Friday, May 23, 2008
What are probiotics?
A significant problem with taking long term antibiotics is that they kill good bacteria called normal flora, in your gut. These are necessary for proper functioning of you gastrointestinal tract as well as immune functions. A new concept in medicine is that some people with gastrointestinal disorders have "dysbiois." This refers to an imbalance in the normal gut flora. Some physicians use special antibiotics to kill off unwanted bugs in the gut and add back desirable microbes for non Lyme patients. It is important that all patients treated for Lyme with chronic antimicrobial therapy supplement with probiotics. The most feared complication of antibiotic therapy is called pseudomembranous colitis. This occurs when antibiotics change the balance of normal gut flora permitting the overgrowth of a nasty bacteria called Clostridia difficile. This can make you very sick. It can cause severe diarrhea, bloody diarrhea, fever and a high white blood cell count. Most patients have a mild form and easily recover with the removal of antibiotics and sometimes Flagyl or Vancomycin orally. Once a patient has had this disorder I get nervous about continued antibiotic treatment. At that point I have to carefully weigh the risks and benefits. Other complications of antibiotics include yeast overgrowth, Candida, which may require the use of ant-yeast medications like Diflucan. Diets that are low in sugar and carbohydrates may help inhibit yeast growth as well. Most probiotics are related to bacteria called Acidophilus or Lactobicillus. Some contain a mixed variety. You can't take to much because it is impossible to replace all the bacteria that the antibiotics kill. I like the Probiotic complex sold at Whole Foods. The usual dose is one to two tablets twice daily. It is recommended not to take these products with the antibiotics although I am not convinced this makes a huge difference. If this is the only way you can take them then don't worry about it. Another type of probiotic appears to be more effective. These are Sacchromyces species, marketed by such names as Florastor. These can be taken anytime. I think a combination of Acidophilus and Sachromyces probably works best. Both can be taken twice daily. Sachromyces is more difficult to find and you may have to order it online. In general probiotics seem to have many beneficial effects. They may help with irritable bowel syndrome as well as reduce lactose intolerance. Please do not omit this supplement if you being treated for Lyme disease. Taking yogurts which are fortified with probiotics is a plus, but this does not eliminate the need to take supplements.