short-term thing, so price may not be a huge factor. But if it’s something you’d need or want to take long term, consider: Is the nancial commitment reasonable for you? And could you get the same bene t from lower cost (and potentially free) interventions, such as eating more whole foods and fewer highly-processed ones? (Learn more: The 5 principles of good nutrition.) Factor #3: Dosage We know that the e ective dose for all probiotics is somewhere between 106 to 109 colony-forming units (CFUs). (FYI, those little numbers mean ‘10 to the sixth power’ and ‘10 to the ninth power. Or simply: 1 million to 1 billion CFUs). Look for probiotics that deliver this dose in one or two administrations per day. Also: Be sure to take probiotics before their expiration date. If you take them afterwards, you may not get the number of CFUs on the label. And… that’s it. Don’t worry about whether your product is refrigerated. (Turns out, that doesn’t matter.)

When it comes to third-party quality certi cations, these aren’t as important as they might be for protein powders and other supplements. But if you’re an athlete and want to be extra safe, it’s not a bad idea to look for a 41 probiotic certi ed by NSF or USP.

Question #2: When should I take my probiotic? It’s best practice to take probiotics right before a meal, which seems to increase the odds of the little bugs doing their job in your digestive tract.33 If you’re on antibiotics, it’s natural to wonder if the antibiotic will wipe out the probiotic. After all, antibiotics kill bacteria, right? The short answer: You don’t really need to worry about this; your probiotic will be ne. (And if you’re concerned, you could ask your doctor or pharmacist about antibiotic and probiotic timing.) The long answer: Antibiotics do kill bacteria. But they work in di erent ways. Some antibiotics disrupt the cell wall or membrane of the bacteria they target, others prevent protein synthesis so the bacteria die o , and others damage the bacteria’s genetic material. Because of this, antibiotics don’t kill all the bacteria they come into contact with, so they may or may not a ect the probiotics you take. And they may or may not a ect your native microbiome. Also, some probiotics are yeasts, like Saccharomyces boulardii, so they’re not a ected by antibiotics. (And to be honest, as an expert in this eld, I’m less concerned about antibiotics throwing our native microbiomes o -kilter than I am about bacteria in our guts developing antibiotic-resistant genes. This is caused by antibiotic abuse or misuse, and can cause antibiotics to stop working when we really need them. But that’s another topic entirely…) There’s also this: No matter when you take your probiotic and antibiotic, they’re both going to be hanging around in your GI tract for about a day.

That means to some degree, everything is going to get mixed together anyway, which is why this really isn’t something to be concerned about.

Question #3: How long will it take a probiotic to work? There’s no standardisation in how long you should take probiotics. If you’re taking probiotics for antibiotic-associated diarrhoea, you’ll want to take them until you’re feeling better. This could be anywhere from one to eight weeks, for instance. But if you don’t notice any improvement in your symptoms after a month, it may not be worth continuing. If you’re taking probiotics for IBS, some research suggests people do better when they take them for shorter periods of time, as in less than eight weeks. As a general rule of thumb, I’d recommend taking a probiotic for a month. Then, use the steps directly below to determine whether it’s working for you. This works out conveniently, since most probiotics are packaged in a onemonth supply. That way, you can make a decision about whether to continue before you buy more.

Question #4: What are the signs your probiotic is working? To answer this question, you want to be really clear on what you hope to achieve by taking a probiotic. Let’s say you’re hoping for improvement in your IBS symptoms. You’ll want to set up a little self-experiment to evaluate whether probiotics are helping or not. So start by asking: What would “improvement” look like? Maybe it’s that you’re able to get through an entire day at work without digestive discomfort.

Or a week without having to miss out on something you wanted to do because of your IBS. Or it could be more speci c: less diarrhoea, constipation, or stomach cramps. Whatever parameters you decide on, the next step is to get in touch with your inner scientist. (We’ve all got one lurking in there!) Collect your data. Grab a journal or keep notes in your phone, and track any changes you notice. You might keep track of data points like your daily symptoms (or lack of symptoms) and/or your bowel movements and their qualities (using the examples in this handy visual guide to poop health). Every two weeks, reevaluate. How are things measuring up against the metrics you decided on? Over time, you’ll see a trend. Either the probiotics are helping, or they’re not. And from there, you can decide on your next move.

