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For over a decade, I have recommended a trial of probiotics to virtually all of my patients. Probiotics are a vast group of living microbial organisms comprising normal gastrointestinal flora. Examples of probiotics include bacterial species  Lactobacillus and Bifidobacterium, as well as the Saccharomyces yeasts. Prebiotics are nondigestible fibers and complex sugars that promote the growth and metabolic activity of the beneficial bacteria, primarily the Bifidobacterium, in the colon. Prebiotics were not defined until 1995.  One example of a prebiotic is inulin, found in Jerusalem artichokes and asparagus stems. Fermented milk products such as yogurt and kefir are considered synbiotic because they contain both the live probiotic bacteria and the prebiotic fuel working synergistically. For thousands of years, the food we ate was unrefrigerated, unpasteurized, and unprocessed. The intestine is our first line of defense against harmful pathogens, chemicals, and preservatives that we do not want in our bodies.
One leading scientific hypothesis proposes that dysbiosis allows tight junctions to loosen up, resulting in leaky gut syndrome or intestinal permeability.
To maximize their effectiveness, probiotics must remain stable in the acidity of the stomach and the alkalinity of the duodenum. If my client is taking probiotics to “promote good gut health,” I support exclusive use of food sources of probiotics. Probiotic supplements are formulated with a special coating to withstand stomach acid and bile before dissolving in the small intestine. The past decade has seen an increase in the number of scientific studies on the effectiveness of probiotic supplements. It is challenging to provide detailed recommendations on which probiotic supplement to take and what dosage, due to variability in strength and viability.
The International Scientific Association for Probiotics and Prebiotics (ISAPP), in The P’s and Q’s of Probiotics: A Consumer Guide for Making Smart Choices, recommends looking at these four criteria prior to choosing a probiotic.
Probiotic Strain–  Try to match the particular strain with published scientific research. Do not take the probiotic with a hot beverage or cereal, as the heat might destroy some of the good bacteria. If taking prescription antibiotics, wait two hours before taking the probiotic so they do not cancel each other out. Occasionally, I will have a patient experience more severe symptoms when they first begin taking probiotic supplements. If you experience the Herx reaction, it is best to cut back on the dosage, while continuing to take probiotics until the toxins are eliminated from the body.
Once the harmful bacteria have been eliminated, it is time for the probiotics to do their job. As a dietary supplement, 1 capsule daily, preferably on an empty stomach, or as directed by a healthcare practitioner.
Culturelle™ contains Lactobacillus GG, an extensively studied strain of friendly intestinal bacteria, naturally occurring in the digestive tract. As I had done with previous marathons, I spent the week prior to the marathon eating very conservatively… only foods and quantities my gut would tolerate. For dinner the night before the race, I ate the typical pre-race pasta meal (fettuccine alfredo with chicken). As I ticked off the miles, and looked at my watch, I knew it was going to be tough to reach my goal time. When I told her how many gels (6) I had taken during the previous marathon, she asked how many calories I eat the day before a marathon.
She recommended a negative split, meaning, run the second half of the race faster than the first. She told me if I was worrying about missing time in the first half of the race, I could intersperse several 1 minute intervals of increasing speed to almost a minute faster than my average marathon pace.
I completed a 20 mile and 18 mile run before my next race, in between two 9 day family motorhome vacations, one of them to the Grand Canyon. On race morning, I took another dose of Imodium and ate my simple breakfast of dry Life cereal. After emptying my thimble-sized bladder I felt like a million bucks, and was excited to see my family at the halfway point.
I saw the first mile marker at Mile 14 and realized I was at least 4 minutes slower than I needed to be to meet my goal time. At Mile 18, my phone died, along with my race day music (bummer), so it was now just me and the gravel trail.
At Mile 21, my family cheered me on and my friend Eileen jumped in to pace me to the finish. Eating close to 3000 calories the day before the race allowed me to fuel less often during the race.
