Digestive Ailments

  • Treating Chronic Constipation

    SpringladyConstipation is one of the most common gastrointestinal complaints doctors see; experts say that at least 4.5 million people—the majority of them women—suffer from constipation symptoms that are serious enough to warrant medical attention. Because it can be an embarrassing topic, however, many patients self-treat their constipation and avoid discussing it with their doctor. Here are some ideas about why—and how—to treat chronic constipation.

    What is chronic constipation and why does it matter?

    For some, constipation can simply mean straining, and for others it means infrequent bowel movements (that differ from normal patterns for that individual). Most complementary and alternative medicine providers, myself included, would agree that a daily bowel movement—or even up to three per day—is optimal. But that might not be feasible for women, since their bowel movement frequency is generally less than that of men.[i] Studies have suggested that the majority of women have bowel movements every other day or less.[ii] Because there can be a wide range of what’s considered normal, from three times per week to three times per day, it is important to clarify what’s normal to you with your health care provider.

    The current standard definition of constipation means experiencing two or more of the following symptoms for three or more months, without the use of laxatives:

    • Straining with defecation more than 25 percent of the time
    • Lumpy or hard stools more than 25 percent of the time
    • Incomplete evacuation more than 25 percent of the time
    • Two or fewer bowel movements per week

    Chronic constipation can lead to a decrease in absorption of select nutrients, internal or external hemorrhoids, pelvic floor dysfunction (e.g. urinary incontinence, or bladder, rectal or uterine prolapse).

    How can laxatives support normal large intestine function and relieve constipation symptoms?

    Laxatives can be helpful temporary solutions to relieve symptoms and to help retrain the bowel. There are a variety of different types of laxatives that work in different ways. Here are the six basic laxative types.

    1. Bulk-forming laxatives.

    These can be derived from psyllium husks, ground flax seeds or methylcellulose, a synthetic material. Their basic function is to absorb water in the intestine to soften the stool, but they can also result in increased flatulence and bloating. They do act faster than food fiber but slower than other laxatives and typically take about a week to work. Bulk-forming laxatives improve transit time and are very compatible with increases in dietary fiber such as leafy greens, ground flax seeds sprinkled on whole grain, high-fiber cereals, and fresh fruits, especially berries.

    2. Emollients and stool softeners

    These agents aid the mixing of watery and fatty substances in the bowel both to soften the stool and to lubricate the stool so it can be passed easier. They also prevent dehydration of the stool by stimulating fluid secretion. Stool softeners can be taken orally or rectally and typically work very fast, usually within 24 hours, so they’re ideal for someone who is in pain because of hard stool. Glycerin suppositories or mineral oil are common examples, but mineral oil should be used sparingly because it can decrease absorption of fat-soluble vitamins. Herbs such as buckthorn bark also serve as stool softeners.

    3. Saline laxatives

    Magnesium salts have been used for decades for constipation, and act fairly quickly. They work by exhibiting a sponge-like action that draws water into the colon to soften the stool and promote transit. When looking for an appropriate product, it’s important to note that magnesium sulfate is more potent than magnesium citrate or magnesium hydroxide and should be used with caution. In addition, individuals with renal impairment or hypertension should avoid saline laxatives.

    4. Hyperosmotics

    These are the newer laxatives on the block. Available as an oral prescription, hyperosmotics create a high concentration gradient to draw fluid out of the bloodstream and into the colon. Examples of hyperosmotics include lactulose, lactitol and sorbitol, and produce effects in 2-3 days. Note: Hyperosmotics can also produce some bloating and flatulence.

    5. Osmotics

    A polyethylene glycol electrolyte solution is what’s normally given to empty the colon before a colonoscopy. The good news is that it can also be used to treat severe fecal impaction. MiraLax is a newer prescription that uses polyethylene glycol to help relieve constipation.

    6. Bowel stimulants

    These laxatives stimulate sensory nerve endings in the colonic mucosa to trigger peristalsis. They also promote fluid secretion into the colon and improve the consistency of the stool. Aloe, senna, cascara sagrada and castor oil are all potent stimulants that can produce a rapid response. They should only be used for more severe cases and should not be used long term.

    Are there natural solutions to constipation that I should consider?