Question #5: Are there any side e ects? Probiotics can sometimes worsen GI symptoms. It’s pretty uncommon, but they can occasionally cause bloating or diarrhoea. It’s also important to be aware of potential drug interactions. For instance, people on oral chemotherapy drugs should check with their doctor before taking probiotics. (And really, if you’re on any prescription medication, it’s a good idea to check with your doctor before starting a new supplement.) Lastly, in people who are extremely immunocompromised, there’s the potential for bacterial or fungal translocation.

That basically means if you have a big ulcer, it may be big enough for bacteria or yeast from probiotics to pass through and get into the bloodstream. And that would cause a total body infection, which is really dangerous.

Of course, this is a rare complication but worth noting for people with a compromised immune system.

How to support a healthy gut without supplements If you came to this article wanting to ensure you’re looking after your gut health, this section is for you. When people ask me if they should take a probiotic or if there’s anything in particular they can do for better gut health, there are two big questions I want to answer: Are they getting enough bre from a variety of sources? Are they getting enough physical activity on a regular basis? I ask these questions because these are the two biggest factors that seem to determine microbial diversity. So if you’re interested in taking probiotics for general health or for one of the issues listed in the “probiotics are not likely to help” category, you’ll want to be sure you’re implementing these two lifestyle changes rst. Not only are they often less expensive than probiotics, but they’re more likely to improve your health overall. Also, if you’re taking probiotics for purpose there’s good evidence for, these practices will be supportive.

Lifestyle change #1: Eat a nutrient-dense diet with enough bre from a variety of sources. If you want to support a diverse microbiome, this is probably the most important thing you can do. Eating a wide variety of bre-rich foods like fruits and vegetables, whole grains, legumes, nuts, and seeds is your best bet. Add in some lean proteins and healthy fats and you’ve ticked the nutrient-dense box, too.

This whole bre thing is really important. One probiotic study done on healthy bodybuilders looked at the group’s gut pro les.34 Though it wasn’t the main aim of the study, the researchers noticed that bodybuilders who didn’t get enough bre had microbiomes similar to people who were sedentary. In other words, they weren’t getting the microbiome bene ts of exercise (more on that in a sec), possibly because they weren’t eating enough bre. Interesting, right?

What are prebiotics? You may have heard that you should be eating prebiotics, a form of bre that “feeds” the microbes in your gut. If you regularly eat bre-rich foods like the ones mentioned above, you’re getting enough prebiotics in your diet. We don’t know which microbes prefer which types of bre yet, so eating a wide array of di erent bre sources is the best approach.

What about probiotic foods? Probiotic foods may also be worth including in your diet. They’re associated with a host of bene cial health outcomes, such as a lowered risk of cardiovascular disease.13

And just a reminder: The only food that’s classi ed as probiotic right now is fermented dairy. This includes fermented yogurts and ke r.

What happens if a bre-rich diet causes GI issues? Sometimes, people eating a whole-food, bre-rich diet experience bloating, diarrhoea, and other digestive symptoms. This can be confusing, especially if you’re putting a lot of e ort into eating well for health reasons. In this situation, people often wonder if there’s something wrong with their gut health or if they need to take a probiotic. The answer: probably not. The bacteria in your gut ferment some of the bre you consume. As they do so, they produce gas. That’s not a sign of poor gut health. It’s just a natural response to eating more bre. But if eating more bre-rich foods causes noticeable and sustained GI symptoms, it’s a good idea to check in with your doctor. If you get a clean bill of health or if your doctor has ruled out everything except IBS, the next step would be to start a personalised FODMAP elimination and reintroduction diet with the help of a specially-trained nutritionist or dietitian. (To learn more about FODMAPs, and for everything you’d ever want to know about doing an elimination diet check out Precision Nutrition’s FREE downloadable e-book, The Ultimate Guide to Elimination Diets.)

Lifestyle change #2: Incorporate movement on a regular basis. In general, exercise is a good thing for your microbiome. Active people tend to have more microbial diversity, research shows.35 So committing to a regular movement routine is a great next step for gut health. But there is a sort of ‘Goldilocks e ect’ with exercise.

For instance, endurance exercise is associated with something called exercise-induced gastrointestinal syndrome, and people with IBS may notice discomfort with intense exercise. So like anything else, you need to nd the right balance that works for you. Focus on physical activity that: you actually enjoy you can do regularly (i.e. several days a week) makes you feel good and energized, not drained or sick.

