23: Why A Gut Supplement Might Not Be Your First Step

Should you take a probiotic for bloating? Are prebiotics better? And does a probiotic with 50 billion CFUs actually work better than one with 10 billion?

If you’ve ever stood in the supplement aisle staring at dozens of probiotic bottles — or bought an influencer-promoted greens powder promising better gut health — this episode is for you.

The Team Gut Girls break down probiotics vs. prebiotics, what the research actually says about probiotics for bloating, IBS and antibiotic-associated diarrhea, and why choosing the right probiotic is much more complicated than looking for the biggest number on the bottle.

Dr. Whitney Baxter, ND, Dr. Dominique Vanier, ND, and Dr. Christina Carew, ND explain why probiotic strain matters, what CFUs actually mean, how to assess probiotic quality, and why some probiotics and prebiotic fibers may actually make gas and bloating worse in certain people.

They also tackle three common probiotic myths:

• Myth #1: All probiotics are basically the same.
• Myth #2: You shouldn’t take probiotics while taking antibiotics.
• Myth #3: More CFUs means a better probiotic.

You’ll learn the difference between probiotics and prebiotics, why genus, species and strain matter, what to look for on a probiotic label, and why Canadian consumers should look for an NPN (Natural Product Number).

The Gut Girls also explore the bigger picture: your gut microbiome is more like a garden than an empty container waiting to be filled with probiotic bacteria. Fiber, hydration, gut motility, sleep, diet diversity, medications and your existing microbiome all influence that environment.

And when it comes specifically to probiotics for IBS and bloating, the evidence isn’t as simple as social media might suggest. Research is mixed, guidelines remain cautious, and the reason you’re bloated matters. A probiotic may be useful in some situations — but it isn’t a universal solution for bloating.

In this episode, you’ll learn:

• What probiotics and prebiotics actually are
• The difference between probiotic genus, species and strain
• Why strain specificity matters when choosing a probiotic
• Whether higher CFUs mean a probiotic is more effective
• How probiotics can interact with antibiotics
• Why probiotics and antibiotics are generally separated by at least two hours
• Why Saccharomyces boulardii is different from bacterial probiotics
• What to look for when buying a probiotic in Canada
• Why expiry dates and end-of-shelf-life viability matter
• How prebiotic foods feed your existing gut microbiome
• Why fiber and prebiotics can sometimes increase bloating and gas
• How SIBO and visceral hypersensitivity may affect probiotic tolerance
• Where probiotic research is strongest
• What the evidence says about probiotics for IBS and bloating
• Why identifying the underlying cause of bloating matters
• Questions to ask your healthcare practitioner before starting a probiotic

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Transcript: 23: Why A Gut Supplement Might Not Be Your First Step

Probiotics for Bloating

Dr. Whitney Baxter, ND: Welcome back to another episode of Team Gut Girls podcast. Today, we’re tackling one of the biggest questions we hear from our friends, from practice. We read about this on social media almost every day. It’s probiotics and prebiotics. Do we need them? Should we be taking them for bloating?

Dr. Dominique Vanier, ND: Yeah, if you’ve ever undone your top button after lunch and thought, “There’s gotta be a pill for this,” you’re definitely not alone.

I’ve been there. We’ve all been there. bloating can send us on a scroll to find a solution or to the pharmacy, basically to get whatever we can as quickly as possible, colorful boxes, whatever, all the things that are gonna promise to fix your gut.

Dr. Christina Carew, ND: And anyone that’s ever bought a probiotic knows they are not cheap.

And there’s so many kinds, and you’re so worried about getting the right kind or the wrong kind that you ask the person who’s in the healthcare store that you ended up going to, and they don’t always [00:01:00] know. So today, we’re gonna simply ask the question, when should I or when should I not take probiotics?

what type of probiotic, what type of pattern of bloating could this be helpful for, and when is it important to avoid it given bloating? What evidence do probiotics have for improving other conditions such as autoimmune conditions? Are there side effects to antibiotics? and much more.

Dr. Whitney Baxter, ND: Yeah, it is one of the most popular, supplements for our digestive tract that’s talked about. and most people have tried them. Many people have, so for their gut health or just overall wellness. So let’s dive in.

Dr. Dominique Vanier, ND: Yeah.

Probiotic vs Prebiotic Basics

Dr. Dominique Vanier, ND: And so before we bust some myths, let’s define actually what a probiotic is and what a prebiotic is.

Dr. Whitney Baxter, ND: So we’ll start with probiotics. these are live microorganisms. So they’re in a capsule, they’re alive, and when given in [00:02:00] adequate amounts, they result in health benefit. So they’re used to replenish the good or beneficial bacteria in our gut microbiome and restore the balance between beneficial species that help us and others that can lead to inflammation, pain, or changes in our stool pattern.

You can find them in a supplement form, so in a capsule, or in our fermented foods. So that’s why we talk about the benefits of yogurt, cheeses, and sauerkraut, et cetera. There are three main characteristics of probiotics that we’re really gonna break down in this episode. So they are live, the dose matters, and the benefit actually has to be demonstrated in a human study.

Okay, Christina, what about prebiotics?

