Signs Your Probiotics Are Working (and Why They Sometimes Make You Feel Worse)

Um, sweet. All right, and we're live. Um, Mary, is there a name for the day after Christmas? Because there's Christmas Boxing Boxing Day. Boxing Day. Boxing. Thanks, [laughter] Leah. Everyone, joined here today with Dr. Rose. Dr. Rose, thank you so much for making the time. Yeah, happy to be here. Yeah, I'm happy to be here, too. This is gonna be fun. So, today we're going to be We're just live right now. We got some people joining in. So, welcome. Uh we're going to be talking about gut health and then we're going to dive into probiotics. There's actually a ton to learn about probiotics. We're going to be talking about some of the history, best practices, uh gut issues, all that sort of stuff. So the theme today is going to be gut health. We're going to talk about 30 minutes a piece. Um disclaimer, everything we talk about, none of this is medical advice. Uh this is just for education purposes only. Um with that said, Dr. Rose, uh, why don't you give some background and context on your experience with gut health? I believe you've written a book on gut health as well, so kind of the expert here. Tell me more. Yeah. Um, I think that probably in most um, functional medicine practices, gut health is a pretty big component. Um what happened in my practice probably 10 15 years ago was that um I just noticed that the a vast number of people were coming in with uh whether it was IBS, chronic constipation, inflammatory bowel disease, gird reflux, it just seemed to be like a pretty that whole section of health seemed to be a good chunk a good percentage of the people coming in. Um and then um another good chunk was also kind of mental health, emotional health. And so that's kind of what's what ended up spurring the book topic, which is the mind gut connection and how the nervous system, the emotions play a role in gut health and vice versa. So that was um yeah, so that book came out about 10 years ago. Okay. um and doing the and so what happened is then I you know I needed to do a lot of research around gut health for the book which was really um a great opportunity and really um kind of spurred me to learn even more than I than I already knew and then it just kind of became more and more of an interest and more and more patients coming to me specifically for gut health etc. And the beautiful thing about kind of having a medical practice is that you learn from your patients. You know, they come in, they have, you know, something that's kind of a little bit different and it spurs you to do research and then you learn and then you have that information available to the next group of patients. So, yeah. Gotcha. All right. Thanks for sharing. What's like if I if my mission was to mess up my gut and the gut [laughter] make my gut as unhealthy as possible, what's what are the top three things I should do to screw up my gut health? Um, a diet extremely high in processed sugars. Um, a diet extremely high in alcohol consumption. Um, and let's see. [sighs and gasps] I mean, there's just the top three. I guess I would say like probably super high amounts of um gluten and dairy. Okay. So, a ton of pizza, a ton of donuts, and soda. Oh, you gotta do soda and you got to do lots of bourbon. Gotcha. All right. Um maybe maybe beer. Beer. That's probably worse. Beer. Beer is the wor. Well, you've got gluten and you've got the alcohol. Why is gluten why is why is gluten is just extremely inflammatory and so everybody has different levels of sensitivity to gluten but um on some level it tends to be in if you if you're consuming large amounts of it you're going to end up with inflammation at the gut level. Um, and so if that's not balanced by healthy fiber and um, you know, adequate water intake and all of that, then you're just going to end up kind of more and perpetually more inflamed at the gut level in my experience. Gotcha. How how does someone know that they have gut health issues? Like what are the symptoms that should make someone think, all right, I should do something about my gut health? So when I'm meeting with somebody um I and we're talking about digestive health, I always do kind of a top tobottom review of systems. So I start with are you having symptoms of reflux, heartburn? Sometimes there's silent heartburn where it's not that classic burning, but it's like a it's a dry uh con kind of quite frequent um cough or a tickle in the throat. Um, sometimes it's more of a pressure and that's why kind of the whole um, people think they're having a heart attack and it's and it's really heartburn, but you know, if you suspect that you might be having a heart attack, it's good to go get it looked at. Um, but that's why it can kind of feel more like just a pressure, not not that classic burning. So, we kind of ask I ask about symptoms about that. Nausea, vomiting, um, excessive belching or burping and then and then bloating, right? So there's a lot of people walking around thinking that like feeling bloated most of the time is normal. Um and they've just lived with it for so long. So assessing somebody's level of bloating, distension, um feeling like there's a brick in the stomach after you eat, uh like nothing really moves. And then actual abdominal pain, cramping, you just kind of I keep going lower and lower, right? And then what are your bowel habits? Are how often are you having a bowel movement? Is it complete? Um, so does that answer your question? I mean, all the way down to hemor all the way [laughter] down to hemor hemorrhoids. Is there blood in the toilet? Right. Gotcha. So, yeah, the gut effects a lot. Uh, for the 11 people who are watching, welcome. Feel free to uh throw in comments. Oh, that's not very nice. Um, so what I lost my train of thought here with um I guess