    Alternative medicine practitioners also often recommend these other methods of treating constipation:

    • Probiotics to help restore normal colonic microflora, specifically the lactobacillus species
    • Digestive enzymes, which enhance the digestive process
    • Bitters, which work by increasing the secretion of digestive fluids. Consider yellow gentian and dandelion root for this purpose. Dandelion root also helps stimulate gall bladder function and improve bile secretion.
    • Turkey rhubarb has been used as a purgative for at least 2,000 years, and encourages bowel movements by stimulating peristalsis
    • Triphala, whose use for chronic constipation is based on principles of Ayurveda. This unique combination of three herbs, or more specifically, three fruits, haritake, amla and bibitake, that gently stimulate the intestines, restore tone to the colon and thus enhance the elimination process while providing a cleansing effect.

    When it comes to chronic constipation, most individuals will only need reassurance, education and basic advice. Others will need further evaluation and/or more sophisticated treatment interventions, whether by exclusively natural methods, conventional methods or an integration of both.

    Working with your health care provider will help ensure that there is no significant underlying cause of your constipation. Your doctor can also help you get symptom relief, improve general health and provide prevention strategies for the future, all with minimal side effects.

    [i] Heaton K, Radvan J, Cripps H, et al. Defecation frequency and timing, and stool form in the general population: a prospective study. Gut. 1992; 33:818-824.
    [ii] Toglia M. Pathophysiology of anorectal dysfunction. Obstet Gynecol Clin North Am. 1998; 25:771-780.

  • Is it IBS? What you need to know about Irritable Bowel Syndrome

    DigestionYou may have heard the term IBS….but what exactly is Irritable Bowel Syndrome? Here, Dr. Brad Jacobs, MD, and chair of Pharmaca’s Integrative Health Advisory Board, talks to us about IBS symptoms, and how to effectively manage them with simple changes to diet, lifestyle and supplementation.

    The first thing to realize is that the term Irritable Bowel Syndrome can be a catch-all term for digestive disturbances. “Typically people have bloating, pain, cramping, constipation and/or diarrhea,” says Dr. Jacobs. “Symptoms can go from mild to disrupting your ability to work and lead a normal life.”

    IBS is usually diagnosed by the absence of evidence of other issues, such as food intolerance, or more serious issues such as Crohn’s Disease or Inflammatory Bowel Disease. That’s why it’s important to get a full examination by your primary care provider to ensure you don’t need to address something more serious. (Note: Blood or mucous in the stool can be an indication of these, and should be discussed with your doctor immediately.)

    Dr. Jacobs says that while doctors are still unsure of the causes of IBS, they do know that it involves the nervous system, which affects the “motility” of the gut, or the way the bowels are able to move food through the digestive tract. Prescription drugs can help balance the nervous system to reduce symptoms, but Dr. Jacobs feels that the risks of these medications can outweigh the benefits. The good news is that IBS is very manageable without prescriptions. “I see dramatic, life-altering results from the following recommendations,” he says.

    “There’s a lot of research to show that regular exercise and sufficient sleep can help alleviate symptoms of IBS,” says Dr. Jacobs. In addition, he recommends getting at least 20-25 g of fiber a day—through whole grains or a gluten-free supplement like chia or flax—along with 8 glasses of water or tea to ensure the fiber is well digested (fiber can worsen symptoms otherwise).

    Dr. Jacobs also recommends a good probiotic, especially one with at least 2 billion CFUs, and boosting your intake of food-based probiotics such as fermented foods and live culture yogurt.

    “You can also attack specific symptoms like pain and cramping with natural supplements such as peppermint oil, which has anti-spasmodic properties (take twice daily), or digestive bitters such as fennel, mint or dandelion—to take before or with meals,” says Dr. Jacobs.

    Dr. Jacobs is also a big proponent of an elimination diet to help identify any food intolerances that might be triggering IBS symptoms. This is part of what he calls the three Rs:

    -Remove offending agents—such as food allergens
    -Repair the gut tissue—with nutrients such as glutamine and zinc (find those in Metagenics’ Ultra InflamX)
    -Restore good digestive function—with prebiotics and probiotics

    Dr. Jacobs also encourages anyone suffering from Irritable Bowel Syndrome to consider acupuncture, which has been shown to be very helpful in treating IBS, as it helps restore normal bowel function from a Chinese Medicine perspective.

    Finally, he says, decreasing your stress can dramatically improve IBS symptoms. “Try yoga, meditation or tai chi. These practices will help harmonize your nervous system and decrease your stress.”

  • The Link Between Probiotics and Optimal Health (Video)

    Don't know why you should be taking probiotics? Here, Dr. Tori Hudson talks about the importance of probiotics for people of all ages. In children, probiotics can be helpful for reducing allergies, asthma, eczema and digestive problems; for adults, different strains can help reduce bowel diseases, bladder infections, vaginal infections and to bring gut flora back into balance after a course of antibiotics.

