Benefits of Probiotics for Gut Health and Migraine

0:00 Migraine Canada. Ask your
0:12 pharmacist. Uh again we are
0:16 very happy and this is the
0:17 first time I can say with good
0:21 weather in Canada. On a good
0:23 weather day I’m hoping that you
0:26 are you have joined us already.
0:29 Um my name is Heather Hani. I’m
0:32 your host for the Migraine
0:34 Canada and Osteopharmacist
0:35 Series. And today it gives me
0:36 great pleasure to welcome our
0:38 very special guest Doctor
0:40 Dragana Skokovich Sonyak. Did I
0:44 get it right or Sonyak? You
0:47 did. The only thing you missed,
0:49 I’m not a doctor, I’m a
0:50 pharmacist. So that’s, the R is
0:51 from Dragon and not the doctor.
0:54 Not from doctor, okay? So,
0:58 apologies, because I keep on
1:00 saying the, welcome to Migraine
1:05 Canada and to Ask Your
1:05 Pharmacist Um, Dragana is a
1:09 pharmacist. Uh, she’s a
1:10 clinical pharmacist and she’s
1:12 currently practicing in
1:14 Hamilton in the family health
1:17 team, is that right? That is
1:17 correct, yes. This team is
1:19 actually a collaborative
1:21 clinical practice where you
1:23 have a pharmacist integrated
1:24 into the clinical setting and
1:27 this is where she provides care
1:29 and provides support for people
1:31 who need to work with someone
1:35 focusing on probiotic s and
1:38 adding probiotic s to their
1:39 clinical management of
1:41 infections and other
1:42 conditions. Uh Draganas work we
1:45 were just talking before we
1:47 started and you said that you
1:50 have been working
1:57 For more than 30 years, you
1:58 started in Croatia and then you
1:59 moved to Canada and got
2:00 licensed in Canada in nineteen
2:01 ninety-five. So, a long long
2:03 time and you started as a
2:06 general pharmacist, I assume.
2:07 And then in twenty fifteen, you
2:10 discovered this or you’ve
2:13 decided to take probiotic s to
2:15 the next level in Canada and
2:16 not only in Canada but in
2:18 Canada and the States. Correct
2:20 me if I’m wrong but probiotic
2:22 seem to be your passion.
2:24 Similar to how migraine is what
2:27 I now feel is my biggest
2:29 passion. And you have actually
2:35 made such an impact on how we
2:37 use a probiotic s in Canada and
2:39 in the US that now you have
2:41 clinical guidelines. You have
2:43 actually guides for people who
2:45 want to prescribe probiotic s.
2:47 Um and this guide is not only
2:48 used in the US and and Canada
2:50 is also used all around the
2:51 world. Welcome. Thank you very
2:54 much for accepting to be with
2:55 us today. I know migraine is
2:57 not what you are usually
2:59 working with but when we
3:02 started talking, we saw that
3:03 there’s a a great a great
3:06 wealth of information that our
3:07 our community would definitely
3:10 benefit from having you with us
3:11 tonight. Well, thank you again
3:15 so much for inviting me. I like
3:16 to talk about many different
3:18 subjects and probiotic s is one
3:19 of the passions that I have. As
3:21 as you mentioned it’s I’ve been
3:24 involved with educating on
3:25 probiotic s for a long time. Uh
3:27 the clinical guide for
3:29 probiotic products available in
3:31 Canada started in two thousand
3:33 and eight. And then expanded in
3:35 US in two thousand fifteen. And
3:37 it’s the resource table or or a
3:40 guideline that has been updated
3:42 every year ever since. So it’s
3:44 a definitely a work of passion
3:47 that has been accepted and
3:49 recognized globally. Uh
3:55 because we do try to look at
3:56 the evidence and you know for
3:56 those for specific strains and
3:57 then help and assist providers
3:59 and clinicians when they’re
4:00 deciding what to recommend to
4:01 their patients. So I believe
4:04 there’s definitely lots for us
4:05 to talk about today. Um and and
4:09 we can maybe start with some of
4:12 the kind of a basic things
4:13 about probiotics because it’s a
4:17 very interesting and a buzzword
4:19 these days. Anything that has
4:21 to do with probiotic s,
4:24 microbiome, microbiota, good
4:25 bacteria. It’s very sexy.
4:28 Everybody likes it. So
4:30 everybody you know you put
4:31 something on a label or a
4:32 headline. Everybody’s
4:33 interested. Uh the fact is you
4:36 don’t not know enough about it.
4:38 And we do know there’s a huge
4:40 impact and we still learn a
4:41 lot. But more we learn, more we
4:44 realize there’s so much more
4:46 that we do not understand. So
4:47 this is
5:04 we are going to try to kind of
5:05 pull the curtain back and
5:06 understand some of the issues
5:07 and and challenges. Maybe get
5:08 some good advice to take home
5:08 and think about what is it that
5:09 I can do at home that will
5:10 improve my gut microbiome and
5:10 it’s supported in a good way
5:11 and why is that important? And
5:12 I’m I’m I’m I’ve always when we
5:16 studied I’ve always heard that
5:18 all disease starts in the
5:19 stomach. Uh that’s something
5:20 that’s like thousands of years
5:21 ago. The first doctors or the
5:26 first health philosophers they
5:30 started by talking about how we
5:32 need to start in the stomach.
5:33 And this microbiome is a
5:35 question that I get from a lot
5:36 of my patients. Like I get the
5:38 question like which one should
5:41 I take? And in pharmacy usually
5:43 we used to get these
5:46 prescriptions that have an
5:47 antibiotic and we add a
5:48 probiotic to them just to
5:50 ensure that there’s no super
5:51 infection. But when it comes to
5:53 migraine there there a lot of
5:56 our patients that live with
5:58 migraine but also with other GI
6:01 issues where there’s also a lot
6:05 of medications that they’re
6:05 taking that that is affecting
6:08 their stomach and they feel
6:09 that there’s a need for us to
6:11 understand a little bit more
6:13 about the microbiome, about the
6:15 gut health and and about
6:17 anything that we can add to our
6:19 arsenal of of you know tools
6:24 that we can
6:30 fight or we can actually manage
6:31 migraine with. Um do you want
6:31 us to start with our stream? I
6:32 would say first hello. I have
6:33 we have guests from Ottawa, we
6:36 have Calgary, we have it looks
6:40 like we have already started to
6:44 have our viewers. Welcome to
6:46 everybody who’s joining us
6:47 tonight. Uh please write your
6:49 comments, your experience, your
6:53 questions in the chat and we
6:53 will try to
7:02 address them as as soon as we
7:03 see them or if we can at the
7:04 end of of this talk. Thank you
7:05 very much for joining us again.
7:05 Dagana, would you like us to
7:07 start with a small presentation
7:09 about what is what are
7:14 probiotic s? Sure. Perfect.
7:15 That would be great because
7:16 again, one of the things that
7:18 you mentioned in introduction,
7:21 the gut microbiome and all the
7:22 questions that we receive. Uh
7:24 the quite often the question
7:25 is, where they come
7:35 and and why we need them and do
7:36 we always have them in a gut?
7:37 Because you know in our
7:38 training as a pharmacist, my
7:39 training as a pharmacist years
7:40 and years ago, the only
7:41 bacteria we wanted to do with,
7:42 we want to kill it, because it
7:43 was causing infection. So, if
7:43 you learn a lot about
7:44 antibiotics, but not enough
7:45 about probiotic s, and I have
7:47 to have say that, you know, 30
7:48 years ago, I was fairly
7:49 ignorant about probiotic s and
7:51 specificity of strains, I would
7:53 tell my patients to eat yogurt
7:54 if they are taking antibiotics,
7:56 we did not know enough at the
7:58 time. So we are learning more
8:00 and more and you know from our
8:03 birth we start picking up the
8:05 bacteria from the environment
8:07 from mother, from caregivers,
8:10 you know playmates etcetera. We
8:13 start kind of populating the
8:15 gut with different kinds of
8:17 microbes that live in our gut.