start like why is the gut like how does the gut affect so many other things in the body? So there's a lot of um receptors throughout the gut. So there's receptors to hormones, there's receptors to neurotransmitters, and I think we I think we're just kind of at the [sighs] the tip of the iceberg in terms of understanding how the microbiome um in the gut, those those beneficial microbes, organisms really kind of impact those receptors and therefore neurotransmitter balance, hormone hormone balance. Um there's also something called the entic brain. Um and it is part of the central nervous system. And so we think of the brain as being in the skull, but there's this whole second brain that's in the gut. And so it's this real intimate relationship between the nervous system, the brain essentially, and the gut. Um and it's a two-way. It it goes both ways. So thus like yes anxiety for example can affect your digestion but also your digestive health can affect your mood um you know whether it's a tendency more towards anxiety or depression. So I think we're just kind of at the beginning research- wise of how how how that works what that interplay is. Gotcha. Okay. What are like what are things people could do like what are the easiest things people could do on their own to improve their gut health and what are like noticeable improvements they might see after you know doing these things for say 3 months. [snorts] So it's a little bit of a difficult question because we are all unique. We are like we all have different baselines in terms of our microbiome in terms of food sensitivities. Um, so in an ideal world, someone is getting tested and maybe we can talk about what that what that testing can look like. But if somebody is not able to or you know wants to kind of get going on this before having the opportunity to to get a gut health panel, then um like vegetables and fiber I think is kind of you know maybe underrated. Um, why is fiber good for the gut? Like what's So insoluble fiber, one [clears throat] thing is that it basically can it can bind toxins really. It can help to bind toxins and then they're more easily eliminated through the stool. The other thing is that fiber just um can kind of uh bul what we say bulk up the stool therefore making it easier to pass. So a lot of my patients are const have different levels of constipation and by for most people who tend to be constipated if we increase water intake and increase fiber content in the food and or add in an insoluble fiber supplement bulking up the stool makes it easier to pass. And so once and if you're pooping every day and they're complete. So I'm not talking rabbit pellet poops. talking about like healthy formed stool then again for most people not everybody but for most people then your bloating and your discomfort is going to go down. So there's three things right there. there's adequate hydration, there's vegetable, therefore fiber intake, and then if that's not quite enough, um, or you're traveling during the holidays, for example, and it's hard to get like the right amount or type of vegetables that you want, an insoluble fiber supplement, um, can be can can be great. So, those are three things. Uh, was what was the question? Five things that you can do to benefit your gut. I I think I was just asking in general, like what are the things you could do? um to benefit your gut. I think that was a good list. What is Okay. Like with bloating um because this is something we hear a lot in the practice. People they're getting bloated. Yeah. What like what actually causes bloating? What's going on in the gut that makes someone bloated? So most of the time it has to do with these microbes. I I I could say bacteria, but it's not they're not all bacteria, but they are all anorobic organisms. So there's these kind of microscopic organisms in the small intestine and the large intestine and they um are most of them are supposed to be there but only in small amounts. when um somebody is maybe not eating the right food for them or there's an imbalance in that microbiome, we get too many of those organisms. And some of those organisms um secrete hydrogen gas, some of them secrete methane gas and then a smaller um percentage of them can also put out hydrogen sulfate gas. It's the gas that's causes the distension. It's the gas that causes the discomfort. And so, um, it's again super common. People are people, some people realize that it's not normal and not ideal. And again, I think a lot of people just have been dealing with it for so long that they just think that's that's what they expect. And some people will have bloating primarily after they eat and then it dissipates. And other people, unfortunately, are living with kind of a some grade or some level of bloating most of the day. Okay. Um, what are they doing to like like what can you do to stop bloating? Is it just the foods you're putting in your mouth or like what like what are because I know a lot of like if you have bad bloating it can be really uncomfortable. Yeah. The way you look like what are like really actionable things you can do to take care of bloating. Um, one, um, nutrition or dietary experiment that you can do is something called a low FODMAP diet. It's F as in Frank, O D like David, MAPS, Maps. Um, and it stands for fermentable, oligo, di mono something, polysaccharides. These are basically starches that aren't easily digested. So, a diet that's low in these starches can for some people minimize bloating. It's kind of a I think of it as like a lowhanging fruit for people. They can do it on their own. They can just experiment. Um, some some foods that tend to be really high in FODMAP, um, uh, starches would be onions and garlic, um, apples and pears. A banana, a ban, sorry, what? I'm losing I lost your sound. So cut so