DrDesChat : Naturopath Burnaby & Virtual BC

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What does choosing a dog and choosing a probiotic have in common?

In the last few decades, research on probiotics has grown exponentially. Our understanding of how they can influence our gut health as well as how they influence seemingly unrelated systems such as the immune system has been greatly refined. Unfortunately, as research creates buzz, so does the marketing world and our shelves are popping up with probiotic labels everywhere. Now, we have a dilemma- how to decide which probiotics give you the bang for your buck. This current article builds on my last article explaining some of the research and the benefits of probiotics. If you haven’t read it you can check it out here.
Are all probiotics created equal?

Saying I take probiotics is as vague as saying I take vitamins. Just as different vitamins play differing roles in the body, we also know that different probiotics with different genus, species and strains do not have the same effects.
If you currently take probiotics take a look at the label now.

What do you see? Can you find the Genus, species and strain of the probiotic?

Some of the lower quality probiotics only specify the genus and species and not the strain. This is because identifying strains take an additional level of evaluation. This step however is proving to be extremely important as we are learning that probiotics with the same genus and species but different strain can play different roles in your health and do not all confer the same benefits.

To conceptualize, consider that all dogs have the same genus and species- Canis lupus. Within this genus and species we have various types of dog breeds. Visually it is evident that different breeds have very different characteristics. For example, some are great hunter dogs others are better sled dogs while some are hypoallergenic dogs. Having a probiotic that doesn’t specify strain is like looking for a hunting dog but blindly buying a dog without knowing the breed.

If you own a dog you very likely chose a specific breed of dog to suit your lifestyle. In the same way, there may be a specific probiotic strain that is indicated for the outcome you are looking for.

Take home message: Top 5 things to know before choosing your probiotic

1. Know your probiotic strain

Look for a known probiotic strain that has been tested in humans and known to confer the specific outcome you are looking for.

2. Know the colony forming unit (CFU)

CFU indicates the amount of live microbes in the supplement. Recommending a dose is very difficult as it depends on the probiotic strain and the outcome you are looking for. Doses range from 50 million to 1 trillion CFU a day.

3. Know the probiotic strain’s tolerability to digestion.

Digestion provides a rough journey for some of these living microbes. Some strains are tough naturally and others aren’t. Has the strain you are taking been studied to assess its tolerability to the gastric acid of your stomach, the bile salts of your gallbladder and the digestives enzymes of your pancreas? Some strains are tolerant; some are not. The ones that aren’t need to be formulated in capsule that will only dissolve in the lower gastrointestinal track.

4. Know your manufacturer: 3 questions to ask.

Does this manufacturer ensure that strain-identification has been done, a process that ensures you have the strain of probiotic you are looking for?  Is the manufacturer diligent about the entire process ensuring that if a probiotic needs to be refrigerated it is from the moment it leaves their hands, through shipment and until the time it gets to your home?  Have they studied the probiotic to ensure it has a stable shelf life until expiry?

5. Are you having a double rainbow “what does it mean” moment?

I know, I’m sorry but it was a bit of the point of this article. I see so many patients taking probiotics but they have no idea what strain or for what outcome. Next time you see the word probiotic I hope you can see through some of the hype of what might be good marketing versus some of the benefits the best of science has to offer today. For overall intestinal and systemic health, the most basic recommendation in adults would be the periodic use of 15-30 billion of Lactobacillus acidophilus NCFM® (talk to your primary care giver). This strain was first isolated from the human gut and has been well researched. It is known to have digestive tolerability and been shown to adhere to the human intestinal wall. It is one of the most common probiotics in the gut and one with a very good safety record. There are over 6o studies on this specific strain demonstrating various beneficial outcomes for certain conditions.
Are you looking for specific outcomes, do you have irritable bowel syndrome or disease? If so, talking to someone who is well versed in the different strains of probiotics can get you inline with the research ensuring it has the best chance at improving the outcomes you are looking for.
If you would like more info, the International Scientific Association for Probiotics and Prebiotics (ISAPP) has been created to demystify some of complexities of this ever growing and expanding body of research. Hope you’ll have a more critical eye next time you see the word probiotic.

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Why you should eat bugs- probiotics that is.

From an early age most of us are taught how to be a good host to our friends.  The 3 golden rules:

  1. Make sure they have food and drink.
  2. Create an environment that will nurture that friendship.
  3. And don’t forget to have fun.

