S2 Ep5: Busting Probiotics Myths with Probiotic Advisor Dr. Jason Hawrelak

Welcome back, everyone. This is Niti, the functional medicine nutritionist and founder of Back to Basics Nutrition in Studio. Today I have the honor of having a conversation with the naturopathic physician and a herbalist from whom I learned firsthand at University of Western State. And he is joining us all the way from Australia. He has taught me and my colleagues how to smartly use pre and probiotics and modify microbiome and treat GI disorders. And I was able to apply that in my practice and I could help heal so many of acute and chronic GI conditions. Dr. Horilich is super passionate about microbiome manipulation and clinical applications and pre and probiotics. And not only that, he leads the research at Probiotic Advisor. He has written extensively in the medical literature and in multiple textbooks and has many, many publications. If I were to read all his accolades, probably, probably my 20 minutes of my time together here might fill up. And so you get the idea. And his practices have helped spark a change in the way thousands of practitioners across United States, Canada and Australia in how they manage their GI disorders. They have started using more of pre and probiotics to the benefit. And so I had so many aha moments when he busted all of those probiotic myths. And so it's my attempt today to spread this powerful message in my mythbuster series and how to use probiotics smartly and Learn from expert Dr. Horlack. Welcome, Dr. Horlack.

Ah, thank you. Thank you for this kind of words as well. But I. I do love teaching and I love having students applying the information they were taught and seeing great clinical outcomes. That always makes me feel very happy indeed.

It's my pleasure as well, Doctor, to learn from you firsthand. And now let's spread this message and all of us, all on LinkedIn, YouTube and Facebook, can learn from you.

All right, so ask away.

Absolutely. I am ready.

So.

So the first one, doctor, the first probiotic myth that you taught us and what we hear from time to time, is probiotics should never be taken with antibiotics. It's a waste of money.

Yeah. And that's one of the interesting myths that was around even when I did my training 20 some years ago. There were people saying, oh, don't take same time, antibiotic will just kill the probiotic bacteria. But luckily there's been a lot of research done even, even at that point, there's a fair bit of research, but in the subsequent sort of 20 years showing that by taking the right probiotic alongside antibiotic usage, we can actually diminish the side Effects that are observed and that's always. And also diminish the degree of damage done to the gut ecosystem and other strains of capacity to help the ecosystem restore itself more quickly post anemotics as well. So I think we've got three good reasons to do so. Now you wouldn't necessarily do it at the same mouthful. So if you're taking your antibiotic, don't take a probiotic at the same time, but you'd space it out by a few hours so they're not sort of floating around the stomach at the same instance. But we know from research that there's good rationale for doing concurrent use of probiotics alongside the antibiotics. Not waiting until afterwards.

Until afterwards. Concurrent administration is advisable.

Definitely.

Perfect. And what happens, Doctor, when someone takes a probiotic, for example, is it going to kill all the bacteria that is there in their gut?

What happens when someone takes a course of antibiotics?

You mean a course of antibiotics?

Yes, not all. And, and each antibiotics can be a bit different in terms of the breadth of action it has. And even this is a bit individual too, that it'll impact 100 people, it'll impact their ecosystem each a little bit differently as well. But there be some that have a much broader impact and there are substantive changes and I think there's these dramatic shifts that, that can occur and then it kind of resettles again, you know, three, four weeks afterwards. But we now know that there are these, I would say, you know, pivotal changes where you get extinction level events. You know, there's a paper published in the journal Gut a couple of years ago showing that a single course in antibiotics, nine species of bacteria went extinct in. This person's got nine species from a single course. You're like, ah, you can't, like that's, you can't come back from that. They're extinct. They're extinct, you know. So I think we've got to be aware that whilst taking probiotics alongside can minimize side effects, can minimize the degree of damage caused, it can't necessarily mitigate completely that. So it's not to say that, you know, we should just be cautious around our use of antibiotics and use them when they're really needed and called forwards, you know, saving life and limb. But I think we should be cautious around experimentation for novel things. Let's see if this works or for viral infections, you know, where I think there's still way over prescribed for, with the degree of microbiome alterations that you see. And it is interesting seeing sort of the major Disruption we, we get from the antibiotic, then it kind of establishes another kind of new normal afterwards. But I think for me the biggest concern is the extinction level events that we get. Because you just think of people that have taken not one course, but not two courses. But you know, sometimes people take two or three courses, antibiotics every year for their entire like childhood and adulthood life. And you're like, their ecosystem is like so weaning down in diversity. It's, it's, it's worrying.