cut onions, pears, garlic out of your diet if you have as an experiment as an experiment. And so you can easily Google low FODMAP diet. Um, anybody can find that. And um, it's again, it's not intended to be a forever way of eating, but if you want to see if you're sensitive to those foods, it can be a way to to deter to see, you know, if that if if that's playing a role for you at all. Um, and then a lot of people will end up being relatively strict on a low-fat MAPAP diet for a month or two. And then um I usually counsel people to kind of slowly reintroduce. And so people will often end up on more of like a modified low FODMAP diet where they can they find that they can tolerate most of those foods at least in moderation. Um and really the ones that they have to stay away from are you know they they can't really have like two apples a day. That's going to trigger bloating. But otherwise they're okay. So that is one thing that somebody could do on their own. Okay. All right. That makes sense. Um, switching topics up here a little bit. Patient goes to a gastro with IBS. Patient goes to a functional medicine doctor with IBS. How do these two providers treat the same thing differently? So, usually if you go to um a gastronurologist, they much of the depends on what you're presenting with. So you could have IBSD which is the diarrhea dominant form. You could have IB IBS which stands for irritable bowel syndrome. You could have C the C version with which is constipation. Or you could have mixed whereas you're alternating diarrhea and constipation. So a gastronurologist um most likely will do a colonoscopy or a also known as a lower endoscopy. Um, and that what they're doing with that is they're they're ruling out something more serious. They're ruling out something like cancer, inflammatory bowel disease, which is Crohn's or ulcerative colitis or a different type of colitis. Um, and if those things are not detected on the colonoscopy, then IBS is considered a diagnosis of exclusion. So there nothing else is evident and so you're given an IBS diagnosis and again maybe you're given a recommendation for uh Mirax which is a over-the-counter laxative. Um some of some gastronurologists might tell you to follow a low FODMAP diet. They also might say that it's stress related and they might just tell you to deal with your stress or to go on something like Wellbutrin. um functional medicine um we are most likely going to want to um run some kind of comprehensive stool analysis. So a test that is a stool test and we're looking at um the microbiome in a lot of detail. We're looking at levels of inflammation at the gut level. We're looking at um uh if there's any oult blood, like blood that you can't visibly see in the toilet or in the stool, but it's there. Um we are looking we're ruling out all sorts of infections. So bacterial, viral, parasitic, um candida or yeast. So again, in an ideal world, we can get all of that information. And then um that also helps us rule out other things like inflammatory bowel disease or infection. Um and IBS can also look exactly like something called SIBO, small intestine bacterial overgrowth or even SEO, small intestine fungal overgrowth. So they can present very similarly, bloating, constipation, diarrhea, cramping. Um but but that is an infection like the bacterial overgrowth or the fungal overgrowth. Those are infections and those do require some kind of antibacterial or antifungal treatment like an antibiotic um or an anti-oral antifungal. So it's just I guess I would say you come to a functional medicine provider with um a previous diagnosis of IBS like we are going to dig deeper. we're going to make sure that it it is IBS, it's not something else. Um, most of us are not going to have the training or ability to do a colonoscopy, but we have these other tools. Um, and you know, we are going to see is there is there a nervous system component to the IBS? Do do your digestive system symptoms worsen when you are stressed or or anxious? Um we are going to look at um all sorts of things from food sensitivities to um you know um autoimmune conditions, all sorts of things that can potentially kind of contribute to this IBS picture. Um and just kind of keep digging deeper and individualize it. Again, everybody's different, but um we do have the benefit of having these advanced tests which can help us together with the data with the results from those tests, piece that together with the person's history to kind of figure out what really is going on. Gotcha. So, when should because that I mean it sounds like the diagnosis of IBS is almost like a I don't want to say out, but it's like okay, you don't have anything else or we're just going to give you this. It is. It is for Okay. So why like so do patients in like conventional medicine like how often are they just getting an IBS diagnosis and told sorry that's just how it is nothing more is that the case I think that's pretty common I mean the way that kind of conventional medicine is right now like if somebody's symptoms are um if they persist if they if they've come like say three times now to their primary care doc and you know again the mirillax hasn't worked the um you know whatever kind of suggestion was made hasn't done anything they will probably be referred to gastro to gastronurology. Um yeah gotcha. Um what so when should a patient go to like a conventional gastro versus go to a functional medicine doctor who like yourself who specializes in something like gut health? So, you know, if there's um uh significant amount or frequent blood in the stool um and or mucus um and or um so to me those can be red flags for inflammatory bowel disease. Again, inflammatory bowel disease is kind of the umbrella um term for ulcerative colitis, microscopic colitis, um Crohn's disease. I