8:19 So not only stomach but small
8:20 intestine, large intestine,
8:21 lower we go in the gut, we have
8:23 more and more bacteria living
8:24 very happily
8:38 hopefully inside the gut. Their
8:39 purpose, we’ll talk about that
8:40 very briefly is really to
8:41 support our overall health And
8:42 you know we all have our unique
8:43 blend of good bacteria with
8:43 some bad bacteria. And there
8:44 are also viruses and fungi and
8:45 phases and other microorganisms
8:46 inside. But you have different
8:50 I have different. We all have
8:51 our unique kind of fingerprint
8:53 of the bacteria in the gut. One
8:55 of my colleagues Doctor Emma
8:57 she calls it poop print. So we
8:59 all have our own unique poop
9:00 print. Inside the gut. So we
9:02 are not really all the same
9:05 when we look at the bacteria in
9:06 the gut. So just looking at
9:10 probiotics and microbiome and
9:11 some of my first slides explain
9:12 the importance of keeping that
9:15 diverse and abundant bacteria
9:18 in the gut. So how does it look
9:21 like? I like pictures and I
9:22 like to slide into many words.
9:24 But when
9:39 look at this kind of a
9:40 illustration The pink line of
9:41 cells illustrates the lining of
9:41 the gut. These cells are they
9:42 look happy and healthy. They
9:43 are tight together. They are
9:44 separating the inside of the
9:45 gut with the outside and on top
9:47 of those cells you see the
9:49 thicker mucus layer and then
9:51 different outer mucus layer
9:51 with a green little rod shaped
9:55 and different kinds of shaped
9:56 bacteria. That
10:02 our happy gut microbiome. When
10:03 we feed those bacteria, good
10:03 diet, which is what we call
10:06 prebiotics or soluble insoluble
10:09 fiber, polyphenols, things like
10:11 that. It loves to eat it, loves
10:14 to ferment it, break it apart,
10:16 and in that process, we they
10:19 produce different kinds of
10:21 metabolites. We call them short
10:23 chain fatty acids and others.
10:24 It’s a mineral vitamins cannot
10:26 be actually absorbed without
10:27 bacteria in the gut and when
10:29 they produce those metabolites,
10:32 those metabolites actually
10:33 communicate with our underlying
10:35 immune system Uh they say the
10:38 60 to 70% of our immune
10:40 responses are regulated by gut.
10:42 But also they communicate with
10:44 the cells that are connected
10:47 with the nervous system,
10:48 central nervous system and it
10:51 can communicate directly with
10:53 the brain. So there’s a huge
10:55 research going on in the gut
10:56 brain connection. But we also
11:08 produce large amounts of our
11:09 serotonin in the gut as well.
11:10 So we cannot really look at the
11:11 gut as separate from everything
11:12 else. It affects the rest of
11:13 the body, You know,
11:13 dramatically. So, this looks
11:14 like a healthy and diverse gut
11:15 microbiota and this is a happy
11:17 patient. But this is what
11:19 happens if the laws that
11:21 diversity, if they lose the
11:23 abundance of good bacteria in
11:24 the gut or we change the
11:26 diversity. That can happen
11:27 because you do not feel
11:36 well. It could happen because
11:37 of the medications,
11:37 antibiotics, stress, all
11:38 different kinds of things can
11:39 affect the gut microbiome and
11:40 what happens then, you lose a
11:41 protective layer on top of the
11:42 cells inside the gut. Those
11:43 cells do not stick together
11:44 well. There is communication
11:47 that is really not desired with
11:49 the underlying immune system
11:52 even with the brain connection
11:54 and we start triggering
11:55 inflammatory responses and you
11:56 know, pain sponsors as well at
11:59 the same time which is observed
12:00 in IBS. It observed in other
12:02 conditions. So this is just a
12:05 quick illustration why we need
12:06 to keep this bacteria in a gut
12:09 happy. And again as I mentioned
12:12 each microbiome is unique. Um
12:14 we are really like to keep
12:16 those communities happy and
12:18 diverse.
12:24 When it comes to probiotics, we
12:25 always like to think about
12:26 shortcuts, you know, if the
12:27 bacteria in the gut is not well
12:29 and unhappy, instead of kind of
12:32 thinking about how can we feed
12:33 it better, we start thinking
12:34 about, hm, how about I give you
12:35 some good bacteria and see what
12:37 happens. And this is why we’ve
12:40 been seeing huge increases in
12:41 research with probiotic s. And
12:45 probiotic by definition is a
12:46 live microorganism when it’s
12:48 given inadequate amount,
12:51 provides a health benefit. So,
12:52 for something to be a
12:53 probiotic, it has to satisfy
12:55 these these live, adequate
12:57 amount, health benefit. We have
12:59 to see all those three for the
13:01 probiotic or something bacteria
13:02 to be a probiotic. So quite
13:05 often eating yogurt is a good
13:08 option. It’s very healthy food
13:10 but might not actually satisfy
13:13 all the irrequiments to be
13:15 labelled as a probiotic. So
13:17 keep that in mind.
13:28 When it also comes to
13:29 probiotic, there is a confusion
13:29 with the names and many people
13:30 and many my colleagues are
13:31 confused because microbes and
13:32 specific probiotic s are
13:33 defined by genus, species and
13:35 strain. Long complicated names.
13:37 These are example,
13:39 examplebacterium is a genus.
13:41 So, it’s a big, huge family. Uh
13:43 species is lactose and then
13:44 strain is actually first and
13:45 last name and sim number or
13:47 social insurance number for
13:49 this particular person. So, we
13:51 know exactly who this is and
13:53 what it does and the last part
13:55 is the most important part.
13:58 Quite often neglected, not
14:00 really paid attention to, this
14:02 last part will tell us what
14:04 this bacteria is going to do in
14:05 our body. For illustration and
14:08 I like to use this one. It’s
14:09 been though it’s a bit
14:10 dramatic, maybe over dramatic
14:12 but illustrates my point. Um
14:16 coli is something that we are
14:18 familiar. We probably have
14:19 heard about it. So, genus is
14:22 actually here or E coli.
14:24 Species is coli. And when you
14:28 at different strains, you have
14:29 completely different outcomes.
14:31 The first strain in a green
14:35 box, Mislain 19 17, is one that
14:37 is actually used as a
14:39 probiotic. It’s a capsule and
14:42 comes as a liquid as well. It
14:43 glues globally and it is
14:45 approved and used for
14:47 inflammatory bowel disease
14:48 specifically ulcerative
14:50 colitis. Very good evidence,
14:51 very safe to use. Second strain
14:54 is the one that most of us
14:56 have. It’s one that kind of
14:57 lives within us but it doesn’t
14:59 cause any problem. More of the
15:00 time. And the last strain is
15:02 extremely harmful strain. It
15:03 can cause bleeding inside the
15:06 gut. So it that’s what kind of
15:08 is almost the infamous strain
15:10 because 20 and some years ago
15:12 this last strain of E coli got
15:14 into the water supply in small
15:17 town in Ontario, Canada. And
15:20 population of that town got
15:22 sick. Everybody got sick. Lots
15:23 of people ended up in hospital
15:25 and some people died. It’s
15:26 called a walkerton a tragedy or
15:28 walkerton scandal it’s a that
15:32 that’s kind of illustrated
15:33 difference between strain could
15:34 be difference between life and
15:36 death. My hope is that you will
15:39 never get enter hemorrhagic E
15:41 coli in our supply of
15:42 supplements but this is just
15:44 why we need to know the strain.
