Probiotics during/after antibiotics?

September 28, 2013 10:43 AM

I'm on a course of antibiotics, so I'd like to begin re-colonizing myself with some helpful gut flora. Totally willing to get whatever from wherever; there are Whole Foods and various hippie stores (no slight intended) around where I can purchase food or pills, if I need something not available at a mainstream big box retailer or grocery store.

I'd really like for any recommendations to be evidence-based. I have a strong, visceral, and negative reaction to woo and outsized claims.

Articles and research about specific bacteria strains I should be looking to introduce, coupled with products that provide those strains, would be perfect.

Also, I recall vaguely some caution as to whether food (like yogurt) actually helps recolonize one's guts, as the bacteria may all be destroyed during digestion. Clarification on which delivery mechanisms (yogurt and similar, or pills, or whatever) are actually useful would be welcome, as are any other words of advice or anecdote that seem relevant and helpful.

posted by jsturgill to Health & Fitness (16 answers total)

Culturelle - If I remember correctly it came out of some strong academic research indicating that this particular strain was good for the gut, but also was exceptionally good at recolonization. Sending lots of bacteria to your gut is great, but the impact is minimal if they don't put down roots so to speak...
posted by NoDef at 11:13 AM on September 28, 2013 [1 favorite]

I have zero research as far as the Best Probiotic. However when I asked my pharmacist they named a few top brands. Some are more expensive than others. I took one that was $10 for a box of 30. The only thing is that you have to take an antibiotic and a probiotic at least 2 hours apart - from what I found online. (The probiotic will not make the antibiotic less effective, however the antibiotic can kill off the good bacteria from the probiotic when taken too closely together.)

My pharmacist also pointed out that sometimes you can't be sure if the bacteria are all alive from some of the box brands. However, I had a huge decrease in gut pain when I took a probiotic the last time I was on an antibiotic (I have pretty bad stomach pain and antibiotics always make it a lot worse, except when I took a probiotic.)

I would ask a pharmacist what they recommend. You can purchase many of them at a regular drugstore/pharmacy/pill aisle. You can also get other options at a health food store. Some of them need to be refrigerated.

I can note that I did notice a difference in taking them. I would have been in a lot of pain without them and it helped me get back on track easier also. (I was on amoxicillin 3 times a day, a slightly lower dose, for 10 days.)

In addition, I would not suggest yogurt during antibiotics. Your Rx may have this note on it, that you can't take dairy products with your antibiotic for something like 2 hours before or 6 hours after - which means if you take multiple doses through the day that you can't really have dairy at all. That's because dairy can make antibiotics less effective.
posted by Crystalinne at 11:15 AM on September 28, 2013

I'm sorry I don't have a cite for you, but I recall reading an in-depth article which concludes with what researchers in-the-know are doing for themselves. Rather than focusing on yogurt and other probiotics, they make efforts to maximize their prebiotics and expose themselves to environmental bacteria.
posted by moira at 11:20 AM on September 28, 2013

I would start with NIH's Oral Probiotics page which basically says our knowledge is incomplete, but probiotics are promising. There a nice selection of research cited in the Key References section.
posted by 26.2 at 11:30 AM on September 28, 2013

When my fiance was going through a round of serious antibiotics for a C. diff infection, his gastroenterologist advised him to take Florastor brand probiotics. I think we bought it at Walgreens.
posted by cabingirl at 11:30 AM on September 28, 2013 [1 favorite]

MedLine (also by the NIH) has some good info as well on these supplements, with references.
posted by mittens at 11:33 AM on September 28, 2013

Also, a study on survival of lactobacillus in stomach acid, improved with the addition of sugar.
posted by mittens at 11:37 AM on September 28, 2013

I found the article at NY Times here. Michael Pollan writes:

Alas, I am impatient. So I gave up asking scientists for recommendations and began asking them instead how, in light of what they’ve learned about the microbiome, they have changed their own diets and lifestyles. Most of them have made changes. They were slower to take, or give their children, antibiotics. (I should emphasize that in no way is this an argument for the rejection of antibiotics when they are medically called for.) Some spoke of relaxing the sanitary regime in their homes, encouraging their children to play outside in the dirt and with animals — deliberately increasing their exposure to the great patina. Many researchers told me they had eliminated or cut back on processed foods, either because of its lack of fiber or out of concern about additives. In general they seemed to place less faith in probiotics (which few of them used) than in prebiotics — foods likely to encourage the growth of “good bacteria” already present. Several, including Justin Sonnenburg, said they had added fermented foods to their diet: yogurt, kimchi, sauerkraut. These foods can contain large numbers of probiotic bacteria, like L. plantarum and bifidobacteria, and while most probiotic bacteria don’t appear to take up permanent residence in the gut, there is evidence that they might leave their mark on the community, sometimes by changing the gene expression of the permanent residents — in effect turning on or off metabolic pathways within the cell — and sometimes by stimulating or calming the immune response.

posted by moira at 11:41 AM on September 28, 2013 [6 favorites]

Adding: the reason given for not putting faith in probiotic pills is the lack of regulation in the market.
posted by moira at 11:50 AM on September 28, 2013

Do not start probiotics until after you've finished your antibiotics. I never did this, and I've now got some really gnarly lactose intolerance issues that are the direct result of having effed up the efficacy of certain antibiotics I've taken over the years by ignoring the no-dairy, no probiotics rule. Wait and give your gut a break for at least a week.
posted by These Birds of a Feather at 1:04 PM on September 28, 2013

You might want to research lactobacillus reuteri. I had stomach issues for a month after antibiotics, and it cleared up after 3 days with Nature's Way brand. I picked that probiotic based on anecdotal research, but I believe there are some studies out there too.
posted by icanbreathe at 1:18 PM on September 28, 2013

I think I disagree with the advice to not take probiotics until after you've finished your anti-biotics. I've always heard the opposite and unless there's an argument as to why you should not replenish good bacteria at the same time you're destroying them, it makes no sense to me.