I really like having a person I treat a lot of people with inflammatory bowel disease, but I really want them to have that colonoscopy. That's kind of the only definitive way to diagnose it. And even though we have a lot of tools um beyond like biologics for treating inflammatory bowel disease, I really like using the gastronurologist, the colonoscopy to get that diagnosis and to see to get a baseline level of inflammation, ulceration, the location within the um colon of where what is affected um because they hopefully will have a repeat colonoscopy. in three or five years and we're going to see if our treatments, you know, what's happening with that and it's just really I I want that diagnosis. I want to kind of know what we're dealing with before we um begin a a comprehensive treatment plan. So, I guess I would say blood and or mucus. Um and and I and red blood again is usually hemorrhoids. um like a few you know red blood on the toilet paper that's I'm not saying that hemorrhoids are not a concern but that's not necessarily indicative of um an inflammatory process happening higher up in the in the colon. Um so yeah so I would say those two those two are times to go to a gastronurologist. Um, it never hurts to have a colonoscopy. Again, I I always like it when people come in and they already they've already had that. Um, because it just gives us a framework of what's going on for what's going on. Sure, that makes sense. Okay. Um, is there ever a scenario where someone doesn't need to go to a gastro or do you say that these two should always work together? like you should always have your conventional doctor, you should always have your functional medicine doctor. No, I don't there's a lot of times when I don't think somebody needs um needs to go to to a gastronurologist. I think um kind of chronic bloating, chronic constipation, um they can go straight to a functional medicine provider. Um in terms of the upper GI, like again, I don't I don't I really don't mind having some referring somebody for an endoscopy or someone coming in already having had the endoscopy again for like baseline. Obviously, if you're coughing up blood that you know, please don't come to me. Come go to go to urgent care. Um yeah. Um but uh what other what other times can they come to us? Um I mean most things I think it they don't they can kind of start with us. It's really when it's like, you know, you're the blood, the mucus, you're like really really debilitated and it's it's an urgent situation um that it makes sense to at least start with urgent care. [snorts] Gotcha. Okay, that makes sense. How confident are you? Like if someone comes in with constipation, uh how confident are you that you could fix their constipation if they're willing to make any lifestyle change? are super motivated to fix, you know, this gut issue. I'm pretty confident. I've got a lot of tools, you know. Give me a number like like what? Like 90% 99%. Um I am um 90% confident that I can improve their bowel habits. Now they might not end up having like you know a stellar bowel movement every day for the rest of their life but um uh I can I can 90% of the time I can improve the quality uh frequ and frequency of the bowel movements. Gotcha. And how do you do that? Sometimes it's dietary modifications. Um, sometimes it's figuring out if there is something like SIBO, small intestine bacterial overgrowth going on. Um, and that if that's happening, it means that there's these microbes that are putting out methane gas. Methane gas slows the motility of the gut. And when you slow down the motility of the gut, there's no longer what we call paristalsis. So there's no longer that muscular contraction. And so nothing moves. Um so if we kind of get to the root of that um and we treat that and then we bring back often what we bring back some motility then they're going to start going again. Um there there's neutrauticals. Um again everybody's a little bit different. So say the person doesn't have SIBO they just have slow motility. We and we we're bringing in things like magnesium fiber. um you know if we have to there are natural laxatives out there that I don't like to use long term but I will use short term. Um sometimes the tools that your grandmother told you about like prunes and prune juice that can actually that can do the trick. Um so there's a lot of investigative work that goes on of why is this person constipated? Why is there slow motility? you know is it and then once we kind of figure out why uh we can start playing with different different tools. Gotcha. Okay. How do um how often do you use a lot of patients come to us because we have access to a lot of peptides. How do you you use peptides in helping patients improve their gut health? Gut health. Um yeah. So two of my favorite peptides for gut health. One is actually BPC157. Um, and this is a peptide that it's actually a sequence of amino acids that mimics part of our own stomach acid. Um, and it has the way that peptides work in general is that they have affinity for different parts of the body, different tissues. And so BPC 157 has an affinity affinity for the gut. Um, it's probably more well known for its affinity for connective tissue and joints and inflammation in connective tissue and joints, but it does also help to heal inflammation in the gut. Um, so I really like using it for that. I've had some good success with that. And then a second peptide that I like to use specifically for leaky gut syndrome um, is laurazzide. And that's actually an oral peptide and that um was originally studied in people with celiac people who have celiac disease. Um but it has this ability to um heal what we called tight junctions um which are so in leaky gut syndrome uh the interasytes the cells that make up the the lining of the gut they