15:47 So we always are looking to see
15:49 you know what is the reference?
15:51 How we can figure out what
15:52 strain to use? So basically
15:54 this is why as you mentioned it
15:56 was an aid. I started with my
15:58 colleagues this project with
15:59 the probiotic guide. Um and
16:02 there’s a Canadian version and
16:04 US version. Canadian has a
16:06 French and English. US only
16:07 English. Um the information is
16:09 available as a mobile app and
16:11 on online as well. And it lists
16:15 a product, lists strains in it,
16:18 lists references we we use to
16:21 assign the indication of a
16:22 specific product. And again
16:24 information changes rapidly. So
16:26 be updated annually. So when we
16:28 ask this guide and I was
16:30 looking at Canadian and US. Is
16:33 there a probiotic for migraine?
16:36 So there is a probiotic in US,
16:39 not available in Canada on a
16:41 shelf but it can be ordered
16:43 online. Um, it is a product
16:46 that I think is actually made
16:47 in the UK. And it has a 14
16:51 strains in it, but they are
16:53 very defined and specific
16:54 strains. It’s a mixture. It has
16:56 level 2 evidence in migraine
16:59 prevention and reduction of of
17:01 frequency and severity of
17:03 migraine s. So when you look at
17:05 the studies done with this
17:06 particular product, there was a
17:08 study done and there were you
17:10 know, less bit less than 80
17:12 patients and they included
17:14 episodic migraines and chronic
17:16 migraine patients in eight to
17:18 10 a week period, forty-5
17:20 showed a reduction in attacks
17:22 versus placebo group. And this
17:24 was actually the only study
17:26 that was showing the good
17:29 results out of seventy plus
17:31 studies done with different
17:33 probiotic interventions in
17:35 migraine. So the research on
17:37 migraine and probiotic s is
17:38 really new and it’s still I
17:41 think we have more to go and
17:43 more to learn about it as well.
17:46 Uh don’t you think that 40
17:48 patients is like 40 episodeic
17:51 roughly 80 or 79. Is this
17:54 enough for us to try a product
17:56 like this if if so so the small
17:59 number in that particular study
18:00 was the reason why we assigned
18:02 a level two evidence for this
18:03 particular product for this
18:07 level one evidence would be
18:09 very strong evidence, very
18:11 well-designed study, and you
18:13 know, sufficient amount number
18:14 of patients in the study. This
18:16 was sorry. Uh because we have a
18:19 a question from Jasmine, she’s
18:21 saying, how would one get a
18:22 hold of that probiotic? Is that
18:24 something if it’s not available
18:25 in Canada, how how can we try
18:27 it? And then is this a a
18:30 probiotic that you would take
18:30 everyday? And and that would be
18:33 used would that be used like so
18:39 the the the product can be if
18:41 you are in Canada it can be
18:43 ordered online which is a
18:44 pharmacist like to discourage
18:46 ordering online but this
18:47 particular one can be ordered
18:49 online And I have had few
18:51 patients with good results for
18:52 this particular probiotic. Uh
18:55 it’s not inexpensive. So keep
18:56 that in mind. And in a study it
18:59 was given everyday as a single
19:01 dose. And then was measured
19:04 after 10 weeks period. So
19:07 experience of my patient is
19:08 that they actually would
19:12 improve and then they would
19:13 stop taking it Have it on hand
19:16 for to take maybe a couple of
19:19 times a year for a month.
19:20 That’s what they would do kind
19:22 of almost take it quarterly for
19:23 a month. So different kinds of
19:26 experiences and again it’s
19:27 probably not for everybody. But
19:28 this is to illustrate to to
19:30 show you that if you’re looking
19:32 for specific targeted probiotic
19:34 for migraine they might not be
19:36 too many options that we have.
19:38 Um And again I would encourage
19:41 you to the Alliance for
19:43 Education on Probiotics is the
19:46 who supports the publishing of
19:48 the guides. And any update, any
19:51 change will be posted through
19:53 this website. So it’s something
19:55 that you can probably follow or
19:56 or an easy access to the
19:58 clinical guides is through this
19:59 A probiotic. com. So you can
20:02 probably you can stop sharing
20:03 the slides. I think we started
20:06 to have some questions around
20:07 this. That’s right. Yeah.
20:08 That’s
20:11 Ask I someone asked what is the
20:13 name of the probiotic? I know
20:15 you said it’s a bio cult so I’m
20:17 just that is correct. Uh but I
20:19 saw online that it’s called
20:21 migra M I G R E A. I’m not sure
20:24 if that’s the right one. That’s
20:25 the one I found online for
20:27 them. And they say they also
20:29 have in the same formulation
20:30 they have B6 and magnesium.
20:34 Uterally in migraine. We
20:36 recommend magnesium would be so
20:39 I’m not sure the B6 link. Um
20:43 and and it it looks like it’s
20:46 reasonable, it looks like it’s
20:48 3-6 dollars on online. Uh I’m
20:50 not sure if I’m seeing the
20:52 right one that you’ve you’re
20:54 referring to. So I would
20:54 suggest I know it’s complicated
20:56 but I would suggest to go
20:58 online, check it on a on a
20:59 clinical guide, see what
21:01 strains are listed. If they
21:02 have the same combination of
21:04 strains and most bio cult has
21:06 have these fourteen strains in
21:08 most of the products make sure
21:10 that this is the same list of
21:11 strains in the product you’re
21:13 ordering. Um Addition of of
21:16 things like a B6 or magnesium.
21:18 Uh it has not been tested in a
21:21 same tablet or same capsule. So
21:23 I cannot comment whether or
21:26 assume that this this new
21:27 product will have the same
21:28 effect. I’m hoping so. However,
21:31 whether the other ingredients
21:34 might impair the viability of
21:36 strains or not unless there is
21:38 a proof or study posted, we
21:40 don’t know. Okay. So the the
21:43 next question what is from Judy
21:45 and she’s saying my naturopath
21:46 and functional doctor say it’s
21:49 not wise reduce pre or
21:52 probiotic s without knowing
21:53 what’s going on in your gut
21:55 microbiome first. What are your
21:57 thoughts on this, Targana? So,
21:59 that is a good question. Um
22:01 first of all, this probably
22:04 leads to the next step the
22:06 doing gut microbiome at home
22:09 testing. Which is something
22:12 that we do not recommend. Um
22:15 gut microbiome testing it’s a
22:17 challenging Uh even in a
22:19 research setting. It’s it’s
22:21 still we don’t have the good
22:22 standard procedures for that.
22:24 We are gathering lots of data
22:26 globally. There are big huge
22:29 projects. Uh looking at gut
22:30 microbiome and see how we can
22:32 harvest and figure out what’s
22:33 in people’s gut s and how this
22:35 changes from the morning to
22:38 night for one person or how it
22:39 changes regionally,
22:41 geographically, etcetera. So
22:42 many things can affect that
22:44 kind of composition. As I
22:45 mentioned, everybody is unique.
22:48 So, the testing I would
22:49 definitely discourage to spend
22:51 your time and and money on
22:53 that. And is it expensive? Is
22:55 it is it something that costs a
22:56 lot of money? Dosas are very
22:57 expensive. There was a a big
23:00 scandal in US. There was a
23:01 company that actually was was
23:05 they had to shut it down
23:05 because the FDA actually had
23:09 some legal process against them
23:10 because of the shady practices
23:12 I guess. So, anyway Um I think
23:16 I don’t want to be like you
23:17 know playing on words. So,
23:20 basically, basically, this is
23:21 the or it will be great if you
23:24 can know how we do the, you
23:25 know, B 12 testing in a blood.