What if I told you that you have been hosting a daily party for years.   Would that be a surprise?  What if I told you the number of guest outnumbered the number of cells you have in your body.  The friends you are hosting are healthy bacteria that reside in your gut.  These friends of yours have been working for years doing critical roles that impact your health.  This party represents a symbiotic relationship- a relationship where both the host and guest equally benefit.

Who are these buggers anyways?

According to the world health organization (2001) “probiotics are live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host.”

Probiotic infomercial

“We have been providing security since your birthdate.  We minimize your susceptibility to evil foreign invaders by occupying your gut wall.  When we are numerous and chilling on your wall we make it much harder for a foreign invader to fit in with us.  We literally crowd them out.

We are positive gossipers unlike the evil pathogenic counterparts.  We send positive communications to your gut cells that in return start a cascade of events important in regulating your immune system, important in decreasing inflammation as well as producing important metabolites such as vitamins and other protective molecules.”

Did you know approximately 70% of your immune system resides in your gut?  Conceptualizing that probiotics can confer digestive benefits seems plausible.  The systemic impact of probiotics on our health is far reaching and much beyond the boundaries of the gut.  Some can reduce the length of colds and flus, impact the skin, eliminate vaginal candidiasis, improve our ability to detoxify and cope with allergies.

How does your gut communicate with your immune system?  Through an immune relationship between your gut-associated lymphoid tissue and your mucosal associated lymphoid tissue.  What we know is that influencing the immune cells in your gut also results in changes in mucosal tissue.  This is why sinus issues can really be a manifestation of gut issues.

A snippet of the research (skip if you wish)

Antipathogenic barrier studies demonstrate that specific strains protect human cells from invasion of certain malignant pathogens.

Specific probiotic strains significantly reduced chronic diarrheal and vomiting in children age 6-24 months(9). Other studies demonstrate that it decreases the duration of diarrhea in acute cases as well.

Preliminary findings suggest that specific strains of probiotics reduce the activity of bacterial enzymes implicated in colon carcinogenesis.

A study looking at children age 3-5 found that “daily dietary probiotic supplementation (L acidophilus NCFM in combination with Bifidobacterium animalis subsp lactis Bi-07) for 6 months was a safe effective way to reduce fever (by 72.7%), rhinorrhea (by 41.4%), and cough incidence (by 62.1%) and duration and antibiotic prescription incidence (by 84%), as well as the number of missed school days attributable to illness (by 27.7%), for children 3 to 5 years of age.”

There are some preliminary findings with promising results that probiotic supplementation in pregnancy and in early newborn years may decrease the incidence of some atopic conditions.

Certain strains of probiotic are critical in the production of Vitamin K in the gut.

Many more roles … Busy little buggers aren’t they.

Hosting fees

There is a bit of problem.  For the most part, our society has evolved and changed its eating habits with little regard for the impact it might have on our friends.  We did have a deal after all.  They would work night and day protecting against the superpowers of evil but we did have to provide them with a nurturing thriving environment.

For the most part we haven’t been very good hosts to our inhabitants.  High fat and low fiber diets as well as acid suppressing drugs make it a rather harsh environment for them to thrive.  In addition, when we use antibiotics one of the side effect is that some of the good bacteria get killed as well.  These factors combined with the reality that our food is pasteurized and dietary sources of probiotics have greatly diminished results in a run down population. This can make us susceptible to dysbiosis or an unhealthy balance of bad to good bacteria.  Remember we had a deal and if we don’t hold our end neither will they.

Probiotic etiquette- take home message

  • Increase your dietary fiber.
  • Take proactive action after taking antibiotics with a strain specific probiotic.
  • If you depend on acid suppressing drugs on a continual basis consider a naturopathic digestive tune-up.
  • Unless you make your own unpasteurized sauerkraut your intake of probiotics is likely minimal.  Consider a daily researched strain specified probiotic such as Lactobaccilus acidophilous NCFM.

Stay tuned the next article will be on how to chose a probiotic.

Have you had a positive experience with probiotics?  I’d love to hear.

 

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What increases the risk of antibiotic resistance?

Here is the answer to last weeks poll question! What increases the risk of antibiotic resistance?