normally line up together like this and they are permeable enough to let nutrients into the bloodstream but um close enough to keep things that we want to keep in the stool in the stool. So proteins, foreign things, um just larger molecules that really shouldn't get into the bloodstream. So a tight junction is like this. And then with inflammation, it's like this. And so things get through that shouldn't. Lorazzide is a peptide that can come in and help to heal that gut, heal that tight junction, bring it back together. Um so those are probably the two that I start with, the two peptides that I'll start with with a um digestive health case. Gotcha. Um, [snorts] what happened? Not sure. We're still live. Hello again. Um, little technical difficulty I guess. So he just like completely left like I can't see his Okay. Well, do you want to stop this feed and resume when we can? Let's just give it a minute. Maybe is there anything that you would add on to the conversation that hasn't been asked yet? Um, we could keep talking a little bit about leaky gut if you want. Um, so one thing I do because a lot of people have heard of leaky gut syndrome. Um, because we're talking about uh something that's happening on a cellular level where these cells that make up the gut lining have a level of inflammation. Um, there's not always actual digestive symptoms associated with that. So people aren't necessarily like experiencing leaky gut syndrome. Okay, on a gut level. But what happens with when there is that level of inflammation is that the immune system like the kind of first responders of the immune system detect these molecules that come into the bloodstream that are not supposed to, right? These are molecules that should stay in the stool, but they pass through into the blood and the first responders of the immune system go into attack mode and they alert other cells in the immune system throughout the body that the body is under attack. And so that's triggers an inflammatory response and that blood goes everywhere in the body. Those immune cells are everywhere in the body. And so that inflammatory response can happen anywhere in the body. So it can happen in the skin. It can happen in the joints. It can happen um even in the nervous system. It can happen in the gut. And that's the underlying theory of autoimmunity or autoimmune conditions. Um that the body is attacking itself mistakenly. Um, and so often times people come in maybe with an autoimmune condition, maybe with other signs or symptoms of inflammation, and it's like, well, how do you get how do you get how do you practice root medicine with that? Um, rather than just throwing, you know, kind of some kind of pharmaceutical anti-inflammatory at it. Um, and often times part of the answer is to, um, assess if there is a leaky gut. um process going on and if so start to heal that. So you know the the cliche that everything starts with the gut. There's some I think there's some truth to that. Um so it's not just like well what you eat you know we are what we eat. That's true too. That's a cliche that's also a little true but um I think it all starts with the gut can really be um accurate and applicable when we're talking about any type of inflammation. You don't have to have an actual diagnosis of an autoimmune disease. Um, there can just be an inflammatory process going on. And we want to make sure that those tight junctions are tight, that there's, you know, not a lot of leaky gut um of that leaky gut process happening. Interesting. Um, what else should we talk about [laughter] [gasps] in front of me? Um, well, I like some of these questions about like um why why people sometimes feel more bloating, more sugar cravings around the holidays. Can we talk about that? That's a good one. That's a good question. I like that question. Um, so it's certainly true. I think that you know whether you have as a baseline you tend to be a bloated you tend to deal with a lot of bloat or maybe you don't but then now you do between Thanksgiving and New Year's you're like you're just walking around feeling kind of meh um it's definitely the majority of people are eating more sugar, more alcohol, more processed carbs um this time of year. It's just, you know, the break room at the office, everyone's bringing in cookies, you're going to your in-laws, you, you know, it's rude to not have that piece of pie or cake. It's just kind of it's in the culture. So, I think that bump up of, you know, again, sugar, processed carbs, and alcohol is a big part of it. Um, I also think that our stress level is higher almost collectively. Um, and there's just busyness, there's financial stress, there's dealing with family that you don't really want to deal with the rest of the year. You don't have to deal with as much as you do during the holidays. Um and so the adrenals are taxed and are we are having yeah we're just having some emotions that are not always so comfortable and um I guess you know trying to feel a little better by and eating sugar and eating and having more alcohol is often a way that we as humans tend to self-medicate. And when we're stressed, we're not necessarily digesting as well either, right? So, we're not we're not we're we're less relaxed. Um, again, you're you're at that dinner party where you don't feel so comfortable. You're with that uncle who you don't with agree you don't agree with politically, and you are in fight orflight mode. And when you're in fight orflight mode, that's not the rest and digest mode. That's the that your body is not primed to digest your food well. Noted. No. Yes. Yeah. [laughter] [gasps] So, I guess you know the the next question would be what do you do about it? There you are. Hey guys, I don't know. My computer just uh took a took a vacation, but we reset it. We're all