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August 8th, 2013

Probiotics: Which one, and in whom?

I continue to be intrigued by the burgeoning use of probiotics  — by both patients and practitioners, including myself — to treat patients’ symptoms of digestive diseases. The problem I run into when considering their use in patients, or when answering patients’ questions about them, is in determining which patients are good candidates for probiotics, and which of the dozens of probiotics to choose.

So, I am asking for your advice and comments on this subject. Here are my questions:

1. For what conditions do you use probiotics (e.g. IBS, IBD, functional dyspepsia, chronic diarrhea, chronic constipation, abdominal pain, etc.)?

2. Do you use one probiotic in particular, or different ones for different symptoms?

3. How long do you try them out before determining they are ineffective and stopping?

4. If one is ineffective, do you try others? If so, in what order?

I am looking forward to hearing your advice and experiences.

 

4 Responses to “Probiotics: Which one, and in whom?”

  1. Jerry Goddard says:

    Most but not all literature seems positive

    The Lancet, Early Online Publication, 8 August 2013
    Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): a randomised, double-blind, placebo-controlled, multicentre trial

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961218-0/abstract

    (admin: edited for length)

  2. Tom Simpson says:

    Have you tried contacting manufacturers directly – e.g., Dr. David Williams (Probiotic Advantage), the makers of Align, Trubiotics, Phillip’s Colon Health, Culturelle, etc? Please keep me posted re: your findings.
    Thank you.

  3. Jerome Helman, M.D. says:

    I have been using a 10 billion active cell dose capsule (lactobacillus and bifidobacter) the past three years on myself and for my patients that does not require refrigeration made by Natural Factors, a Canadian company. I have mild Crohn’s disease and have had normal bowel activity on the supplement. I purchase it through Swanson Vitamins, an internet company (catalog #NFC015, $21.57 for 180 capsules). There is some information from the literature about the 10 billion active cell dose. I recommend it to all the elderly to enhance immune system function, those traveling overseas, those receiving antibiotics and everyone admitted to a hospital, especially ICU. True, there is no large evidence based study encompassing these issues.

    The recent negative study of probiotic use regarding antibiotic diarrhea did not offer a prebiotic substrate. There are other uncontrolled dietary factors that resulted in a negative study.
    Jerome P. Helman, M.D.
    Gastroenterology, Nutrition

  4. Mark Burger says:

    1. For what conditions do you use probiotics (e.g. IBS, IBD, functional dyspepsia, chronic diarrhea, chronic constipation, abdominal pain, etc.)?
    —–Fix the gastrum (hypochorhydria … usually … in older individuals and stressed-out patients (most)) so that digestion is complete so that undigested food dose not enter the colon to select for the wrong organisms + give probiotics for ALL of these conditions. Dysbiosis is at the root of all of them. Correcting the microbiome will allow for the production of more butyric, acetic, formic acids to soothe the IBS/IBD/diarrheal/constpated bowel. We give betaine HCl + Pepsin + Pancreatin (aka B.P.P. by Thorne Research) 2-6 caps w/each meal and this “cures” dyspepsia 80% of the time [avoiding patients with ulcers]. They wean themselves onto the appropriate dose (2-6 caps).

    2. Do you use one probiotic in particular, or different ones for different symptoms?

    —–For post-antibiotic: Saccharomyces boulardii lyo BID for 14 days (even concurrent with antibiotic if you can), then change to multi-species, high CFS count probiotics.

    3. How long do you try them out before determining they are ineffective and stopping?

    ——— 1-2 months. If they are “ineffective”, you need to add FIBER in the form of flax/oat/legume/psyllium/etc. as much as 35 grams/day (pre-biotic). Mixed fiber is superior to “psyllium-only” approach. It’s also necessary to start the patient on a good omega-3 fatty acid to aid in the “sealing” of the cell cement between enterocytes and reduce leaky gut.
    Adding glutamine in 5 to 8 gram/day doses to feed enterocytes. This should take effect in a matter of 1 week since the cell turnover is rapid.

    4. If one is ineffective, do you try others? If so, in what order?
    —– S. boulardii, combo of S. boulardii (yeast) and multi-species (probiotic) minimum 6 Billion CFU dose, then 80-750 billion CFU (a la VSL #3 sachets by Sigma-Tau PO QD).

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