  • Natural Ways to Battle Heartburn

    Did you know? Many natural remedies are available for reducing symptoms of acid reflux, GERD or heartburn. Here, Dr. Brad Jacobs talks about strategies for reducing acid reflux, as well as supplements that can coat the stomach and increase tightening of the esophageal sphincter, including marshmallow root, DGL, d-Limonene and melatonin.

    Acid reflux (otherwise known as heartburn) is more than just a minor health concern. People who live with chronic heartburn can experience serious discomfort, to the point that they have trouble eating and can’t sleep at night. Here are some natural ways to ease—or erase—acid reflux symptoms.

    “There are many different causes of heartburn,” says Dr. Brad Jacobs, MD, and chair of Pharmaca’s Integrative Health Advisory Board. An important one to keep in mind, he says, is anxiety or stress. “That can increase your production of acid in the stomach and thus increase your chances of having heartburn.” That’s why he tells his patients experiencing heartburn to try and reduce anxiety or stress through meditation, yoga or anything else that will help calm and center them.

    Different foods and eating behaviors can also aggravate heartburn. “You want to avoid things like alcohol and caffeine that can relax the sphincter between the stomach and esophagus,” says Dr. Jacobs. Other foods, such as tomatoes, can have the same effect. Because each person’s trigger foods are different, it’s a good idea to work with a health care professional to identify which foods might be causing the problem. Dr. Jacobs also encourages patients to avoid large meals toward the end of the night, since lying down on a full stomach can increase the chances of reflux.

    As far as treatments, Dr. Jacobs says there are a variety of herbs and supplements to consider. Marshmallow root, for example, helps provide a coating around the stomach that limits acid reflux. Deglycyrrhizinated licorice (DGL) is another helpful supplement. “DGL can be quite effective—take 1-2 pills before meals to again provide a nice coating in the stomach,” he says.

    For a more intensive treatment—especially good for people who experience long-term heartburn symptoms—try d-limonene, says Dr. Jacobs. He recommends taking one every other day for a minimum of a 10-day course (find it in Enzymatic Therapy's Heartburn Free).

    Finally, Dr. Jacobs points to recent research about melatonin’s usefulness in treating heartburn. “A dose of 3 mg, taken in the evening time (usually 1-2 hours before you go to bed), has been shown to actually increase the tightening of the esophageal sphincter, thereby decreasing your risk of recurrent reflux.”

    While many people turn to medications to ease heartburn symptoms, Dr. Jacobs strongly suggests looking into these non-prescription solutions first. Why? “Those who take medications such as proton pump inhibitors often have a hard time getting off of them,” he says. “Studies have also shown that your reflux symptoms can increase as you’re coming off those medications.”

    Finally, Dr. Jacobs recommends a full examination by a physician if you have persistent symptoms and are over 40 years of age. They can take a closer look at your esophagus and stomach to ensure nothing more concerning is going in.

    Speak with a Pharmaca practitioner about natural solutions to acid reflux.

  • Frequently Asked Questions About Probiotics

    Fish OilProbiotics are an important part of your supplement regimen and can support immunity, balance digestive health and more (learn more about which strains to look for based on your health concern.) Here, Tori Hudson, ND, member of Pharmaca's Integrative Health Advisory Board, answers some of the most common questions our practitioners get about how and when to take probiotics.

    I eat yogurt; aren't I getting enough probiotics?

    Not all yogurts contain active live cultures of probiotics, and not all contain the same species and strains of probiotics. In those that do contain active live cultures, there are differences in the number of these live and active cultures. Optimally, the yogurt would come with a label that reveals the species it contains as well as the number of colony forming units (CFUs) it contains. Beware though that the number of CFUs listed is based on the amount contained in the yogurt at time of manufacture. Some yogurt manufacturers will feature more information on their website about testing and quality assurance that will tell you about the stability of the probiotic strains in their yogurt.

    Two other issues with yogurt as a source for your probiotics: the dose is lower per serving than you could easily get in a pill, and many yogurts contain sugar and are high in carbohydrates and calories. Using a dietary supplement as a source of probiotics rather than yogurt is more efficient, reduces calorie/sugar intake, offers more accuracy in labeling and can deliver higher amounts of probiotics in a shelf-stable form. Some supplemental probiotics even have more sophisticated delivery systems that allow the probiotics to bypass the stomach acid so that they're even more prominent in the intestines.