good. Um, so yeah. Did you guys transition into the probiotics episode? Not quite, but we can. Cool. Uh yeah, we got like 20 minutes here. Let's shift back into uh let's start talking about probiotics. So okay. Um Dr. Why don't you start off with talking about what what is a real probiotic? What are what are actually what are probiotics? So they're live organisms. They're live microbes and there's different ones um you know like lactobacillus, acromancia um they are um organisms that are meant to sort of match what we have what we have on our own, right? So that it's like basically what we have what the same organisms that make [clears throat] up our own microbiome. Um, there's also prebiotics. Um, you will also often find products that maybe are just a prebiotic or a pre and probiotic. And that's like food for that's like because these are live live organisms, you need to feed the organisms. Um, and so it's usually like inulin um or some type of um f food essentially to keep them alive. So, it's usually like a fiber. Um, that often is what the prebiotic will be. Gotcha. So, sorry. What's the difference between what's the difference between a probiotic and a prebiotic? So, the probiotic is the organism itself. It's the live organism that's going to kind of hopefully sort of match your own microbiome. And then the pre-biotic is not live. It's food. It's food for the organism for the probiotic. Gotcha. Okay. Um, so if someone's just taking a probiotic, is that useless or do you need to take both? Um, [sighs and gasps] I think again, you know, if your diet is pretty rich in fiber, you're probably feeding both your own microbiome and the probiotic supplement that you're taking. Um I think it also depends on the specific neutrautical supplement and what you know how it's formulated um in terms of shelf life and is it refrigerated and all that like does you know does it did does that specific probiotic require a prebiotic in the same product or not? And I usually leave that up to kind of the manufacturers. I mean the companies that we use are like I think of them as kind of like physician grade brands. Like they have been this is like all they do is formulate these and I have trust in these brands and they um and I get I see good results clinically. So, usually if um a product from one of these brands is formulated in a certain way, I'll trust that the what we're wanting is we're wanting to take a probiotic supplement that actually is what it says it is on the label that it's it's it's alive and it's the same, you know, kind of quantity that's listed on the label. It's not that easy. So, people will often say like, can I pick up a probiotic from wherever? and I'm usually hesitate to say yes to that. Now, if somebody says, "Can I pick up a B complex or vitamin C from anywhere?" That's usually your it's a little safer. It's not that hard to formulate to to manufacture vitamins. It's much harder to manufacture um probiotics that are actually what they say they are and that and that they are alive by the time they actually get to you. Okay. So, if you're Why do some probiotics need to be refrigerated and some probiotics don't? And if you're taking a probiotic that is not refrigerated refrigerated, is it even a real probiotic? Um, [sighs and gasps] again, that's kind of a manufacturing question. I don't know this the specifics except that um most probiotics do need to be refrigerated. That kind of helps with the bio keeping them. If you're taking a probiotic that is not refrigerated, are you not actually taking a real probiotic? Nope. There are some specific ones that are made to be to to to stay alive at room temperature, but they need to specifically kind of um say that you need to kind of know that from the company that they are not intended to be refrigerated. Again, it's very brand specific. So um most most probiotics most high quality probiotics should be refrigerated but there's a few in particular that I will give my patients uh who travel a lot who whether travel like travel travel travel travel a lot or they like literally like have a long commute and they like to take their probiotic in the middle of the day and they don't have access to a refrigerator and it's just like easier for them to have one that they don't have to keep refrigerated. Um, but that's I can literally think of like one like that. So, for the most part they are ref they should be refrigerated. How often are patients coming in and they're just taking like crappy no good probiotics, prebiotics? So, I can't really speak to the like I don't know if they're crappy, right? Like I don't know. I well I guess how often do like do you see any because a lot of people take probiotics like I even before I even started working on med matrix I was like I took probiotics as you think okay it's good for your gut um but how often are those actually like like I'm just curious like are like because you're talking about like there's very few select brands that you trust and so like how often are patients coming in who are taking probiotics and you're like yep that's a great probiotic keep taking it versus like oh no that's not actually a good probiotic let's get you on a different one. I guess the way that I think of it is like I don't really know. It's not like I there's certain brands that I know are crappy. Um I know ones that I really like. I but I just don't have I guess the way that I would phrase it is I don't have faith in a lot of the products out there. I can't say that it's not going to work for one person. it might be great for that one person, but all of we are all so unique and our microbiomes are so unique that um I think kind of a a catchall of just taking a lot of these probiotics that you can now get, you know, on the shelf of any CVS, I just don't know. So, I can't I can't