Probiotics?

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FBurnaby

FBurnaby

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I'm having difficulty finding what the scientific consensus is on probiotics, and I'm specifically interested in FM physicians' view of supplemental probiotics. A relative is taking one from probioticamerica.com for a king's ransom and I want to make sure they're not wasting their money. Any thoughts would be appreciated!
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Just a med student, but what is he taking them for? There's pretty good evidence that probiotics can help prevent antibiotic-associated diarrhea so I know docs are starting to jump on that train. I think they definitely can't hurt to try for some minor GI issues (diarrhea, constipation, bloating, etc.), but if he thinks they're going to improve his hyperlipidemia or CV disease, that's another story.

That being said, you also have the issue of which bugs are actually doing the work and if the supplements have what they say they have in them...
 
It sounds like taking them as a cure all (i.e. "this is why I've been so fatigued, depressed, fat, bloated") and I would be more open to it if I knew there were some testing and it wasn't so expensive. Just wondering what the FM doc's response is when they encounter these kinds products/situations.
 
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FBurnaby said:
I'm having difficulty finding what the scientific consensus is on probiotics, and I'm specifically interested in FM physicians' view of supplemental probiotics. A relative is taking one from probioticamerica.com for a king's ransom and I want to make sure they're not wasting their money. Any thoughts would be appreciated!
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When encountering patients like your "relative" you learn not to get all that excited about it --- I've had patient's swear up and down that the only way they can pass gas is to sit in a tub filled with warm water and rubbing alcohol and pour this mixture over their heads -- or that the only way they can "cure" a backache is to lean forward at the bathroom sink and drink cold water by allowing it to run down the sides of their mouth into their throat -- Not kidding one iota

Personally, I have no opinion, nor do I care to take the time to investigate any particular company/ brand of non-FDA regulated supplements -- I do tell patients I have treated someone in the hospital who trashed his liver with a supplement purchased OTC at the local GNC which put him on the DILI list AND the transplant list -- patient was in his late 20s

I tend to regard this almost like I regard chiropractic (and remember that I'm a D.O.) -- not worth my time and effort -- if they're not spending my money on it, what do I care ---
 
Probiotics are a big topic at the conferences these days. I find them helpful in restoring balance in chronic diarrhea patients and helping prevent C. diff in hospitalized patients. No need to buy the "top of the line brand" Generic acidophilus at the grocery store vitamin section works just as well.
 
styphon said:
I like to use them in IBS. Also abx associated diarrhea (most pt's demand even more abx for their abx diarrhea, usually leave unhappy).
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Luckily I've found that after one round of augmentin diarrhea, patients are usually much more receptive to the "you don't need antibiotics" talk.
 
Probiotics are great. The nerve system to the gut is sooo advanced and sensitive, while mostly autonomousLy controlled.
After end nerve impulses back to the brain is something we may know less about than if they went trough a black box.

Yoghurt is not a good option. Does not have enough bacterial units and may not even have the proper types.

Personally, I have found long-term use great for the stomach and especially if you work out and eat a lot at all times.

Don't listen to so many studies here. They will never be done.
 
DrMason said:
Probiotics are great. The nerve system to the gut is sooo advanced and sensitive, while mostly autonomousLy controlled.
After end nerve impulses back to the brain is something we may know less about than if they went trough a black box.

Yoghurt is not a good option. Does not have enough bacterial units and may not even have the proper types.

Personally, I have found long-term use great for the stomach and especially if you work out and eat a lot at all times.

Don't listen to so many studies here. They will never be done.
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Do you really think the oral probiotics are all that great? Do we know the quality of the bugs? Bioavailability/absorption? I think Greek or Bulgarian yogurt (or real lassi) with fruit (good source of prebiotics) are good options. Same with fermented foods.
 
Doctor4Life1769 said:
Do you really think the oral probiotics are all that great? Do we know the quality of the bugs? Bioavailability/absorption? I think Greek or Bulgarian yogurt (or real lassi) with fruit (good source of prebiotics) are good options. Same with fermented foods.
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It is all about the number of colony-forming units and the strain.