Right, yeah. And that's when we see so many eczema, psoriasis, so many skin conditions happening with kids because the, the, the gut microbiome is slim and devoid of so many good ones.

Yeah, I mean, I think, you know, you can read papers and Books by Dr. Martin Blaser Talking about, you know, the loss of our ancestral microbes and the consequences of that microbes that we've always had until, you know, the last 50, 100 years where really since antibiotics have come to the fore. But also all the weird chemicals that we use all the time and antiseptic, this, antiseptic, that chemicalized diet is just meant that we really knocked out a considerable portion of microbes in western nations, which is, which is quite sad when you compare to what we had from ancestrally speaking and what our, you know, populations who still live a more traditional lifestyle without the medication use, without C section birth, without formula feeding without food, chemicals galore, what their ecosystems look like. Yeah.

Surely said, but that's the world we live in.

Yeah.

The second probiotic myth that goes around, Doctor, is probiotics should be taken on an empty stomach. True.

Yeah, that's false. And I think, when, I think the concept here was is that your, which was a false idea anyway that your stomach acid was less acidic when it's empty and it was more acidic when you put food in there. Because I think the idea is we have food, we make more acid. So people thought, okay, well that's, that's bad. Whereas the PH of our stomach, when it's empty, like when there's no food in there, it's actually far more acidic. As you know, it's two, two and a half versus when we've got food, it's three and a half, four, four and a half. So the PH is actually much more towards alkaline or more towards neutral when we've got a meal in there. And that enhances survival of lactobacilli and bifidobacteria based probiotics. So for some it doesn't matter. So Much like the spore forming ones. Doesn't matter, you know, it doesn't matter if you take it with or without food. Saccharomyces doesn't seem to matter if you take it with or without food. But for lactobacilli and bifidobacteria based ones, we will definitely get enhanced survival. Taking with a meal and actually a bigger meal will get better survival. And we now have research showing that too. But I think it was this false conception around the stomach ph, you know, because those people still say now I'll take it before bed on an empty stomach. It's like, no, if you want to get better survival, take it with food, take it with a meal. You'll get better. Better actual clinical outcomes because more bacteria are alive to reach the small bowel, the large bowel to do the work. Perfect.

Another, another myth busted. Thank you, Dr. Awesome. The third one coming is there are so many bottles available in health stores and drugstores and grocery stores with all different probiotic formulations. If someone was to randomly pick a bottle and start taking those, would that help that person? Like for whatever, maybe constipation or whatever, they would randomly pick a bottle and start using those. Would that help them? Would that harm them? What, what would happen?

It could do anything, actually. It could help them. It could harm them. I think indiscriminate use of probiotics I think means you don't get the best outcomes anyway. I think what the research has shown is that some probiotic strains about specific attributes or actions that they have, you know, so there are some probiotic strains that do speed up your transit time. So if you are constipated and you take the, you know, bifidactrim, lactose, HN019, it will speed up your transit time and improve symptoms of constipation and do so quite effectively in many people versus if you took a, another probiotic strain like lactose strain LA5 that doesn't speed up transit time, you will not get that same sort of benefit. You know, so if you're just kind of going, oh, I'm concentrated, I'll just take a probiotic, you're the chance of you finding one just randomly that actually has the actions that you're wanting. Right are, it's possible, but it's also, you know, there are some productions that might slow down your gut transit time too. And I think there's interesting. This is a slightly different. Well, I think it's related, but there was a study that was, that was done with some Israeli researchers around probiotics and antibiotic use. Okay. And there's some really cool aspects of the study, but in this study it showed that the specific Israeli probiotic preparation they trialed actually slowed the restoration of the gut ecosystem after antibiotics versus not taking a probiotic. Okay. But what was which was like made worldwide headline don't take probiotics alongside antibiotics because it slows down the restoration. But what was interesting here is that the lactobacillite in this specific supplement produced antimicrobial compounds which inhibited the growth of good bacteria in the gut. Yeah. So it kind of illustrated what can go wrong. If you just indiscriminately take a probiotic that doesn't have evidence for me is helpful in the situation, you might actually get a worse outcome. Whereas if you went with a probiotic strain that's been shown to speed up restoration of the gut ecosystem or protect against side effects, you're not going to get that outcome, you know. So I think it's just choosing probiotics judiciously based on the research evidence behind. And that's the whole idea about my probiotic Advisor database is making evidence based decisions easier. So you can go, let's look at what the research says, what probiotic strains have got this action, what probiotic strains are good for this indication. And it just means we get much better clinical outcomes. And we're like, will this trial is random preparation and hope that it does something, you know, which I don't recommend. There is the small but possible chance of a harmful outcome too, like that Israeli station.

