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Digestive Health

Q&A with Dragana Skokovic-Sunjic


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What role does the microbiome play in maintaining overall health and how does the microbiome influence conditions beyond the digestive system?

Humans have massive amounts and vast quantities of living (and dying) bacteria in their gut. Bacteria are primarily in our gut but can be found everywhere: on our skin, in our mouth and elsewhere. Communities of bacteria and other microorganisms are collectively referred to as microbiomes.  Why do we have them? They support our health: inside our gut, they break down foods we can not digest and produce by-products that support our overall health. They regulate many different processes in our body, including our digestive system,  immune system, brain function and overall health.

So, the idea is to keep those communities of live bacteria, our microbiome, happy, healthy, and functioning well. We do this by various means: a good lifestyle, great food choices, and avoiding harmful influences such as different medications, antibiotics, excessive alcohol, etc.

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Can you explain the concept of probiotics and how they impact the balance of the microbiome?

Sometimes, there is a possibility or opportunity to use a probiotic, another live bacterium, to support our gut microbiome and overall health. That sounds straightforward: take some bacteria, and all will be well. Not so fast. During our medical training, we learned that bacteria or microbes could be deadly. Some of the horrible infections are caused by bacteria. Some of the life-threatening issues are caused by a simple microbe. Harmful bugs can take over and cause disease, leading to complications from which we can die. That is why we use antibiotics to kill harmful bacteria and resolve the problem; again, it is very simple. When we talk about bacteria being used as an intervention or as a therapy in the form of probiotics, we have to tread very carefully. With events and discoveries of good microbes in fermented foods a century or more ago, we learned that homemade yogurts, kefir or other fermented foods could provide live cultures. These living bacteria would support our health. Fast forward a hundred years, and we now have those live bacteria in different forms, such as capsules, sachets, tablets, and fortified drinks in much higher amounts. How do we know whether these bacteria will be helpful or not? How do we know if these bacteria will not cause an infection or worsen our problems?

Over the last few decades, there has been extensive research done looking into using specific bacteria (probiotics) to support human health, and use probiotics as a therapy for a variety of issues and symptoms. Most of the studies support the use of specific probiotic strains for selected symptoms. 

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What precautions should patients take when using probiotics, especially in conjunction with other medications?

One of the most critical points is to be very careful when selecting a probiotic. They are NOT all the same. Different strains will often provide very different benefits. For example, certain probiotics can be used to prevent and treat vaginal infections, and others will work for improving mood. Most probiotic strains can offer benefits for digestive symptoms, however, some are more effective for controlling diarrhea, and others will help relieve constipation – the completely opposite effect. When combining any over-the-counter, natural health products or probiotics with other prescription medications, it is best to consult with your pharmacist. In Canada, we have a resource offering the most up-to-date information on which strains could provide benefits for specific symptoms – Clinical Guide to Probiotic Products Available in Canada. This resource is designed for healthcare professionals, however, it is accessible by anyone at www.ProbioticChart.ca or as a mobile app Probiotic Guide Canada. 

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Can you share some information regarding the effectiveness of probiotics in preventing or treating common gastrointestinal issues?

The Clinical Guide to Probiotic Products Available in Canada summarizes the list of probiotic strains that have been proven beneficial for various gastrointestinal issues, including constipation, diarrhea, irritable bowel syndrome, and some inflammatory bowel diseases. Each listing has a list of supporting studies, information about product storage, dose and the level of recommendation.  The pediatric section of this resource offers additional information about probiotics that could be used for colic or issues with regurgitation or gastrointestinal mobility in infants. It is always wise to discuss any intervention with your healthcare provider before using it. 

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What advice would you give to Canadians interested in using probiotics for general health?

This is one of the most common questions. And the answer is always complex. Most of the healthy individuals do not need to take probiotics. We can support our gut microbiome by eating a balanced diet, rich in prebiotics (including fibre), ensuring sufficient sleep, less stress, avoiding excessive alcohol, and processed foods, and getting enough physical activity. In a society that is always looking for an easy solution, probiotics have become one of the popular solutions. Often my patients are taking a probiotic, without knowing what strain(s) are present in the product, what benefit they expect from it or if they would be safe to take long-term. This approach can often result in wasting resources, delaying appropriate treatments or experiencing side effects from unnecessary treatment. 

On the other hand, sometimes even healthy people could benefit from probiotics. Examples are preventing travellers’ diarrhea, and minimizing risks of common infections disease and similar. 

The bottom line is – to check if you need probiotics, and if you do, consult the Clinical Guide to Probiotic Products Available in Canada and speak with your healthcare provider. 


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