23:27 So, oh, you’re low. You can
23:28 take it and you fix it. Does
23:29 not really apply to the
23:31 microbiome. Um so, you
23:34 mentioned probiotics and
23:36 probiotics. I do discourage
23:37 taking probiotic s unless you
23:38 know what you need to to
23:41 address and you know, what you
23:42 need to to to you take for the
23:45 desired outcome. However eating
23:49 foods with the live cultures in
23:50 it is good idea. Anytime in
23:53 life, anytime for any reason.
23:57 So, you know, good yogurts,
24:00 kefir, sauerkraut. I know that
24:02 patients with migraine s have
24:03 to be careful with certain
24:05 fermented foods because of the
24:07 thyroid in it but they are also
24:09 fermented foods that do not
24:10 contain thiamine. So, that will
24:13 be good options. However, as I
24:16 mentioned, feeding the bacteria
24:18 in your gut, good diet, good
24:22 prebiotic would be excellent
24:24 idea anytime. Prebiotics are
24:28 present in different foods.
24:30 Artichokes, leeks, onions,
24:34 bananas, most of the fruits and
24:36 vegetables have probiotic fiber
24:38 in it. Um psyllium is great,
24:40 probiotic, fiber, artichoke,
24:42 root, Jerusalem artichoke root.
24:46 I’m just trying to think what
24:47 other foods have it. Um you
24:50 know are grains good or beans?
24:53 Are they good? Beans are
24:54 actually also good amount beans
24:57 grays have also lots of soluble
24:59 fibre that sometimes it’s not
25:01 the best prebiotic but again
25:03 it’s good for digestion anyway.
25:05 Uh inulin is excellent even
25:07 like it’s a supplement. It’s a
25:08 powder to add. A metamucil or
25:11 psyllium fiber. Uh there is
25:13 also resistant potato starch
25:16 believe it’s in Canada called
25:18 MS prebiotics. So there are
25:20 good prebiotics with a good
25:21 evidence behind it. It can be
25:23 easily added to diet. If you’re
25:25 trying to avoid and look what
25:28 foods you’re taking. So
25:30 prebiotics will actually feed
25:31 your good bacteria. It might
25:33 take some time to get those
25:34 colonies up and and you know,
25:37 strong but it’s always good
25:38 idea to to actually ingest good
25:41 prebiotic. And again, if if we
25:47 don’t, if everybody has their
25:49 own print of microbiome, then
25:53 how would we know which one
25:55 they are missing if if
25:57 everybody is unique if if
25:59 everybody is different. How
26:00 would we decide which strains
26:03 are needed for what? Basically.
26:06 That’s correct and this is why
26:08 why the testing is really not
26:10 you know we can test, we can
26:12 figure out things but what to
26:14 do with these results we don’t
26:17 know. And most companies will
26:18 actually sometimes take
26:19 advantage and give you the
26:22 tailored you know
26:24 individualized probiotic s to
26:25 to support each. Probiotics do
26:28 not do not colonise the gut.
26:30 They never colonise the gut.
26:32 Unless your newborn baby. Then
26:33 you might colonize the gut. But
26:35 if you’re adult you cannot call
26:37 that you should not colonize
26:39 the gut with probiotic s
26:40 because that will be actually a
26:41 problem. Uh you know what I
26:44 like to kind of when I explain
26:45 to my patients, I like to say,
26:47 you know, when you think about
26:49 probiotic s, it’s like getting
26:50 you have your company, somebody
26:52 is coming for a visit for
26:53 Thanksgiving, you have a great
26:55 time, you you know, feel great
26:57 and they leave. Those friends
26:59 coming over, they’re
27:00 probiotics, they make you feel
27:01 better and then they leave.
27:02 They don’t stay for you
27:03 forever. So, imagine if the
27:06 probiotics would colonize the
27:08 gut. People have a mess. So
27:11 this is something that is kind
27:14 of if you can expand on it just
27:17 for for us to understand a
27:19 little bit more. So when I do
27:22 add a probiotic to my diet it
27:25 is it doesn’t stay there. It
27:27 just works on changing that ego
27:30 ecosystem that is in my gut
27:32 kind of. To make it a little
27:34 bit more balanced. Until my
27:36 body is able to like like the
27:39 question I have from Lisa. She
27:42 says I use a probiotic and
27:44 wonder if it’s not the right
27:46 combination to eliminate the
27:47 amount of migraine headaches
27:50 that she’s suffering. So this
27:51 comes this comes to me it it
27:56 makes it a little bit difficult
28:00 to understand. So first does
28:05 does Lisa need to be taking a
28:07 daily probiotic if it’s
28:10 actually something that just
28:11 goes away just to keep it
28:13 going. And how know if it’s the
28:16 right combination So, first of
28:19 all, if you have improvement in
28:21 symptoms, that means whatever
28:23 you’re taking, it’s working.
28:24 Also, if you are supporting the
28:28 microbiomes in your gut with a
28:30 good fiber diet, prebiotics,
28:32 you can attempt to stop
28:34 probiotic and see if symptoms
28:36 would return. That would be a
28:38 great way to assess whether you
28:40 need to stay on it or not. Um
28:43 if you remember the first
28:44 slides I showed you. So, if you
28:46 take probiotic s, you’re
28:47 getting something very strong
28:48 that is going to start breaking
28:50 down prebio and fibre producing
28:53 that mucos layers allowing your
28:56 own bacteria to thrive. And it
28:59 will not stay. It will not
29:00 populate but it will allow the
29:02 rest of the bacteria to have a
29:04 good good start and continue
29:07 proliferating on its own. I
29:10 know it’s kind of confusing and
29:11 quite often I see some
29:15 resources even like those
29:16 designed for healthcare
29:18 professionals say. Probiotics
29:19 colonized the gut s. They do
29:20 not. So that’s that’s one of
29:24 the things that you have to
29:25 keep in mind. Okay, So again to
29:29 go back to Lisa. So if she’s
29:30 using a probiotic, does she
29:33 need when someone is living
29:34 with migraine, other than this
29:37 one that we saw that there was
29:38 a small study on, if she’s
29:40 using a probiotic, how would
29:44 she know if this is, number
29:46 one, does she need to take it
29:46 everyday? That’s the question I
29:48 always have, is it forever that
29:50 I’m going to have a probiotic,
29:51 or do I need to kind of recycle
29:54 or diversify the kind of
29:58 bacteria that I’m introducing.
30:00 How do we do this? Um so based
30:03 on symptoms that’s that will
30:04 tell you whether you need to
30:05 stay on it longer or not. If
30:07 you are trying a probiotic,
30:09 taking it daily is usually a
30:11 good idea. Uh for any reason,
30:13 for example, you’re trying to
30:16 minimize the risk of diarrhea
30:17 with antibiotics. You take it
30:19 throughout your antibiotic
30:21 course and for two weeks after
30:24 minimum and then you can stop.
30:24 So, those be kind of a
30:28 timelines. For migraine
30:29 sufferers, if you have a for
30:32 example, gastrointestinal
30:34 symptoms, if you have diarrhea
30:35 or constipation or intestinal
30:37 pain or abdominal pain with
30:40 migraine that or maybe precedes
30:41 the migraine, it could be IBS
30:44 related in from a in irritable
30:47 bowel syndrome related. Um you
30:49 might select a probiotic for
30:51 IBS. However, once symptoms
30:55 improve, I usually suggest you
31:00 try to stop it and see what
31:01 happens. Because hopefully you
31:05 are supporting your own
31:08 bacteria with a good diet and
31:09 you do not need help from
31:11 outside. Okay. So the answer
31:14 would be stop and see if
31:17 there’s a change in your
31:18 migraine. How long that would
31:20 it take for her to see if
31:21 there’s a a change? Usually
31:24 quite a quite a a soon a a
31:26 couple of weeks after
31:28 discontinuing if the symptoms
31:29 starts coming back then you
31:31 would go back on it. Um
31:33 similarly to the patients with
31:34 IBS for example. Uh some of
31:36 them refuse to discontinue
31:39 probiotic s because they feel
31:40 so much better on specific
31:41 kinds. Uh but some of them will
31:44 go off for a couple of weeks, a
31:45 month, three months and then
31:47 maybe take it for a week or two
31:49 only when needed if there’s a
31:51 flare up. For some certain
31:52 chronic conditions like
31:54 inflammatory bowel disease,
31:56 those patients might need to
31:58 take the probiotic s regularly.