    How old do children have to be before taking probiotics?

    The ideal time to introduce a child to probiotics is in utero! Probiotics are one of the most important dietary supplements a pregnant woman can take. I put it in the top three important supplements, along with fish oils and folic acid.

    Later, infants can be introduced to probiotics through mom's milk when breastfeeding, or as a powder—put on the nipple or on a finger that is then placed in the infant’s mouth. Pediatric studies confirm that when probiotics are introduced as early as week one, it can reduce the incidence of vomiting, reflux, constipation and diarrhea. Other research also confirms reduction of Colic, crying time, spitting up and constipation when introduced in the first three months. As they grow, you'll find special formulations for children of all ages at Pharmaca.

    Do seniors need different strains/strengths of probiotics?

    As we age, the microflora of the gut changes, including a reduction in the numbers of good bacteria (lactobacilli and bifidobacteria) and an increase in the numbers of potentially pathogenic bacteria. These changes can result in gastrointestinal disorders and infections, including antibiotic-associated diarrhea, clostridium difficile, constipation and irritable bowel syndrome.

    A growing body of research is showing that when the elderly supplement with some species and strains of probiotics, they're seeing positive effects such as a reduction in fecal enzymes, improvements in vitamin synthesis, cholesterol reduction, lactose intolerance reduction, reduction of potential mutagens and predigestion of proteins. Some of the research that has been done includes Bifidobacterium longum 46 and B. longum 2C, and several Lactobacilli species.

    What's the best time of day to take a probiotic?

    There are numerous opinions on this. Some say to take them on an empty stomach so that the stomach acid is relatively low, which may result in a higher chance of the probiotics adhering to the intestinal wall and colonizing the colon. Other researchers assert that probiotics should be taken with food for optimal colonization. I am of the belief that they should be taken with food because the increased gastric pH is more favorable for the probiotics. But I think the most important thing is to take them at a time that will work for you and not worry about the details.

    Can I take them while I'm on antibiotics?

    Not only can you, but it’s very smart to do so. By doing so, you can reduce the incidence of antibiotic-associated diarrhea, which can range from mild to severe. Probiotics, such as Lactobacillus spp., (consider L. rhamnosus, L. acidophilus, L. plantarum, Bifidobacterium spp. and Saccharomyces boulardii), can not only reduce the incidence of antibiotic-associated diarrhea by as much as 42 percent, but they can also improve antibiotic therapy as they keep the infection-causing microbe from adhering and multiplying.

    As far as when to take the probiotics in relation to your antibiotics, S. boulardii does not appear to be inhibited by the antibiotics, but the lactobacilli species can be and should be taken at least 2-4 hours after the antibiotic dose. Consider taking the probiotics for 1–3 weeks longer than the duration of antibiotic treatment.

    I've read that probiotics can help with mood elevation or depression, is that true?

    There is a growing body of evidence linking gut health to brain health, and one study showed that even daily consumption of a probiotic-containing yogurt for three weeks significantly increased mood.

    It appears that probiotics can also help to deliver neuroactive substances such as serotonin and GABA, which act on this brain-gut axis. Further research is needed to identify which species and strains are most beneficial to mood and the brain.

  • Digestive Products by Herb Pharm

    By David Bunting, Herb Pharm

    Shop all Herb Pharm products >

    Good digestion is one of the most crucial factors influencing our health. Together with oxygen and water, food provides all of the starting materials for building and maintaining our bodies and minds. And digestion is the body’s gateway for all of the nutrients found in food, the proteins, carbohydrates, fats, vitamins, minerals and various secondary phytochemicals that feed and heal us. This one complex process is thus linked to every other function in our body, starting at the cellular level. Poor digestion leads to poor health.

    Herb Pharm carries a large selection of products that positively influence the digestive process, system and organs in various ways. In some cases, there is overlap in the effects of products, but each has its own unique features. This article gives an abbreviated overview of our digestive system products intended as a short guide to their differentiation and uses.

    What might be considered the most quintessential digestive product is bitters. Bitters begin working as soon as they hit your taste buds through a reflex action on our stomach and pancreas, stimulating the production of digestive juices. Bitters also stimulate the liver and prepare the gall bladder for the release of bile. Consuming bitter flavor in our foods was always a part of eating; it is something we as a species evolved with and relied on for good digestion. Because the modern diet is skewed heavily towards sweets, the reintroduction of bitter plants like dandelion greens and radicchio into your diet is extremely beneficial. Using Herb Pharm's Digestive Bitters is another simple way to reintroduce this important digestion-enhancing flavor. Hold diluted Digestive Bitters in your mouth for a minute before swallowing to ensure that the taste response is triggered.