Dr. Christina Carew, ND: Yeah, not to be confused, because they sim- sound very similar, but prebiotics are non-digestible food compounds. Generally, they’re more fibers. they’re abs- [00:03:00] they don’t digest and absorb, very well in the intestinal tract, we actually can use them to help with things like stool moving, for instance, or feeding our good bacteria.

they travel inside our intestinal tract to our colon, where most of the microbiome lives, and that’s where it ferments them and gets more beneficial microbes. So if you’ve ever s- done one of those stool tests or considered them, you’ll see that there’s all these categories that say, beneficial or good bacteria.

That’s what these ones, are able to, provide. And lots of those beneficial bacteria are things that are in the common probiotics that we have every day. So prebiotic foods often include the oligo-fructose foods, and, Whitney talked a lot about all the different sugar alcohols, so this is, something in that category.

wheat, onions, banana, [00:04:00] garlic. So some people do struggle with digesting some of these foods, so just keep in mind that if it’s not good for you, it’s not good for you. and inulin, lactulose, so there’s all kinds of things that are considered prebiotics, and all different companies that are selling them to you

Powders Greens and Red Flags

Dr. Whitney Baxter, ND: So a big thing that I get asked in practice, I don’t know about you guys, or, from my friends, I’ll often get a text, “What do you think about this?”

It’s the prebiotic and probiotic powders that are combined. There’s, greens combination powders or multi-nutrient powders. Yeah. I’m sure you know what I’m talking about. They’re often, promoted by celebrities or influencers on social media. and when I can finally find the ingredients on these websites, I can look through and find the species that are used, and they’re often packaged with, like Christina just went through, these prebiotic compounds.

So to o- to, to give you the live species of your gut, but also fuel the healthy [00:05:00] microbiome. Sometimes there’s additional nutrients or supplements or adaptogens, things that help us adapt to stress. they can be stimulating, they can be calming, so it all depends. And often they are good strains. they do have evidence, but for what?

It’s hard to just give one species to cure all bloating or to help overall wellness. So we’ll talk about that in this episode. But really consider what are they promoting? Is the dose really high, or is it accurate to what the study was used? Do you need this? Might it worsen your bloating? So again, if we’re fueling a lot of good species, if they’re fermenting fibers, that can create more symptoms.

So always ask your practitioner. Naturopathic doctors, dieticians should know a lot about these products, especially if they’re worsening your gas and bloating. And keep in mind these other things in them. So they might interact with any medications that you’re taking. They might really amplify some symptoms of [00:06:00] anxiety or insomnia or indigestion.

Some patients I’ve known have loved these or others it can trigger really bad headaches or anxiety or, insomnia. So it’s all not always one size fits all.

Dr. Christina Carew, ND: Also, a lot of them are subscriptions, so people only get- the, good price if they agree to take it for six months, eight months, a year, and maybe you don’t need it that long.

Dr. Dominique Vanier, ND: Mm-hmm. Yeah, I’m always, a bit suspicious when I can’t find ingredients online. That’s always a red flag for me. as a practitioner, I, wanna be able to weigh in on whether something may help, may not, like, how to match that with the patient’s condition, and if I can’t even find the ingredients, then, yeah, can’t have that conversation.

Or it’s

Dr. Christina Carew, ND: a proprietary blend- Yeah … so you actually don’t know how much- Yeah … any of those things are in there.

Dr. Dominique Vanier, ND: For sure, yeah.

Dr. Whitney Baxter, ND: let’s talk- Or the… Sorry. Or they’ll link to studies that make no sense, or [00:07:00] they’re just grasping at straws. you really, and you really have to dig for that kind of stuff.

Or it’s been funded by the supplement company. Yes. So it can be sneaky.

Myth One Strain Specificity

Dr. Dominique Vanier, ND: let’s go into the myth busting section. So myth number one is, that a probiotic is just a probiotic. Just buy something at a natural food store and it will all be good. And, personally, this is really a common thing I hear, that, people end up treating, the whole probiotic category as just one pro- product.

and so imagine someone tells you, for example, like, all blood pressure medication, they’re all the same, right? Like- we know that’s, not true. And so if you take that analogy as it relates to pharmaceuticals, we’re gonna have many different drugs in a drug category that can treat a condition, or if one doesn’t work, we’re gonna switch to another.

We can see that with probiotics. So we wanna think of it like they’re all different [00:08:00] species like we’ve talked about. They’re all different doses. They’ve all been studied to do different things. and this brings up the point of strain specificity, especially about what strain of species is on that label and what is it telling you that it treats.

And so let’s, break that down a little bit further. And so how they are named, what does that label actually mean? So bacteria are named by genus, species, and strain. So for example, a lot of our listeners may know, Bifidobacterium. that’s a really common one that we’re gonna see on many probiotic labels.

Bifidobacterium is the genus, and Bifidobacterium infantis is, again, another common one that I re- r- often talk about. That is the species, and then it can go even further into, a bifido infantis, and then the number beside it, and that’s the strain. Okay, so we have these different levels. And those numbers and letters at the end, they’re not packaging decoration.

they’re very specific. You can even tie it back to all the research papers. another example [00:09:00] is Bifidobacterium coagulans and Lactobacillus plantarum, both really common probiotics. and the… it’s the way, like a dog, a collie and a chihuahua are both dogs. So they’re both dogs, but they’re both very different dogs.

