# Beware of Probiotics/Cedar Sinai



## Pete (Jan 20, 2000)

My doc at Cedar was nice enough to spend about 1/2 hour on the phone with me tonight. In a nutshell he said that I peaked at 60 minutes on my first breath test which is definately SIBO. The 90 minute peak on my second one he admitted is inconclusive. His big warning to me tonight was DO NOT TAKE PROBIOTICS. He said that by taking probiotics my SIBO will come back much quicker then it should. Said that all Lactobacillicus species will feed and cause gas. He said he is 100 percent sure on this and that this is very misunderstood and is their specialty. Told me not to eat yogurt too. So once again my opinion is if probiotics do not help you, why take them? Maybe they are making matters worse. Flux,As far as my burping and feeling like I need to burp go, he wants me to try peppermint oil before meals. Because I am doing this he wants me to double my PPI. He feels my dyspepsia may be related to my fundoplication. 2 weeks trial of peppermint and if that doesn't work then 2 week trial of baclofen. Does this sound reasonable?Pete


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## Ugh (Jan 30, 2001)

I wonder how he can be 100% sure unless he has access to data people here don't. Maybe you can ask him what information he has that makes him 100% sure. The only things I've seen are inconclusive and if anything lean toward a positive result for probiotics in SIBO cases (I'm referring to the articles/studies Kmottus posted). Obviously your Doctor probably has access to things we haven't seen, so maybe you can ask him what those are, so we can see how he can be 100% sure about this.


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## HipJan (Apr 9, 1999)

thanks, Pete. I am interested in learning more about this. I feel that probiotics have helped me - esp. after taking antibiotics. but........


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## JeanG (Oct 20, 1999)

Hi Pete:Thanks for the info. Probiotics have been a definite help for me, though, and until I see studies backing up what the doc says, I'll continue to take them.Like anything else, they probably affect each person differently.JeanG


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## mitchell goldstein (Apr 6, 1999)

it is safe to say that there are no absolutes in medicine. what helps one individual may hurt another. good advice for one may be bad for another. pete, your doctor's advice maybe appropriate and helpful for you but he can not advise those that he has not seen. blanket statements especially with regards to yogurt and the like make little sense.


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## Kathleen M. (Nov 16, 1999)

Sounds like it is time for me to go the the library, copy all the relevant articles and send them to CS.My personal opinion of the doctors there based on what they use for the tests and some of the comments they are reported to have made is that they may not be reading the medical literature as well as one would hope.Lactobacillus may produce some gas but they produce MUCH LESS than anything else living in the gut because they end the energy producing cycle at lactic acid. They are not nearly as Gas producing as other thigns and the only way to get 100% no gas from colon bacteria would be to live in a germ free lab or take super duper antibiotics all the time and hope you don't get resistance from them.And lots of other species seem to be more likely to be the culprits in SIBO. Probiotics tested in people with SIBO have NEVER been in problem in any of the clinical trials for probiotics in SIBO although they've not been sucessful in many of the trials either.And Lactobacillus has been shown to cause REMARKABLE reductions in gas produtcion in IBSers. I gather they haven't read that paper either.I know some people think these people are the greatest doctors, but I have very little faith in them or their approach.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## Patty (Mar 18, 1999)

Well, speaking from experience.....I took acidolphilus for a long time before it started to affect me in a negative way. Initially, it seemed to help keep my bowels working more normally, then all of a sudden gas and D started (and I was always C before). I tried it a few more times before giving up; the gas and growling sounds in my intestines made me stop.


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## SteveE (Jan 7, 1999)

kmottus--You may be right, but my personal experience with probiotics has not been helpful at all, and in a few cases (certain brands/types), I've felt worse.


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## Pete (Jan 20, 2000)

They did not say probiotics are bad for everyone. Only if you are diagnosed with overgrowth in the small intestine. They don't have an effective way at the present time of treating SIBO. Once the antibiotic works the overgrowth will return. Point is that probiotics will(in his opinion) make it come back sooner. They are starting clinical trials for alternative treating methods besides antibiotics.Pete


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## bonniei (Jan 25, 2001)

> quote:Sounds like it is time for me to go the the library, copy all the relevant articles and send them to CS.


That would be cool. Kmottus I hope they respond to you and then we'll be able understand their reasoning a bit better


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## Kathleen M. (Nov 16, 1999)

What evidence do they have that Lactobacillius is 1) A major organism that contribute to SIBO... my brief study into this leads me to believe it is a minor player in SIBO and2) Lactobacillus generates gas in the GI tract??!!??Conventional wisdom is that it is one of the species that does not.Also lactobacillus may help keep some of the other organisms that seem to be more likely to cause SIBO in check.Lactobacillius in clinical trials in patients who have conditions that pretty much guarentee they have SIBO (short bowel syndrome, kidney problems and others) indicate that they either HELPED the SIBO or did NO harm.So I have NO clue what evidence they are useing to assert that in 100% of people with SIBO Lactobacillus with make them WORSE.Could you ask them for the list of clinical trials they are using to base their opinion on.I'm willing to have my mind changed on this, but they'd better have something that explains all the wholes in the theory.And yes I KNOW probiotics do not work for everyone, alot of how they work for you will be based on what particular group of organisms you've got in the GI tract and how those organisms respond to the invasion of the lactobacillus,But to assert that Lactobacillus is 100% harmful for everyone who has SIBO seems to be a ridiculous statemtent.Other doctors who are looking into using antibiotics for treating SIBO are looking into certain probiotic species, so maybe it's a academic dispute. The other group is the academic enemy and anything they suggest we must oppose (sillier things happen in academics....believe me).Gastroenterology Oct 1999 Vol 117(4) pgs 794-7. They were using a yeast species (and yeasts DO cause lots of gas when they ferment unlike Lactobacillus) and they found it was no better and no worse than the placebo. So this can't be used to say probiotics will harm every person who has SIBO.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## Kathleen M. (Nov 16, 1999)

Peppermint oil may relax the sphincter at the top of the stomach and increase acid reflux.It may also relax the stomach so you don't burp as much. Just monitor the symptoms of reflux and stop or reduce the peppermint if those symptoms increase.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## Kathleen M. (Nov 16, 1999)

> quote:In a previous study we have characterized the mucosa-associated lactobacilli in healthy individuals and found some strains with good colonizing ability. Upon colonization, they seemed to reduce gas formation.