32:00 Because they cannot really
32:03 support their own microbiome
32:05 appropriately to maintain the
32:08 to keep the inflammation and
32:11 flare ups under control. So
32:12 they might need to stay on it
32:14 longer. There is really no side
32:18 effects on staying on probiotic
32:20 that is helping you longer
32:23 aside from the cost. That’s
32:25 really something that I always
32:27 am concerned about as a
32:28 pharmacist but my patients
32:30 spending time and money on
32:32 something that that they might
32:33 not need. Okay. And I I have
32:36 Judy who’s saying and you have
32:38 touched on this. She says
32:39 unfortunately I fermented foods
32:43 are triggers for her. And
32:47 how does
32:47 she know or how does
32:49 she know which medications are
32:53 are which which probiotic s are
32:55 from fermented versus
32:57 non-fermented Even I don’t know
32:59 this. How can I tell from
33:01 looking at the pack if this is
33:03 fermented or not fermented? So
33:06 this is interesting because
33:08 most of the probiotic s that
33:10 are listed in the guides with a
33:12 good evidence do come from
33:15 human body. They originated
33:18 from either mother’s milk or
33:21 from a healthy gut or from
33:25 urethra of healthy women or
33:26 vagina of healthy women. Uh
33:28 different parts of human body
33:30 are actually sources for most
33:32 of the strains that we have in
33:36 present in strong and and
33:38 evidence-based probiotic s. Uh
33:42 certain strains will actually
33:44 help ferment food. So they are
33:49 just strains that you know
33:50 ferment milk you know break
33:52 down the lactose in milk so
33:53 they becomes yogurt. So it’s
33:55 easier to digest. But if you
33:57 let this yogurt sit longer and
33:59 becomes cheese then the other
34:01 parts of fermentation will
34:02 happen. Then you have products
34:03 and and byproducts that will
34:07 actually possibly trigger
34:08 migraine s. So that’s why it
34:11 it’s a bit tricky. Okay? Um so
34:16 I have one question that was
34:18 earlier. I’m not sure if we go
34:19 back to it. Uh just so that we
34:22 don’t forget to answer this
34:23 question. Um I think the
34:26 question was about
34:31 I think it would, it was about
34:33 poop transplants, Mm-hmm. And
34:35 that was Suzanne is, is asking,
34:37 so, what about that? Is that
34:39 something that is similar to
34:42 taking a probiotic or So, a a
34:46 fecal matter transplant or FMTs
34:48 have been studied and and you
34:51 know, I actually worked with a
34:52 few of the researchers at
34:54 McMaster University that have
34:56 done lots of great studies with
34:58 this particular approach and
34:59 it’s different kind of
35:00 gastrology departments across
35:01 globe have been doing the
35:04 research with this. Uh
35:06 initially we were extremely
35:07 excited about the results we
35:09 were seeing the inflammatory
35:11 bowel disease with the
35:14 transplant from healthy donor
35:16 to a patient. Uh and then with
35:18 the CDFicil treatment etcetera.
35:21 But we also have found that
35:23 sometimes you can actually
35:25 harvest bad things from the
35:27 donor and then implement in the
35:28 patient that is already not in
35:31 the best health. So this is
35:34 something that is still really
35:38 a subject of huge research. We
35:40 are learning more about it.
35:42 What is encouraging is that
35:43 they have been some advances in
35:49 how much I don’t know say like
35:51 refining or or changing or
35:53 analyzing what is harvested
35:55 from healthy donor and making
35:57 it a probiotic. So there is a a
36:00 first FDA approved what we call
36:02 precision probiotic or that
36:05 kind of a next level probiotic
36:07 that is basically a blend of
36:09 bacteria harvested from a
36:10 healthy donor and it’s now
36:12 going to be used in a in a very
36:15 sick individuals as a
36:18 probiotic. So there are few of
36:19 them down pipeline and then one
36:22 person has been approved I
36:23 believe a month ago or two
36:24 months ago in in the in the US.
36:27 Well this is beautiful news
36:30 because as you well know
36:32 migraine Canada and and in this
36:35 community we are very big on
36:38 hope and what is next and what
36:40 is how is the science going to
36:42 help us going forward and you
36:44 are bringing more news or more
36:47 good news to us saying that
36:48 it’s going to be even more
36:50 precise and it’s going to be
36:52 much better what we understand
36:54 about probiotics. Before we
36:56 started this chat we were
36:58 talking about how bad is the
37:01 funding that is going into
37:04 research that is not based on
37:07 medication. This is we need to
37:09 understand our bodies a little
37:11 bit more to understand what we
37:12 can do and there’s not enough
37:14 money going in there. And
37:15 that’s why something as it it
37:18 looks like it’s it’s it makes
37:20 sense for us to study a little
37:22 bit more and understand a
37:23 little bit more. But you’re
37:24 saying there’s going to be
37:25 precision medicine and that is
37:27 excellent news. I I’m also
37:30 hopeful that it’s going to be
37:31 reasonable and accessible to
37:32 all our community members. I
37:36 have, like, we have another
37:39 colleague, Praveen, Gulati, is
37:42 a very, very active pharmacist
37:44 who’s very interested in
37:46 migraine and is always
37:47 supportive and and is is also
37:49 asking a question, is there a
37:51 basic is there a basic
37:54 probiotic that we can start
37:55 everybody on? Is there one that
37:57 you would say, if you want one
37:59 kind of that would work, for
38:02 most of the community members,
38:04 which one would that be So this
38:06 is excellent question. So first
38:09 of all this reminds me of the
38:10 question what probiotic is good
38:12 for general health. Uh if you
38:14 are generally healthy or like
38:16 to maintain health you do not
38:17 need to take a probiotic as a
38:19 supplement. That’s number one.
38:21 Um but if you’re asking about a
38:24 good probiotic to start if you
38:25 have migraine s there’s only
38:27 one I would recommend to try.
38:29 Which is one that we mentioned
38:30 in a slides. Um I’d hate to to
38:33 promote brand names but
38:35 sometimes they have to use
38:36 brand names because they cannot
38:37 tell you fourteen strains that
38:39 is in that particular product.
38:41 Uh and I have no financial ties
38:42 with any of those companies. So
38:44 the BioCult would be one I
38:46 would suggest to try if you
38:48 have migraine s. That’s that.
38:50 Uh but if you have if you are
38:54 concerned for any reason about
38:56 the state’s status of your gut
38:58 microbiome. Make sure to feed
39:00 it properly. You know minimise
39:02 stress, sleep. Well all those
39:04 things that can be no common
39:05 sense that nobody wants to do.
39:06 Uh the actually support your
39:10 gut microbiome. Uh eating
39:12 slowly and mindfully, I know,
39:14 avoiding irritants, avoiding
39:16 too much alcohol, antibiotics,
39:18 cortical steroids, and certain
39:22 medications might affect
39:23 microbiome. Also avoiding
39:24 sweeteners. This is something
39:25 that we have learned recently.
