Probiotic with antibiotic

[Elizabeth86]

This is only the 3rd antibiotic I've ever given to any of my children in my 10 years of parenting. I should be giving a probiotic, right? Any tips on what I need to look for for my 4 year old? Thanks.

[Selkie]

Here's an article from my favorite gastroenterologist, Dr. Will Bulsiewicz, who says the way to rebuild the gut flora is by using food, not probiotics.

https://www.wellandgood.com/restoring-gut-flora/

While most people think the most effective way to restore gut flora is doubling down on probiotic supplements, capsules containing bacteria strains linked to promoting good gut health, Dr. Bulsiewicz actually warns against it. "Scientific studies have actually showed this is a less effective way to help with restoring gut flora because when you take a probiotic, you're introducing outside foreign species of bacteria that's not truly meant to be part of a balanced community inside of you. They're good, but they don't colonize," he says, adding that the bacteria in probiotic supplements don't stick around, the same way bacteria from foods does. "You have to rebuild your gut using food," he says.

5 foods that help with restoring gut flora

1. plants, lots of plants

The best thing you can do to help rebuild your gut according to Dr. Bulsiewicz: fill your diet with a wide range of plant-based foods. "The single greatest predictor of a healthy gut microbiome is the diversity of plants in your diet," he says. If you aren't used to eating a lot of plants—including veggies, lentils, beans, fruit, and herbs—Dr. Bulsiewicz's big tip is to go slow, building up how much you eat over time and not just going from zero to 100 overnight. It's good advice to follow for the other foods on this list, too.

2. whole grains

There's a reason why Dr. Bulsiewicz wrote a whole book about fiber: It's the biggest ally of good bacteria in the gut. It's why plants rank number one on his list of foods for restoring gut flora (all plants have fiber) and also why whole grains (which are naturally high in fiber, too) ranks high as well. Dr. Bulsiewicz says it's crucial to get fiber from food as much as possible, not a supplement. "All the research on the benefits of fiber on the gut focus on fiber-rich foods, not fiber supplements," he says.

3. berries, nuts, and soy

Why single out these types of plants in particular? They are three foods that are particularly high in polyphenols, aka organic plant compounds with antioxidant and anti-inflammitory properties, which Dr. Bulsiewicz says have a powerful effect on the gut. "Polyphenols behave as a prebiotic. They're consumed by the healthy microbes that live inside of us," he explains. But he emphasizes that in order to reap the benefits of polyphenols, you need a healthy gut to activate their benefits, so it's important to not ignore the other foods on this list, too.

4. prebiotic supplement

When it comes to probiotics, Dr. Bulsiewicz strongly advocates using food, not supplements, for restoring gut flora, but he is into the idea of taking a prebiotic, aka food for the bacteria living in the gut. "A prebiotic supplement can be helpful because it's not outside bacteria; it's just fuel for existing bacteria," he says. "So what you're doing when you take a prebiotic is you're bringing the good guys back as quickly as you can."

5. fermented foods

Because fermented foods (such as yogurt, sauerkraut, and kimchi) have naturally-occurring probiotics, they land a spot on Dr. Bulsiewicz's list, but he says there's no need to get too obsessive about eating them. "There aren't great studies saying that fermented foods are good at restoring gut flora," he says. "There is evidence that they are good for the gut when you eat them on a regular basis, but there aren't studies saying loading up on them to heal the gut works."

[kristin0713]

Yes, you should give a good probiotic two hours apart from the antibiotic so that they don't work against each other in a negative way. 

 

[J-rap]

We have someone on long-term antibiotics in our family.  Several Mayo infectious disease doctors have told me that a healthy diet + daily yogurt is what they'd recommend over probiotics, when on an antibiotic.

 

[Corraleno]

There are two different reasons to take probiotics with or after antibiotics: to replenish the good gut bacteria that the antibiotics killed off, and to protect the gut and gut lining from overgrowth of bad bacteria and bad yeast (like Candida) while the the normal gut flora is disrupted. I agree that food is the best way to replenish the good gut bacteria, but you can also take Florastor while taking antibiotics in order to protect the gut lining and prevent diarrhea and overgrowth of bad yeasts and bacteria. Florastor is a good yeast (saccharomyces boulardii) and it is not affected by antibiotics. 

[Pawz4me]

Second Florastor. It’s what our doctors and dentists have always recommended to take along with antibiotics. 

[KSera]

The food approach is likely the ideal one for general good gut bacteria, but the biggest concern with antibiotics is C Diff, which Florastor is specifically shown to outcompete and help prevent. And the antibiotics don’t kill the S. Boulardii yeast unlike probiotic bacteria. The consequences of C Diff are high enough that I’m not personally willing to take a chance relying on diet to be good enough to prevent it. The Florastor doesn’t colonize, but can be discontinued a couple weeks after the antibiotics are done. 