During the race, I took 1 Bluberry Roctane (caffeinated), 1 Honey Stinger, and 1-1.5 bags of Sport Beans (caffeinated). Although it was still 76 degrees at the finish, my heart rate was much lower during the September race because of the cooler temps.
It’s best to try to exceed the established standard for adequate intake (AI), especially if you have chronic diarrhea. Use a large water bottle labeled with ounces or liters to keep track of how much you are actually drinking.
If you do not like the taste of plain water, try adding slices of lemon or lime to improve the flavor. If you have diarrhea, room temperature water is often easier to tolerate than very cold water, which can cause cramping. Another colleague and friend Kate Scarlata is also a wonderful FODMAP resource, including some free downloadable handouts (I love free stuff!). If you are a runner and would like to contribute to this book (by filling out surveys or contributing personal suggestions), please email me directly.
Sodium is plentiful in the foods that we eat—and combined with chloride—in the form of salt. If you ever have any of the symptoms for low sodium or potassium, please contact your medical provider immediately. If you have chronic diarrhea, ensuring the diet includes adequate amounts of sodium and potassium is fairly simple. WHO developed a formula for oral rehydration salts that is relatively inexpensive to produce and distribute. You can also add sugar-free Crystal Light (I prefer lemonade flavor) or other sugar-free powdered beverage mix to improve taste. One of the difficulties in assessing ORS is identifying the quantities of sodium and potassium in a given volume.

The goal is to keep rehydration solutions as close as possible to a normal plasma osmolality of 285-295 milli-osmoles per kilogram, in order to maximize absorption and prevent osmotic diarrhea.
Something you may notice about both oral rehydration solutions and most sports drinks is that they both contain some form of sugar, usually in the form of glucose. When I recommend electrolyte replacement, it depends on the frequency and severity of the diarrhea.
People with three or four stools per day may be able to use sports drinks or electrolyte-enhanced water, supplementing with ORS as needed.
Thank you to Melinda Hemmelgarn, MS, RD and KOPN Food Sleuth Radio for allowing me to bring a topic out of the bathroom and onto the radio.
When I started having diarrhea at age 13, my pediatrician took my family history seriously and ordered a barium enema to rule out UC. Get a great gastroenterologist who is up on all the latest research and treatments for IBD.
There was not much published literature, but there were a lot of theories about how the body’s bacterial population influenced overall health. By the time my book was nearing completion in 2012, I had to re-write the whole chapter because of all the new scientific studies!
Put simply, probiotics are good bacteria that are supposed to live in your intestinal tract.
In 1965, researchers coined the term “probiotics,” though the concept and use of beneficial bacteria to promote health had been around since the early 1900s.
They provide fuel for the probiotics already living in the intestine, favoring the good bacteria over the harmful ones. Fructooligosaccharides (FOS), which occur naturally in garlic, onions, green bananas, zucchini, watermelon, and peaches, are another type of prebiotic. However, it is my experience that those who suffer from IBS-D (diarrhea predominant) or who are FODMAP-sensitive do not tolerate prebiotics; it exacerbates their diarrhea.
In order to fight these invaders, the cells in the small intestine tightly line up next to each other, forming an impermeable barrier.  Probiotics assist the cells in maintaining these tight junctions.
Openings created between the cells may permit proteins or toxins cross the intestinal barrier. Further down the GI tract, they must adhere to the surface of the small intestine and effectively populate the colon. Yogurt is the most common and familiar form of probiotic, which contains primarily Bifidobacterium and Lactobacillus species.
However, if a patient is actively experiencing gastrointestinal symptoms from a known disease or disorder, I typically recommend they add an over-the-counter probiotic supplement to their daily regimen. Once the probiotics are released, they can adhere to the intestinal wall and support immune system function.