You may want a mix of Lacto and bifidi with other types for different things, but most yoghurt has too low amount of bacteria. Bioavailability in PB capsules is more an issue about the integrity of your gut than the mere amount you can put per square, to say so.....
About 5 years ago, I attended a lecture with Dr Rindfleisch at University Wisc in gut-associated immune dysfunction. He spoke about something as simple as putting the baby to breast right away and the importance of vaginal birth for the proper formation of lactobacillus in the sterile gut. And this is evolving science and dynamic as nothing else. I have had Crohns patients on PICC lines for recurrent blood cloths due to infected pain pumps where surgery has not been very helpful. After 6 months of detox, the disease is being calmed down and after two more years of same they are entirely different. GI doctors used to say I was a quack, or at least suggest so, but word of mouth from patients is something the medical establishment have not found out how to regulate yet.

Cutting edge, integrative and low-risk healing science that is actively developing every day. Definitely a better alternative than steroids and hoping the flare doesn't need surgical resection.


The young physicians of today will have to become MUCH BETTER and MUCH SMARTER than us from the previous generation. Student loans was bad in my "previous life", but nothing like now!! At the same time, the fragmentation of healthcare remains the biggest threat to us overcoming lack of proper healthcare. If there was more respect and APPRECIATION of primary care doctors instead of lobbyist driven selective agendas mostly for pandering,it would be a huge start.

I am optimistic. For once, the millennial generation tends to be better at thinking themselves. For second, they are now being exposed to age-management, direct practice care and the flexibility you can have if you do not swallow he notion that you cannot have your own work. I have a primary care friend on of the major cities that made about 500 K last year and was working less than when he was family doctor for a multi-speciality group and no call.

His kids and my kids have met a couple of times and we both agree our family life is not comparable to how it was.
 
DrMason said:
It is all about the number of colony-forming units and the strain.

You may want a mix of Lacto and bifidi with other types for different things, but most yoghurt has too low amount of bacteria. Bioavailability in PB capsules is more an issue about the integrity of your gut than the mere amount you can put per square, to say so.....
About 5 years ago, I attended a lecture with Dr Rindfleisch at University Wisc in gut-associated immune dysfunction. He spoke about something as simple as putting the baby to breast right away and the importance of vaginal birth for the proper formation of lactobacillus in the sterile gut. And this is evolving science and dynamic as nothing else. I have had Crohns patients on PICC lines for recurrent blood cloths due to infected pain pumps where surgery has not been very helpful. After 6 months of detox, the disease is being calmed down and after two more years of same they are entirely different. GI doctors used to say I was a quack, or at least suggest so, but word of mouth from patients is something the medical establishment have not found out how to regulate yet.

Cutting edge, integrative and low-risk healing science that is actively developing every day. Definitely a better alternative than steroids and hoping the flare doesn't need surgical resection.


The young physicians of today will have to become MUCH BETTER and MUCH SMARTER than us from the previous generation. Student loans was bad in my "previous life", but nothing like now!! At the same time, the fragmentation of healthcare remains the biggest threat to us overcoming lack of proper healthcare. If there was more respect and APPRECIATION of primary care doctors instead of lobbyist driven selective agendas mostly for pandering,it would be a huge start.

I am optimistic. For once, the millennial generation tends to be better at thinking themselves. For second, they are now being exposed to age-management, direct practice care and the flexibility you can have if you do not swallow he notion that you cannot have your own work. I have a primary care friend on of the major cities that made about 500 K last year and was working less than when he was family doctor for a multi-speciality group and no call.

His kids and my kids have met a couple of times and we both agree our family life is not comparable to how it was.
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I am heavily in favor of integrative and functional medicine. I actually have read through quite a few things on the Univ of Wisc Integrative medicine fellowship website and print out stuff from the site for my patients.

I'm not convinced that throwing 10^15 CFU will matter. It is about absorption. You have to fix gut health, as you suggested. I am a huge proponent of the anti-inflammatory diet, then using probiotics and prebiotics in the form of food to help with absorption and positive change. I don't have faith in the probiotic pills themselves for the reasons you mentioned.
 
Have you guys heard of any significant side effects of probiotics or even worsening of GI discomfort?
 
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