[sbgrace]

Another voice saying you need Florastor. I have it on hand here because one son did pick up c diff and so he takes it all the time. But I give it to my family members whenever they are on antibiotics. 

[Harriet Vane]

Yes, food is best for building gut health.

But also yes, use a probiotic while taking antibiotics (separated by at least 2-3 hours). Why? First, because antibiotics are basically like a nuclear bomb. Your body needs help when you take something that so thoroughly cleans out the gut. And second, because having nearly died of sepsis from a c diff infection following antibiotics, I would never, ever risk c diff again in either myself or my loved ones.

And I can attest that after my hospitalization, one intervention that made a noticeable difference for me was taking massive doses of probiotics. Obviously that's a more extreme situation, but it deeply impressed me with how helpful probiotics can be.

I recommend both Florastor and Align to give a broader spectrum of support. Do not take them at the same time. If it were me, I would take Align in the morning a couple hours after my antibiotic, and I would take Florastor at night separated by a couple hours from the antibiotic.

[prairiewindmomma]

We were recommended Florastor to prevent c diff also--at least 2 hours after abx.  Eating healthily as mentioned above is important for continuing to keep a healthy flora going, but when you're bombing the heck out of your gut with antibiotics (which really do have a time and place in medical care), you need to send in some emergency help with probiotics until you can work  on getting your varied and rich microflora going again.

We've had family members with c diff. It is a very real concern.

[Selkie]

Just to clarify, in the article I linked above, Dr. Bulsiewicz is specifically talking about how to repair the gut after antibiotics - and says studies have shown diet to be more effective than probiotics. And it sounds like another poster was told the same thing by Mayo Clinic docs.

In his book Fiber Fueled, Dr. Bulsiewicz says:

For years I was a believer that the best way to recover from antibiotic use was to take a probiotic for a few weeks. But a recent study has completely changed my mind. In it, researchers from Israel showed convincingly that probiotics actually impair the microbiota's ability to stabilize and return to normal after antibiotics. They actually slow recovery. So unless directly recommended by a doctor, I avoid probiotics immediately after antibiotics. Instead, focus on your diet first. Maximize plant-based diversity. Then add in prebiotics to help your gut microbes bounce back faster. Avoid chemicals, saturated fat, and pesticides in your food. No alcohol. Exercise and get into nature. Go to bed early and sleep at least eight hours.

 

So OP, if you are giving probiotics, just be careful to follow the dietary recommendations as well, and look into prebiotics, too.

Edited May 10, 2022 by Selkie

[KSera]

5 minutes ago, Selkie said:

Just to clarify, in the article I linked above, Dr. Bulsiewicz is specifically talking about how to repair the gut after antibiotics - and says studies have shown diet to be more effective than probiotics. And it sounds like another poster was told the same thing by Mayo Clinic docs.

In his book Fiber Fueled, Dr. Bulsiewicz says:

For years I was a believer that the best way to recover from antibiotic use was to take a probiotic for a few weeks. But a recent study has completely changed my mind. In it, researchers from Israel showed convincingly that probiotics actually impair the microbiota's ability to stabilize and return to normal after antibiotics. They actually slow recovery. So unless directly recommended by a doctor, I avoid probiotics immediately after antibiotics. Instead, focus on your diet first. Maximize plant-based diversity. Then add in prebiotics to help your gut microbes bounce back faster. Avoid chemicals, saturated fat, and pesticides in your food. No alcohol. Exercise and get into nature. Go to bed early and sleep at least eight hours.

 

So OP, if you are giving probiotics, just be careful to follow the dietary recommendations as well, and look into prebiotics, too.

The florastor isn’t primarily about recovering a good gut biome after having taken antibiotics  it’s something you take while you are on them to prevent C Diff from over colonizing. For people who do not contract C Diff from taking antibiotics, sure, I agree with you that real food is going to do the best job at rebuilding a good gut biome. I just don’t personally advise anyone take the chance of letting C Diff take hold in the first place. The consequences are far too high and the research on Florastor is solid. (Which will surely be a bad pun to anyone unfortunate enough to experience c diff.)

[Selkie]

9 minutes ago, KSera said:

The florastor isn’t primarily about recovering a good gut biome after having taken antibiotics  it’s something you take while you are on them to prevent C Diff from over colonizing. For people who do not contract C Diff from taking antibiotics, sure, I agree with you that real food is going to do the best job at rebuilding a good gut biome. I just don’t personally advise anyone take the chance of letting C Diff take hold in the first place. The consequences are far too high and the research on Florastor is solid. (Which will surely be a bad pun to anyone unfortunate enough to experience c diff.)