make a definitive statement that they're bad for you, but I just can't really speak to it. Um, I think that the mis the kind of common misconception is that we should all be on probiotics all the time. And the other one is that if I'm bloated that I should take a probiotic. I think those are not always accurate statements. Okay. Can you tell me more [laughter] what you So um depending on one's diet, depending on one's baseline microbiome, it might be beneficial to take a probiotic every day, but it's not necessarily like something that we all need to do no matter what. When should someone take we'll get into like how probiotics can like cause more issues, but like when should someone take a probiotic? Um, if you have been on an antibiotic afterwards, you can take a probiotic. Now, if you're on an antibiotic, there is a one type of probiotic that is safe to take or not safe, but it's effective while you are on the antibiotic, and that is sacroyces bulardi. The reason why is because it's actually a yeast and so it's not going to get killed off by the antibiotic. So sacroyces bulardi is a probiotic. Um and if you're you know you specifically look for that probiotic. Um that's what if you take that while you're on an antibiotic then it can benefit your gut microbiome um while you're while you're doing the antibiotics. So anytime somebody's So that's that's the antibiotic topic. And then if you're having um if you have some kind of diarrhea, right? If you have some kind of infective diarrhea um that it can be really beneficial to take a probiotic during that time and even after. Okay. So this is interesting. So those are two like those are the two scenarios you described when you're either taking antibiotics or having diarrhea. These are small parts of your life. So, should you be um less often on a probiotic than you are more often taking one? That makesense. Um I mean that's probiotic. If someone's sorry, let me say that differently. If someone's been taking a probiotic every day for the last five years, yeah, not a good thing. I can't make definitive statements like that. Everybody's different. So, um, no, it's not necessarily a bad thing. If they feel better on it, if they feel like they digest better, that they're less bloated, that they're pooping better, then yeah, I think I think it is like a good idea for them to be on it. Okay. So, what if you're taking a probiotic and you're still bloated, your poop is still messed up, then I one of the first things I do is I have them go off the probiotic because it could be making things worse. Gotcha. How can a probiotic actually make someone's gut issues worse? Because if your what if you have what we call disbiosis where your microbiome is out of whack where those those organisms that are in your gut are either like in the wrong ratio, you have ones that are too high, others that are too low and those are just off. That sometimes bringing in exogenous organisms, which is what the probiotic is, is just going to exacerbate the situation. Um, and so it's it's again if we're trying to figure out why somebody is bloated or what factors are contributing to the bloat, that's that's an easy one to to start with. Well, let's just take that out of the equation. Let's see what your baseline is without taking a daily probiotic. Maybe you are still bloated and we, you know, I'm not saying that's going to be the only reason that they're bloated, but let's at least take that factor out, that variable out. Gotcha. Okay. What advantage like what advantage is there to coming to a functional medicine provider and like like yourself and like getting a full workup and like getting a personalized probiotic regimen recommendation versus just kind of doing some research and finding a good brand online and ordering that. Well, again, as you can tell kind of from this whole conversation, like I really like when we have the opportunity to do a a test where we can actually do a stool test and we can actually get kind of a readout of what is what was this individual's microbiome look like? What which organisms are kind of too low? Which ones are too high? Is there an infection that we need to treat? And if we treat the infection, many times if the person is eating well for them, then the microbiome is going to eventually kind of balance itself out. So that's my preference is that if they they come to me and then we can really kind of figure out specifically what's happening in your gut rather than taking kind of a generic probiotic. Once I know what's happening in with this person's microbiome, I can I can specifically say, "Oh, look, you're low in acromancia. Let's let's bring in some acromancia and let's, you know, let's see what happens." Um, so, um, or it I can tell, oh, it looks like, you know, your f I can kind of [clears throat] tell that, um, you know, there's not there's really kind of low levels of short- chain fatty acids here. And you tell me you're eating a lot of fiber, but we somehow need to bump that up in your diet because I can kind of tell from your from this panel that um, there it's not enough fiber for your needs right now. Okay, that's really interesting. Really personalized. Um, so I think a lot of people have this like conception that more is better. So with like probiotics, like you'll see like the thing they advertise is like one billion probiotics. Is more better with probiotics? Like you just want the biggest number of probiotics on the bottle possible or is that No, see, not necessarily. Again, it's the quality of the of the probiotic. It's also which organisms are in there. Um, and so there's like one that I prescribe pretty pretty often and the, you know, the maintenance is kind of, you know, two capsules a day um for most people. If somebody's dealing with um, regular diarrhea for