Extra credit: Focus on deep health. If you’ve already got your bre and exercise habits down, that’s great news. Wondering what else you can do? There’s a lot of talk about the impact of sleep, stress, and other factors on gut health, but we don’t have much in the way of human data on how they impact microbial diversity.

How does alcohol impact gut health? We know too much alcohol can be detrimental to gut health. But interestingly, moderate red wine consumption seems to be associated with greater microbial diversity, possibly due to the polyphenols in wine.36 And actually, these e ects are more realistic than the resveratrol buzz we always hear about red wine, because all polyphenols seem to interact with our microbiota. So I’d recommend drinking rarely, or in moderation of red wine speci cally.

(Wondering if you’d be healthier if you quit drinking? Find out in this article on the real tradeo s of alcohol consumption.)

So as a next step for people who have the two main lifestyle changes down, I recommend focusing on practices that support your deep health, or your overall health. These can also help you make intentional decisions about what you eat and how you move, bringing it all full circle. What do those practices look like? Some places to start include: Managing stress Getting enough sleep Taking care of your emotional and mental health Seeking connection through meaningful relationships Shaping your environment to support your health and wellbeing This might seem a little anticlimactic if you’re really charged up about getting better gut health. I get it. The microbiome is a fascinating area of research. But in the scheme of things, we have very little in the way of practically-applicable data. While we wait for more evidence, we do know this: The behaviours that are associated with many other positive health outcomes may also be bene cial to our microbes. That’s actually good news, because it means in most cases, we don’t need fancy, expensive supplements for a better microbiome.

So the stu that’s good for your overall health? It’s probably also good for your gut.

Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes—in a way that’s personalised for their unique body, preferences, and circumstances—is both an art and a science. If you’d like to learn more about both, consider the Precision Nutrition Level 1 Certi cation. The industry’s top education programme. Master the science of nutrition and the art of coaching. The Precision Nutrition Level 1 Certi cation is your springboard to a deep understanding of nutrition, the authority to coach it, and the ability to turn what you know into results. E ective Nutrition Coaching – the missing piece in health and tness After 25 years in the eld, Precision Fitness has learnt that professional nutrition coaching is missing in every corner of our industry — from personal training and manual therapy, to functional medicine, group exercise, yoga, and beyond. Without e ective nutrition skills, professionals struggle to get impressive results with the people they work with, which often signals the end of the relationship. After trying (and failing) to help multiple clients or patients, it’s easy to see why many lose their passion for the work and even consider leaving the eld altogether! But with e ective nutrition skills, you can feel con dent, competent, and credible. You can o er advice that you know is right. And you can transfer knowledge in the right way, so that each person you work with gets the results they’re looking for. Put simply: Knowing how to coach nutrition e ectively is the key to helping people get the results they deserve.

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If you’re a coach, or you want to be…

ARTICLE

Clearly, 2021 has been an immensely trying year worldwide, given the uncertainty, loss, and constant change caused by the coronavirus. As a result of COVID-19, the Mental Health Association now reports a “staggering” increase in anxiety and depression. Anxiety disorders are the most common mental illness in America, according to the Anxiety and Depression Association of America. It a ected 40 million people each year pre-pandemic, with prevalence rates estimated to range from 18% to 25% of the population. In addition to ongoing stress, anxiety can be caused by a number of interacting factors, including genetics, brain chemistry, medical conditions, substance abuse, phobias, and trauma. Women are twice as likely as men to have generalised anxiety disorder. Treatments for anxiety can include counselling, medication, cognitive behavioural therapy, and exercise. Everyone’s needs are di erent when it comes to treating anxiety, but the good news is that exercise is easily accessible and a ordable — and also yields multiple other valuable physical and mental bene ts. Whether you’re a beginner or an exercise a cionado, here’s how a tness routine can help anxiety: 1. Exercise Alters Brain Chemistry Research shows that exercise stimulates the release of hormones that make you feel better, such as serotonin, dopamine, norepinephrine, and gamma aminobutyric acid (GABA). By helping to balance or increase these neurotransmitters, workouts can improve your mood over time. 2. Physical Activity Enhances Executive Function Exercise stimulates the frontal regions of the brain and thereby helps control the amygdala, which activates the “ ght or ight” response when triggered by anxiety, fear, aggression, or anger. It also helps you concentrate better, organise and interpret Information and make decisions faster. 3. Training Relieves Stress