I actually don't have my own opinion one way or the other, as I have very little personal experience with antibiotics and none with probiotics. I was just letting her know what a top gastroenterologist/gut health expert recommends. Many general practitioners and other doctors are not up to date on the latest studies (there is something like a 17 year lag between when studies are completed and when doctors actually start implementing the findings) so it is always good to hear advice from someone like Dr. Bulsiewicz who has made it their life's work to study a particular area of health and keep up with the latest research.

[KSera]

17 minutes ago, Selkie said:

I actually don't have my own opinion one way or the other, as I have very little personal experience with antibiotics and none with probiotics. I was just letting her know what a top gastroenterologist/gut health expert recommends. Many general practitioners and other doctors are not up to date on the latest studies (there is something like a 17 year lag between when studies are completed and when doctors actually start implementing the findings) so it is always good to hear advice from someone like Dr. Bulsiewicz who has made it their life's work to study a particular area of health and keep up with the latest research.

I agree. I looked up his work and it looks really solid on nutrition and the gut, but I couldn’t find anywhere at all that he ever mentions anything about C. difficile, so it just doesn’t seem to be an area of his. I’m pretty passionate about helping others avoid it due to life experience. It’s a horrible disease. 

[Selkie]

9 minutes ago, KSera said:

I agree. I looked up his work and it looks really solid on nutrition and the gut, but I couldn’t find anywhere at all that he ever mentions anything about C. difficile, so it just doesn’t seem to be an area of his. I’m pretty passionate about helping others avoid it due to life experience. It’s a horrible disease. 

He has a lot of experience with C diff - there is a lot of information about it in his book.

[KSera]

1 minute ago, Selkie said:

He has a lot of experience with C diff - there is a lot of information about it in his book.

Ah, okay. It did seem strange that any gastroenterologist practicing currently wouldn’t have a lot of experience with it given how frequent it has become.  I guess it’s just not in any of his info online. I’m curious what he recommends during the time people are taking antibiotics, since C Diff frequently begins before the antibiotic course is even completed and if he addresses Florastor/S. boulardii specifically. 

[Elizabeth86]

5 hours ago, J-rap said:

We have someone on long-term antibiotics in our family.  Several Mayo infectious disease doctors have told me that a healthy diet + daily yogurt is what they'd recommend over probiotics, when on an antibiotic.

 

The problem is that she isn't eating very well.

[Selkie]

1 hour ago, KSera said:

Ah, okay. It did seem strange that any gastroenterologist practicing currently wouldn’t have a lot of experience with it given how frequent it has become.  I guess it’s just not in any of his info online. I’m curious what he recommends during the time people are taking antibiotics, since C Diff frequently begins before the antibiotic course is even completed and if he addresses Florastor/S. boulardii specifically. 

Ok, I did a quick search on my Kindle while I ate lunch. There is no mention of Florastar/S. boulardii in his book.

Lots of info on C diff - how it is treated with fecal transplants, how it used to be rare and mainly found in older hospitalized patients taking antibiotics, but now there has been an explosion of cases involving younger people who have never stepped foot in a hospital or had recent antibiotic use. The huge increase in new cases happened at the same time that a dietary additive called trehalose started being used in the US. It is a sweetener that improves stability and texture and is added to many foods such as pasta and ice cream and even beef. Trehalose has been shown to promote the growth of C diff but is still on the market and widely used.

His recommendations for what to do while taking antibiotics are the ones I've already mentioned above. His basic recommendation (not only during antibiotic use, but at all times) is a diet rich in plant diversity (he says the single greatest predictor of a healthy gut microbiome is the diversity of plants in one's diet).

Edited May 10, 2022 by Selkie

[prairiewindmomma]

For my kids who aren’t eating well on antibiotics, I try to get them to drink a little strawberry kefir. Some Antibiotics make my kids’ tummies hurt, and a little food buffer helps. Loss of appetite is a common side effect with ampicillin (and doxy). Kefir has the side bonus of a bit of culture naturally, like yogurt.

[mathnerd]

I gave S Boulardii in powder form: broke capsule and mixed with smoothies or other beverages when my son was on antibiotics.

I used Jarrow Formulas, but Florastor is a great brand as well:

https://jarrow.com/collections/probiotics-prebiotics/products/saccharomyces-boulardii-mos-5-billion-cfu-90-delayed-release-veggie-caps
Whole Foods and Sprouts carry them if you are in a hurry and cannot wait to order online.