Right, Right. Yes. And that's why when some, when patients come to me and they're like, what you gave me that work, but I've been taking probiotics for years and it never worked. Well, that's because it's very specific to their need, right doctor?

Yeah, that's right. Because if you wanted to choose one that has that action, like some will help with your bowel syndrome symptoms, some won't, some will help with, you know, pain aspect of your wild symptoms and some might help with speeding up the transit time aspect of things. So it's really trying to choose ones that have the actions that we're after to help that person. Yeah. And I think it makes it clinicians can navigate that with the right, you know, access to evidence. But I think it's trickier for the general public. But I do think you're safer and you get better outcomes if you get guidance on what specific probiotics to take rather than, than Just randomly taking ones from the health. For sure.

Sure, yes. Thank you. And I remember you taught us so I wanted to share that it should be a red flag when anyone is. They should not pick up a random bottle. But if they are picking up a random bottle from a drugstore or a health store and it does not say the specific strain like HN001 or S. Boulardi, this and this. So if it does not say a number that should give you an indication that, that that company is hiding something or those are not good practices.

So yeah, I think for me it's definitely a red flag if a probiotic label doesn't have the strain details. So that's not just the species. I could be like those acidophilus or if that's lactis, but it's the HN019 or the LA5 or NCFM, those kind of strain details. Because that, then we can actually look at the research base on those strains and see what they do and what they can't do. Well, yes, but if it's not listed in label then then it's either to my mind, the company's either has chosen like non research strains that we'd have no evidence for what they're useful for or probably that that's the main outcome. They're hiding information. If they're not willing, you know, if they're not, if you contact them and go, hey, can you talk about strains? They can earn you something like that. Oh, we can't share that. It's proprietary information. It's like if you chose well researched strains with clinical trials showing efficacy, you don't hide that. You want the world to know. It's like look at the great strains that we paid for and are using your stuff. These are all the great attributes that they have. You know, you don't go, no, it's proprietary information. We're not going to share that information with you. So for me it's, it's like generally a sign of poor choice of probiotic strain ingredients when there's, when the label does not have the strain and if the company won't will tell you what strains are in there either.

Wonderful, thank you for sharing that. The another one that is coming up doctor is the probiotic. Once someone takes a probiotic, it will be in their GI tract forever.

Yeah. Which again was a myth 20 some years ago and I've been really trying to bust that since then because the research is quite clear that that's not reality. You know, we've got research from the 1970s, 80s, 90s, 2000s, essentially showing temporary residents. Yeah, even a good strain may stick around for a week or two weeks, but each day this population gets less.

And less, less and less.

Yeah, and some, some strains pass straight through you. Two days later they're gone from, from your gut ecosystem. That depends a bit on your transit time, I'm sure too, in terms of how slow things move through your gut. But generally the idea of permanent colonization is not realistic with, with the strains we have access to. Now there is the odd study with a specific, you know, this study published with Bifidacterium strain, ah, 1206 or something like that, that did stay in like 30 of people for six months. That is an exception rather than the rule, you know, and that most of the studies show that you only get this very temporary impact and you only get short term colonization.

Oh, wow. Okay, gotcha. And so if someone were to take the same probiotics that they would take, if they were to take it for say, years, like I had a patient who came to me and she was like, oh, I have been taking this probiotics for three years. What would happen to their gut?

Well, probably no and probably not that much. I mean, I think probiotics are somewhat limited in most circumstances in terms of the degree of change the ecosystem they induce. All right, comparatively like, compared to a change, a big change in diet compared to prebiotic use, where you can get these massive ecosystem shifts in populations, probiotic impacts will be relatively minimal. But what won't happen, I would argue, like, if you do stool tests while she's taking that, that probiotic, it'll probably show up while she's taking it, but two weeks afterwards it will not. You should be taking it daily for three years. You won't generally find that it'll stick around after she's stopped taking it. I think that's more that the thing is like, we can just check that afterwards easily enough to do if you want to go through the expense of doing it. But you can do a stool test while she's taking it, do a stool test two weeks later, and chances are you hopefully would have showed up in the first place if it's a good strain with and decent amounts in the supplement. But then it won't, you know, two weeks afterwards. And you see that commonly enough in clinical practice for sure with patients.

