Dr. Amy Nett: I’m not sure if you’re saying they specifically get constipated because of the Prescript Assist and MegaSporeBiotic, which is what it sounds like since you say they take other probiotics, and those are both tolerated because a lot of patients will have a change in their bowel movements when they’re doing the herbal antimicrobial protocol. I mean, one thing to tease apart is that they’re taking only the Prescript Assist and MegaSporeBiotic, and we’re seeing constipation, or is it really just that they’ve started the whole antimicrobial protocol, and then they’re noticing constipation because it can be difficult to tease that out. That said, if that the patients do really well with probiotics that contain Lactobacillus, Bifidobacterium, and Saccharomyces boulardii, it’s not essential that patients take Prescript Assist and MegaSporeBiotic. In our experience, Prescript Assist and MegaSporeBiotic are both really well tolerated, because remember, if some patients have certain types of SIBO, they might not respond well at all to Lactobacillus-containing probiotics. That’s why I had to be on the safe side, we tend to just start everyone on Prescript Assist and MegaSporeBiotic. I have very few patients who haven’t responded well to Prescript Assist. Tammy says, “That’s right. One patient only took soil-based probiotic and got constipated every time she took it.” Okay. Just have her take a probiotic that she tolerates well. It’s more important that she’s taking a probiotic than what probiotic it is.
There are a lot of different high-quality probiotics out there, and if you find that patients just don’t tolerate one, then just make a recommendation for another one. I sometimes like Equilibrium probiotic because that has a pretty high number of different strains in it. Jarrow has a number of good probiotics. You can use Udo’s Choice. I think those are fairly good probiotics. Klaire, I really like Klaire Labs’ Ther-Biotic Complete and Ther-Biotic Detox Support. Those are Lactobacillus and Bifidobacterium. Saccharomyces boulardii is almost always a good option to include. There’s nothing magical about Prescript Assist or MegaSporeBiotic. Just use a different one. And then Tammy says, “I wonder if constipation is the sign of formaldehyde being released from yeast that are dying.” I’m not familiar with that. I haven’t heard of that theory, so I wouldn’t be able to answer that with certainty.
Here again, we’re talking about the antimicrobial protocol. Most supplements are actually just fine to take with the antimicrobials. I’m trying to think if there’s anything — I don’t think there’s anything that specifically an absolute contraindication to take concurrently. Of course, the probiotics need to be taken one to two hours away from the GI-Synergy or other antimicrobials that you’re using preferably, but there really aren’t any supplements that I can think of or medications that negatively interact or interfere with the antimicrobial herbs. We often start our patients on the antimicrobial protocol and also include nutrient support, just like you’re saying, vitamin D, B complex, magnesium. A lot of our patients are starting those at the same time, absolutely okay.