39:27 Uh artificial sweeteners, all
39:29 of them will actually have
39:30 negative effect on a gut
39:32 microbiome composition. So,
39:34 those kind of things, avoidance
39:36 and you know, ensuring
39:37 whichever way easier for you to
39:41 feed bacteria with a good good
39:43 food. Um sometimes you know
39:46 even healthy individuals might
39:49 need a probiotic. If you’re
39:51 travelling you might need
39:52 something that will minimise
39:53 risk of traveller’s area. There
39:55 are quite a few of them listed
39:57 in a guide. In fall usually
39:59 people are concerned about
40:01 flus. And common colds. They
40:03 are few probiotics for kids and
40:05 for the adults that have proven
40:06 effective in risk of community
40:10 infectious infectious disease.
40:12 Um so, you know, those things
40:14 might be good options to
40:16 thrive. So, those are kind of
40:19 things that I would recommend
40:20 but I do not have one sec, oh
40:21 everybody should be should,
40:23 should be on it. So, there’s no
40:24 such a thing. So, then, I
40:27 possibly can go to Shruti’s
40:28 question and Shruti does have
40:31 symptoms but not diagnosed with
40:32 IBD but does have chronic
40:34 migraine and she said, last
40:36 year, she had to go on way too
40:39 many cycles of antibiotics last
40:40 year and she now feels that her
40:43 gut health is completely off.
40:45 Uh classic migraine progressed
40:47 to migraine with aura and
40:49 vestibular migraine. She just
40:51 started taking probiotics but
40:52 she’s not sure how to go around
40:54 about this and how to recognize
40:56 when it is working. Hm. Okay.
40:59 Uh because she mentioned the
41:04 the repeated causes of
41:05 antibiotics and potentially IBD
41:08 or IBS? She’s not diagnosed.
41:11 So, she has it she she does
41:14 have symptoms. So, she’s not
41:16 sure she doesn’t have a
41:17 diagnosis but she does have
41:18 symptoms that. Okay. She’s
41:21 identifying. Yes. So, so we
41:23 usually we usually suggest that
41:25 you know, people do follow up
41:27 with a healthcare professional,
41:28 that’s for sure. But sorry, she
41:30 just connected me. She said
41:31 IBS. Okay. She did confirm IBS.
41:34 So, no, the development of IBS
41:35 after you know, repeated
41:38 courses of antibiotics is
41:40 common. Or after the, you know,
41:42 if you have the viral infection
41:44 of the gut, you know, post
41:46 viral IBS is very common as
41:48 well. So, if there’s no red
41:50 flag symptoms such as blood in
41:53 the stool or you know, weight
41:55 loss or something like that.
41:57 Then, you can assume that is
41:59 IBS then you can do the trial
42:00 of of probiotic s for for IBS
42:03 specifically. But if it does
42:05 not work, that’s a twelve
42:07 definitely needs to be followed
42:09 up with the physician. And I’m
42:10 thinking also what I’m finding
42:12 with the patients if they can
42:15 control the abdominal symptoms.
42:18 They quite often have and
42:22 report improvement in headaches
42:24 and migraine s. So it’s you
42:27 know we do not recommend
42:30 probiotics for IBS to prevent
42:31 migraine s but patients do
42:33 report mode improves you know
42:35 the the frequency and severity
42:38 of of migraine s improve as
42:39 well. Okay, and then she had
42:42 another question saying, she
42:44 just caught a piece of content
42:45 on Instagram where the person
42:47 said that sometimes certain
42:48 bacteria and probiotic s can
42:50 trigger attacks. Something to
42:52 do with histamine production.
42:53 Can you comment on this or do
42:56 you have an have you heard of
42:57 this? Can you tell us a little
43:00 bit more about histamine and
43:02 gut test? Uh so again this is
43:07 it’s a it’s probiotic s are not
43:10 always probiotic product. Um do
43:13 not always contain safe and
43:16 proven ingredients. And quite
43:18 often they combine with other
43:20 ingredients that might be
43:23 questionable. Um the histamine
43:26 production the probiotic s will
43:28 not trigger the proven
43:30 probiotics and safe probiotic s
43:32 approved by FDA or you have
43:33 grass status or NPN number in
43:36 Canada will not trigger the
43:37 histamine production. That’s I
43:38 that’s what I would like to say
43:42 as I mentioned, they have
43:43 actually anti-inflammatory
43:47 function. They really support
43:49 production of serotonin. So
43:51 definitely beneficial effects
43:54 have been observed. You said
43:59 something interesting and you
44:00 said something about children
44:01 and babies are you know they
44:04 need to colonize. Maybe a lot
44:05 of our community members as
44:07 well have children who are
44:09 living with migraine and in
44:12 childhood. A lot of it comes as
44:14 abdominal migraine where they
44:15 have the symptoms of nausea,
44:17 vomiting, tummy ache, a little
44:19 bit of headache, a little bit
44:20 of photosensitivity and and
44:23 their tummies are very very
44:25 sensitive. What do you think
44:26 about probiotic s in children,
44:29 what, what, what are you, how
44:30 do you, how do you go around
44:32 this? So, there is a definitely
44:34 lots of research in a, in a
44:36 using probiotic s specific
44:37 strains in pediatric population
44:39 for different reasons.
44:41 Functional abdominal pain, some
44:43 of the symptoms with the
44:44 functional associate of
44:45 abdominal pain, would be
44:48 headaches and moods, changes,
44:49 irritability, etcetera. So,
44:52 there are probiotic s that can
44:53 be used for functional
44:54 abdominal pain in kids as well.
44:58 Always a good idea to try. What
45:01 I also like that certain
45:03 probiotic strains have a
45:04 multiple effect in kids. I’m
45:06 not sure why we observe this in
45:08 children more than in adults.
45:10 So those proven strains for
45:12 example there are few that will
45:13 help with the diarrhea,
45:16 constipation, minimise risk of
45:18 infection disease, help with
45:20 functional abdominal pain, even
45:22 prevent childhood eczema and
45:24 and topic dermatitis. So kind
45:25 of when at it, wow. Because
45:28 probably kids do tend to react
45:31 and respond to probiotic s, you
45:33 know, with the full system,
45:34 with everything that is in
45:36 their, in their body. Uh so,
45:38 choosing one, I would say,
45:39 refer to the guides, choosing
45:41 one that has a a dose all
45:44 symptoms specifically
45:45 functional abdominal pain would
45:47 be a good idea. Um and I’m
45:51 going to ask again, is there
45:52 one that you go for? So I know
45:57 you don’t want to mention brand
45:59 names but unfortunately even
46:00 for me as a pharmacist you go
46:03 to the pharmacy and there are
46:04 shelves full of probiotic s and
46:07 so yeah I understand completely
46:08 and again I’ll tell you the
46:10 first of all let me tell you
46:11 this particular probiotic s is
46:13 sold there are few two of them
46:15 actually globally I think in
46:19 under everywhere in the world
46:20 with the same name one is
46:21 called bio Gaia Gaia is the one
46:24 I give my patients when it’s a
46:27 child yeah colleague or if they
46:30 have. That’s correct. And
46:31 second one, second one will be
46:32 cultural which contains
46:35 lactobacillus rhymnosis GG. So,
46:36 that’s one would be also a good
46:39 option. So, one or the other,
46:40 not in combination. Um but
46:44 you’re right, you know,
46:44 sometimes as my own curiosity,
46:48 I walk in any pharmacy. I walk
46:49 in anywhere especially in
46:51 Canada, US. Uh I checked the
46:54 probiotic aisle or shelf. It
46:56 used to be small part of the
46:57 stomach section. Now, it’s like
46:59 a shelves and aisles of
47:01 probiotics. What is very
47:05 distressing and disturbing for
47:05 me to see that most of those
47:09 products do not even have
47:11 strain listed. Uh others have
47:14 strains that have no evidence.
