Dr. Amy Nett: I think prebiotic fibers are generally the best way to support the microbiome and food sources, eating a wide array of plant food, but also if you’re going to be using antibiotics, probably getting into the supplemental forms of prebiotic, whether glucomannan, inulin, larch arabinogalactan, fructooligosaccharides. You can use resistant starches, whether that’s psyllium husk, plantain flower, green banana flower. We use a fair amount of partially hydrolyzed guar gum that can be fairly well tolerated.
There are some other products that are a combination of prebiotic fibers, like Microbiome Labs has MegaPreBiotic, which I really like, or Klaire Labs has BiotaGen. Starting those, probably … if you know you’re going to have the antibiotics, using the prebiotic before the antibiotics and then potentially during the course of antibiotics, and then after, while you’re re-establishing the gut microbiome, I do often also use Saccharomyces boulardii when patients are on antibiotics.
Saccharomyces boulardii is a beneficial strain of yeast, and since one of the big risks when you’re taking a course of antibiotics is yeast overgrowth, Saccharomyces boulardii, that beneficial strain of yeast, can actually help to decrease the risk of yeast overgrowth. Saccharomyces boulardii I’ll use, and again, all commonly have patients taking probiotics while they’re on antibiotics. I don’t think it matters too much which strain you’re using, but the important thing is when you’re taking antibiotics to take the probiotics at least probably two hours away from the antibiotic so that they’re not interfering.
And then again, as the other question I think that Aileen was asking is, should you really be taking probiotics after antibiotics based on some of the most recent research, and there is a question around that, and so I normally have that, and now I’ve been having that discussion with my patients, we don’t know what the right answer is. But again, anecdotally, a lot of people feel better taking probiotics after a course of antibiotics both during and after. Whether or not there should be probiotic-containing foods like kefir, kimchi, sauerkraut, etc., versus an actual supplemental probiotic, again that’s another question that that needs to be addressed, I think. Generally, number one, prebiotics, number two, probiotics, and then for probiotics consider Saccharomyces boulardii, the beneficial strain of yeast, and then probably also some more typical probiotics, whether those are Lactobacillus and Bifidobacterium combination or whether you want to use MegaSporeBiotic probiotic, a bacillus-containing probiotic that we use quite frequently, or something else that works well for the patient.