Unless they for some unknown reason produce more gas in the small intestine when they do not in the colon.AuthorsNobaek S. Johansson ML. Molin G. Ahrne S. Jeppsson B.InstitutionDepartment of Surgery, Lund University, Lund University Hospital, Sweden.TitleAlteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome.SourceAmerican Journal of Gastroenterology. 95(5):1231-8, 2000 May.


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## Kathleen M. (Nov 16, 1999)

Under some conditions you can force lactobacillus to produce gas, but your daily intake of aflatoxin BI in the US should be pretty low. Just don't eat moldy peanuts or other moldy things when you have lactobacillus around. Aflatoxin is a potent carcinogen so generally it is kept at a really low concentration in the human diet in the US. In china it is not well regulated and may be a problem in some areas and is implicated in the high levels of liver cancer in some regions of China.


> quote:The main characteristic of *homofermentative lactic acid bacteria is that they do not produce gas from glucose and other sugars*. However, in these experiments Lactobacillus casei, Lb. plantarum and Streptococcus lactis in broth media with glucose, galactose, lactose and sucrose, and aflatoxin B1 produces acid and also a significant amount of gas. *In the control media without aflatoxin, these bacteria did not produce gas.* The data suggest that lactic acid bacteria, known until now as homofermentative, become heterofermentative because of the influence of aflatoxin B1. The results of these investigations are of practical value because they may explain the defect of cheese "blowing," which can appear in Trapist cheese vacuum packed in foil. This type of unusual "blowing" occurs approximately one month after cheese manufacture. This defect can be characterized by very large holes and cracks inside the cheese. The flavor is similar to that of young cheese, which can be very undesirable for a ripened, Trapist, aged cheese.


AuthorsSutic M. Banina A.InstitutionDepartment of Microbiology, Faculty of Agriculture, University of Belgrade, Zemun, Yugolsavia.TitleInfluence of aflatoxin B1 on gas production by lactic acid bacteria.SourceJournal of Environmental Pathology, Toxicology & Oncology. 10(3):149-53, 1990 May-Jun.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## moms777 (Jan 29, 2000)

After taking the neomycin for a week, I felt good for about 30 days and now I'm back to my old self







I take probiotics (Culturelle) every day even during my treatment. I wonder if the results would have lasted longer had I not taken the Culturelle?


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## Blair (Dec 15, 1998)

Pete I agree with your Doctor.


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## Guest (Jun 15, 2001)

Here's the results of a study regarding lactobacillus: "In summary, the incidence of infections caused by lactobacillus may be underreported in the literature because of the failure to recognize it as a pathogen, especially in patients with severe underlying diseases. ..." Here's the link: toxicity:http://path.upmc.edu/cases/case183/dx.htmlListen to your doc.


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## Kathleen M. (Nov 16, 1999)

The article is about lactobacillus infections in bone and muscle in immunocompromised people (like they have AIDS). Which is very different from living in the colon.People who are immunocompromised get infections from just about every normally harmless bacteria, fungi etc that live on people, birds, animals, etc.And the article verifies that Lactobacillus species do not produce gas from fermenting sugars.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## Ugh (Jan 30, 2001)

> quoteoint is that probiotics will(in his opinion) make it come back sooner.


Maybe you can ask him what he bases such a strong opinion on. I'm not saying he's wrong, I'm just surprised he can be so sure unless he is looking at data we haven't seen. Also, I know he is only referring to probiotics and SIBO....some people posting in this thread seem to be confused and think the doc was referring to probiotics in general.


> quote:what helps one individual may hurt another. good advice for one may be bad for another.


Mitch, I'm not sure that would hold true for probiotics and SIBO. I don't see how it could help one person and hurt another. I can see how it might not do anything for one person and help another, but not help one and hurt one. The argument that it is helping would be that it is eliminating harmful bacteria in the SI and that when this bacteria is replaced with the probiotic strain, the symptoms are lessened. As I understand it, the argument that it might hurt you is you are increasing the number of bacteria in the SI and probiotic strains may not be any better than the other ones. I think it would be unlikely that both of these arguments could be true, which is what you seem to be suggesting.slantgrl, maybe that's why it is called Small Intestine Bacterial Overgrowth and not Small Intestine Bacterial Infection. The small intestine isn't steril in the first place. [This message has been edited by Ugh (edited 06-15-2001).]


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## Kathleen M. (Nov 16, 1999)

And just for the edification of newer members.I started out thinking that the probiotics = bad for SIBO made sense until I started looking through the literature and found only evidence that this theory didn't fit the data.If there is some data or studies where they have looked at Lactobacillus and prove it is a source of gas in the GI tract or that probiotics when given to people who have SIBO got substantially worse I'm willing to change my mind back again, but everything I've found tends to lead me to believe the theory may be logical, but the assumptions that logic is built on is faulty.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## HipJan (Apr 9, 1999)

why do so many doctors seem to frown upon the use of probiotics in general (not just in the case of SIBO patients)? I assume because there are still not volumes of accepted data about probiotics out there?