Oh wow. Okay. And so will it have an impact on the other, other strains which were there in the first place. Would, would it, would it look like a dysbiotic?

I wouldn't Think that taking a probiotic daily for three years would cause it? Like if you took L rhominosis GG daily for three years? No, I wouldn't think it's going to cause any changes. Okay. Or HN019 or those kind of strength? No, I, I don't think so. I mean, I think you could make an argument that it might be competing against your own indigenous bifidobacteria, for example. And, but I, I don't think I've seen that from, from a research perspective that taking bifidobacterate based probiotic will inhibit your end result less of your own bifidobacteria. I have not seen that. So I think from that perspective we're not really worried about a dysbiotic change from, from taking a probiotic typically daily. Although you know, you might argue with that that, you know, that that probiotic strain that was preparation available in Israel, that had lacto that produced compounds that killed off other beneficial bacteria, that one daily for three years might induce negative changes to your gut ecosystem.

Beautiful. Wonderful. Yeah, that is some awesome information which people would only get if they were to go into research, which we just got in last couple of minutes. Awesome. Dr. And for our listeners who have been hanging around till year, I know I can learn from you all day long. But keeping our time in mind and your valuable time in mind, I wanted to leave our listeners with some powerful tips and valuable takeaways that they can use in their day to day life. So in common practice we see someone would fall sick and antibiotics is something that is advised and yes, it is life saving. So if someone were to take antibiotics, is there a probiotic that you would say take along with it?

Yeah, I mean I think I would say based on the research and based on my clinical experience, ideally I'd recommend two different probiotics alongside a course of antibiotics. One would be, you know, Saccharomyces cervacei variety Boulardi from the Biocodex company in France. And secondly would be Lacto spenosis gg, which is available multiple places throughout the world. Both those ones have a great data set behind them for antibiotic associated producing antibiotics side effects and for helping to protect the ecosystem, help restore it. So I mean to me those two are by far the best. Now the saccharomyces you could do at the same time, same mouthful, say antibiotic because it's not a bacteria, won't be impacted. But then you would do the LGG at a different time point, a couple hours away. But with food.

Oh wow. Okay, gotcha. And for our listeners who are in United States, we see ESB in form of. It's in stores in form of Florester.

Yeah, Florista. It's easy available in most parts of the world. The bio parts of the world. So yeah, it's Floristor in, in the US it's like Alta Lavor in France or Print Roll Fort in in Germany, Eco Norm I think in India. So it's, it is widely available. It's widely available even though it's like a, you know, pharmacy brand. It's actually, it's the well researched saccharomyces that has almost every single study done on saccharomyces uses that one. So we can kind of know for sure what kind of therapy attributes it has.

That way you know, you are getting the right stuff and good stuff. Perfect. And the other one that I had the aha moment when I was starting from you doctor was the stomach bug.

The ah yes, viral gastroenteritis which is all too common because everybody with kids is going to generally experience that and can be life threatening. It's often more inconveniencing. But you know, with kids who develop dehydration it can be more of a life threatening thing. But again there's great research on lacto sternosis, GG lgg for shortening the duration of viral gastro. You know and, and you might go it's only short it by one day, but geez, if you've got a kid with vomiting, diarrhea and they're doing that for 24 hours less, that is a huge clinical difference to your. Big difference to your quality of life, you know, so definitely clinically significant change and shortened duration of symptoms obviously means less daycare loss, less childcare loss, less work loss for parents too. There's a lot of flow on effects and I think less degree of damage to the gut too for that matter. Because I think you can get the longer that infection is going on for the increased chance of getting more tissue, more small intestinal cells damage for that process and more nutritional impairment as well. And I would argue that we shorten the duration, we can minimize that.

Wow.

Yeah.

And I know so many people, especially with young kids, they would come across that more often than big kids. But again even it can happen in any age group. And yeah, and for us here in the United States, I've seen it with cultural. So yes, if cultural is added along, it will reduce the life, the sickness span of that stomach bug tremendously. And it is such a powerful probiotic. So I'm, I'm glad I could use it in my practice. And hopefully those who were able to hang until the end are going to get the benefits of adding a probiotic supplement with their antibiotics and something for the, for the viral if you guys don't have to deal with it, but if you do, you, you know what to where to find in your drugstore or grocery store. Awesome. I so appreciate your time, doctor and for that valuable information and the powerful message that we are about to spread.

Ah, you're welcome. I'm glad we can make time to make it happen.

Thank you, doctor.