    Neutralizing Cordial has attributes shared by some of the other digestive products in that it is of service in treating digestive gas, nausea and colic. However, this formula stands apart due to its ability to alkalize the digestive system. While rhubarb root is generally considered a laxative, it actually has a dose-dependent amphoteric function. Neutralizing Cordial is great when traveling as well as in the home medicine cabinet.

    While many single extracts can have a positive influence on digestion, one especially worth calling out is Peppermint Spirits. This powerful preparation is effective in reducing stomach upset and digestive gas as well as spasms such as hiccups. Peppermint Spirits also help relieve nausea and are a good alternative to Ginger for those whose digestive fire is already warm. Peppermint is cooling and relaxes sphincters, so is not appropriate in acid reflux or where there is dampened, weak digestive fire.

    Bringing the theme of liver and digestion full circle is Healthy Liver Tonic, Herb Pharm's primary liver support compound. Among other herbs in this compound are bitters like Dandelion, Oregon Grape and one of my personal favorites, artichoke. As with Digestive Bitters, these bitter tasting herbs improve the digestive process and systemically support liver-related digestion. Keeping the liver healthy is one of our best strategies in maintaining good digestion and overall health.

    In recent years we have seen a dramatic increase in various digestive, gut and food-induced disorders. The best and easiest way to avoid digestive problems is to stop them before they start. The first and probably most important step is to examine your diet and replace unhealthy foods with better options, including bitter greens. And it makes sense to begin strengthening your digestion at the same time, starting with regular use of Digestive Bitters. These simple steps can be used to significantly improve digestion and assimilation, which are truly fundamental to wellbeing.

  • Snapshot: Different Probiotic Species and Strains

    As a follow up to our post on how to choose a probiotic, here's a snapshot look at different probiotic strains, when they're useful and where to find them.

    Probiotic species & strains  Health benefits Where you'll find it

    B. longum


    The most significant and important probiotics in the body, and among the first to colonize in the sterile GI tract of a newborn infant (also found in human breast milk). Stimulates the immune response and promotes microbial balance by crowding out bad bacteria that cause discomfort and neutralizing everyday toxins in the gut. Aids production and absorption of B vitamins, blocks harmful invaders, boosts the immune system and helps maintain regularity. Helps break down carbs without producing excess gas. May help to prevent or minimize various allergies or allergic reactions, inflammation associated with Crohn’s disease, or colitis.May have positive impact on cholesterol levels.

    Lowers the pH of the intestine/vagina to inhibit the growth of harmful bacteria.



    L. acidophilus

    Most commonly used probiotic.Lives in the mouth, intestines (maintains integrity of the wall of the small intestine, aiding nutrient absorption and supporting immunity) and vagina (adheres to the walls of the vagina and urinary system where it can fight infection). Helps to synthesize vitamin K and many antimicrobial substances, giving it antibiotic properties.


    L. rhamnosus GG

    One of the most effective strains for combating antibiotic-associated diarrhea and traveler’s diarrhea. Lives in the intestines, and fights infections both in the gut and urinary tract. Assists in dairy digestion and lactose intolerance.

    L. plantarum 299V

    Reduces pain, bloating and improves constipation in Irritable Bowel Syndrome. Helps with antibiotic-associated diarrhea.
    • Jarrow Formulas Ideal Bowel Support

    S. boulardii

    A probiotic yeast resistant to stomach acids and antibiotics. Effective against reducing acute diarrhea in children and adults. Protects against both antibiotic and travelers’ induced diarrhea. Promotes immune and digestive health.

    B. infantis

    Excellent for both children and adults, B. infantis is one of the first colonize in the newborn’s digestive tract. Helps to impede the growth of harmful bacteria.Excellent producer of B vitamins. Offers good results with IBS (bloating, gas, diarrhea, constipation, urgency and abdominal discomfort), IBD, ulcerative colitis and traveler’s diarrhea.

    L. casei





    Helps control diarrhea, has potential anti-inflammatory effects on the GI and aids in relieving antibiotic-associated diarrhea. Produces lactic acid to lower the pH of the gut, impeding the growth of harmful bacteria. Lives in the mouth and intestines of both infants and adults.