And so evidence for one strain may not transfer to another, which is an important point. So for example, when a patient tells me, “I tried a probiotic, and it didn’t work,” my conversation with them is, “Just because one probiotic didn’t work, it doesn’t mean that the next one is gonna be the same.” And sometimes we have to trial and error these until maybe one is helpful or until we can confidently say, “This is not actually gonna be helpful for this person

Dr. Christina Carew, ND: And then sometimes also on the packages, they’re grouped together with a whole bunch of other things, similar to what we saw with the prebiotics.

So they may also include things like beneficial yeast strains, so yeasts that b- are often belonging to the, category or group called Saccharomyces. and so you [00:10:00] might see that there’s, Lactobacillus and Bifidobacteria and Saccharomyces, or some combination of those, with many strains or one strain of each of these.

So each of these is very different, like having … You probably have, eight black T-shirts, but they all fit you a little bit different, and one has a V-neck, and one is, a lighter material. Same kind of idea. They’re not all doing the same thing, and they don’t all make you feel great

Picking a Quality Probiotic

Dr. Whitney Baxter, ND: Any other tips on how to choose a probiotic you want, that you wanna share with our listeners, other than if you just try to find the cheapest one on the shelf that says it’s good for health?

Dr. Christina Carew, ND: Yeah.

Dr. Whitney Baxter, ND: What should you look for?

Dr. Christina Carew, ND: if you’re just throwing something in there, it’s probably not gonna do that much good for you.

Yes. Unless there’s like a real reason why you’re taking it. So be informed would be certainly like the first piece of the puzzle. It’s [00:11:00] picking, picking any food or picking anything, you wanna know, what you’re looking at. hopefully finding from a reliable manufacturer is important.

So in Canada, we have these things called natural health product numbers on them. they should, if they’re sold in a store, have a natural health product number on it. It’s sometimes on the small print on the front or on the back of the label. It just means like it’s registered with the government of Canada, and it’s, able to be sold in Canada to consumers.

the probiotic should be labeled in a way that you can find out, what is inside of it, what is the use by date. so there should be like a manufacture date and a use by date. And the, the reason that this happens on probiotics more than anything else is that they are alive, and so they will start to die over time.

And so a probiotic that you’ve had in your fridge for a couple of years probably doesn’t have [00:12:00] much value left in it because over time it sort of degrades. No different than fruits and vegetables that you bought a month ago. They probably don’t taste the same. They might be a little bit mushy. Same kind of idea.

And so even though you can’t physically see a difference in them, they do change.

Myth Two With Antibiotics

Dr. Christina Carew, ND: Okay, so myth number two, antibiotics will kill probiotics, so I shouldn’t take them together. It’s, a good question because often people, especially if they’re given a rigorous regime, so we had talked earlier about H.

pylori, and some of the H. pylori, protocols are antibiotics four times a day. So there’s, a lot of… not a lot of time when you’re not taking, an antibiotic. Or I treat lots of people who have Lyme disease, and some of the work that we do does involve a lot of antibiotics, and so same kind of thing.

how do we structure a plan of the day? So the antibiotics are designed to kill the bacterial infection. However, they’re not super specific. They’re not [00:13:00] like laser, like maybe what we see in some of the, different types of medicines that are out there. And so they can kill off both the harmful and the good species of the microbiome, which is why you wanna put in a probiotic to begin with.

You’re like, “Oh, maybe I’ve, killed off some of the good stuff.” so probiotics can help offset the impact of killing off some of the good guys. and sometimes that may even mitigate some of the side effects of the antibiotics, which often are things like constipation or diarrhea. about, between five and thirty percent, so one in, one in twenty to six in twenty people will experience antibiotic-associated diarrhea, after taking antibiotics, during taking antibiotics, or even up to eight weeks later.

So if you’ve ever just not felt good after, sometimes that’s because some of the good guys got killed off. [00:14:00] and so what if you are taking something where it is, many times a day, sometimes, using a beneficial yeast like the Saccharomyces one we talked about earlier. There’s a product called Saccharomyces boulardii.

It actually doesn’t seem to be killed off by the antibiotics, and so it’s actually one that lots of people will take at the same time, so you don’t have to worry about staggering it. but if you’re looking at replacing good bacteria, some of the research for maintaining bacterial balance on things like, Lactobacillus acidophilus, KCI GG, bulgaris, Bifidobacterium.

So there’s, Enterococcus, Streptococcus. There’s all these different strains. if you’re taking it with an antibiotic, you want to separate that just so you don’t kill the antibiotic at the same time, or the probiotic at the same time as taking the antibiotic

Dr. Whitney Baxter, ND: You almost have to listen to this episode while you’re at the [00:15:00] store, staring at the shelf, reading these little tiny labels- and funny names.

it’s interesting you brought up the H. pylori protocol. It’s a good example, because it is, it’s really intense for a long time, and you have to… Yeah, four times a day, three probiotics and one proton pump inhibitor.

