IBS—Free at Last!

What are Probiotics? Microwarriers!

A picture is worth a thousand words... or a trillion microbes! "Probiotics" is a difficult and wordy concept to explain: "live microorganisms which when administered in adequate amounts confer a health benefit on the host." Huh?

What if you had an entertaining and factually accurate DVD that could do the job for you? You could teach (or learn) about probiotics the easy way, watching lively graphics and hearing the story of probiotics directly from world-class experts! Health Point Productions has recently released just such a DVD: Microwarriers. The Power of Probiotics. You can learn a lot just by watching the trailer:

See what I mean? The movie really brings the miniature and powerful world of our microbial life-partners up to a size that anyone can see and understand. The experts interviewed in the movie are the real deal. I heard two of them, Dr. Mary Ellen Sanders and Dr. Martin Floch, speak just last month at the Yale Workshop on Advances in Probiotic Use.

If you want to learn more about the relationship between humans and bacteria, and about the manufacture and use of probiotic foods and supplements, you might like to own this 53-minute movie. If you are a health care provider or an educator, this movie makes a great teaching tool, and would be an excellent addition to your professional media library.

Probiotics, FODMAPs and IBS: Pearls for Practice

How does a body with IBS decide what, when and how to take probiotics? I'll take a crack at answering these questions for someone using a FODMAPs elimination diet to get better.

At its heart, the FODMAPs elimination diet is an experiment. The scientist in me wants to keep you off probiotics until you've run through the entire elimination and challenge process. This would keep your experiment protected from those "confounding variables" that might confuse issues of cause and effect. In the ideal experiment, changes in your in symptoms would clearly be due to changes in your diet.

If you are already using a probiotic when you start the FODMAPs elimination diet, you should continue to use it throughout the process.

If you are not already using a priobiotic, I'd suggest removing the fermentable carbs from your diet before you add one, in other words, at least wait until you have completed the elimination phase. When you decide to add one, consider the following tips:

• Choose one that includes bifidobacterium, which consume low FODMAP carbs, produce desirable short chain fatty acids, but do not produce gas; B. infantis is one species of bifidobacterium with good evidence to support its use for IBS.
• Purchase your probiotics from a retailer that cares about temperature-controlled storage and shipping. Although some products are now shelf-stable and don't necessarily have to be refrigerated, their potency can still be diminished by extended storage over 70 degrees F.
• Don't kill the good bacteria by taking them with a hot cup of coffee or bowl of hot oatmeal! Take your probiotics with a cold meal or well before or after a hot meal.
• If you are one of the "very sensitive" people (you know who you are!), open the capsule and begin with just a fraction of a dose of the probiotic sprinkled on some cold food or stirred into a cool glass of water. Work your way up to the full labeled dose over a few day's time.
• Probiotics have a sort of threshold effect. You won't get the medicinal effect if you don't take enough of the product, so don't skimp.
• They don't seem to linger in the system--you should take them "ongoing".
• If you reach the point where you feel you don't need them as much anymore and you want to cut back, you should probably still use them at the full dose for a week or two a month so they can keep up their good work.
• Even if you don't usually take probiotics, consider using them following a bout of food poisoning, gastroenteritis, or antibiotic use.
• Don't take probiotics without consulting your health care provider if you are critically ill or immunosuppressed.
• Check back here often, as I will probably tinker with these recommendation as new information becomes available. Last updated 4/30/2011.

How do Probiotics Fit In On a FODMAPs Elimination Diet?

You and I both want to know! I don't have all the answers, but I'd like to share some of my thoughts on this, since it is one of the most frequent queries I receive. I look forward to reader and professional comments on this one.

I think we can all agree that bacterial fermention in the gut is normal and desirable to a certain point. The bacteria in our guts have their own jobs to do for us, and they have to eat--fermentation is how they do it. This normal state of affairs can be disrupted by illnesses, infections, use of antibiotics, or food intolerance or allergies. If too much gas is produced as a result of bacterial imbalance, it can be part of the IBS picture

Or, the bacterial fermentation piece might be perfectly normal, but your nervous system may be so sensitive that you experience normal gas expansion of the colon and abdomen as a painful sensation.

When we use a FODMAPs restricted diet we deprive certain gut bacteria of their favorite foods. This decreases gas production. But we don't want to give up the health benefits of the short chain fatty acids (SCFAs) and other substances that gut bacteria produce for us.

A key point is that each species of bacteria has its own favorite food, and produces a unique combination of gases and SCFAs. People with IBS (and eating a FODMAPs-restricted diet) need a gut stocked with critters that like to ferment non-FODMAPS carbohydrates, don't produce gas, and do produce large amounts of desirable SCFAs. Oh, and it wouldn't hurt if they could also control gut pH, help the immune system function properly, and "box out" bad bacteria. And they should be safe, of course. Bifidobacteria appear to be the best candidates.

Enter probiotics. When we take probiotic supplements we are ingesting microbes that we think will help, in large enough quantities to have a medicinal effect. Probiotics in general show a lot of promise for treatment of IBS, but we have much, more more to learn about them. Specific probiotics that have been studied and have evidence showing a good treatment effect are: Bifidobacterium infantis (best), Bifidobacterium animalis, and VSL#3 (a patented blend of different species of bacteria).

People who are immunocompromised (due to illness or immune-suppressing drugs) or who are critically ill should not take probiotics without discussing the risks and benefits with a health care provider.

My next post will cover the nitty-gritty of how and when to take probiotics when using my FODMAPS-elimination diet program. Stay tuned!