    L. reuteri



    Provides strong protection against infection and helps maintain a healthy immune system. Treats and prevents diarrhea. Helps relieve colic. Releases a substance capable of killing bacteria, yeast and fungi, making it popular for vaginal infection support against candida, UTIs.


    S. thermophilus


    One of the most useful strains in the commercial food industry. True starter strain for making yogurt (used in making cheeses too). Ferments milk sugar (lactose) that turns into lactic acid, which is effective at preventing lactose intolerance and also lowers the pH of the yogurt preventing the growth of harmful bacteria causing food poisoning. Keeps microflora of intestines balanced.May have benefits for chemotherapy patients.

    B. breve

    Unique in its ability to compete against harmful bacteria due to the large variety of molecules it can digest (including plant fibers otherwise thought non-digestible). Inhibits E. coli. Present in the intestines and the vagina (inhibits growth of candida albicans, the primary cause of yeast infections). Decreases occurrence of gas, diarrhea and bowel irritations.

    L. helveticus

    Exerts antimicrobial activities against pathogens, helps reduce symptoms of lactose intolerance by breaking down lactose, helps to prevent and reduce diarrhea, may have implications on lowering cholesterol and blood pressure as well as help with calcium absorption. Lives in the intestines.


  • How Do I Choose a Probiotic?

    We know now that probiotics are good for us. But with so many to choose from, how do we choose one that’s right for us? Not all probiotics are created equal; different varieties of bacterial strains have different benefits, in addition to differing potencies, routes of ingestion, manufacturing methods and so on. Read on to learn how to choose a probiotic that’s right for you.

    First, identify why you need probiotics. It may be to counteract a course of antibiotics, to support digestion, to treat a yeast infection or simply to boost immunity. While many products are formulated to suit a particular need, others are general in their labeling. Here are a few things to keep in mind when looking for a probiotic that suits your needs.

    While taking antibiotics
    Antibiotics are good at their job of wiping out invasive bacteria. The problem is that they are also good at killing beneficial bacteria, setting the stage for gastric distress, diarrhea and possible secondary infection—making it critical to take probiotics concurrently. Note that you should always take antibiotics and probiotics on opposite schedules so their effects do not counterbalance each other (i.e. take probiotics at least 2 hours away from antibiotics).

    While on antibiotics, take a higher-potency probiotic (20-100 billion) to replenish gut flora, and continue them for a month or more after your course. For this purpose I recommend Renew Life’s Ultimate Flora Critical Care,Nature’s Way Primadophilus Optima, Pharmaca’s Ultimate Probiotic Blend and Pharmax High Intensity products.

    Yeast and women’s balance
    Probiotics are very effective in balancing vaginal flora, which helps guard against infection and prevent overgrowth of candida. Suppositories offer a direct method to assist vaginal flora—be sure it has at least a billion lactobacillus to support vaginal flora. Taking oral probiotics at the same time can offer maximum coverage. Try Jarrow Formulas’ Fem-Dophilus or Vitanica’s FemEcology. Both of these products are formulated for vaginal flora balance and can be used as suppositories as well.

    Probiotics for children
    Probiotics are extremely important for developing digestive tracts and supporting immunity. Kid-specific products are formulated to make them appealing for little ones. Try Jarrow Formulas’ Yum-Yum Dophilus or Nature’s Way’s Primadophilus Kids.

    Potency is measured in colony forming units (CFUs). A good first step is to ensure you choose a product that gives a “good until” date to ensure potency until a certain date. (Some manufacturers only stamp their CFUs at the time of manufacture, e.g. “1 billion active L. acidophilus and B. bifidum at the time of manufacture.”) Because probiotics are live organisms at the time of manufacture, over time you can expect a slow die-off of bacteria, which ultimately renders the probiotic useless. This happens much faster if the product is improperly stored.

    Potency varies widely in probiotic supplements, generally between 1 and 100 billion CFUs. Currently there are no standardizations for dosing and potency with probiotics. You may need a period of adjustment to identify what potency is optimal for you, but here are some general guidelines to help you start.

    • For mild digestion problems (gas, bloating, diarrhea) try starting with a lower dose (5-10 billion CFUs) and working up.
    • For more severe digestion issues (chronic diarrhea, gas, bloating and infections), you may want to try taking a lower potency every other day and working your way up to a much higher potency (since there can be gas and bloating associated with probiotics colonizing in the gut).
    • For bowel regularity, try New Chapter’s Probiotic GI Tract.
    • For general intestinal maintenance, try taking 1-2 billion CFUs per day, as in Enzymatic Therapy’s Acidophilus Pearls. Many people choose to take a much higher maintenance dose because they have found that it gives them optimal digestion and immunity. A popular product for daily use is Jarrow Formulas’ Jarro-Dophilus EPS,which contains 5 billion per dose and does not require refrigeration.