A)    Failing to finish an antibiotic prescription
B)    Long term use of antibiotic prescription
C)    Both increase the risk
D)    Both decrease the risk

The suspense is about to end.  It was a question to setup this week’s discussion.  And like any well-written poll question two answers must be somewhat right.   The poll results demonstrated that the majority answered C and that was what I was expecting.  The goal is to bring some perspective to answer C and some consideration for answer B.

This poll question was inspired by an experience I had while taking the pharmaceutical prescribing course for naturopathic physicians in BC.  A renowned pharmacist teaching the course simply asked us the above question.  In perfect unison we answered “c” looking to show off our brilliance on such a simple question. Our answer was followed by a slight pause.  I was starting to feel like we had been setup.

He responds, “Well which is it? Taking an antibiotic for too long or not too long??  It can’t be both.”

I know, you want to rebuttal.  Of course, if you cease taking your antibiotic before you have kicked the infection you can contribute to antibiotic resistance.   Simply, this is because the bacteria that survive will learn to adapt and outsmart the antibiotic.  We also know that individuals who are on long-term prescriptions of antibiotics are at increased risk of antibiotic resistance.  This isn’t really what he wanted to emphasize.   Neither do I.  I’m sure these two facts are why you answered C in the first place.

The question really is then:  Is failing to finish an antibiotic prescription in itself really increasing you risk?  Are there better markers for ceasing the prescription than the one written on the prescription pad?

He left this question hanging and started asking us his next series of questions.  “Has anybody seen an antibiotic prescription for 5 days??” We raised our hands.  “7 days?? How about 10 days” We raised our hands.  “How about 4?? Or 6?? Or 8 days??” Nobody raised his or her hand.

“Of course not!  You can’t possibly prescribe for 4, 6 or 8 days because nobody does that and you will look foolish”.   He continued to say with a slight grin.  “Welcome to the art of prescribing.”

The point was understood.  We have been trained to think that hell will freeze over if we do not finish that prescription.  The reality however is that the length of the prescription is based on clinical experience and can vary for various factors including the prescribers biased preference for a 10 day versus a 7 day prescription.   Another reality is that prescribing physicians can’t tell the future and can’t always tell whether you will need 7 or 10 days worth of antibiotics or heck maybe you are in real need of the forbidden 8-day prescription!  There really isn’t any evidence that a person who was prescribed the antibiotic for 7 days versus 10 days had different risk of antibiotic resistance.

So here are a few take home messages.
•    If you have a non-life threatening infection and you have been symptom free and fever free for 48hrs it is wiser to stop taking the antibiotic regardless of the prescription length.   You will decrease you risk of antibiotic related complications such as diarrhea and decrease the risk of antibiotic resistance.
•    Do not prematurely cease taking your antibiotics if you are still experiencing symptoms and fever.  Consider revisiting your primary care physician to discuss the prescription if you are nearing the end.
•    Consider taking strain specific probiotics that have been shown to decrease antibiotic associated complication.

That’s it! Just some juicy food for thought!

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The scoop about your poop

Imagine the euphoria of observing a beautiful brown foot long sinker with all its majestic substance contrasting the beautiful white backdrop of the porcelain bowl.  The pursuit of the perfect poop is not always an easy one but is certainly one worth the mighty effort.

I am here today to start a poop movement!  The topic of poop needs to move from the nuisances of our lives to a front row Hollywood show.  Poops everywhere are here to speak up.  They have been trying to tell you something for years but have you been listening?

Let’s open the bathroom doors and liberate the knowledge of learning a new language: poop reading.

Brown poop. Yes that is normal.  Big surprise!  Ever wonder about these others colours?

Black poop may be a red flag!  When you have a digestive bleed originating in the stomach or esophagus it mixes with the acid of the stomach to make tarry black stools.  Other less worrisome causes are iron supplements and bismuth compounds such as pepto bismol.

Red poop may be a red flag!  When you have a digestive bleed originating below the stomach it will be red.  This can be a sign of colon cancer and thus should be taken with a great level of attention!  Irritable bowel diseases are also associated with bloody stools as are fissures or  hemorrhoids- you should be checked out.  The only time you can take a deep breath and relax about it is if you consumed some red beats!  Beats have a magical way of making your poop a colourful experience.  If this is the case enjoy the show.

White/Gray poop can be a sign of a bile duct blockage or liver disease.  This is also not a colour to kid about.