Dr. Dominique Vanier, ND: Antibiotics.

Dr. Whitney Baxter, ND: What’s that?

Dr. Dominique Vanier, ND: Antibiotics, not probiotics.

Dr. Whitney Baxter, ND: Oh, yeah. Sorry. Yeah. It’s the opposite.

Imagine. The opposite

Dr. Dominique Vanier, ND: of that. That would be better tolerated, I would imagine, yeah.

Dr. Whitney Baxter, ND: Much. Much.

Dr. Christina Carew, ND: not as effective.

Dr. Whitney Baxter, ND: and, some pharmacists I’ve spoke to will say, “Don’t recommend probiotics or beneficial yeast strains because it’s too much.” And it’s true, but it, can help. just having that conversation is good, and if they start having symptoms, there’s some options we could do.

but let’s talk about specific recommendations for how to take your probiotics with your antibiotics. [00:16:00] So you can separate the antibiotics and probiotics by at least two hours. And, remember, a high, so we’ll talk about this, high colony-forming units, or CFU, does not guarantee it will work better. It depends on what you’re using them for.

But if you’re separating, then that’s the best you can do, or taking them at the opposite ends of the day. So if you are just taking one or two doses of the antibiotics, maybe in the morning, then take your probiotics right before bed

Dr. Dominique Vanier, ND: Yeah, that’s helpful. There’s a way, there’s a way around all this.

Myth Three More CFU Better

Dr. Dominique Vanier, ND: myth number three, the, is that more billions on the box, so when you’re reading the labels, so when, basically a higher dose, so more billions on the box means that it works better.

so for example, 10 billion, 50 billion. There’s actually some probiotics that are hundreds of billions, although those are much more rare. And so as it relates to the, what Whitney just said, the colony-forming units, so the CFUs, this refu- refers to the number of viable cells in the probiotic [00:17:00] supplement, and there ideally should be a CFU number listed beside each strain.

There are a few exceptions to that, though. many probiotic supplements contain 1 to 10 billion CFU per dose, but some products contain, like we said, 50 billion, 100 billion, more than that. So the question is, is does a larger CFU mean it’s more potent and more beneficial? And the answer is not necessarily.

Let’s break that down. So colony-forming units, or CFU, is the old- is really only one piece of the picture. So strain identity, viability at end of shelf life, and the, indication really matter more than that number alone. And a high-CFU product is not automatically gonna be more effective, and a low CFU is also not ineffective.

We can extrapolate this a little bit to, fermented foods, so we know that there’s a lot of different, species strains in there, but the dose is a lot lower than, for example, probiotics. And a lot of [00:18:00] people do find fermented foods as a probiotic food can be beneficial for their gut. So that’s a, that’s an good example of how, a low CFU can still be, helpful

Dr. Whitney Baxter, ND: So just some quick examples, of how we think about the low, moderate, and high number of billions in the product.

Sometimes the low, it can be where we start if we’re seeing if it’s gonna trigger bloating or just for general wellness, single-strain products, single-strain things that have been studied for, example, irritable bowel syndrome. That might be at a lower, number or CFU. and then as they go up in amount, they’re used to handle, for example, antibiotics, so to really prevent wiping out everything.

So there are some hospital-used blends for, high-dose antibiotics or C. difficile prevention. so those are just some examples [00:19:00] And then sometimes people compare those higher doses to faster or bigger benefit, like Dominique introduced. But remember, we’re not using it as a drug to overwhelm a target.

We’re closer… It’s closer to planting your garden. We need to think about the whole environment, what’s going on. So can you tolerate those prebiotic foods, those fibers? Are you eating them? Are you feeding the beneficial species that already live in your gut instead of just sprinkling seeds on top of a flower bed?

Dr. Christina Carew, ND: So you guys don’t subscribe to my, plant as many tulip bulbs as you can in hopes that some of them will still be there?

Dr. Dominique Vanier, ND: I tried that. I tried that, and then, the squirrels got them, and, I don’t think any of them grew.

Dr. Christina Carew, ND: I wish I knew

Dr. Whitney Baxter, ND: that. I do re- I do relate to your weed story in my garden when you pulled- Yeah

a bunch of weeds and then they all came back.

Dr. Christina Carew, ND: Yes. We tried to do it with our grass. We took, the weeds out of the grass, so we finally did grass seed, and it didn’t start fast enough, and [00:20:00] then the weeds came back. Yeah.

Gut Garden Fiber and SIBO

Dr. Christina Carew, ND: and so that’s really the same thing that happens in your gut. And so probiotics are a piece of the puzzle, but we also have to think about am I eating fiber in my diet?

can I introduce more fiber? And, probably not doing, a massive fiber dump all at once because that will also not feel so great. are you having enough hydration? Because fiber is definitely gonna suck up some of the water. It’s, can make you more constipated. It’s one of the hazards sometimes of having high fiber.

what is my sleep quality? We know that the sleep really, is impacting the gut, and if we aren’t sleeping well, we’re not repairing. Are there other medications or dietary factors that are fact- impacting my microbiome? So we’ve talked in a couple past episodes, things like proton pump inhibitors, which slow down our stomach acid formation, can also prevent some of the foods from breaking down well enough to feed [00:21:00] our microbiome.

is that a piece of the puzzle? Are, is there an overgrowth of good microbiomes but they’re in the wrong place? So when we talked in earlier episodes about things like SIBO, the bacteria that are in our gut that are helping, so that are breaking down food and creating this beneficial microbiome, are largely in the large intestine.