    In addition, probiotic formulas are often formulated with added prebiotics—non-digestible food that feeds probiotics and promotes healthy flora. Examples of prebiotics include FOS and inulin. Try Jarrow Formulas’ Jarro-Dophilus + FOS or Pharmaca’s Acidophilus and Bifidus.

    Other considerations


    Since many probiotics are grown in a culture that contains dairy, people who are completely lactose intolerant must look for dairy-free formulas. There may also be traces of gluten in some products, so be sure to check the label or ask a qualified health practitioner for a gluten-free option. A few allergen-free products to try include Pharmax HLC, Jarrow Formulas’ Allergen-Free Jarro-dophilus or Thorne Research’s FloraMend.


    Many probiotics require refrigeration to maintain potency, which can be inconvenient—especially for travel—but there are several good probiotics that do not require refrigeration. Try Jarrow Formulas’ Jarro-Dophilus EPS, Essential Formulas’ Probiotics 12 Plus Original Formula or Enzymatic Therapy’s Pearls. Be sure to follow proper storage of your probiotic, paying attention to moisture, light and temperature.

    Delivery methods

    There are a variety of delivery methods for probiotics, including liquids, powders (great for infants!), capsules, chewables and suppositories. Fermented foods are also a terrific source of probiotics, including kefir, yogurt, sauerkraut, anything pickled, miso, tempeh and soy sauce. Kombucha is a popular fermented tea that is a great source of probiotics.


    Be sure to read directions thoroughly! Products can differ based on whether or not they should be taken on an empty stomach.

    Side effects

    Probiotics are considered generally safe and well tolerated, and serious side effects are fairly uncommon. Possible side effects include gas, bloating and tenderness in the gut (either to the touch or with motion) and possible diarrhea or constipation. Because these symptoms occur while the bacteria are colonizing in the gut, they tend to become less pronounced with ongoing use. There have been rare reports of infection occurring in the severely ill or immune-compromised.

    There is no evidence that higher doses of probiotics are unsafe (even though they may be more expensive and unnecessary for some). When in question, start lower and work your way up. Back off on potency if you are experiencing uncomfortable symptoms from the probiotics, but don’t give up! Speak with a qualified health practitioner if you have concerns with any side effects from probiotics colonizing.

    Trusted manufacturers

    Perhaps the most important aspect in choosing your probiotic is purchasing from trusted manufacturers with good manufacturing practices and quality control! These brands should have research available to demonstrate the effectiveness of their products, including proof of potency and ability to survive the environment of stomach acids and bile salts. Special manufacturing techniques are required to ensure the probiotics make it to their destination for colonization (i.e. small or large intestine). Examples of these techniques include enteric coating and “beadlet” technology. A few examples of trusted manufacturers include Pharmax, Metagenics, Pharmaca, Renew Life, New Chapter, Jarrow, Udo’s and MegaFood.

  • What Are Probiotics (and Why do I Need Them?)

    YogurtProbiotics are microorganisms, including both bacteria and yeast, that live in the small and large intestines (also referred to as the gut). Collectively, all organisms in the gut are referred to as flora.

    There are more than 400 different types of bacteria species living in the gut, accounting for a whopping 3-5 pounds of body weight. Your gut is also home to a network of lymphoid tissue that makes up 60-70 percent of your immune system. That’s why keeping a healthy balance is critical to your ability to fight infection and optimally digest and metabolize food.

    Two genuses of bacteria—Lactobacillus (L.) and Bifidobacterium (B.)—are the most beneficial strains commonly used in probiotics, and a complete probiotic should contain strains of both in order to provide protection for both the small and large intestine. Here are a few examples of specific strains of these genuses that have unique capabilities:

    L. acidophilus strains predominantly live in the mouth, small intestine and vagina. They greatly benefit digestion by producing enzymes that break down food (e.g. lactase, which breaks down dairy), assisting in absorption of vitamins K and B, calcium and fatty acids, and protecting against infection and disease by lowering the pH of the gut to make it uninhabitable by bad bacteria.

    B. bifidum predominantly live in the large intestine and vagina, and adhere themselves to the walls of each, thus preventing bad bacteria from colonizing. B. Bifidum also produces substances that lower the pH of their environment so bad bacteria cannot thrive, and enhances assimilation of minerals.