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## Kathleen M. (Nov 16, 1999)

I'm thinking it is because the probiotics started out as an alternative medicine thing with some of the claims being fanciful and is also something they just were not taught in medical school and I don't know if the companies that make them really spend the $$ to market them to doctors (although I'd guess Imodium's Probiotica may become an exception to that).There are quite a few studies on them in the medical literature and most of them seem to be favorable, with a few that showed no benefit, but also no risk. Many of the pediatric treatment papers for SIBO which is a big problem for kids with certain conditions seem to be favorable to using probiotics.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## Pete (Jan 20, 2000)

Please don't get confused and think that he means probiotics are bad for everyone. Not everyone has SIBO. Flux, where are you.I am very interested in your opinion here


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## mitchell goldstein (Apr 6, 1999)

to the best of my knowledge none of the contributors to this webpage are medical doctors. unfortunately there are a few wannabe's that pollute the air. the practice of medicine is an art performed by people who have had a background in basic medical science. in addition to this classroom training they spend from 1 to 10 years(depending on specialty) training in hospitals. the practice of medicine is an odds game with no guarantee of results when following accepted protocol or not. much of medicine is not black or white but a blending of black, white, gray and sometimes red! i find it very amusing how many of our posters make absolute statements with regards to medical issues when they haven't the foggiest idea of what the actual practice of medicine entails. anything can happen at any time to any patient undergoing any procedure or taking any medication. again, the odds would speak against many of these occurrences but nothing is absolute. every doctor develops a unique style based on his own experience in practice and training. a procedure, treatment modality or medication that one doctor might consider the best he has to offer might be frowned upon by his colleague. since i don't believe we have anybody in contention for the nobel prize in medicine we should be more open minded and flexible. we shouldn't be quick to judge another's material if it doesn't appear to be black or white when we have no expertise to do so. ibs is a disorder which includes abnormally intense focus on a bodily function; many of the threads on this webpage prolong and intensify this focus when we should be trying to go in the other direction and return our bowel function to a comfortable autopilot if you will. i'm here to get helpful hints and to provide whatever help i can and not get involved is this scientific gibberish!


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## Kathleen M. (Nov 16, 1999)

I'm sorry if reading the medical literature and introducing some science into the whole medical issue is so offensive.I am concerned when doctors seem to be ignoring what evidence we do have.Yep medicine is an art, and it is supposed to be based in science as well. And ignoring data that doesn't fit your biases is not a good way to be conducting medical research or practicing medicine.Sometimes a doctors feelings about things are wrong. Any number of longstanding practices that doctors just know work have been shown in rigorous testing to be useless. There needs to be a melding of your experince and objective use of science as ignoring the data available often leads you down the wrong path no matter how 100% sure your feelings tell you something is.While I may not practice medicine I am qualified to analyze the data available and make an informed opinion about the data.The data says Lactobacillus doesn't produce gas under normal conditionsThe data in patients with SIBO done by doctors who practice medicine and the opionon of several doctors who work with pediatric patients with SIBO is that probiotics will not hurt the patients and may improve the condition. Else why would they include the use of probiotics as one of the treatment modalities to try in papers written about how to treat SIBO??All my experience as a researcher leads me to question pretty much any assumption anyone has about anything (including me) Any number of times the data is saying X when you think Y should be happening and it can be very hard to see that. Medical doctors unfortunately get precious little training in how to do that and that can cause big problems when they design experiments and analyze the data. It is difficult to make sure the experiment proves you wrong and it is also suprisingly difficult to read the medical literature and make sure you are not making false assumptions. For anyone trying to have any scientific basis to the work that they do.K.PS I am not making ABSOLUTE statements. Find the data to PROVE me wrong and I'll change my mind. I've already changed it once on this subject. ANd the only one who is 100% for sure is Pete's Doc, NOT ME.Did you really mean to come off as sounding like there shoud be NO science in the practice of medicine because it sounds like you believe science and data have very little if any value in the practice of medicine.FWIW all biologists know that EVERYTHING involving animals is a #### shoot. I am a firm believer in the Harvard Law....under the most rigoursly controlled conditions the animal (or human) will do as they damn well please. Scientists are acutely aware that nothing is 100%, or works the exact same way in all organisms. Because the organisms we study seem to delight in teaching us humility.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html [This message has been edited by kmottus (edited 06-15-2001).]


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## mitchell goldstein (Apr 6, 1999)

kmottus, when you treat your first patient maybe then you will understand! when you see a patient do poorly despite the fact that modern medical principles have been adhered to and applied properly or when you see a patient thrive and do well despite the fact that his case has been grossly mishandled maybe then you will understand. i don't know what your background or education are but laboratory science and the analysis of its data is a far cry from treating patients in a clinical setting! a doctor who treats laboratory data or diagnostic tests while ignoring the whole presentation of his patient or his own medical intinct is a poor doctor indeed!


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## Julia37 (May 9, 2001)

>Yep medicine is an art, and it is supposed to be based in science as well. And ignoring data that doesn't fit your biases is not a good way to be conducting medical research or practicing medicine.<That's right! And almost all the doctors I've ever met were doing exactly that.kmottus, have you ever read Elizabeth Peters' novels? All her continuing characters are academics - and they can't be any sillier than real life!To me, any doctor that talks in absolutes is giving me a red flag. I know enough about science and analysis to know there's a lot medical science doesn't know, and just as much that is fairly obvious but that it refuses to recognize (food allergies, anyone? Thyroid disease?). Perhaps if medical science actually did know everything, instead of only thinking it does, then experiments and analysis would not contain any surprises. They are a very, very long way from achieving that.I can understand that someone who is not technical and analytical like me might not be comfy with a doctor saying "it's very unlikely" versus "absolutely not", but a doctor who doesn't stay open to possibillities(sp?) is not doing himself or his patient any favors.