That’s where the most of them should be, where the stool basically gets all the water sucked out of it and looks like what in the toilet. But sometimes what happens is the, those good microbiome components are in the wrong part of the gut, and so that actually can lead to an overgrowth. There’s nothing to change them.

When probiotics meet them and they’re in the wrong spot, then the sen- sensation that may happen can be a lot more bloating and gas and some of the things that you’re maybe taking the probiotic for in the first place. we [00:22:00] also know that people that have more visceral hypersensitivity, so in our episode on disorders of gut-brain interaction, we talked about how some people just have more sensation.

High Dose Side Effects

Dr. Christina Carew, ND: They can feel food moving. They can feel their abdomen expanding. they can feel movement in our gut. And so some, species of fermented fibers or probiotics may even worsen some of those symptoms. and so often those higher dose products, the higher CFUs, can worsen the side effects because now we’re throwing a whole bunch of stuff in there all at once, especially when we first start.

And so sometimes it’s better to even open some of those capsules and take some out to get introduced to it. And often in the very, very high dose ones, they’ll come in sachets, and the recommendation even on the packaging is, not to take the full thing all at once

Dr. Whitney Baxter, ND: Yeah, that’s a good reminder. Those can be great.

Those [00:23:00] ones.

Prebiotics Explained

Dr. Whitney Baxter, ND: Okay, so that was the myths that we hear all the time or we read about. So let’s dive into more specific things, and we’ll reiterate a lot of these points that we just talked about. So first, let’s again break down what the foods that we’re feeding, the, the foods to eat to feed these healthy species that already exist in our garden or our ecosystem.

So a reminder that these are non-digestible food compounds, so fiber. So we’re not taking them, digesting them, and absorbing them for our benefit, our growth, our energy. They are feeding the species of the gut. So the idea is that you’re feeding the beneficial microbes you already have instead of necessarily adding new ones.

Prebiotics typically consist of non-starch polysaccharides and oligosaccharides, so sugars. Although other subsist- substances are being studied, such as resistant starches, polyphenols. So, these are some things that you [00:24:00] might be reading about.

Top Prebiotic Foods

Dr. Whitney Baxter, ND: Commonly know prebiotic things or words, sometimes you’ll see on the packages of probiotics that they’re FOS-free, meaning that it’s not gonna trigger someone who has that visceral hypersensitivity or irritable bowel syndrome because they don’t have added prebiotics or they haven’t been, like, grown with those things to feed them.

So oligo fructose or fructose oligosaccharides, that’s the FOS. So these are found in foods such as wheat, onions, honey, bananas, garlic, and leeks. Inulin is a pretty common one that we hear about. Lactose, lactulose, sorry. Lactulose, it’s a synthetic disaccharide or sugar, used to treat constipation. fermentation of oligofructose in the colon r- may result in several physiological effects, including increasing the numbers of the beneficial species [00:25:00] bifidobacteria in the colon, which may decrease those bad guys or pathogenic strains, producing vitamins and digestive enzymes in our gut.

They can increase calcium absorption, increase fecal weight, so that stool, helping you eliminate more, and then, also lowering blood po- blood lipid levels or cholesterol, and shortening the gastrointestinal transit time. So really helping to move things through. So these are the ways that they help that, our, they help our, physiology or our health by feeding the healthy species in our gut.

so it depends on a number of things. So you can eat all these beneficial foods, fibers, polyphenols, to hopefully fuel the beneficial species in our gut, so they create all these health benefits. But it always depends on the baseline, what’s already going on in that ecosystem.

Do You Need Probiotics

Dr. Whitney Baxter, ND: So that’s sometimes we would wanna give you a probiotic or a speci- specific species, [00:26:00] to really, to help flourish, our garden.

Dr. Christina Carew, ND: And I would say one of the interesting pieces about that is, not everyone needs them, right? So we think, “Oh, I must not be getting these,” but lots of people are getting them already from their diet, or they have a really rich microbiome to begin with. So it’s not like a, a everyone needs these, which is often what the social media makes you think.

Choosing The Right Strain

Dr. Christina Carew, ND: Okay, so you’ve decided you need a p- probiotic. How do you actually choose which ones, to consider for you? So strain specificity is, a big piece that we talked about. So remember there’s the genius or the, sort of category, so bifido, lactobacillus, saccharomyces. Then there is the species, so infantis or cerevisae, or, [00:27:00] other sort of, categories are the second names.

You’re gonna see the first name. They’re all gonna look the same on the side of the package. Then there’s a second name. Those ones all change, and then often there’s also a strain number. and so that says, it basically came out of this thing. And part of this is, think of it like a recipe. So if you were to recreate that product, you need to know which of the strains are there so that you can also understand how they behave or what they would do.

baking soda and baking powder sound similar, do similar things, but also not exactly substitutes for one another.

