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Ask the Wellness Educator

Dear Dr. Jen,
Do probiotics and prebiotics help to rid the body of bad bacteria? I'm trying to avoid the need for antibiotics!

Dear SR,
The key to preventing "bad" or infectious bacteria from taking over the gastrointestinal (GI) system is to simply crowd them out with healthy bacteria. Probiotics create a healthy bacterial environment in the GI system and can help restore the microflora if it has been damaged by antibiotics, medications, toxins, or other harmful factors. Because there are so many opportunities to damage the delicate flora of the GI system, many of us lack optimal quantities and quality of these beneficial bacteria. Consequently, we become vulnerable to infection and inflammation.

Prevention is key; we should focus on maintaining a healthy GI system in order to optimize our ability to defend against damaging factors and pathogenic bacteria. It's a lot easier to ward off an infection than it is to fix a GI system that has been compromised or damaged. Once a GI infection takes hold, secondary problems can occur. Inflammation ensues, leading to a compromised intestinal barrier. This opens the floodgate to leaky gut syndrome. Because problems can arise, it's better to avoid that slippery slope if at all possible.

If you are past the point of prevention, probiotics can be effective in managing an infection and help to halt the progression of problems. Probiotics have two main modes of action:

1- Once established, these "good" bacteria will crowd out infectious bacteria. By taking over the space, they simply don't give bad bacteria space to thrive.

2- They have important anti-inflammatory actions. They can reduce the secretion of the inflammatory chemicals that are present with infections, thereby protecting the intestinal barrier. This sets up an environment which is more friendly for the probiotics to survive in and do their job.

Hundreds of different probiotic strains naturally occur in the gut, and scientists still have a lot to learn about each one. Every strain has its own special action, flourishes in a particular part of the GI tract, and has a preferred environment. Because of the diversity of these bacteria, it's recommended to shake up your probiotic regimen from time to time. Manufacturers make different combinations with different strains, so it's good to expose your GI to the smorgasbord of beneficial bacteria that are available.

Prebiotics are the "food" for probiotics. Some probiotic formulas contain prebiotics as well. If you have an infection, you should avoid prebiotics because in some instances they also feed the bad bacteria.

If you're just trying to maintain a healthy GI, you can take 10-30 billion CFU of probiotics on a daily basis. If you're currently taking antibiotics, you are at risk for depleting your healthy bacteria, so take at least 50 billion CFU or more daily. Although the antibiotics may also damage some of the supplemental probiotics, I feel that they still help minimize the harm done by the antibiotics and ultimately make it easier to restore GI balance.

One last note about probiotics: make sure you are buying a good quality product! Certain manufacturers have a reputation for specializing in probiotic manufacturing and are very trustworthy. This ensures that you are getting a product that is active, alive, and efficacious. It's definitely worth spending a little bit of extra money for this category of supplements. The NEEDS Wellness Educators are happy to provide advice about which products will suit you best to help you save time and money.

Gut 2002;50(Suppl III):iii54–iii59

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