47:17 Um the the claims sometimes are
47:20 will be kind of over over the
47:22 top. But the the worst part is
47:25 when if the product does not
47:26 have a strain listed on the
47:29 label. What it means is that
47:31 they actually can change the
47:33 strain if the one that using
47:36 becomes too expensive or not
47:37 available. So if you for
47:40 example have a good result with
47:41 some unknown probiotic with no
47:44 strains listed might work for
47:45 you a couple of months and if
47:47 you continue it will stop
47:48 working because they can change
47:49 the strain without telling you
47:51 what they did. So I mean you
47:56 talked about that guide that
47:58 you have. And the guide is for
48:01 education but you also provide
48:03 the same information for
48:04 patients. So saying, what
48:07 strains? And I have the same
48:09 question. If I want to find out
48:11 which strain to use for what?
48:13 Is that part of the guide that
48:15 you provide through AE probio?
48:17 Yes, that’s correct. Okay. So
48:20 so I will find the link and I
48:22 will put it in our chat I think
48:25 for AE ProBio and will help. Uh
48:30 if you go to April bio. com the
48:32 landing page will get give you
48:34 links to the guide US guide and
48:36 Canadian guide. Um and if you
48:38 go to website you can actually
48:40 do a search button drop list of
48:43 all the indications then you
48:44 can narrow down your, you know,
48:47 selection or you can just go
48:48 one by one and see what each
48:50 product can be used for, all
48:52 references are listed, studies
48:54 are listed, everything is
48:55 listed there, and we do
48:56 encourage people to check the
48:58 studies, if they are, like to
49:00 maybe chat more, or take the
49:02 guide to their physician or
49:04 pharmacist, and discuss it with
49:07 them. Okay, and, and that is
49:10 something that we also, as a
49:12 community, try to say, if your
49:15 pharmacist doesn’t know this,
49:15 you know where to send them to
49:18 learn a little bit more because
49:19 we need the pharmacists to
49:21 actually be able to support you
49:23 and your community. Um we were
49:25 talking about a case before you
49:27 started about a patient who
49:28 went to an actual
49:33 store or
49:34 a natural health store
49:35 and she was recommended a very
49:37 expensive probiotic. And you
49:40 want to tell us about this case
49:41 as a this is this is not
49:45 unusual case but today I I was
49:47 working and the patient I was
49:50 not seeing patient for
49:50 probiotic but with my
49:51 medication review I ask what
49:54 prescriptions what over the
49:55 counter medications they take.
49:57 This is patient with diabetes
50:00 and we just recently started
50:01 her with a specific medication
50:03 that works by a kidney for
50:05 controlling her diabetes. She’s
50:07 not well controlled her sugar
50:10 is very high. So she was taking
50:12 started taking this particular
50:14 she said probiotic combination
50:16 but upon, you know, search, I
50:19 found that this is a a product
50:21 recommended by the health food
50:23 store clerk to her. Um it’s a
50:28 symbiotic. So, it had different
50:30 kinds of of extracts at a very
50:32 potent cranberry dry juice
50:35 extract. In the capsule and did
50:37 not state any strains in it.
50:41 There’s a dry kefir cultures.
50:45 Um and fermented milk cultures.
50:47 So basically we don’t know
50:49 whether it’s the bacteria that
50:50 can be alive. Whether they
50:53 provides any benefit. They
50:53 don’t know what’s in it. But we
50:55 did know that it was a very
50:57 high amount of cranberry juice
50:59 extract. Which has a simple
51:01 organic acids that would
51:02 actually directly interfere
51:04 interfere with her new
51:05 medications and potentially
51:07 increase her risk of kidney
51:09 stones. So that’s why you know
51:12 it’s it’s getting a device on
51:16 these over the counter natural
51:18 health products from somebody
51:20 that has evidence-based
51:23 training and does understand
51:25 your specific condition your
51:28 other medications you’re taking
51:29 is probably the best. And I’m I
51:32 I did say this before we
51:33 started. Um it’s it’s it’s sad
51:39 that we don’t have a lot of you
51:40 Tragana in pharmacy. Uh I’m
51:42 hoping that your efforts to
51:44 educate and to bring this
51:45 knowledge to every pharmacy in
51:48 Canada and the US is is very
51:49 impressive and is we’re very
51:51 thankful that you’re helping us
51:54 as pharmacists get educated on
51:57 this on this very very
51:58 important subject so that I can
52:00 support my patients and I can
52:01 support our community with
52:04 information that is reliable.
52:05 Um one question I also get from
52:09 my patients probiotic s in the
52:13 fridge versus probiotic s on
52:15 the shelf. Uh and there’s a a
52:19 like a general feeling that the
52:20 one I refrigerated are better.
52:24 Mhm. Because probiotic s
52:26 actually are very fragile and
52:29 they cannot live at room
52:29 temperature but most of my
52:31 aisle is basically room
52:33 temperature. What do you think
52:35 of that? So this is a very
52:37 common misunderstanding and
52:39 very prevalent. I always have
52:41 questions about that. And my
52:42 most of my patients believe
52:44 that refrigerated products are
52:45 better. For some reason. Um
52:48 that’s not true. So basically
52:50 what it does it is storage
52:53 environments are connected with
52:56 the strain stability. Some
52:59 strains are excellent but they
53:01 are not resistant to exposure
53:04 to to light, oxygen, or
53:05 temperature. They need to be
53:07 preserved usually in a dark
53:09 glass bottles in a fridge. That
53:11 way we can guarantee that
53:13 they’ll stay viable for a long
53:14 time and once you take the
53:16 capsule or tablet or whatever
53:17 that is, it will provide your
53:19 benefit. Other strains can be
53:21 actually freeze dried
53:24 completely derived, put in a
53:25 capsule and kept it at the room
53:26 temperature and they’ll stay
53:28 viable until you actually
53:29 ingest them and then they
53:31 become, they kind of wake up
53:33 and they’re also probiotic s
53:34 that are spor based, that are
53:37 resilient to exposing them to
53:38 high heat, even baking with
53:41 them, they’ll still be viable
53:43 once they’re in your system.
53:44 Like what? I would like to know
53:46 what I can cook with that
53:48 actually have one. So there is
53:50 actually a there’s a probiotic
53:54 product available in states
53:56 that has that spor in it. But
54:00 most of us cannot really buy
54:01 that strain and cook with it.
54:02 That strain is added to
54:03 different foods. So this is you
54:05 know that once four but with
54:08 spores we also have to be
54:10 extremely careful. We want to
54:11 make sure that the spores is
54:12 safe. Because we also have a
54:14 product which pores that have
54:18 shown side effects with kids
54:22 with immune suppressed issues.
54:25 So, spores are, you know, could
54:27 be tricky when you use the
54:29 probiotic s with spores. So,
54:30 check the dose that really are
54:32 listed in a guide or very safe.
54:34 So, that’s why storage
54:36 requirement based on a on a
54:39 strain, you know, stability,
54:42 nothing else. And you know,
54:44 some strains can be viable and
54:46 really effective at like a half
54:47 a billion colony forming unit
54:49 or you know the amount how we
54:52 express the strength and others
54:53 they need 450 colony forming
54:56 units to actually get the
54:57 effect. So, you know, more of
55:00 the is not important while
55:01 before they we used to say if
55:04 it has more bacteria, it’s
55:05 better and if it has more
55:07 strains, it’s better. That is.
55:09 That’s not true. That’s not the
55:11 science. We know now that some
55:12 are great with a very low
55:13 amounts will provide benefit.
55:16 Others, we know needed in in a
55:17 higher amount. So, more it’s
55:20 not a good idea. You know, when
55:22 you say more strains and I do
55:24 see hear this from my patients,
55:25 you know, if you have a broken
55:27 faucet in your house, you’re
55:30 going to call a plumber to fix
55:32 it and you probably have their
55:33 phone number to call them
55:34 because you know they’re good.
