Probiotics

Oct 30, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Well, Les was born in the States by accident." My dad was describing how my great uncle got his American citizenship. This made Uncle Les eligible for the US draft in World War 2 (WW2), but he never had to serve. That was as close as we could get to a family member of ours being in the military. We had not heard of anyone named Harold Shewfelt. Dad had a funny story about a non-relative Shewfelt who lived in the small town of Pinawa when my parents arrived in the early 70's. This man was very polite and told my Dad that if he was ever interested in being a Jehovah's Witness to let him know. I talked about Ben Shewfelt. I've never met Ben, his wife or any of his relatives, but when I moved to Dauphin, many people asked me if I was Ben's boy. I am not. Apparently, Ben was a very nice barber in Dauphin and his wife was a teacher in the Eclipse. None of these stories were about Harold, and so were not helpful to the man on the phone. The man on the phone said he was calling from the Canadian Airforce. The man on the phone asked me if I was related to the Harold Shewfelt who died in a mid-air collision in WW2 while serving with the Canadian Air Force.

Some mysteries are personal because the parties involved share your last name. Some mysteries are personal because they involve things that live inside you. The term microbiome was coined by Nobel Laureate Joshua Lederberg in 2001. He won his Nobel Prize in 1958 in Physiology or Medicine, but in 2001, after the human genome project was complete, he noted the genes of microorganisms that live in or on us outnumber our genes by a factor of 150. Being "good to your gut microbiome" is very trendy right now, but the idea didn't start with Lederberg. In fact, the idea of your gut being full of good microbes that keep you healthy is way older than I thought. In 1899 Henry Tissier, a pediatrician working at the Pasteur Institute found "Y" shaped or bifid bacteria in the poop of healthy babies. We now call these types of bacteria Bifidobacterium, and Tissier thought they might be able to treat diarrhea. Ilya Mechnikov, who also worked at the Pasteur Institute and won the 1908 Nobel Prize for his work in immunology, loved yogurt. Mechnikov figured "intestinal putrefaction" could be stopped by the bacteria in soured milk products like yogurt and kefir. Mechnikov tried to be scientific and said more study was needed on how exactly these yogurt bacteria could be helpful to humanity, but people didn't listen. Over 100 years ago, the market exploded with fermented food products, tablets, powders, and liquid concoctions that all claimed to be fountains of youth.

The recent explosion in probiotics mimics all those new products that came out with little scientific evidence in Mechnikov's time. To get some science back into the picture, the American Gastroenterological Association (AGA) recently released some guidelines on the use of probiotics. If you think probiotics are the bee's knees, I'm probably going to disappoint you. The headline reads "AGA does not recommend the use of probiotics for most digestive conditions".

What does the AGA say? Let's start with the good stuff. Probiotics my prevent diarrhea from happening in people who take antibiotics. They say the studies show for every 13 people who take probiotics, one will be able to prevent diarrhea from their antibiotic. If you are hoping to use a probiotic to prevent diarrhea after an antibiotic, start taking the probiotic 2 or 3 days after starting the antibiotic, and keep taking it for 3 days after the antibiotic is finished. Try to separate the probiotic from the antibiotic by about 2-3 hours. This is because the antibiotics could possibly kill the bacteria in the probiotic. Good bacteria to look for in your probiotic to prevent antibiotic induced diarrhea include Lactobacillus rhamnosus (L. rhamnosus) like in Cultrelle or Saccharomyces boulardii (S. boulardii) like in Florastor. Probiotics might be okay to treat constipation if they contain Bifidobacterium lactis (B. lactis) like in Activia. Bifidobacterium infantis (B. infantis) as found in Align might be good for irritable bowel syndrome. L. rhanmosus or S. boulardii might be good to prevent traveler's diarrhea.

Now the bad news. Probiotics don't reduce the duration or severity of acute gastroenteritis. There isn't any good evidence that probiotics help for Crohn's disease, ulcerative colitis, or diverticulitis.

I'm often to recommend probiotics to prevent a yeast infection after a woman has been on antibiotics. The good news is probiotics are still very safe for most people, most of the time. The bad news is there isn't much evidence that they are effective at preventing yeast infections. Vulvovaginal candidiasis is estimated to be the second most common form of infection after bacterial vaginosis. A Cochrane review in November 2017 by Xei et al. looked through many, many published trials. They chose ten randomized control trials they deemed to be good enough to give them useful information. These trials looked at probiotics alone or in addition to regular antifungal medications to treat yeast infections. Trials were excluded from this review included if they looked a women who repeatedly go yeast infections over and over again, women who had a yeast infection and another vaginal infection on top of that, women with diabetes and women with suppressed immune systems or on immune suppressing medications. The Cochrane Review authors found what they call "low and very low" quality evidence that probiotics might speed up how fast a yeast infection was cured in the short term but didn't seem to help with yeast infection cure rates in the long term. But the review authors did find that probiotics were very safe and unlikely to cause any adverse effects.

I am a terrible detective. I was so stunned by the man on the phone who said he was from the Air Force, I didn't ask enough questions. Where did Harold Shewfelt die? Was the mid-air collision in Canada during training? Was it in Europe? Was it elsewhere? The little bit of information that I got was that Harold was from the Dauphin area and he seemed to have had family in the Dauphin and Neepawa area. That's all I have. But now I want to know more. We're coming up to Remembrance Day again. If anyone out there knows anything about Harold Shewfelt or his family, let me know. I'll pass the info onto the man on the phone. Help me find out about a Canadian Airman who shared my last name and who died in service to our country.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

AGA does not recommend the use of probiotics for most digestive conditions - https://gastro.org/news/aga-does-not-recommend-the-use-of-probiotics-for-most-digestive-conditions-2/#:~:text=June%209%2C%202020-,AGA%20does%20not%20recommend%20the%20use%20of%20probiotics%20for%20most,that%20probiotics%20may%20benefit%20patients.

Probiotics - https://gastro.org/practice-guidance/gi-patient-center/topic/probiotics

Cochrane Review Probiotics and Yeast Infections - www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010496.pub2/full

 


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