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Should you take probiotics

Kolasa, Kathy
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Wednesday, December 12, 2018

Q Is the push to take probiotics just another fad or is there a good reason to take them? AD, Winterville.

A You may have heard me suggest eating yogurt with active cultures if you are taking an antibiotic to help avoid diarrhea -- I’ve been saying that for years. But there is lots more information about probiotics. Chelsea Viscardi, a Brody medical student, explores your question.

Healthy and bacteria are not two words that we often associate with each other. When it comes to staying healthy, we usually think of staying away from bacteria. However, in your gut there are lots and lots of good bacteria. They help with digestion, making sure that you get all of the nutrients out of the food you eat; and with keeping your bathroom habits regular.

To help them help you, you can consume probiotics — as food or in pills. Many different types of probiotics have been studied and some have been found to help treat or prevent GI related problems. Commonly used probiotics are Lactobacilius, Bifidobacterium, Streptococcus thermophilus and Saccharomyces boulardii. Each of these has been shown to be effective against different types of diarrhea and constipation. I will describe three conditions experienced by adults.

Traveler’s diarrhea: If you are planning to take a vacation that may have different sanitation standards than your own, you could be at risk for traveler’s diarrhea. While this is usually only an unpleasant condition and not serious, some health professionals suggest taking a probiotic daily two days prior to travel until you return. This may help prevent spending your vacation admiring the bathroom tiling. Ask your doctor which one is right for you as the products vary greatly.

Dr. Kolasa already mentioned eating a food with active cultures while taking an antibiotic. The experts are not sure of the timing, dose, and strain of probiotic, so ask your doctor for a recommendation. Most suggest starting the probiotic on the day you start the antibiotic until one to two weeks after you have finished the course of antibiotics. If you use a food source, be sure to account for any added calories. Remember, it is important to take any prescribed antibiotic exactly as prescribed including the exact length of time.

Not only can probiotics reduce the risk of diarrhea, they can also help get things moving. The recommendation is to start the probiotic on the day you notice you are constipated and continuing until you feel more regular. Studies have shown that this use of probiotics also may decrease belly pain associated with constipation. Probiotics can be found in foods such as yogurts, kefir, sauerkraut and apple cider vinegar. They may also be found in a popular slightly alcoholic drink -- kombucha -- which is produced by fermenting tea using a “mother” or mushroom. However, we do not know the safety and effectiveness of this drink. It is known that the microbial population varies greatly. Until more is known, you won’t find many health professionals recommending it.

There are foods with added probiotics including Activia and DanActive yogurt. Special K recently came out with a dry cereal Nourish Berries & Peaches, that contains probiotics. It’s new so we don’t know much about it, but it may be an option for those without access to refrigeration.

Since the pills and powders are sold as dietary supplements, the Food and Drug Administration does not regulate them and there is no way to know what’s listed on the label is in the bottle. So, if you choose to take a probiotic product, buy from a reputable company. Make sure it has live cultures or it won’t be effective. The label should state “live cultures” as well as the specific strains. For example, Activia contains live cultures of Bifidobacterium. At this time there really isn’t a “generic” probiotic that will promote gut health for everyone. Dosing is important. More research is needed but some experts suggest you look for products that contain at least 10 billion “CFU” or colony forming units per serving size or dose.

Some products have been studied to have health benefits. They include DanActive, Activia, Culturelle, Align, Florastora, Bacid, VSL#3. If you do start using probiotics, you may notice some bloating and gas. This can be an uncomfortable side effect go away if you stop taking them. Some experts are not enthusiastic about adults or children routinely using probiotics noting that they are powerful regulators of host metabolism. Those experts would suggest probiotics only be administered based on strong scientific evidence giving the dose and strain needed for therapeutic effects.

If you are struggling with a medical condition related to your gut, it is important to talk to your doctor or registered dietitian nutritionist before starting or stopping the use of probiotics. In another column we will explore more microbe-based foods like cheese, Acidophilus milk, kefir, brined olives, salted gherkins, sauerkraut, kim chee, miso, natto, tempeh and poi and their possible role in supporting gut health.

Professor emeritus Kathy Kolasa, a registered dietitian nutritionist and Ph.D., is an Affiliate Professor in the Brody School of Medicine at ECU. Contact her at kolasaka@ecu.edu.

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