And so if we have, something similar but not the same, and the research is on something that is slightly different, it may not always perform in the same way.

Dr. Dominique Vanier, ND: Yeah.

And and that, goes back to the point earlier that when somebody says, “Probiotics [00:28:00] don’t work for me,” personally, I really wanna drill down on that answer, Which one did you try? For how long, right? ‘Cause the… I think also the length of time is important, ’cause sometimes we have to temper those expectations.

if somebody tried it for a week and it didn’t help, sometimes probiotics can take longer, right? up to a month, like an entire bottle to really evaluate, sometimes two bottles. and so the honest answer is that, it’s, it doesn’t really tell you much except for really working through how long somebody’s taken it, how many times they’ve tried, other ones, right?

‘Cause we’ve talked about there’s so many different species, different, and different product types.

Dr. Christina Carew, ND: Yeah.

When Probiotics Help

Dr. Christina Carew, ND: So why don’t we talk about where is good evidence for specific probiotics?

Dr. Dominique Vanier, ND: And certainly always talk to your doctor or naturopathic doctor before, taking, supplements or antibiotics or probiotics.

we’ve linked the World Gastroenterology Organization’s global guidelines on probiotics and prebiotics in [00:29:00] this podcast, but let’s, let’s break this down a little bit further. So, some examples are for acute diarrhea, probiotics have been shown to shorten the length of acute diarrhea illness in children by one day, and I know that doesn’t feel like a long time, but as a parent, that can feel like a long time.

certain strains have been shown to be safe and effective in meta-analyses and controlled clinical testing trials. another area is prevention of antibiotic-associated diarrhea, so that is when, somebody takes antibiotics, and then, we’re trying to prevent them from having diarrhea during or after taking antibiotics.

And, there’s a decent amount of literature on this. And so some studies confirm that, probiotic effectiveness for both younger patients and adults currently undergoing a course of antibiotic treatment, where probiotics can be helpful. Of course, it depends on the type. another area is immune response, so many strains, and the, prebiotic o- [00:30:00] oligofructose have evidence suggestive of enhanced immune responses in studies for preventing infections.

That can include, like influenza episodes over the cold and flu season. Another one that, personally touches my heart, ’cause both my kids had this, was infant colic. there is some research there on specific types, so L. reuteri, as well as B. animalis species, lactis BB12 specifically, have been shown to reduce crying time in breastfed infants with colic.

Again, there’s the, there’s a lot that’s still unknown about infant colic, but that is an area of research.

IBS And Bloating Evidence

Dr. Christina Carew, ND: Yeah, and then, most of the people who are listening to this are probably on here ’cause you’ve been told that you have IBS. And can it help with IBS? The research is mixed.

so there is some information that says, yeah, people that take probiotics seem to [00:31:00] have general, lowered pain tolerance and more relief of pain. but it doesn’t necessarily mean that all people that take it will get that. And most of the issue around this is, there are really small studies, there’s lots of different strains, some of them are combinations, some of them are by themselves.

it’s hard to differentiate what’s the cause of someone’s bloating. And so just because they’re in bloating and in a trial doesn’t mean that we know why they’re bloating, and is a probiotic solving that problem? So we’ve already talked at, 20 episodes of all different reasons for bloating. And so if you have, pelvic venous congestion and you’re taking a probiotic, it’s probably not gonna help, right?

But if you have something else, that might be more treated with a probiotic, then maybe it will be more beneficial. there is some bloating studies on some bifido strains, so bifido infantis, [00:32:00] longum, and lactobacillus rhamnosus. but again, that doesn’t always work for everyone. And so the American Gastroenterology guidelines say that, prebiotics or probiotics cannot be recommended for the treatment of gas related symptoms ’cause their effectiveness has not been convincing.

So not enough people who took them had the outcome that they were looking for. and so there’s more than one cure to bloating, which we’ve talked about extensively. And so taking a probiotic may not be the solution. I would say also, like IBD, people who have Crohn’s and ulcerative colitis, the research is actually not bad when someone is in a flare to help them get out of a flare for probiotics, but there’s not great research that says if they continue to take probiotics will it avoid a future flare.

And so that may also get us thinking about, how long do I need to [00:33:00] take this for? Is it something that I take every day like a multivitamin forever? Whole different ballgame of multivitamins we can talk about another time. or is it something that I need because I just did this aggressive treatment, I was traveling, I got a traveler’s diarrhea, something like that.

Dr. Dominique Vanier, ND: One important point about the, like the guidelines, and I know, actually the three of us have presented on this before, is the real issue with, the American Gastroenterology guidelines and the Canadian arm as well, is that the, a- all, the species end up getting combined. So you actually even end up getting, yogurt in kind of the same study as, a capsule, and it’s like you’re comparing apples and oranges.

And so it’s really difficult to, determine if, an intervention can help a specific group of people when it’s so heterogeneous like that.

Dr. Whitney Baxter, ND: Exactly. And even the criteria for irritable bowel syndrome has been changing, right? So [00:34:00] some of these studies will use, Rome IV criteria, which you had to have pain with irritable bowel syndrome.