A constant state of anxiety negatively a ects both the body and the mind. A tness routine serves as an outlet for physical tension by lowering cortisol levels, as well as a bene cial mental diversion or escape. ff

8 Ways a Fitness Routine Could Help Your Anxiet

4. Physical Training Boosts Self-E cacy Exercise improves self-con dence. It confers feelings of accomplishment and progress, and empowers individuals as a proactive way to take control of their health. 5. Working Out O ers Socialisation and Community Working out at a gym or taking exercise classes provides social opportunities to o set the isolation and loneliness that can accompany anxiety. If you’re not ready to go back to a gym but want to be physically active, consider working with a personal trainer or using the YBell Fitness App to train with a friend. 6. Fitness Routines Provide Structure Scheduling and performing regular exercise sessions creates a routine that delivers welcome structure and a sense of control that can help manage stress and anxiety. 7. Movement Increases Energy for those whose anxiety can result in the inability to focus, lowered productivity or mental paralysis, exercise stimulates blood and oxygen ow to the muscles and the brain, thereby rousing both the body and mind. 8. Physical Exertion Improves Sleep Studies show that regular exercisers enjoy better sleep and feel more rested, which enhances coping skills and physical health. Researchers say the best results come from consistent tness routines, recommending at least 30 minutes per day, 4 to 6 days per week. The modality is up to you — cardio, strength training, resistance training, yoga, stretching, and more all have been proven bene cial. There isn’t one way to exercise that is inherently more helpful than others. To treat your anxiety, nd activities you like and consider varying your regimen periodically to stay motivated. You can persevere over time with this smart investment in your physical and mental health. As always, speak to your doctor if you have concerns about your anxiety or feel you need additional ways to treat it beyond exercise.

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SOMETHING YUMMY FOR YOU BUTTERNUT SQUASH SOUP WITH CHILLI & CRÈME FRAÎCHE Come in from the cold to a warming bowl of autumnal soup 70

KEEP WARM THIS AUTUMN Ingredients 1 butternut squash, about 1kg, peeled and deseeded 2 tbsp olive oil1 tbsp butter 2 onions, diced1 garlic clove, thinly sliced 2 mild red chillies, deseeded and finely chopped 850ml hot vegetable stock 4 tbsp crème fraîche, plus more to serve

Method STEP 1 Heat oven to 200C / 180C fan / gas 6 STEP 2 Cut 1 peeled and deseeded butternut squash into large cubes, about 4cm / 1½in across, then toss in a large roasting tin with 1 tbsp of the olive oil. STEP 3 Roast for 30 mins, turning once during cooking, until golden and soft. STEP 4 While the butternut squash cooks, melt 1 tbsp butter with the remaining 1 tbsp olive oil in a large saucepan, then add 2 diced onions, 1 thinly sliced garlic clove and ¾ of the 2 deseeded and finely chopped red chillies. STEP 5 Cover and cook on a very low heat for 15-20 mins until the onions are completely soft. STEP 6 Tip the butternut squash into the pan, add 850ml hot vegetable stock and 4 tbsp crème fraîche, then whizz with a stick blender until smooth. For a really silky soup, put the soup into a liquidiser and blitz it in batches. STEP 7 Return to the pan, gently reheat, then season to taste. STEP 8 Serve the soup in bowls with swirls of crème fraîche and a scattering of the remaining chopped chilli.

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Did you know that personal trainers who have their NASM Corrective Exercise Specialization (NASM-CES) earn 48% more on average than other personal trainers without the NASMCES. That's an amazing pay increase in an industry where your income is typically determined by the number of clients you have, how many sessions they book and how much they are willing to pay. NASM’s Corrective Exercise Specialization applies to all clients, which means you bring increased value to new and existing customers. Obtaining the NASM-CES demonstrates your continued passion and investment in education, helping you better establish yourself as a leader in the tness industry. You can also apply the NASM Corrective Exercise program to clients that are already in good physical condition but want to do more! Maybe they are preparing for a race or competing in a sport. You will have the added value of making sure they are able to do their very best, maintain movement e ciency and help avoid injury as they challenge their bodies and push the limits.

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