I've been meaning to do a post about
probiotics for a long time. (Just like I mean to do a post about giving your kids antibiotics.) There are a lot of people who go around spewing anecdotal stories as if they are facts, and a lot of people who are too stuck in their ways to listen to facts. I try to strike that medium between open-minded and yet cautious and wise. Being a nurse and having access to lots of scientific studies and research helps. So does an insatiable curiosity that won't rest until I know the truth.
So, let me break this down to you.
The digestive track runs from your mouth to your butt- it is the path that food takes from the time it enters your mouth until it leaves your body. Your entire digestive track has bacteria (flora) in it. The digestive system also creates and excretes enzymes throughout it's entire track.
(**Note** Some diseases prevent the creation and excretion of enzymes and therefore supplemental enzymes are given; for instance, people with CF don't make enzymes in general and must take a comprehensive enzyme to help digest their food while people with lactose intolerance simply don't make the enzyme to digest lactose, and proper supplementation can assist them to digest small amounts of lactose properly. Enzymes and bacteria/flora/
probiotics are NOT the same thing. Remember, enzymes are
made by your body while the bacteria/flora
enter your body and live there.)
For the most part, when we have problems with our digestive track, they are usually in our stomach and intestines (unless you have reflux, which is in your esophagus, but also your stomach.) The stomach and intestines are referred to as the GI track/system (GI standing for gastrointestinal.)
In the GI track, there are different kinds of flora. The kinds of flora that exist in the GI system are particular to the areas where they live. For instance, your stomach is a highly acidic place- it is part of how you digest your food. So certain bacteria can live in your stomach but if they move to a more
alkalotic are of the GI system, they will not live. Likewise, things that are normal in one part of our GI system can make us sick if they are in a part of our GI system that they do not normally inhabit.
I am sure you have all heard of
e.coli. We work really hard to prevent
e.coli from being in the food we eat, right? We cook our poultry and try not to let raw chicken and eggs touch stuff and clean it up well when it does touch our counters. Because
e.coli can make you sick in your stomach. But did you know that
e.coli is a normal inhabitant of the last parts of your digestive system? We all have it in our poop. And when you get a urinary track infection, the most likely cause is from
e.coli that has migrated from the butt to the vagina and up in to the urinary tract (obviously, this is most common in women, although men who get urinary tract infections could get it from hands that have not been washed well since
e.coli also lives all over our skin.)
The antibiotics that we give to treat a
UTI (urinary tract infection) are designed to kill
e.coli- make sense, right, because that is what is clogging up our urinary tract and making us sick. But since the medication goes to all areas of our body, it doesn't just kill the
e.coli in our urinary tract, it also kills the
e.coli in our digestive tract, which is why we end up with upset stomach and diarrhea. Makes sense, right?
(FYI- if you think you may be getting a
UTI, research has proven that cranberry is effective in
e.coli UTI. So if you have an issue where you pee and you think "man, that was really burning" or whatever, take a cranberry supplement- you may prevent a
UTI! I always keep a bottle in my bathroom cabinet. HOWEVER- if you have a known
UTI, or if you get a
UTI with back pain or severe symptoms, please see your doctor and take antibiotics. If you don't, you could end up with irreversible kidney damage. The cranberry should be taken only at the
first signs of
UTI, not to treat an established
UTI. There is also some thought that if you are prone to
UTI and get them frequently, you could take cranberry as a preventative. Talk to your doctor- I am not a doctor!)
So, back to
probiotics and stuff. I am writing this specifically because there are people who are saying that you can use
probiotics to prevent stomach sickness/travelers diarrhea and other
illnesses when you travel to areas that do not have safe water and food practices. So let me first address what
probiotics do.
Specific
probiotics are used to re-establish healthy gut flora when we know we have killed it off. For instance, the treatment for
giardia and
C.diff is a medication called
Flagyl.
Flagyl is known to kill off normal healthy gut flora as well as whatever the infective agent is. So during and after your course of treatment with
Flagyl, it may be beneficial to take a
probiotic (in the hospital we give
lactobacillus acidolphilis,
although there may be others depending on age- talk to your doctor!) to help restore the normal healthy flora. These things can usually be found at your local drug store (my local
CVS carries 2 kinds that my doctor recommended for Anna after she had
giardia.)
When you are taking an antibiotic for a
UTI or sinus infection, your doctor might encourage you to eat yogurt with live cultures daily. Why? Because the antibiotic might kill off normal flora in your gut that can be replaced with the cultures (bacteria) in yogurt. Every antibiotic focuses on killing different kinds of bacteria, so each antibiotic might kill different kinds of healthy flora.
Lactobacillus supplements will not restore every kind of healthy flora- it will only restore
lactobacillus. So sometimes yogurt (or other
probiotics, at the suggestion of your doctor!) will help.
