Many of my patients, despite being very knowledgeable about supplements and being interested in natural remedies, are still not taking probiotics on a regular basis. Even when they are taking antibiotics for a flagrant bacterial infection, they may not think of taking probiotics. There was even one episode where a patient of mine told me that her pharmacist strictly warned her to specifically not take probiotics while on antibiotics.
I find this interesting, because if there was one thing we learned in integrative medicine fellowship, it was that probiotics are our friend. The stronger yeast strains may be concerning for those who are immune-compromised, but in general, probiotics are our friend.
Take a recent study, for example, published in May 2012 in the Journal of American Medical Association. A review of 63 randomized controlled trials showed that out of 11,811 people, those who were on probiotics had an associated reduction in risk of antibiotic-associated diarrhea. So, even if you are one of those people who don't like to take daily pills, at least if you are taking antibiotics, try adding a probiotic to your routine during the time you are on the medication to make sure that your intestinal tract stays healthy and balanced.
Many patients think that probiotics are only good for gastrointestinal issues, but they have other benefits as well. Sure, it can be a great friend to our gut function, but it also can help those with frequent infection issues. I like to utilize probiotics to help those with autoimmune diseases to help regulate their immunity since these patients have a tendency toward infections and many of their medications suppress immune function. A major caution for those who are immune-compromised: You shouldn't be on a probiotic that has too many species and specifically not strong yeast species since your immune system is compromised and there may be a potential risk for overgrowth. This is the reason why I regularly caution patients to check with their physicians first before starting any supplements. But in general, the common low species variety with hearty CFU counts that you can find in the health stores that are allergen-free is ideal for overall gastrointestinal and immune health.
Let me take this opportunity to talk about a few patient cases that demonstrate the benefits of probiotics.
I had an older female patient who came to me for irritable bowel syndrome with a propensity toward constipation and gastroesophageal reflux. After our initial discussion as to what might be beneficial for her work up, she decided she wanted food sensitivity testing. When the results came back, we explored the categories of foods that caused inflammation in her system and she consequently removed those foods from her diet. Her symptoms improved about 60 percent, but she wanted to know if there was anything else she can do to help the rest of her symptoms.
When she first started seeing me, she wasn't sure she wanted any more supplements, since she felt that she takes enough and felt certain that removal of food triggers alone would rid her of all her gastrointestinal issues. After our discussion once she had removed food triggers and symptoms improved but plateaued, she wanted to give probiotics a try. We started her on a gluten-free, dairy-free probiotic and after about four weeks on it, she noticed that her symptoms were mostly gone. We discussed the idea that she may have had some small bowel dysregulation in flora after many years of irritation and inflammation of the gastrointestinal tract from food triggers and that she needed to rebalance the flora after the removal of food triggers to get her bowel to fully heal. She is now on probiotics daily and recently told me that she had fewer colds last winter season, which she attributes to the probiotic's role on a healthy immune system.
In that patient's case, we see that the probiotics helped with gastrointestinal issues as well as helping patients achieve and maintain a healthy immune system for fighting against colds. Let's move onwards toward another patient example where probiotics helped her with recurrent urinary tract infections.
I was treating a woman in her 40s who presented with recurrent urinary tract infections. She felt like she was "borderline interstitial cystitis" because she always felt some low level of burning in her bladder and was concerned that it would become "full-blown interstitial cystitis." She was concerned about taking cranberry for her recurrent urinary tract infections because she thought that the acidic foods made the burning in her bladder worse. So, she wanted to know what other options could work for her.
During our initial visit, she also expressed concern that her back and joints hurt regularly and that she never used to have reactive airway disease with colds, but the last few years she started getting some wheezing with her upper respiratory infections.
Based on her history of many symptoms pointing toward a more inflamed physiology, I recommended that we test for food sensitivities to remove all offending triggers and worked with her on lowering stress and improving her sleep and relaxation schedules. She started walking more often and basically did an overhaul on her lifestyle patterns to lessen inflammation. After several months of these changes, she felt significantly better in regard to pain, sleep, and overall energy. She said that even the burning feeling lessened. But, she was still getting recurrent urinary tract infections, although it was less frequent.
I counseled her on appropriate bathroom self-cleansing routine and then we talked about the option of probiotics. She still didn't want to use cranberry extract but thought she would give probiotics a shot at helping her immune system rebalance itself. After about six to eight weeks on the probiotic, she started noticing that her urinary system was more balanced and calmer. After about 12 weeks, she noticed she had not had a urinary tract infection for about four weeks. We are now about a year and a half into her regimen and she hasn't had another urinary tract infection except once during that time period.
These patient examples show us that while probiotics definitely are our friend and can be helpful in many areas of health issues, a lifestyle change and diet change usually is needed to create a healthy foundation for our probiotic friend to help us achieve our health goals.
So, as we settle into the winter months, keep in mind that maintaining a healthy anti-inflammatory diet and not succumbing to overwhelming stress is very important... but we should also keep our helpful probiotic friend within our reach as well, with the guidance of our doctor, so that we can have a joyful, healthy holiday season.
Hempel, S, et al. Probiotics for the Prevention and Treatment of Antibiotic-Associated Diarrhea: A Systemic Review and Meta-Analysis. JAMA. May 2012. JAMA. 2012;307(18):1959-1969. doi:10.1001/jama.2012.3507
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