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James McNabb, M.D., C.N.

Colonoscopies and Probiotics

I was talking with my friend Carl the other day, who was complaining about 21 days of diarrhea after a recent trip. A test for giardiasis was negative and Flagyl didn’t seem to help. I mentioned that pathologic bacteria like E.coli could be the problem. I asked him if he had been placed on antibiotics for any reason lately. The reply was no but he did have a colonoscopy recently.

I hear this frequently from patients, that following a colonoscopy, some aspect of GI distress happens. The problem ensues, in my opinion, because of the severe disturbance of the colonic bacteria in preparation for the colonoscopy. The bowel is completely emptied of its contents so that the colonoscopy can proceed. While the bowel is not completely sterilized, it comes very close to it. Probiotics is the word that describes normal GI flora. What most colonoscopists fail to realize is how important normal colon bacteria, or probiotics, are to us. Let’s look at their many functions.

We realized how important normal GI bacteria are when we examined how poorly the children born with weak immune systems were when placed in sterile environments (the bubble boys). When they were exposed to normal GI bacteria, they became healthier. These are the functions of these bacteria.

1. Occupying ecological niches. When there are plenty of normal bacteria occupying all the places in the GI tract, when pathologic bacteria come along, there are no places for them to attach and they pass out. Let me use an analogy. Assume in your neighborhood that your neighbors have lived there for year. Everyone is happy. Now assume that half or more move out for some reason. Now your troubles begin, for you do not know what will happen if transients, drug dealers or worse move in.
2. Probiotics also make many of our vitamins and necessary nutrients for us. Most of us remember Vitamin K, but how about pantothenic acid, and biotin? They also make short chain fatty acids like butyrate which colonic cells use as their preferred fuel.
3. Bacteria make up the majority of stool volume, and by increasing stool volume, we have larger and softer stools. This shortens GI transit times. By taking out the trash more quickly, colon polyp rates go down as well as cancer rates.

Probiotics need food. We don’t eat what they eat, and they don’t eat what we eat. We do not have the enzymes to breakdown fiber. Probiotics do. Thus by eating fiber, we are giving the bacteria what they need to grow and multiply. American diets are typically low on fiber. I recommend adding fiber to the diet in the form of ground up flax seed and Metamucil as an extra source of fiber. (Please build up slowly or gaseous symptoms will develop.)

The bottom line for colonoscopists is to recommend Probiotics to their patients after the procedure. One capsule with meals (TID) for several weeks is a good idea. Taking probiotics daily on a long-term basis is not a bad idea either. The bacteria will survive the stomach better when it is buffered with food. And don’t forget to recommend some type of fiber to feed them.

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