    Many more strains exist that have shown specific beneficial properties. Consult with a qualified health practitioner for strains that are specific to helping certain health conditions (e.g. L. Rhamnosus, called the “travelers’ probiotic,” because it has shown protection against diarrhea while traveling).

    Beneficial yeast can also serve as probiotics. Here are a few examples of yeasts commonly found in probiotic formulas:

    Saccharomyces boulardii is a yeast that can sustain flora in the gut and help prevent and treat diarrhea from various causes (e.g. traveling or antibiotics).

    Saccharomyces cerevisiae, also known as brewer’s yeast or nutritional yeast, has been used for thousands of years to make dough rise and create alcohol (due to the yeast’s special ability to ferment certain sugars). S. cerevisiae has many beneficial effects, and is high in protein, fiber, B vitamins and folic acid.

    Different types of probiotics can be helpful for a variety of health conditions—they aid nutrient absorption, produce key vitamins, improve digestion and immunity, balance intestinal and vaginal flora, protect us from antibiotic use damage and improve overall wellbeing.

    Now that we know a bit about types of probiotics, the next step is in figuring out how to choose which one is right for you.

  • Enzymes: Beyond Digestion

    Enzymes aren’t just vital for digestion—they’re important for the function of every cell in the body. In order to maintain balance in the structure and function of cells, tissues and organ systems, there are millions of metabolic enzyme reactions happening in your body.

    Where do enzymes come from? Enzymes are proteins made by the pancreas, liver, gall bladder and other organs—as well as by every living cell—to enable biochemical reactions. Digestive enzymes are particularly important because they break down food (including protein, fat and carbohydrates), a process that in turn provides energy to the body. Digestive enzymes are made primarily in the pancreas.

    Enzymes are also available in raw foods in our diet (but once foods have been heated/cooked or processed, the enzymes become damaged and unavailable for assisting digestion of that food). Pineapple enzymes (known as bromelain) and papaya enzymes (papain) are two highly concentrated raw sources of enzymes that can be especially helpful, and both are commonly sold in supplements.

    You may also want to supplement if you’re experiencing symptoms such as painful digestion, gas/bloating, heartburn and diarrhea/constipation. Supplementing with plant-based digestive enzymes can also increase the body’s capacity to produce other systemic, inflammation-fighting enzymes—more on that below.

    Digestive Enzymes to try:
    Digest Gold from Enzymedica
    Integrative Therapeutics’ Similase
    Rainbow Light’s Advanced Enzyme System
    Papaya Enzymes from Pharmaca and Zand

    The digestive tract isn’t the only place our body uses enzyme reactions, however. Systemic (also known as proteolytic or metabolic) enzymes can help break down inflammation in the body. Inflammation is mediated by the immune system and is a natural and necessary response in every cell of the body. However, higher levels of inflammation have been associated with aging and it’s important to maintain a healthy inflammation response.

    Enzymes can help decrease inflammation in different bodily systems (e.g. joints, heart, lungs, blood, immune, breasts, prostate, skin), and supplementation with systemic enzymes can help with aches, pains and muscle soreness from everyday activity. Experts believe that systemic enzymes can also help cleanse blood of foreign invaders such as viruses, therefore strengthening the immune system as well as breaking down scar tissue in the body.

    Are digestive and systemic enzymes one in the same? It’s believed that enzymes are utilized differently when taken at different times. When enzymes are taken with a full stomach, for example, they will work on digesting food. If taken on an empty stomach, they can help break down other proteins in the body, such as those causing inflammation.

    But supplement forms of digestive and systemic enzymes generally contain different levels of enzyme activity to accomplish what’s desired. Though you may see some positive benefits by taking a high-quality digestive enzyme on an empty stomach, it won’t generally have the same effect as taking a formula that is optimized for systemic use.

    Systemic enzymes to try:

    Wobenzym from Garden of Life
    Bromelain from Jarrow Formulas or Pharmaca
    Enzymedica’s SerraGold (helps improve circulation, speed tissue repair, alleviate joint discomfort, support heart health and relieve respiratory complaints)
    Enzymedica’s Natto-K (to support circulation)
    Enzymedica’s ViraStop (to help breakdown toxins and debris in blood)

    Ultimately, the body is designed to make the digestive and metabolic enzymes we need. But just like many other bodily functions, this process slows as we age. By supplementing with digestive enzymes the body can focus on making metabolic enzymes—the “energy of life” needed to forge every biochemical reaction in the body.

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