As others said, C Diff is a big concern during antibiotics and taking a probiotic yeast supplement is one preventative. Also, simultaneously start giving probiotic yoghurt (Stonyfield organic is a great choice  if you don’t make your own) or better yet, make smoothies using kefir which have many more colonizing probiotics than other foods ( either buy kefir or very easy to make that as well). 
 I also add a healthy pinch of turmeric powder and black pepper powder to all my stir fries along with minced garlic and ginger: these are good for a healthy gut and preventing infections of the gut.
 

Edited May 10, 2022 by mathnerd

[Harriet Vane]

5 hours ago, Selkie said:

Ok, I did a quick search on my Kindle while I ate lunch. There is no mention of Florastar/S. boulardii in his book.

Lots of info on C diff - how it is treated with fecal transplants, how it used to be rare and mainly found in older hospitalized patients taking antibiotics, but now there has been an explosion of cases involving younger people who have never stepped foot in a hospital or had recent antibiotic use. The huge increase in new cases happened at the same time that a dietary additive called trehalose started being used in the US. It is a sweetener that improves stability and texture and is added to many foods such as pasta and ice cream and even beef. Trehalose has been shown to promote the growth of C diff but is still on the market and widely used.

His recommendations for what to do while taking antibiotics are the ones I've already mentioned above. His basic recommendation (not only during antibiotic use, but at all times) is a diet rich in plant diversity (he says the single greatest predictor of a healthy gut microbiome is the diversity of plants in one's diet).

FTR It’s actually really difficult to actually get a fecal transplant in this country, even when you live in the same town as one of the tiny handful of hospitals that does the procedure in the US. And even when you are in the ICU literally fighting for your life with severe sepsis. And even when you have to take that wretched drug cocktail for a full six months to really, actually kill off that demonic infection. Ask me how I know.
 

It (FMT) is considered a transplant procedure with significant risks (including potentially  “catching” a health condition like cancer, etc.) and it is considered experimental. It shows incredible promise, but it is only approved by a hospital committee if they seriously think the patient will die or if the patient has suffered multiple serious infections over a short period of time.

I begged for this procedure but was not approved. Hence the six months on a bonafide drug cocktail and long-term physical therapy and permanent food intolerances and so on.

So yeah, take Florastor. Because I exercised and I had a super healthy diet with tons of veggies and bone broth and mostly homemade everything. It wasn’t enough.

I do trust you are sharing what you read accurately. It’s just that my real-life experience was totally different. Diet didn’t prevent my illness and it definitely was not sufficient to heal it. 

[Selkie]

32 minutes ago, Harriet Vane said:

FTR It’s actually really difficult to actually get a fecal transplant in this country, even when you live in the same town as one of the tiny handful of hospitals that does the procedure in the US. And even when you are in the ICU literally fighting for your life with severe sepsis. And even when you have to take that wretched drug cocktail for a full six months to really, actually kill off that demonic infection. Ask me how I know.
 

It (FMT) is considered a transplant procedure with significant risks (including potentially  “catching” a health condition like cancer, etc.) and it is considered experimental. It shows incredible promise, but it is only approved by a hospital committee if they seriously think the patient will die or if the patient has suffered multiple serious infections over a short period of time.

I begged for this procedure but was not approved. Hence the six months on a bonafide drug cocktail and long-term physical therapy and permanent food intolerances and so on.

So yeah, take Florastor. Because I exercised and I had a super healthy diet with tons of veggies and bone broth and mostly homemade everything. It wasn’t enough.

I do trust you are sharing what you read accurately. It’s just that my real-life experience was totally different. Diet didn’t prevent my illness and it definitely was not sufficient to heal it. 

I am so sorry you went through that and glad that you are okay now. That sounds like a horrible ordeal.

I feel like I am not doing a great job imparting bits and pieces of his extremely interesting book, so anyone who wants to learn more should definitely read it themselves. Just to clarify about the diet he recommends - he advises a fully plant-based diet with no meat or animal products at all. He says consumption of animal protein results in increased intestinal permeability and inflammation, whereas plant protein has the opposite effect - and that animal protein also causes production in the gut of a dangerous substance called TMAO (trimethylamine N-oxide) which greatly increases the risk of cardiovascular disease, dementia, diabetes, and kidney problems. He also says that there is no scientific evidence that bone broth heals the gut, and instead recommends a plant-based broth that is anti inflammatory and full of antioxidants (recipe is in the book). 

[Spryte]

Another C Diff survivor here recommending Florastor while on abx and a few weeks after. In addition to a good probiotic. 2-3 hours apart from the abx.

My team of docs also recommends a good diet, lots of fermented foods. But Florastor is non-negotiable.