The human body contains over 100 trillion microbes with over 500 different species, most of which are located within the intestine (gut), namely the small intestine, colon, and stomach. We commonly consider these microbes to be beneficial probiotics, but not all of them are—There is a balance of “good” and “bad” bacteria that maintains a microbial ecosystem within the body. The role of these bacteria is multifaceted—influencing our metabolism, absorption of nutrients, immune strength and support, and overall health. Since the balance of bacteria is pertinent to the absorption of nutrients and food, an imbalance (more “bad” bacteria than good) can cause a variety of concerns, including many obvious gastrointestinal-related issues such as bloating, diarrhea, and abdominal pain.
One of the most common complications of HIV (human immunodeficiency virus) is chronic diarrhea related to the increased occurrence of “bad” bacteria, known as enteric pathogens, inside the gut. In folks with HIV who face this issue, the virus causes immune suppression that allows these pathogens to proliferate in the gut. Not only that, the gastrointestinal tract is usually one of the biggest sites for HIV infection. Even in those who are considered undetectable, the treatments may cause diarrhea unrelated to any gut bacteria issues. Though the risk of bacterial imbalance in the gut decreases with treatment, the treatment alone may cause chronic diarrhea.
Either way, chronic diarrhea can cause a range of issues, from reduced quality of life to depression and unintentional weight loss of lean body mass, which may impact immune health. In this case, the role of probiotics in the HIV population becomes pertinent. Not only can probiotics help regulate the balance of bacteria within the gut, research has shown an immune benefit in a variety of people—those living with cancer, cystic fibrosis, and HIV. To be clear, probiotic supplementation is not a catch-all treatment, but one piece of the complex treatment regimen needed to support the entire person, not just the condition.
For those with detectable HIV, the active virus can cause gut inflammation which flattens the tiny finger-like bristles inside our intestines (known as villi) and results in rapid movement of nutrients and food through the gut. Treatments for those with undetectable HIV may cause diarrhea in a variety of ways, the most common of which include pulling more fluid into the gut and impacting the lining of the GI system which controls motility. The faster food moves through, the greater the risk of diarrhea, and fewer nutrients are absorbed. Chronic diarrhea also depletes the body of electrolytes and hydration, which can cause damage to the kidneys. In this case, probiotics can protect the gut barrier, improving its function, as well as increase production of proteins known to combat gut inflammation and regulate motility.
It’s important to note that all people are different, so generalized recommendations are not exactly a guarantee for anyone. Furthermore, foods containing probiotics do not have sufficient varieties or quantities of beneficial bacteria to make these results a reality. Simply put, one cannot eat enough yogurt or drink enough kombucha for the probiotics in them to be impactful.
Choose a probiotic supplement that has at least 10-12 individual strains of beneficial bacteria and has probiotic numbers in the billions or trillions. Pair this supplement with fiber-rich foods, such as quinoa, oats, fruits, vegetables, and beans. The fiber found in these foods, and many more plant-based foods, serves as prebiotics to feed the probiotics and allow them to proliferate in the gut.
As research continues, our understanding of the roles gut health plays in those living with HIV (whether detectable or undetectable) continues to expand. Conducting accurate and reliable nutrition science is difficult, since it’s difficult to control the diet of the study subjects, but the data is accumulating gradually. As we learn more, we will continue to uncover the seemingly endless potentials of prebiotics, probiotics, and optimal gut health.