whatever reason, you know, we don't really Yeah. that their tendency is towards loose stool or diarrhea, I will bump it up to four a day. Um, and then if it's something like inflammatory bowel disease and they're having a flare up, we I can go up to 10. I know this sounds excessive, but 10 capsules a day of this probiotic for a limited amount of time. Um, so no, more is not always better. Like, you know, most people aren't going to need 10 of those a day. Um, usually two will suffice. So, and within the individual capsule, not necessarily. I don't think more is always better because you don't it is possible to have too many microbes, too many of these B of these organisms in the gut. Gotcha. So, when I think of probiotics, I don't necessarily think of like life-changing results. I might think of, okay, you're a little less bloated or, you know, 50 years from now, you might um live a little longer because your gut was was healthy. Have you ever like put someone on a probiotic or changed their probiotic regimen and just like completely like seen their health turn around? Um yes actually um you know that's not necessarily the only thing that we did but um I think it's usually the cases where I have seen a vast turnaround is when somebody has that IBSD picture where they um are dealing with diarrhea and urgency and frequency to the point where these are real scenarios They do not leave their house until the middle of the day every day because they are having such frequent bowel movements. Like they literally can't be far from the toilet. They can't schedule anything the in the morning because they just need that proximity to the bathroom. Um I have had people who are in um corporate they are like CFOs, CEOs and they have meetings all day long every day and they will not eat because if they eat they have to go to the bathroom and so they will intentionally like not eat anything until the end of the workday because they can't sit through meetings um without needing to go to the bathroom. for some people like that if we bring in the right probiotic and again with there's a couple other tricks that I have tools that I have um and it reduces the urgency and the frequency um of the bowel movements that is life-changing. What are these little tricks? You got to [laughter] There's another product that I like that's um amunoglobulins. And so sometimes this high quality probiotic um it's called VSSL number three or Vizbiome. It's the same two different brands basically the same probiotic blend with amunoglobulins. Um those two together for a lot of people seem to be the right cocktail in you know um really changing those those bowel habits. Cool. All right. What are your um what are your three favorite brands for supplements? Are we talking about probiotics or supplements? Sorry, probiotics. My bad. Okay. um brands for probiotics. Yep. Um I so Vizbiome, V I S B I O M E. And then the one that I think is and that I think they might is more like a direct to physician practices, but the same the same blend, the same probiotic blend um you can I think get just online. It's VSSL number three. Um and um uh Claire Labs, K L A I R E. Um I think they might be operating under a different slightly different brand now, but that one they have a high quality just kind of like maintenance probiotic. Um it's called the biotic t hyphen biotic. So I like all of those. Um yeah. Cool. Awesome. Last thing, I'm going to try this share feature here. Okay. I got a image for you. Well, while I'm pulling this up, what's your opinion on kombucha for gut health? Yeah, I mean, fermented foods in general can um again, for some people can be definitely beneficial. It can be a good way to improve one's own microbiome. Um it it's not the ticket for every single person, but um uh you know, if you feel good on it, um it's probably not doing any harm and it could be helping. Gotcha. Okay, cool. Um so lately there's been these big There we go. this big uh explosion of like these sodas that have like probiotics or like probiotic sodas. I see I saw them at the hot yoga studios. I see them at like health food stores. I see them at like you know the local Takaria. Like they're everywhere. Do these how like do these are these sodas with like probiotics good for you? Are they actually helping with gut health or is it kind of just a marketing thing that makes people feel good? Think it's probably a marketing thing that makes people feel good. That's my if I had to guess um I would guess that um a the actual like quantity and specifics of the whatever antibiot probiotic is in there is probably not medicinal. Um, and then you know, whatever the sugar, even if it's I don't know what kind of sugar, if it's stevia that they're used to sweetening or what they're putting in there, you know, natural cane sugar, that's probably negating the benefit of the probiotic. Um, so again, it might not be doing a whole lot of harm, but if somebody thinks they can drink that kind of instead of like really addressing gut gut issues or taking a high quality actual probiotic supplement, I don't I don't think that really works. Okay, gotcha. I think but I I do think it's I think culturally I think it's fascinating because again 15 20 years ago people were like you know probiotics were kind of like you know woo woo and it was like you know kind of nobody really understood it and you know it was just kind of this weird thing and now they're on soda cans. Interesting. Yeah. Cool. That's uh time for us today. Thank you for everyone who joined us live. Um, if you are interested in becoming a patient, just go to the website, click get started. Um, and you can schedule a time with the patient coordinator to talk. Uh, until then, Dr. Rose, thank you so much for joining and we'll see you in the next one. Bye, everyone. It takes.