Now they’re back to saying, oh, you can say you have discomfort, not just, severe pain. So it’s, different, yeah, like you said, different groups of people being studied with different interventions. Very hard to draw conclusions, and these guidelines are very conservative, and they wanna see black and white answers, and we know our bodies aren’t like that.

Yeah. So we know probiotics in the research is really good for acute things, acute diarrhea, immune responses, like very quick acting, or antibiotics. they help. And really we’re just trying to get you to a place where you take the probiotic, it starts to help over a couple of months, and then you can take over with prebiotics.

So continuing to fuel that garden and those species that live there. okay.

Do They Colonize

Dr. Whitney Baxter, ND: So let’s… I’ve always been, interested about this, is does taking a small pill of these [00:35:00] microorganisms or the probiotic capsules colonize our massive gut microbiome? Do they stick around and do they live there? So back to this garden analogy, there’s more than just taking a pill or seeding a garden.

A lot of us know this. We need to water it, make sure there’s the correct amount of sunlight, the soil has enough nutrients in there, there’s no other, bugs eating things. And probiotics are just one piece of the whole health picture or puzzle. What is your antibiotic history? What is your dietary habits?

What kind of fibers are you eating right now? Are you eating too much fiber or too little fiber? How are you sleeping? Are you drinking enough water to get your gut moving? Will the probiotics reach that large intestine to colonize that microbiome? So will they set up shop? Is your gut moving effectively?

Is it going too quickly? Is it going too slow? So yes, it’s a giant population versus [00:36:00] what’s in that probiotic, so it’s likely going to take time. Be consistent. So Dominique said, maybe you need it for a month, maybe two months. so it’s gonna take time to recolonize something that was wiped out by antibiotics, for example.

And there are trillions of cells that already live in this gut microbiome. and there’s a lot of different species, so there’s fungi, there’s viruses, there’s a lot of different bacterial species. and every individual has their own unique makeup. N- not everybody’s microbiome is the same. It’s based on how it started in the womb, then what happened at birth, what we eat, our environment.

So it’s really complex. so this microbiome interacts with cells of our immune system, the thin lining of our digestive tract, so that depending on the strain that you’re taking, the amount, what it’s [00:37:00] indicated for, it can really help, and there is exciting th- studies to show this. It can really help influence that immune system that already lives there.

the biofilm that we’ve talked about in other episodes on this pod- on this podcast, the health of our gut. And what we’re hoping for is that these species ferment the foods and fibers that we’re eating to create the beneficial side effects, like reducing inflammation, reducing pain. So it’s very complex, but yes, the idea is that your environment is good enough that they can take up shop and stay there

Dr. Dominique Vanier, ND: Yeah.

Making Them Work Better

Dr. Dominique Vanier, ND: how, so let’s talk about how you can increase the likelihood that the probiotics will make a beneficial shift in the microbiome.

Dr. Whitney Baxter, ND: And that’s why our, treatment plans and our conversations are really unique to each individual and can take effect over time. ‘Cause we’re always starting with making sure someone has regular gut [00:38:00] movement or motility.

so listen to our episode on constipation and bloating. We talk a lot about that. And we’re always slowly adding in more whole foods, fibers. We’re doing, a pre-fiber assessment, how much somebody’s already eating. We’re doing a transit time test. How long does it take to eat that blue muffin and then to see it?

So how long is that, conveyor belt actually taking to get things out? so then we’re slowly adding in more whole foods, fibers, these prebiotics to fuel a healthy species of your gut, decreasing anything that is altering the microba- microbalance, like high s- sugar intake, processed foods, poor sleep, stress management.

Maybe they’ve just been on a lot of medications that can alter the gut microbiome. So keeping all of these things in mind. Anything else that you guys recommend to, in your practices?

Dr. Christina Carew, ND: I would say, and I don’t know that this is in research [00:39:00] anywhere, but I feel like I heard it somewhere and then I’ve always used it, is I often tell people to take their probiotics at night.

‘Cause I think about it as, that’s when we’re repopulating and everything’s, moving in the gut and everything’s being restored. It’s not, like, competing with all the other stuff that’s going on in your life. I don’t know if there’s any research behind that, but I always think about it. It’s, a easy time for people to remember.

And so sometimes brushing your teeth is, a good trigger to remember to take something.

Dr. Dominique Vanier, ND: That’s interesting. I will, Similarly, I’ll say habit stack. So I’ll do it, I don’t th- I don’t know if there is research, at least I haven’t really come across, the timing being a thing, but, the consistency is important, right?

I think that’s trying to… what we’re trying to get at, which is, we wanna do it every day, because at least that’s what’s been studied. another thing is, the thing I focus on is, having as much of a diverse diet as possible. So we know, the fibers, the food that we eat is going to then translate into [00:40:00] the health of our microbiome, the diversity of our microbiome.

And so if we can focus on a really wide range of fruits and vegetables and all the good stuff in our diet is then that is… that should be beneficial to all of our bugs.

Dr. Christina Carew, ND: Do you also tell people to rotate? So the people that are insistent on taking a probiotic all the time, do you get them to rotate to different brands?