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## Ugh (Jan 30, 2001)

> quote:. i'm here to get helpful hints and to provide whatever help i can and not get involved is this scientific gibberish!


Huh? Mitchell, so I guess you're sticking to non-scientific gibberish then. I have no idea what your point is. Of course people here aren't doctors, but to assert that only an MD can comprehend this discussion is ridiculous. In fact, I believe most doctors know very little about bacteria and the intestines. If for example you took several weeks and studied gas you would probably know more about gas then over 99% of doctors in my opinion. There is nothing wrong with trying to be informed and questioning the advice of Doctors rather than blindly following their advice. Having said that, Pete's doctor should know more than all of us about bacteria, which is why we are curious what he knows that makes him 100% sure.


> quote:kmottus, when you treat your first patient maybe then you will understand!


Yes! And lets not question the police until we are cops and can be in their shoes, or wonder about a lawyers advice until we take the bar, or question are governments actions until we get elected and are blessed with that mystical energy force by which we become all knowing... blah blah blah...what a load. This thread was about probiotics and SIBO, and nobody here is claiming they know anything for sure except Pete's doctor...and we want to know why based on what we've seen. Nobody is saying the doctor can't be right, we just want to know why he thinks the way he does....sorry, just pissed off and you make it easy.[This message has been edited by Ugh (edited 06-16-2001).]


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## flux (Dec 13, 1998)

> quote:In a nutshell he said that I peaked at 60 minutes on my first breath test which is definately SIBO


I've been curious, for your H2 study, did you...eat no less than 12 before the exam began and only a low-carb diet, like lamb and rice?not smoke?had your mouth washed with antibacterial mouthwash before the study began?These are things the study didn't mention and those are troubling because they are important to ensure a good study.Assuming they were, then I'm beginning to entertain that the peak at 60 minutes could be SIBO, but I'm not saying definitely because peaking at 60 minutes still is not absolute. The lactulose test is so temperamental that even under well-controlled conditions it could produce a bad result.However, I still think that your gas problem is related to something colonic.Regarding the probiotics, I'm not convinced of studies that say probiotics don't make things worse or even make things better for SIBO because it seems amazing that they could avoid or even interfere with the mechanism that seems to bring about the problems caused by SIBO. But at the same time, I don't agree with the notion that there would any dramatic increase in gas production from these bacteria, which as K has explained are mostly non-gas producing.


> quote:As far as my burping and feeling like I need to burp go, he wants me to try peppermint oil before meals. Because I am doing this he wants me to double my PPI. He feels my dyspepsia may be related to my fundoplication. 2 weeks trial of peppermint and if that doesn't work then 2 week trial of baclofen. Does this sound reasonable?


The peppermint should make belching easier presumably lowering LES pressure and therby allowing gas to move up into the esophagus. So yes, I think this sounds reasonable.------------------I am not a doctor, nor do I work for profit in the medical/pharmacological field, but I have read scientific and medical texts, and have access to numerous sources of medical information that are not readily available to others. One should always consult a medical professional regarding advice received.


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## Kathleen M. (Nov 16, 1999)

I've worked with enough biological organisms to understand FULLY that sometimes the best layed plans of mice or men oft go awry.You do everything right...it fails.You muck it up...it works.ALL THE TIME. Whether your talking yeast, mice, bacteria, people. Humans are NO different in this regard. (PS does working with patients in a clinical trial count in your eyes...been there, done that, and they are no more and no less flukey than any other organism I've worked with other than they complain that they get bored when they eat the same 3 day diet for 6 weeks and the yeast, etc. don't...or at least not in words this researcher can understand).However do you think it is a good thing for a doctor to tell a patient something that is biologically unlikely to be true or is that OK in your opinion because the doctor either wants it to be true or thinks it is in the best interest of the patient to state things without knowing if they are true or not.Lactobacillus DO NOT produce gas from carbohydrates like other bacteria in the colon do.May be misrepresenting biological facts is OK for you, but it bothers me.Again the only person who is 100% certain here is Pete's doctor. NOT ME. Show me an experiment where Lactobacillus produce gas, or especially produce MORE gas than is produced other bacteria in either the colon or the small intestine and I'll change my tune.I AM NOT 100% certain, but the preponderance of the evidence suggests at least that THEORY about why probiotics are bad for patient with SIBO is bogus.However, I would take information like when he works with patients 80% of the time taking probiotics make it worse (without coming up with a biologically implausable mechanism--problem is doctors are not trained extensively in microbiological physiology as it's hard enough to understand people well enough to practice medicine) that I would take as evidence the doc knows something...but the explainations all seem to be of the I logically think it would be bad type of thing but not one that appears to have been formed by reading any of the relevant data or lit.At least pull down the microbiology text and find out if Lactobacillus produce gas before offering it up as a theory.Does it bother you that I think doctors are just human beings like the rest of us and they make very human errors just like the rest of use and don't take everything they say by faith alone?Doctors are not gods and they can make the same errors in logic that anyone else can. I just would like that they fact check there assumptions. Is that TOO MUCH to ask?Flux reading around it sound like at least in animals (vet journals) that lactobacillus may at some level be a normal resident of the small intestine when there isn't any pathology. In fact they seem to be trying to get it to live in the animals as it increases weight, may be interacting with the mucosa in beneficial ways and have some beneficial immunological type responses. This may be why it is not hurting people with SIBO, the benefits of getting it to live in the small intestine may outweigh any problems it causes.I dunno if it's to any sort of biological certainty, but there is alot of lit about using lactobacillus to ferment the silage and alot of what lactobacilli do when they are living in the small intestine in animals. You'd think if it was a really bad thing the papers would be more of the how can we rid the animals of lactobacillus type of thing.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html [This message has been edited by kmottus (edited 06-16-2001).][This message has been edited by kmottus (edited 06-16-2001).]


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## flux (Dec 13, 1998)

> quote: This may be why it is not hurting people with SIBO, the benefits of getting it to live in the small intestine may outweigh any problems it causes.


It's hard for me to see how they would not make matters worse. In an intestine where the motility is hampered, sloughed off tissue, mucus and bacteria don't get flushed out at a regular pace and this gunk starts physically interfering with digestion and absorption at the brush border where the villi sit. In addition, any large volume of bacteria, lactobacillus included, should chemically alter bile making it useless and thus interfering with fat absorption.------------------I am not a doctor, nor do I work for profit in the medical/pharmacological field, but I have read scientific and medical texts, and have access to numerous sources of medical information that are not readily available to others. One should always consult a medical professional regarding advice received.[This message has been edited by flux (edited 06-16-2001).]


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## Kathleen M. (Nov 16, 1999)

I get what your saying, but the animal data seems to indicate overall lactobacillus supplementation increases weightgain and other things they want to happen in animals.There has been a recent study that indicated that one of the bacteria was interacting in germ-free mice in way that was beneficial to the organism (not sure it was just colonic or also small intestine). And one of the articles seem to indicate that lactobacillus (now this may be in normal levels in the small intestine--there is always some amount of bacteria living in there and if any bacteria at all was bad then we'd all be really sick) may be altering the mucosa in a way that sounded like it might explain the increased weight gain (which I assume = increased absorption).Now large amounts of bacteria of any kind would be bad, but some bacteria may be more likely than other to be problematic. Just like any ecological systeme some organisms are more likely to get out of hand that others, and I'm not sure how likely lactobacillus (even though common in the small intestine) is to be a problematic species.Now most of this is done in animals, not humans so there could be differences.Title Diet supplemented with yoghurt or milk fermented by Lactobacillus casei DN-114 001 stimulates growth and brush-border enzyme activities in mouse small intestine. Author Thoreux K ; Balas D ; Bouley C ; Senegas-Balas F Address Laboratoire d'Histologie, Facultï¿½e de Mï¿½edecine, Nice, France. thoreux###unice.fr Source Digestion, 59(4):349-59 1998 Jul-Aug Abstract The nutritional benefits of lactic acid bacteria in fermented dairy products have been well documented, especially in terms of weight gain and feed efficiency, but not in terms of small intestine adaptation. The effects of a diet supplemented (30% wt/wt) with milk fermented either by Lactobacillus casei DN-114 001 or yoghurt for 3 or 15 days were investigated in the small intestine of mice by morphometry, kinetic analysis and determination of brush-border enzyme activities. Results were compared with those obtained with standard or milk isocaloric diets. Cell proliferation and villous area were significantly increased in the proximal intestine of mice fed the fermented-milk-supplemented diets for 3 days and were associated with hypertrophy and hyperplasia of Paneth and goblet cells. Lactase-specific activity was increased by fermented-milk diets at days 3 and 15, whereas there was no variation in maltase-specific activity. Alkaline phosphatase-specific activity was increased after 3 days of the three tested diets in the whole intestine, and after 15 days in the proximal intestine. Aminopeptidase activity was increased in the distal part of the intestine after 3 days of the 3 diets. Our findings suggest that diets supplemented with fermented milks have a positive effect on the trophicity of the mucosa in the small intestine of mice. Here is an isolating a lactobacillus species that colonizes the small intestine of the pig.Title Lactobacillus mucosae sp. nov., a new species with in vitro mucus-binding activity isolated from pig intestine. Author Roos S ; Karner F ; Axelsson L ; Jonsson H Address Department of Microbiology, Swedish University of Agricultural Sciences, Uppsala. Source Int J Syst Evol Microbiol, 50 Pt 1(-HD-):251-8 2000 Jan Abstract A new Lactobacillus species from pig small intestine has been identified. In an attempt to isolate Lactobacillus reuteri strains carrying the putative colonization-factor gene (mub, for mucus binding) a mub-derived gene probe was used to screen pig intestinal material. A number of isolates were obtained and primary characterization showed that they were Gram-positive, catalase-negative, non-spore-forming, non-motile rods. Growth occurred at 45 degrees C but not at 15 degrees C and the DNA G+C content was 46 mol%. Cell wall analysis together with DNA-DNA hybridization and analysis of the 16S rRNA sequence revealed that the new isolates represent a previously undescribed Lactobacillus species closely related to L. reuteri, Lactobacillus fermentum and Lactobacillus pontis. The name Lactobacillus mucosae is proposed for this species and the type strain is S32T. This one indicates these probiotic strains aren't doing alot of the things associated with GI flora in general. Is this what you were concerned that Lactobacillus was doing?Title Establishment of Lactobacillus and Bifidobacterium species in germfree mice and their influence on some microflora-associated characteristics. Author Norin KE ; Persson AK ; Saxerholt H ; Midtvedt T Address Department of Medical Microbial Ecology, Karolinska Institute, Stockholm, Sweden. Source Appl Environ Microbiol, 57(6):1850-2 1991 Jun Abstract Germfree mice were inoculated with both Lactobacillus acidophilus A10 and Bifidobacterium bifidum B11. Both strains were established and present in more than 10(8) cells per g of cecum and colon contents. Furthermore, L. acidophilus A10 was established in high numbers in stomach and small intestine. Contents from different parts of the intestine were investigated with regard to the following microflora-associated characteristics: degradation of mucin, beta-aspartylglycine and tryptic activity, conversion of cholesterol to coprostanol and bilirubin to urobilinogen, deconjugation of bilirubin glucuronides, and reduction of the cecum size. In spite of being established, the microbes were not able to mediate any alterations of the parameters investigated. All animals retained values as found in their germfree counterparts. Here is another probiotics are not altering intestinal things (small intestine is in the MESH not the abstract) in a way that sounds like may be a thing problem bacteria do.Title Inability of Lactobacillus casei strain GG, L. acidophilus, and Bifidobacterium bifidum to degrade intestinal mucus glycoproteins. Author Ruseler-van Embden JG ; van Lieshout LM ; Gosselink MJ ; Marteau P Address Dept. of Immunology, Erasmus University, Rotterdam, The Netherlands. Source Scand J Gastroenterol, 30(7):675-80 1995 Jul Abstract BACKGROUND: Lactic acid bacteria have been suggested for use in the prevention of relapse of ulcerative colitis and of recurrent pouchitis. These strains may not damage the protective intestinal mucus glycoproteins. METHODS: Lactobacillus casei strain GG and strains isolated from a commercial fermented product (Lactobacillus acidophilus, Bifidobacterium bifidum, and a mesophylic lactic culture) were cultured in vitro on hog gastric mucin and human intestinal glycoproteins. Furthermore, germ-free rats were mono-associated with Lactobacillus GG and poly-associated with the other strains. Glycoproteins were isolated from rat distal ileum, cecum, and colon. Mucus degradation was established by assaying carbohydrates (hexosamines, hexoses, pentoses), proteins, and blood group antigenicity. RESULTS: All strains colonized the intestinal mucus but were not found in the deep crypts. Degradation of mucus glycoproteins was observed neither in vitro nor in vivo. CONCLUSION: The tested strains do not break down intestinal mucus glycoproteins and thus far are safe to use for therapy. It appears they think getting lactobacillus to grow in these people is a good thing...but I'm not clear what the implications of the endpoint tested for was. Of course I dunno if these people were prone to SIBO or not. I also don't know if Lactobacillus tends to overgrow or under what conditions.Title Survival of yogurt-containing organisms and Lactobacillus gasseri (ADH) and their effect on bacterial enzyme activity in the gastrointestinal tract of healthy and hypochlorhydric elderly subjects. Author Pedrosa MC ; Golner BB ; Goldin BR ; Barakat S ; Dallal GE ; Russell RM Address US Department of Agriculture Human Nutrition Research on Aging, Tufts University, Boston, MA. Source Am J Clin Nutr, 61(2):353-9 1995 Feb Abstract The effect of the live bacterial yogurt cultures, namely Streptococcus thermophilus and Lactobacillus bulgaricus, and a mucosal adhering strain of Lactobacillus gasseri (ADH) on small intestinal and fecal bacterial characteristics was examined in 10 elderly subjects with atrophic gastritis and 23 elderly normal volunteers (11 received yogurt and 12 received ADH). Neither S thermophilus nor L bulgaricus was recovered from the stomach or small intestine of subjects fed yogurt or pasteurized yogurt. ADH was recovered from gastric or small intestinal aspirates in three of four subjects and in the stools of four of five subjects diagnosed with atrophic gastritis. In 11 of 12 normal subjects, ADH was isolated from stools. There was a significant reduction in fecal bacterial enzyme activity in both normal volunteers and subjects with atrophic gastritis after being fed with viable ADH. Adherent strains of bacteria such as ADH are likely to survive passage through the gastrointestinal tract and thus have greater metabolic effects. I think the recent gene expression paper was reported on this bb, but I didn't find it in the medline search...I'll see if I can find the link here (I don't think I figured out which words would pull it up).Anyway I'd like to hear your analysis of these papers.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## Kathleen M. (Nov 16, 1999)

bump for flux.


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## Kathleen M. (Nov 16, 1999)

bump for flux


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## flux (Dec 13, 1998)

> quote:Anyway I'd like to hear your analysis of these papers.


I don't doubt that probiotics do good stuff for us as these papers say. I have two books on intestinal bacteria and one that is just about probiotics. This is essentially more of the same. The question is whether they can and actually do help with BO.Right now, for me, it is just a matter of the weight of evidence. And I still think it is still a feather. If a brick gets collected that says probiotics help in BO, then I'll accept it too, and start thinking of it as a paradox. (Don't we hate paradoxes?) Perhaps then we will come to a better understanding of how it then works. Perhaps for all we know, probiotics have such a positive effect on the deranged motility causing BO that they effectively treat the disease itself, perhaps.------------------I am not a doctor, nor do I work for profit in the medical/pharmacological field, but I have read scientific and medical texts, and have access to numerous sources of medical information that are not readily available to others. One should always consult a medical professional regarding advice received.


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## Kathleen M. (Nov 16, 1999)

Paradoxes are fun aren't they







While I'm not sure the evidence supports they help, but there is enough evidence thatI just can't buy the 100% certainty that they make BO worse. I don't think we know enough to come down on either side. The more I read the less certain I am that it would hurt (as they do things in the small intestine that are generally good things, and aren't as likely as other bacteria to do the bad things).But ecology overall is problematic to understand even in simple systems and the whole bacterial overgrowth/probiotics thing is more an microbial ecology issue rather than a physiological issue.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## Blair (Dec 15, 1998)

Well my graph indicated SIBO and probiotics make me worse. So my two cents worth is they are NOT GOOD for everyone.


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## Kathleen M. (Nov 16, 1999)

Just to be clear.I NEVER said they were.Even adding something good to a complex ecological system could occasionally make something bad in the system behave even worse. I would expect that in these cases (upsetting the apple cart of ecology cases) that the problems would be quite noticable when you start but may get better after a couple of weeks to a month. Eventually a new steady state should be generated that may be better than the original state, but the living with the change over may be unbearable. (In cows the switch over from one microbial ecology steady state to another state must be done slowly, or you can rupture part of the stomach. A friend of mine was working with the guys at my grad school who were trying to figure out the best way to switch cows from one diet to another. Luckily for the cows they had a tube inserted into the stomach and the cap would blow off before the stomach ruptured. Not so lucky for my friend as when the cap blew off the disgustingly smelly partially digested glop would be sprayed all over the stall).In the study with IBSers (which could also cause this upsetting the apple cart kinda problem) who had gas problems and were given probiotics (note the SIBO is also supposed to be causing gas problems with antibiotics fixing it) which was fairly small (30 in the treatment group) the gas went away quickly with no one getting an increase so the rate of having microbial ecology upset seems likely to be low, but since Culturelle warns of a transient (week or two) increase in gas production (which would mesh with the apple cart upset theory) I suspect it is reasonable to assume that it does happen at some low but noticable frequency.However, the blanket they are 100% bad for everyone with SIBO certainly doesn't appear to be justified by the data in the medical literature.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html [This message has been edited by kmottus (edited 06-18-2001).][This message has been edited by kmottus (edited 06-18-2001).]


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## Blair (Dec 15, 1998)

K, I know you didn't, I just mentioned my own personal experience in case there are others like me who keep tring Probiotics and are not getting better but acually feel worse. For years I tried different Probiotics and yogurts certain they would help. Now at least I have some clue as to why they didn't if CS is to be believed. the same goes for fiber suppliments like metamucil or starchs like FOS. Just looking for a common link to others like me with my paticular brand of "IBS"


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## Kathleen M. (Nov 16, 1999)

One interesting paper popped up in the search for NSAID-leaky gut thing that pegged my interest about the probiotics/SIBO thing.I'm gonna have to find out why they say what they do (is it more of an opinion or what studies back up what they say that I may not have found, yet).Again nothing is going to help 100% of anybody.AuthorsGotteland M. Cruchet S. Verbeke S.InstitutionGastroenterology Unit, Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile. mgottela###uec.inta.uchile.clTitleEffect of Lactobacillus ingestion on the gastrointestinal mucosal barrier alterations induced by indometacin in humans.SourceAlimentary Pharmacology & Therapeutics. 15(1):11-7, 2001 Jan.Local MessagesHSL currently receives; holdings are incomplete.AbstractBACKGROUND: Chronic nonsteroidal anti-inflammatory drug (NSAID) ingestion strongly affects the gastrointestinal mucosa as a first stage before ulceration. *Some Lactobacillus strains may stabilize the mucosal barrier by increasing mucin expression, reducing bacterial overgrowth,* stimulating mucosal immunity and synthetizing antioxidant substances; these events are altered in NSAID-associated gastroenteropathy. AIM: To determine whether ingestion of the probiotic Lactobacillus GG (LGG) protects the gastrointestinal mucosa against indometacin-induced alterations of permeability. SUBJECTS AND METHODS: Four gastrointestinal permeability tests were carried out in random order in 16 healthy volunteers: (i) basal; (ii) after indometacin; (iii) after 5 days of living LGG ingestion before indometacin administration; (iv) after 5 days of heat-killed LGG ingestion before indometacin administration. RESULTS: Indometacin significantly increased basal sucrose urinary excretion (29.6 mg and 2 over black square]; [1 and 2 over black square]7.1-42.1] vs. 108.5 mg [68.2-148.7], P=0.0030) (means [95% CI]) and lactulose/mannitol urinary excretion (1.03% [0.73-1. 32] vs. 2.93% and 2 over black square]; [1 and 2 over black square].96-3.90], P=0.00012). Heat-killed LGG did not modify the indometacin-induced increase of gastrointestinal permeability, while live bacteria significantly reduced the alteration of gastric (47.8 mg [31.1-64.6], P=0.012) but not intestinal permeability induced by NSAID. CONCLUSIONS: Regular ingestion of LGG protects the integrity of the gastric mucosal barrier against indometacin, but has no effect at the intestinal level.I wonder what they use to state that. ------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## Kathleen M. (Nov 16, 1999)

Blair--Here's one for you







Probiotics with different diets had differnet results, so could be one cause of probiotics being a problem in some cases.Probiotics reinforce mucosal degradation of antigens in rats: Implications for therapeutic use of probioticsPessi T, Sutas Y, Marttinen A, Isolauri EJOURNAL OF NUTRITION 128 (12): 2313-2318 DEC 1998Document type:ï¿½Articleï¿½ï¿½ï¿½ Language:ï¿½Englishï¿½ï¿½ï¿½ Cited References:ï¿½39ï¿½ï¿½ï¿½ Times Cited:ï¿½10ï¿½ï¿½ï¿½ Abstract:The effects of probiotics, administered with different diets, i.e., unhydrolyzed or hydrolyzed dietary antigens, on macromolecular degradation in the gut mucosa were studied. Rat pups were divided into five feeding groups at the age of 14 d. In addition to maternal milk, the milk group was gavaged daily with cows' milk and the hydrolysate group with extensively hydrolyzed whey formula, while controls received sterile saline. In addition to these diets, the milk-GG group and the hydrolysate-GG group were given probiotic bacteria, Lactobacillus GG ATCC 53103 (10(10) colony-forming units per day). At 21 d, the absorption of macromolecules, horseradish peroxidase and beta-lactoglobulin across patch-free jejunal segments was studied in Ussing chambers. The degree of macromolecular degradation was studied by means of HPLC gel filtration. The absorption rate of intact horseradish peroxidase differed among the feeding groups (P = 0.038). This was due to the high median (interquartile range) absorption of intact horseradish peroxidase (ng x h(-1) x cm(-2)) in the milk group [255 (14-1332)] and supplementation with L. GG in the milk-GG group [35 (8-233)] restoring the status to the control level [22 (0-116)]. A parallel effect was seen in the hydrolysate group [100 (9-236)] vs, the hydrolysate-GG group [1 (0-13)]. A gel filtration study confirmed that larger molecules were absorbed across the mucosa in the milk group compared to the other groups. The absorption of degraded horseradish peroxidase differed between the feeding groups (P = 0.005). L. GG had a distinct effect when administered with unhydrolyzed, native protein vs, hydrolyzed protein: it increased absorption of degraded horseradish peroxidase in the milk-GG group [7310 (4763-8228)] vs. the milk group [3726 (2423-5915)], while reducing it in the hydrolysate-GG group [2051 (1463-2815)] vs. the hydrolysate group [4573 (3759-9620)]. Our results showed that probiotics not only restore aberrant macromolecular transport, but they also have a specific effect on mucosal degradation depending on dietary antigen: adjuvant-like properties (unhydrolyzed antigen) and immunosuppressive-like properties (hydrolyzed antigen). The antigenicity of the diet therefore should be taken into consideration, when introducing novel probiotic functional foods for the management of gastrointestinal disorders.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## Kathleen M. (Nov 16, 1999)