Green poop can be OK or a pain in the butt.  Don’t worry you will know the difference.  Fever, abdominal pain and some diarrhea likely infectious in nature.  I feel great but my poop is a tinge green?  That’s great you are probably consuming quite a bit of spinach.  As long as it’s digested there’s no need to worry.  If it’s not digested then you may benefit from a little naturopathic digestive tune-up.

Yellow poop can be a sign of pancreatic disease.  The pancreas produces enzymes critical for the proper digestion of fat.  Sub-par functioning of the pancreas can lead to yellow poop.

Floaters- once in a while floaters are no big deal.  Fat in the stool or gas can give your stool that little extra buoyancy.  Nonetheless,  if this is a consistent occurrence it can be a sign of chronic pancreatic insufficiency which means not enough enzymes are produced to break down the fat.

Sinkers– Yay, woohoo, great job!  Keep it up!

Marble poop is due to poop glue deficiency! Poop glue?!?!  Well when you ingest fiber it is fermented by bacteria that reside in your colon and it produces beautiful poop glue and lubrication.  This keeps poop from breaking into pieces.  For a lubricated and bulkier experience increase your dietary sources of fiber and water.

Soft poop not yet diarrhea but certainly not the hulk of poops either.  This tends to be indicative of malabsorption.  Some of the most common offenders are due to fructose, sorbitol, lactose in dairy, gluten in wheat or even more generalized food sensitivities.  Removing the offending culprit is key.

Thin and windy poop may be a red flag!  Progressively narrowing stool can be indicative of colon cancer!  It may also be a simple sign of excessive straining.  Go ahead relax and enjoy your poop experience- let it fall out instead of pushing it out.

Poop jam the most common cause is a simple case of dietary fiber and water “under consumption”.  If that doesn’t do the trick, perhaps a hypoallergenic diet should be considered.

Diarrhea can be caused by a GI infection, malabsorption or food sensitivity.

Our poop is a great indicator to the health of our digestive system.  Our digestive system is one of the most fundamental systems to our health, influencing seemingly unrelated systems such as the immune system, respiratory health, skin health and joint health.  Just remember we are giant walking tubes from our mouth to our anus.  The digestive track is a major system in which we interact with the outside world.  It’s important we have it working as best we can!  I wish you daily successes along your pursuit of perfect poos.

 

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My story

This is the most personal blog I have written thus far.  I wanted to take a step back from the usual content to properly introduce my story and the goal of this blog.  Many often wonder how one becomes a naturopathic doctor.  Let’s face it, most people pass much of life without really knowing what the heck one does, how to say it and especially what to expect from one!  Heck, even spell check doesn’t recognize the word.   Some of the preconceived ideas of what I do make me laugh, and well, if they didn’t make me laugh they would probably make me cry so I choose to laugh instead.  So how did I become one? I was raised by parents who were very involved with health.  My father, a world class and Olympic level wrestler knew the synergistic importance of both physical fitness and mental fitness to health and success.  My mother, an incredible teacher who was also a lifelong learner herself studying and reading all she could on health and nutrition.  This lead to the upbringing of an active and healthy eating child who preferred collecting Halloween candy than eating it.  This laid a strong foundation that lifestyle had so much to do with health and how well you could feel.  Our relationship with our thoughts, food, exercise and our body was essential to feeling well.  While I was growing up, I was seen much more often by a naturopathic physician than my medical doctor, not due to avoidance simply due to great health.  Naturopathic medicine offered the solutions I wanted to provide.  It is what I wanted to do.  I have often seen many people with preconceived notions that if I’m a naturopathic physician then I must be anti-medical physician.  To be clear, I could not disagree further.  Life is not black and white and neither is health care.  In the gray is where the sweet spot of patient care lies.  Optimum patient care is what I care about- that is really the bottom line.

I’ve been sporadically blogging since November 2010 about various health topics.  I’d like to formally introduce my blog.

The reason I wanted to blog is that one of the naturopathic principles is that doctor act as teacher to empower our patients.  I believe this is one way I can do that.  My goals are to:

  • Improve wellness IQ with a little flare.
  • Share some personal experiences.  So you can see how I walk my talk.
  • Empower you to collaborate in informed decision making with your primary care giver.

I hope you will join me on this journey.

There are a couple of ways to follow this blog if you aren’t already.

1. Join the RSS feed (it’s on the sidebar of my website, the orange icon)

2. Join the newsletter and receive a compilation of the weeks articles freshly delivered once weekly.  The sign up is also on the sidebar of my website).

À votre santé,

Mélanie

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