55:36 That’s your strain or maybe the
55:39 plumber has the assistant. So,
55:40 the two of them will come and
55:41 fix it. You do not call me,
55:43 your grandma, your friends,
55:45 your neighbors, and everybody
55:47 to come and fix your faucet
55:49 because it’d be too many people
55:51 here. Even if you have a good
55:52 plumber in this group, he will
55:54 not be able to work because he
55:55 will be all telling him what to
55:57 do. So, combination of strains
56:00 unless it’s already proven to
56:02 work together well, it’s not a
56:04 good idea. Many companies do
56:05 that. They pick one strain with
56:07 a good evidence and keep adding
56:09 few more just so they’re
56:11 different than others and they
56:12 can say, oh, we have many
56:13 strains. Last thing I want to
56:15 say, you mentioned pharmacists
56:16 and doctors pharmacy
56:19 specifically because I’m a one.
56:21 We have inquisitive mind. We
56:24 have evidence-based minds. Even
56:26 if your pharmacist is not
56:28 trained in probiotic s, they
56:29 can learn very quickly. We will
56:31 ask questions, we would ask for
56:32 the evidence. We will be kind
56:34 of nitpicking things that will
56:36 figure out what’s best for you.
56:38 So, trust your pharmacist, talk
56:40 with your pharmacist and and
56:41 you don’t need to multiply me.
56:43 We are there’s many pharmacists
56:45 across Canada and globally.
56:46 They are amazing healthcare
56:49 providers and probably
56:50 misunderstood because people
56:52 think we just count pills and
56:52 do nothing else. You have what
56:55 pharmacists can do. Um when you
56:57 go to your website and and the
57:01 first thing that pops up is a
57:04 recent webinar that is on
57:10 probiotic s and COVID. And what
57:12 happened to all of us who got
57:14 COVID or got the vaccine and a
57:16 lot of us have seen changes in
57:19 our bowel movement, in our
57:20 bowel health and overall with
57:25 we feel that there’s an effect.
57:28 So this is this is something
57:30 that is coming up next week
57:31 because we don’t know the
57:33 answers. There’s lots of
57:34 research published with very
57:36 confusing information and
57:37 results. And this is why we
57:39 gathered I would say the best
57:42 minds in this area. Uh Doctor
57:45 Gregory Reed, Doctor John
57:46 Damianos, Doctor Paul
57:48 Vishmeyer, Doctor Jordy Esperay
57:50 Mazzo. Uh moderated by Doctor
57:52 Peter Lin. We have a few other
57:55 investigators but you know,
57:56 have not heard back from them.
57:57 So, we’ll have those people,
57:59 those researchers and
58:01 specialists present their
58:03 research and their opinion and
58:05 their expertise and they will
58:06 ask each other question and the
58:09 audience will be able to ask
58:10 questions. So, we are trying to
58:12 figure out because research was
58:13 done looking at using
58:15 probiotics to prevent COVID or
58:17 using it to minimize risk of
58:18 complications or minimize long
58:20 COVID or minimize
58:21 gastrointestinal sy very
58:24 confusing results so that’s why
58:25 because we don’t know, we are
58:27 asking experts. So, it’s a free
58:29 registration so anybody can
58:30 register and we are really
58:33 getting up with the numbers.
58:35 So, we hope that this will be
58:37 something interesting and we’ll
58:38 record this panel discussion
58:40 and will be posted on the
58:41 website as well later. That
58:43 would be great because I still
58:45 get questions around COVID and
58:48 what COVID a lot of our
58:50 community members have seen
58:51 their their headaches get worse
58:53 and I’ve seen that if they have
58:56 IBS that had gotten worse. Um
58:58 possibly Jasmine has a question
59:01 that might be our last question
59:03 which is her migraine meds
59:06 actually give her constipation.
59:08 She only has a bowel movement
59:11 once a week with a probiotic
59:12 help with this. Uh there are
59:16 certain probiotic s that have a
59:20 good evidence for constipation.
59:22 I definitely would suggest to
59:23 explore. I’m not sure whether
59:24 you’re in Canada or US. Explore
59:26 the option. Everybody tonight
59:27 at it is eh is eh from Canada.
59:32 I think on Facebook at least
59:33 and I think this is one of our
59:39 so so yeah the probiotic trend
59:41 probiotic and it quite often is
59:42 in a it’s a multiple
59:44 multifaceted approach. If this
59:46 is causing you know such a rare
59:49 bowel movement you know making
59:51 sure maybe even adding some
59:52 kind of a a peg flakes such as
59:56 or mirror would be a good idea
01:00:00 because I like those products
01:00:01 because you can actually tailor
01:00:03 the dose. You take maybe just a
01:00:04 teaspoon or half a teaspoon
01:00:05 daily to make sure everything
01:00:06 is moving properly. Eating a
01:00:08 kiwi or two kiwis per day where
01:00:11 the skin is recommended by
01:00:13 gastrointestinal associations
01:00:14 globally to to minimize risk of
01:00:16 migraine s if you like kiwi
01:00:17 that would be probably easy to
01:00:19 do. Um and you know trying
01:00:21 things once once everything
01:00:23 establishes they can maybe even
01:00:24 stop probiotic probiotic and
01:00:26 then maintain the bowel
01:00:29 movements with the you know
01:00:30 good fiber kiwi maybe. Uh and I
01:00:35 know that every or we we keep
01:00:36 on saying the same things. I’m
01:00:38 just going to remind that
01:00:39 magnesium. Uh citrate the one C
01:00:42 for constipation. So citrate is
01:00:44 the one that actually helps if
01:00:47 you have constipation and it’s
01:00:48 also potential preventives that
01:00:51 you can add to your
01:00:53 medications. Um it give it a
01:00:55 try as well I love the the kiwi
01:00:59 advice because we’re seeing
01:01:01 more reports from our patients
01:01:04 saying that actually it does
01:01:06 help and it’s it also is rich
01:01:08 in vitamin C, fiber and it
01:01:11 actually does a good job. Uh we
01:01:14 have reached the end of our
01:01:16 tonight’s broadcast, our
01:01:18 webinar. We would like to thank
01:01:21 everybody who’s joined us
01:01:22 tonight and Dragana it’s it’s
01:01:26 it’s a pleasure. It’s it has
01:01:27 been very informative. Um I
01:01:29 think that we will need to go
01:01:33 to your website and learn a
01:01:34 little bit more and have these
01:01:37 guides and find out and and
01:01:38 when we go next to to buy a
01:01:41 probiotic, we’re going to take
01:01:43 a little bit more time to try
01:01:45 and find the the one that is
01:01:49 designer kind of. Yeah. and
01:01:53 speak with your pharmacist and
01:01:55 you mean, definitely speak with
01:01:56 your doctor but speak with your
01:01:57 pharmacist as well. That will
01:01:59 be absolutely something. I
01:01:59 would us. Absolutely. That’s
01:02:02 why it’s called Ask Your
01:02:04 Pharmacist. This is our monthly
01:02:06 webinar where we are trying to
01:02:10 encourage our community members
01:02:13 to go and talk to their
01:02:15 pharmacists and find
01:02:16 pharmacists like you that have
01:02:17 developed a knowledge that is
01:02:20 advanced knowledge on a subject
01:02:22 that is very important for our
01:02:24 community. Thank you very much.
01:02:25 Again, thank you for everybody
01:02:27 who has joined us tonight and
01:02:28 we hope this was useful for you
01:02:32 and we hope to see you next
01:02:33 month again. Thank you. Thank
01:02:36 you. Have a very good night.