Looked through the references there are a couple of things where something that the probiotics are excreting seem to be mucking with other microbes.It lowered but didn't eliminate h.p. in the stomach and in a trial where they induced ulcers with an NSAID something excreted by the probiotics did influce the microbial ecology and ulcer formation (drug alone altered the microbial ecology and the probiotic seemed to prevent that from happening).Not great evidence, but that it may be able to muck with the overall ecology is one reason that there could be mostly good but occasional bad...depends on what your ecology is currently like and what the mucking actually does to the ecology.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## Blair (Dec 15, 1998)

I'll tell you my theory about Probiotics. really just a guess. Ok lets say SIBO is a fact and in some people causes IBS, the intestine then goes on the defensive against the bacteria using whatever it uses to do this (MNL likes to elaborate on this) How does the intestine differentiate between so called good ( lacto) and netrual( e-coli) bacteria? And as far as the gas goes, maybe even good bacteria in the SI interfere enough with digestion that unabsorbed sugars get to the colon causing gas, there can't be all lactobacteria in the colon. I've thought about this now for years, tring to explain why most yogurts make me sick but one paticular yogurt Yoplait custard style doesn't. I can also eat ice cream is its not lactose intolerence. My good friend simply says the Yoplait is "ice cream" and not real yogurt anyway. He used to make his own and eats lots of Mountain High Yogurt, always telling everyone how great this is for you , blah, blah, blah. Someday he's going to wear that yogurt







.


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## Blair (Dec 15, 1998)

I'll tell you my theory about Probiotics. really just a guess. Ok lets say SIBO is a fact and in some people causes IBS, the intestine then goes on the defensive against the bacteria using whatever it uses to do this (MNL likes to elaborate on this) How does the intestine differentiate between so called good ( lacto) and netrual( e-coli) bacteria? And as far as the gas goes, maybe even good bacteria in the SI interfere enough with digestion that unabsorbed sugars get to the colon causing gas, there can't be all lactobacteria in the colon. I've thought about this now for years, tring to explain why most yogurts make me sick but one paticular yogurt Yoplait custard style doesn't. I can also eat ice cream is its not lactose intolerence. My good friend simply says the Yoplait is "ice cream" and not real yogurt anyway. He used to make his own and eats lots of Mountain High Yogurt, always telling everyone how great this is for you , blah, blah, blah. Someday he's going to wear that yogurt







.


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## Ugh (Jan 30, 2001)

I don't think it's possible for the bacteria in a yogurt to make you sick in the way you describe, and even if your theory about SIBO was right, SIBO doesn't work like that. It's probably just an ingredient in the yogurts or maybe it's not the yogurt at all that makes you have symptoms. I don't see how the bacterial makeup of Yoplait would be less in a custard style. If you want to test your theory just take some probiotic Acidophilus and see if that makes you sick. In my opinion it won't.


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## Ugh (Jan 30, 2001)

I don't think it's possible for the bacteria in a yogurt to make you sick in the way you describe, and even if your theory about SIBO was right, SIBO doesn't work like that. It's probably just an ingredient in the yogurts or maybe it's not the yogurt at all that makes you have symptoms. I don't see how the bacterial makeup of Yoplait would be less in a custard style. If you want to test your theory just take some probiotic Acidophilus and see if that makes you sick. In my opinion it won't.


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## Blair (Dec 15, 1998)

Yes very sick the next day. Just last month took the probiotic Bifidus, had a very bad next day. GGS acidophillus takes a few days longer but with the same results, sick. Only the freeze dried ones don't do much. I beleive this is because they are dead in those capsules. I did the whole Probiotic thing for years after first getting sick. A very bad mistake on my part.


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## Blair (Dec 15, 1998)

Yes very sick the next day. Just last month took the probiotic Bifidus, had a very bad next day. GGS acidophillus takes a few days longer but with the same results, sick. Only the freeze dried ones don't do much. I beleive this is because they are dead in those capsules. I did the whole Probiotic thing for years after first getting sick. A very bad mistake on my part.


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## Ugh (Jan 30, 2001)

No offense, but I don't think probiotics are causing your symptoms. You said yourelf when you took acidophilus you were okay. Well, you said a few days later you were sick, and I don't see how you can conclude acidophilus is causing that when you seem to be saying yogurt makes you sick more quickly. I've read things where they determined yogurt doesn't even deliver much probiotics to the intestine, which is why people use probiotics.


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## Ugh (Jan 30, 2001)

No offense, but I don't think probiotics are causing your symptoms. You said yourelf when you took acidophilus you were okay. Well, you said a few days later you were sick, and I don't see how you can conclude acidophilus is causing that when you seem to be saying yogurt makes you sick more quickly. I've read things where they determined yogurt doesn't even deliver much probiotics to the intestine, which is why people use probiotics.


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