In addition, when you have healthy gut flora, you are more likely to be able to defend yourself against infections. It just make sense- when everything is working right, things are less likely to go wrong. Just like when you have healthy skin free of cuts and lacerations, you are less likely to get an infection in your skin. Common sense. So having a healthy gut is a good and
desirable thing. Most of us have a healthy gut, and if we don't, we know it (because we vomit or have diarrhea.)
Now, let me talk about what
probiotics don't do.
Probiotics don't affect any illnesses that are viral or parasitic in nature. So, Hepatitis A, worms, and a whole variety of things that you may be exposed to when you have unsafe food and water will not be prevented of affected at all by using
probiotics. It's just common sense- you don't treat a viral infection with an anti/pro biotic (which is why we don't give antibiotics for the flu- it's viral!)
Bacteria can "battle" other bacteria- this can happen in the gut when we are exposed to bacteria that should not be there. However, in these situations, the abnormal bacteria is just as likely to win as the normal flora. It is kind of a toss up. Having more of the normal bacteria by taking a
probiotic is not going to ensure that the healthy flora wins when it fights the bad bacteria. That's not the way it works- more doesn't mean better. It just depends on what abnormal bacteria makes it into the gut. Either the good flora is able to fight the bad bacteria or it's not.
Probiotics don't prevent bacterial stomach illnesses that the good flora simply aren't
equipped to fight. To put it in different terms: having more soldiers does not mean
you will win a battle. If there are less soldiers on the other side, but they are wearing bulletproof armor and all you have to try to fight them off is bullets... well, they will probably win- especially if they are fighting you with bombs and grenades. When it comes to bacteria in the gut, some are just more powerful than the healthy flora. So
probiotics won't prevent or shorten an illness caused by any of the bacteria that are not
susceptible to the healthy flora.
(**NOTE** When you plan to travel to an area that has potential for unsafe food or water, it is good to talk to your doctor and have a prescription for antibiotics in case you were to become sick. Your doctor will probably tell you not to take the medication unless your diarrhea becomes bloody (this is typical of bacterial diarrhea, as opposed to a viral diarrhea.) If you diarrhea is ever bloody, it is important that you are treated right away. If you are traveling and don't have a script with you, see a doctor.)
Probiotics don't do the job of enzymes. If you can't digest your food because you don't have the right enzymes,
probiotics won't help. Interestingly, when Anna was diagnosed with
giardia, my doctor informed me that prolonged
giardia infections can cause lactose intolerance (because it affects the enzyme production.) Thankfully, I took Anna off dairy while we were still in Ethiopia. So a newly adopted child with symptoms of lactose intolerance who also has
giardia will
definitely be helped by medication and
probiotics- not because this creates the enzymes, but rather because it creates a setting in the gut where the enzymes can be produced and do their job.
What it comes down to is this:
probiotics are good, but like any good thing, they can be misused and misconstrued. Just like antibiotics are not the cure for the common cold,
probiotics are not the cure for all stomach illnesses. In fact, there is almost no way to ensure that you won't get sick if you are traveling in a place with potential for unsafe food or water. There are some things you can do to try to stay healthy, though:
- Start out healthy and aim to stay that way. If you have recently been sick or on antibiotics, talk to your doctor about what you may need to do in order to be in top-notch condition to travel. Know what is safe and unsafe in the country you are visiting, and be mindful of anything you put in or near your mouth. Vigorously wash your hands with soap and water for 30 seconds before eating. Use alcohol hand sanitizer appropriately and often.
- Certain medications can be used to prevent travelers diarrhea. Bismuth subsalicyate (the active ingredient in adults Pepto Bismal) can help prevent e.coli and viral stomach illnesses if taken with meals. (**NOTE** Bismuth is not safe for kids and therefore there is no Bismuth subsalicyate in kids' Pepto. If you are traveling with kids, they do not need to take Kids Pepto before meals, and they should not take adults Pepto. Not sure what bismuth is? It is one of the most "natural" things in nature- it is #83 on the periodic table of elements. Bismuth subsalicyate is a stabilized version of bismuth.)
- Have a plan if you do get sick. Talk to your doctor about a prescription for travelers diarrhea (talk to your pediatrician about a script for your kids if they are traveling with you.) Make sure that if you are vomiting or having a lot of diarrhea, you have electrolyte solution (Gatorade powder or similar, Pedialyte for kids) and drink frequently if you become sick. The more hydrated and nourished your body is, the more likely you will be to fight off the illness.
Anyway, I would like to reiterate that I am not a doctor and these statements have not been evaluated by the FDA. But if you are intrigued, please engage in your own research (and remember, wikipedia is NOT a good reference!) Look in the medical and science journals. There is some interesting info out there.
And just for fun, a poll: