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Exploring Your Gut & Microbiome

Q&A with Dragana Skokovic-Sunjic 

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What inspired you as a clinical pharmacist to dedicate your career to sharing your knowledge on probiotics?

Pharmacists are famous for their strict adherence to scientific evidence, proof of benefits for the use of medication, appropriate selection, and the do-no-harm approach. As the research on probiotics was growing, the market was expanding at the same time. More than a decade ago, the disconnect between what we learned from the studies and what the consumers were purchasing was evident. At that time I started working with a team of experts in this field, and we have been actively assessing the latest evidence, matching it with the products offered on the market, and publishing the Clinical Guide to Probiotic Products Available in Canada as a reference for selecting appropriate probiotics for desired outcomes.

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What are prebiotics and probiotics, and how do they play a role on the microbiome?

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. They support our health: inside our gut, they break down foods we can not digest (prebiotics) 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.

By internationally accepted definition, probiotics are ‘live bacteria that, when administered in adequate amounts, offer health benefits’. We use them as an intervention, carefully selecting when and which strain to use. To provide benefits, probiotics do not need to ‘colonize ‘ the gut or stay as a part of our own microbiome.

The term prebiotic describes food for bacteria in our microbiome or for bacteria ingested as a probiotic. Prebiotics are usually selectively used by friendly bacteria and, in turn, provide a health benefit. Most prebiotics can be found in healthy foods, such as vegetables and fibre-rich carbohydrates.

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What is your advice for Canadians looking to make an informed choice on prebiotics or probiotics to take for their personal 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 (cold and flu).

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

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 is the biggest piece of advice you’d give to someone who is looking to prioritize optimal microbiome health and overall wellbeing?

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 to improve 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. It is best to consult with your pharmacist when combining any over-the-counter, natural health products or probiotics with other prescription medications. In Canada, we have a resource offering the most up-to-date information on which strains could benefit specific symptoms – Clinical Guide to Probiotic Products Available in Canada. This resource is designed for healthcare professionals. However, it is accessible by anyone at or as a mobile app, Probiotic Guide Canada.

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