However, one difficulty in creating a clinical trial is the wide variety of yeasts and bacteria species available. When independent companies test products, they find wide variability in the quantity and potency of live bacteria in each capsule. I do not recommend one particular brand over another, primarily because information changes quickly, and specific probiotics may be better-suited for a particular medical condition. Scientific studies have determined health benefits from 50 million to over 1 trillion colony forming units (CFUs) per day. Strain, quantity of CFUs, serving size, health benefits, proper storage conditions, expiration date, and additional corporate contact information should all be included. It may take two to four weeks for those symptoms to subside while the good bacteria insert themselves into the intestine. Charcoal tablets taken about two hours after the probiotics can help bind and remove the toxins. Together with Lactobacillus rhamnosus, Lactobacillus GG is a subspecies of Lactobacillus casei. So earlier this year, I signed up for a downhill, but Boston-qualifying marathon called Light at the End of the Tunnel Marathon on July 13, 2014.
I ate quite a bit of chicken, some dairy, eggs, a fair amount of bread (gluten and I are still friends), and actually very few veggies. That evening before bed,  I took my dose of Imodium and and a Prilosec (proton pump inhibitor). I was able to have a normalish BM and popped two more Imodium (for some of you that may be TMI). About a mile into the tunnel, I had a sickening realization: all my fuel had fallen out of my pocket. We researched possibilities… and I decided to run the exact same race, only in September (they call it Tunnel Lite, since there are fewer runners). We only met in person one time, she gave instructions on improving my form while I peppered her with 1000 questions. As we drove to the starting line, I watched the outdoor temperature (on my car’s thermometer) dropping.
So I used the trick taught by my coach: over the next several miles I sped up to ~45 seconds faster than goal pace for 1 minute, then slow back down to race pace. I realized at this point, I did not have the nausea that had plagued me with all three of my previous marathons. I didn’t pay attention before my July race because I thought I would be carrying all my fuel and water.
Remember that all non-alcoholic, caffeinated-free fluids count toward your total, including water, ORS, juices, milk, herbal teas, decaf coffee, and soup. My heart breaks for you, because I know how bad it must be to be causing so many physical problems.
In my experience, this is often due to dehydration, or inadequate water and electrolytes in the body. Salt is added to processed, canned, frozen, and fast foods to extend shelf life and improve taste. The World Health Organization (WHO) has studied and used oral rehydration solutions extensively in Third World countries for many years to treat severe diarrhea such as colera.
This oral powder comes in individual packets that dissolve in one liter of clean drinking water. Sports drinks commonly list sodium and potassium in milligrams, whereas medical solutions list milliequivalents (mEq) per liter of solution. If one of my clients with chronic diarrhea complains about ongoing fatigue and severe diarrhea (15-25 trips to the bathroom each day), I recommend aggressive replacement of fluid and electrolytes with an ORS. If millions of people suffer from chronic diarrhea, don’t you think it should be talked about? According to my grandparents, she was one of the first patients to be treated with high dose corticosteroids at a hospital in Chicago in 1958. Over the years, I have met, treated, and counseled hundreds (maybe thousands) of patients suffering from active Crohn’s or colitis.

Of all the strategies I discuss with clients, adding probiotics has resulted in the most significant decrease in chronic diarrhea.
Beyond the benefits of carbohydrate, protein, fat, and calcium contained in the yogurt itself, it contains active cultures of L. Once the foreign invaders are inside, antibodies are created as the immune system is activated.
However, fermented dairy beverages such as kefir actually contain a higher concentration of live cultures.
In scientific studies, many probiotics are used individually or in combination with other bacteria or yeasts. The following table presents different conditions and the species of probiotic which has been scientifically studied and proven effective for that particular disease or disorder.
One exception: you may continue to take a yeast probiotic (such as FloraStor®), with your antibiotic.
It occurs when the bad bacteria are dying off and the body is unable to release the toxins quickly enough.