I also heard of a small study (which I can't identify) that seemed to indicate that prebiotic foods are more efficient that probiotic supplements.

I take Whole Foods brand that comes in the refrigerated section, though I'm thinking of trying Pearls. Also, making or buying (live) cultured foods would be a good idea.
posted by Blitz at 1:26 PM on September 28, 2013

I'd be taking saccharomyces boulardii:

Saccharomyces boulardii is a tropical strain of yeast first isolated from lychee and mangosteen fruit in 1923 by French scientist Henri Boulard. It is related to, but distinct from, Saccharomyces cerevisiae in several taxonomic, metabolic, and genetic properties.[1] S. boulardii has been shown to maintain and restore[citation needed] the natural flora in the large and small intestine; it is classified as a probiotic. However, some experts believe that in severely immunocompromised and immunosuppressed patients, it can cause disease in the form of a systemic blood infection, fungemia, or localized infection[citation needed].
Boulard first isolated the yeast after he observed natives of Southeast Asia chewing on the skin of lychee and mangosteen in an attempt to control the symptoms of cholera. S. boulardii has been shown to be non-pathogenic, non-systemic (it remains in the gastrointestinal tract rather than spreading elsewhere in the body), and grows at the unusually high temperature of 37 °C (98.6°F).[2]
...
Medical uses

There are numerous randomized, double-blind placebo-controlled studies showing the efficacy of S. boulardii in the treatment and prevention of gastrointestinal disorders.[3]

Acute diarrhea
Two studies each showed a significant reduction in the symptoms of acute gastroenteritis in children, versus placebo, by measuring frequency of bowel movements and other criteria.[4][5] Children over three months are recommended to take two doses of 250 mg a day (BID) for five days to treat acute diarrhea. Children under three months are recommended to take half a 250 mg capsule or sachet twice daily for five days.
A prospective placebo-controlled study found a significant reduction in symptoms of diarrhea in adults as well taking 250 mg of S. boulardii twice a day for five days or until symptoms are relieved.[6]

Recurrent Clostridium difficile infection
Administration of two 500 mg doses per day of S. boulardii when given with one of two antibiotics (vancomycin or metronidazole) was found to significantly reduce the rate of recurrent Clostridium difficile (pseudomembranous colitis) infection. No significant benefit was found for prevention of an initial episode of Clostridium difficile-associated disease.[7]

Irritable bowel syndrome
A prospective placebo-controlled study found patients with diarrhea predominant irritable bowel syndrome (IBS) had a significant reduction on the number and consistency of bowel movements.[8]

Inflammatory bowel disease
Further benefits to inflammatory bowel disease (IBD) patients have been suggested in the prevention of relapse in Crohn's disease patients currently in remission[9] and benefits to ulcerative colitis patients currently presenting with moderate symptoms.[10] The recommended dosage is three 250 mg capsules a day (TID).[citation needed]

Travelers' diarrhea
Austrian vacationers taking S. boulardii traveling around the world were found to have significantly fewer occurrences of travelers' diarrhea than those taking placebo. The more S. boulardii taken in prevention, starting five days before leaving, the higher the reduction in diarrhea reported. The reduction was also found to be dependent upon where the vacationer traveled.[11] The recommended dosage is one 250 mg capsule or sachet per day (QD).

Antibiotic-associated diarrhea
There is evidence for its use in the prophylactic (preventative) treatment of antibiotic-associated diarrhea (AAD) in adults.[12] There is further evidence for its use to prevent AAD in children.[13]
...
[etc.]

You wouldn't have to worry about taking it with your antibiotic since, as a yeast it's largely unaffected by antibiotics; in fact that would probably be a good thing.

"... grows at the unusually high temperature of 37 °C (98.6°F).[2]" reminds me of something I find puzzling about the use of yogurt as a probiotic: the standard incubating temperature for yogurt is ~110°F; wouldn't a yogurt culture selected for ability to grow at at 98.6°F have a far better chance of being effective as a probiotic?
posted by jamjam at 1:28 PM on September 28, 2013 [2 favorites]

Mary Roach's Gulp quotes two micorbiologists as saying that there's not much worth taking in probiotics we see in stores now.

That said, a family member who has stomach problems has found great relief in taking Nutrition Now PB8. It's refrigerated.
posted by The corpse in the library at 1:44 PM on September 28, 2013 [3 favorites]

I was just going to recommend Nutrition Now PB8! My fancy gastroenterologist suggested it to me.
posted by Sidhedevil at 2:29 PM on September 28, 2013 [2 favorites]

This is a question for your doctor, full stop, you're getting a lot of bad and horrifically irresponsible advice here. We have no idea what antibiotic you are taking, we have no idea why, we have no idea whether you have a history of various kinds of gastrointestinal complaints that absolutely must inform a complete answer, and none of us, no matter how confident, have any business providing advice on this question that you should be asking of the physician who prescribed you the antibiotics. The NIH education page with references linked to above is a great place to start for the current evidence based understanding of what probiotics can be reasonably expected to do for you.

Also important to keep in mind is that in the last 20+ years of extremely active research, no one has yet to demonstrate that they have a culture of anything that will actually affect the health of either healthy or sick volunteers when given live that doesn't also have the exact same effect when given dead. Paradoxically though, even dead many probiotic cultures have been show to possess statistically significant if tiny positive effects on both healthy and sick volunteers. The most plausible theoretical model for why this is the case posit that probiotic cultures, live and dead, serve as especially effective food for feeding the cultures you already have.
posted by Blasdelb at 6:06 AM on September 29, 2013 [3 favorites]