Dr. Whitney Baxter, ND: I don’t. I always like to see if it changes how they feel. if that, what they’re taking, you need, they need to take in order to feel better, or if anything’s sticking around. Like, how is their baseline ecosystem there? I’m always curious about that.

Dr. Dominique Vanier, ND: Yeah. I think the goal is, to get people feeling better and to stabilize the system and for them to feel better for a while.

And then we can start seeing, did, do you need this still, right? have things shifted enough where maybe we don’t even need the probiotic anymore, or is it still as effective as it was before? And then at that point, I would reconsider changing it to something else, [00:41:00] if I still feel like they need one.

So it’s so individualized, right? With, like, how we have these conversations.

Dr. Whitney Baxter, ND: Yeah. Yeah. Fine. I wish, I always say I wish that there was a template that I have for your treatment plan, but I don’t. So we’re going to build this, so we’re gonna work together and see how you feel.

Practical Buying Checklist

Dr. Whitney Baxter, ND: Okay, just some quick practical takeaways of how to think about probiotics when you’re taking them, if you’re talking to your doctor about them.

so again, we talked about matching the strain and the dosing indication you’re using. So as practitioners, we’re using evidence-based dosing tables, not just the highest CFU or, number on the package of that probiotic. Speak, with someone who understands, why you’re dosing it, what you’re taking, and all the species.

And then verify the strain level, labeling, and end-of-shelf viability. So again, these probiotics are alive. Double-check that expiry date [00:42:00] and if it has that NPN number. If you’re immunocompromised, so if autoimmune conditions, if you’re really sick often, if you’re going through chemotherapy or radiation. So there’s many things to think about before taking any supplement, especially with probiotics, because they are alive and they do really interact with our immune system.

So something to keep in mind So if you are someone who’s really blown- prone to bloating, you’re very- you’re sensitive, your system’s really sensitive, you have a lot of, indigestion or discomfort, you might wanna start with like a lower CFU on that bottle, and then see if you can slowly go up. Again, it’s always depending what you’re treating.

And then again, we talked about the timing with antibiotics. Try to separate it by at least two hours if you wanna add in a probiotic, or taking them on opposite ends of the day. And then again, in Canada, probiotics, must be licensed, so they need an NPN number by Health [00:43:00] Canada. So just some things to think about before plucking one off the shelf.

And then we asked, we talked a lot about prebiotics and probiotics in our fibers. have you had your bloating assessed to see what the cause is? Lots of causes of bloating. do you have irritable bowel syndrome or something that’s more functional? Is there a hypersensitivity or excess pain experience that you’re noticing?

so things to think about before taking lots of probiotics to hopefully help.

Talking To Your Doctor

Dr. Whitney Baxter, ND: So how can we talk to, how can we talk to listeners about how to speak to their practitioner?

Dr. Christina Carew, ND: Yeah. So I would definitely suggest before grabbing a random bottle off the shelf, trying to see, especially with so many tools now that help us to narrow in on things, the internet is so much better than it was even five years ago, looking for evidence for probiotic use with [00:44:00] the condition that you have, whether you have IBS or infant colic or, H.

pylori. Is there some evidence out there about which probiotic strain might you wanna use? so part of it could be going into your healthcare practitioner and saying, “Hey, I found this. Would… What do you know about it?” Or, “I, need to find this out. How would I go about looking for it?

are there probiotic strains that you in particular recommend for me or might be useful for my symptoms?” or telling them about your experience. “I tried this probiotic. It made me feel worse. Here’s what I felt. is that any in… Does that information help you in, helping me to get better?”

and sometimes people are gonna know tons about this, and sometimes people are gonna look at you like you’re sideways, and they think that everything is exactly the same. They said, “Go to the store and buy flour or buy sugar,” and didn’t realize, [00:45:00] there’s, 20 different cake boxes on, the shelf.

And certainly sometimes this may be an area where you do have to do more of this advocacy on your own

Dr. Dominique Vanier, ND: Yeah. Yeah.

Final Rapid Fire Recap

Dr. Dominique Vanier, ND: Okay, let’s do a quick recap of this episode. So we’re gonna rapid fire some points here. Number one, probiotic, it’s a category, it’s not a product. The strain is what matters.

Dr. Christina Carew, ND: More isn’t always better. More billions, more trillions is not always better.

Dr. Whitney Baxter, ND: You can take probiotics with those antibiotics, just space them out.

Dr. Dominique Vanier, ND: And for bloating specifically, the evidence is real but modest, and guidelines are cautious. And like we’ve talked about in, like, all of our episodes, there are so many different causes of bloating, so drill down on what’s going on there.

Dr. Christina Carew, ND: And one single pill is not going to change the entirety of the garden that it’s planted [00:46:00] in.

There’s lots of other components that need to be considered, and so probiotics are also not the magic pill

Dr. Whitney Baxter, ND: Yeah, so whether it’s bloating, reflux, constipation, other digestive symptoms, there’s often more than one cure, like thing that we wanna do to support that whole system. It’s not just a pill.

Probiotic might not be the only thing that you need. It’s just one piece of the puzzle, not the whole picture. And remember, better gut health changes everything. So thank you for listening to another episode of Team Gut Girls