It began as a whisper in the back of my head… maybe I should train for a full marathon?  But if I run a full marathon, I need a tangible goal. I trained in earnest, getting my workouts in while keeping **BOSTON MARATHON** in the forefront of my mind. Since I had experienced nausea the first two marathons about mile 19, I was curious to see if it was related to the acid in my stomach somehow. It hit me… I was going to have to use the fuel they provide at the aid stations on the course. It was challenging to both recover from the last race and simultaneously prep for the next. While I have focused on carb loading, I have never tried to come close to 3000 calories the day before a race.
By the time we got to the start it was a very chilly 38 degrees… a far cry from the 63 degree start just 8 weeks earlier. Once we left the tunnel, I noticed the mile marker chalk lines weren’t on the ground like they had been at the previous race.
I was alternating Sport Beans and water with my favorite oral rehydration solution packets.
But when I lost my fuel 1 mile into the race and needed to refill my water bottles on the course, I didn’t know where the aid stations were. While uncommon, those with chronic diarrhea can be at risk for hyponatremia, or low blood levels of sodium, due to extra losses from the stool. The quantities of sodium and potassium are not high enough to replace those lost by chronic diarrhea.
In developing countries, untreated diarrhea in children, elderly, and the immune-compromised can be life-threatening.
It is more important to realize the higher the osmolality, the greater the chance of osmotic diarrhea. Therefore, rehydration beverages containing all three components—sodium, potassium and glucose—are recommended. Unfortunately, she died after a car accident at at age 17, so we do not know what would have happened to her UC long-term. While living with IBD is challenging, I am here to tell you it does not have to run or ruin your life. While this has prevented many types of dangerous illnesses, it has resulted in fewer beneficial bacteria living in our gut as well.
Many autoimmune and gastrointestinal disorders have been linked to leaky gut syndrome; these include Crohn’s disease, celiac disease, Type 1 diabetes, psoriasis, and eczema.
In today’s marketplace, you can also find probiotics in soup, cheese, energy bars, even cereal.
Studies have shown that some species are more effective in treating a particular disorder or disease. In the short-term—days to a few weeks—these toxins can exacerbate the symptoms being treated and cause more gas, bloating, or diarrhea. That night I had to get up and pee twice during the night, so I knew I was plenty hydrated!
You can see a pin prick of light that gets bigger and bigger as you get closer to the end of the tunnel.
My gut was quiet, so I took a shot of caffeinated gel and chugged down some water with three miles to go. So we talk about life… what happened in your childhood or the status of your current relationships. How had I missed this important tidbit in all my years of researching irritable bowel syndrome (IBS)?
Nevertheless, sports drinks may work for those with mild diarrhea, or if you are unable to access a better alternative. They may also create their own flu-like symptoms including headache, joint and muscle pain, body aches, sore throat, general malaise, sweating, chills, or nausea. To date, this is the best-studied and most extensively documented probiotic lactic acid bacteria strain in the world, containing 30 billion viable organisms per capsule. I mix the powder into a slurry, gulp it down just before the race, and then fuel again in 1.5 hours! The air temperature was rising, but I noticed my heart rate was staying around 164, a good place for me. And we don’t talk about carbohydrates or FODMAPs or what you put in your smoothie this morning. Foods that contain high amounts of potassium include spinach, potatoes, tomatoes, citrus fruits, melons, bananas, dairy products, dried peas and beans, nuts, and chocolate. The downside, there are no porta potties on the course, and only a few outhouses along the way. My calves started cramping just slightly at Mile 25, but it was much more manageable than it had been during my previous marathons. However, many of these foods are not tolerated by those with intestinal problems, so electrolyte beverages and replacements may be a better alternative. The good news, again I was able to run a whole marathon without any diarrhea, but bad news, I started getting nauseated at mile 19 and it slowed me down the rest of the race. I will spend an entire blog post on it in the future, but you can read more and check it out here.

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Comments to “Culturelle probiotic for ulcerative colitis fran?ais”

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