What to Do If You Need to Take Antibiotics | Chris Kresser
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What to Do If You Need to Take Antibiotics

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what to take with antibiotics
Taking antibiotics is never ideal, but sometimes it's necessary. iStock.com/amphotora

Note: The Prescript-Assist supplements discussed in this article are no longer available. Please click here to learn more about a substitute, the Daily Synbiotic from Seed.

I wrote this a while back when I had more time, thinking it might come in handy during the book tour. I was right!

A few years ago, I wrote an article about the often devastating effects that antibiotics can have on the gut flora. While it’s extremely important to avoid unnecessary antibiotic use, what about those who have carefully considered their options and decided that antibiotics are necessary in their situation? Is there no hope for recovering a healthy microbiome?

Need to take antibiotics? You need to read this article.

While having to take antibiotics is never ideal, there are many cases where it is absolutely necessary, and don’t worry – the situation is far from hopeless. It will take some time and effort, but there are many things you can do both during and after a course of antibiotics to minimize the damage and encourage regrowth and diversification of your gut flora.

Probiotics

To some, taking probiotics during a course of antibiotics might seem contraindicated. After all, won’t the antibiotics just kill all of the probiotics anyways? First, keep in mind that probiotics don’t need to actually colonize the gut to be beneficial; even transient strains can have powerful therapeutic effects.

There are quite a few randomized, placebo-controlled trials that have demonstrated the effectiveness of probiotic use during a course of antibiotics for reducing side effects and preventing gut infection. (1, 2, 3, 4, 5, 6, 7)

For example, a study on 135 hospital patients taking antibiotics found that only 12% of the probiotic-receiving group developed antibiotic-associated diarrhea, compared with 34% of the placebo group. (8) Additionally, while 17% of the placebo group developed diarrhea specifically from C. difficile, nobody in the probiotic group did.

One interesting study tracked changes in gut bacteria in three different groups of people receiving antibiotics, with one group receiving placebo, one group receiving probiotics beginning after the antibiotic treatment ended, and the third group receiving probiotics both during and after antibiotic use. (9) The group receiving placebo had significantly higher levels of facultative anaerobes (their chosen marker for gut dysbiosis) 20 days after finishing antibiotics compared with baseline, while the two groups receiving probiotics had no significant difference. But even though both of the probiotic groups ended up back at baseline levels, only the group taking probiotics during as well as after antibiotic treatment maintained stable levels of facultative anaerobes throughout the experiment. In the group receiving probiotics only after completion of antibiotic treatment, facultative anaerobes increased significantly during antibiotic treatment, and decreased only after beginning probiotic supplementation. This clearly demonstrates the importance of taking probiotics during antibiotic treatment, as well as after.

Most of these trials used different strains of Lactobacilli, Bifidobacteria, or Saccharomyces boulardii. Lactobacillus and Bifidobacterium are two of the most common genera used as probiotics, so these supplements are readily available in most health food stores or vitamin shops. S. boulardii is actually a beneficial yeast rather than a bacteria, so it’s particularly useful during antibiotic treatment because the antibiotics can’t kill it. S. boulardii is also preferable under these circumstances because there’s no risk of it harboring genes for antibiotic resistance and later transferring those genes to pathogenic bacteria. (10)

Another option for probiotics is a blend of soil-based organisms, such as Prescript Assist. I haven’t located any studies on their effectiveness in conjunction with antibiotics, but based on my clinical experience, I believe they’re a great choice.

As with anything else, the best probiotic to take will depend on a person’s particular circumstances (such as the antibiotic they’re on and the state of their digestive system), but the two supplements I recommend most often are S. boulardii and Prescript Assist. If you don’t do well on either of those supplements or just wish to add more variety, feel free to add in a supplement with strains of Lactobacillus and Bifidobacterium. Do your best to take any probiotic supplement as far away from your antibiotic dose as possible.

Prebiotics

As I’ve mentioned before, prebiotics are much more effective than probiotics at promoting the growth of beneficial bacteria in the gut. Thus, prebiotics are an incredibly important part of any regimen to protect or rebuild a healthy microbiome.

During and after antibiotic use, focus on getting plenty of soluble fiber, which feeds beneficial bacteria and is found in starchy tubers, squash, and peeled fruits. It might be best to avoid too much insoluble fiber while your gut is in a compromised state, since it can be irritating to the gut lining.

However, one type of insoluble fiber that can be extremely helpful for supporting healthy gut flora is resistant starch. (11) I’ve talked about resistant starch before here and here, and the easiest way to get a concentrated dose of RS is to use Bob’s Red Mill unmodified potato starch. As with any supplemental prebiotic, it’s a good idea to start with a small amount and work your way up. In this case, you could start with 1 teaspoon and work your way up to 2-4 tablespoons per day. If you find that RS doesn’t work well for you, you might consider trying an inulin-based prebiotic such as this one.

If possible, introduce any prebiotic supplements before beginning the course of antibiotics so your body can get used to them. That way, you won’t have to deal with possible side effects from introducing the prebiotic on top of possible side effects from the antibiotics.

Supporting diversity

As I mentioned in my article about the impact antibiotics have on gut flora, the main difficulty after a course of antibiotics isn’t recovering the number of flora present; it’s recovering the diversity. As we’ve seen, probiotic supplements can be incredibly helpful for preventing antibiotic-associated diarrhea and lowering the risk of a gut infection, and I recommend continuing with probiotic supplementation for a period of time after finishing your treatment. However, you can’t expect manufactured probiotic and prebiotic supplements to achieve the diversity of an ancestral microbiome on their own.

One of the best ways to expose yourself to more diverse beneficial bacteria is by consuming fermented foods, so I highly encourage you to experiment with a variety of different ferments.

These can include kefir, beet kvass, sauerkraut, kombucha, kimchi, and other fermented vegetables or fruits. Keep in mind that foods like yogurt and kefir will probably only have a handful of bacterial strains if you buy them from the store, so homemade is best.

Another way to diversify the bacteria you’re exposed to is by gardening or otherwise getting your hands dirty, although I haven’t seen any research on whether that exposure translates to a more diverse set of gut bacteria.

As far as prebiotics go, just try to get as much variety in your plant foods as you can, in addition to supplementation with resistant starch or another prebiotic formula. Some of the best sources of soluble fiber include carrots, winter squash, summer squash (especially peeled), starchy tubers, turnips, rutabagas, parsnips, beets, plantains, taro, and yuca. Green bananas and unripe plantains (which you can dehydrate to make chips) are good whole-food sources of resistant starch.

Support for the Gut and the Liver

When antibiotics throw your gut flora into turmoil, the gut lining and digestive function as a whole take a hit too. To soothe your digestive system, it’s a good idea to ramp up your consumption of bone broth and other glycine-rich foods while you’re on antibiotics, and continue to consume these foods after the treatment is finished to promote healing.

If you experience nausea or other digestive upset from the antibiotics, ginger can be extremely helpful for reducing inflammation and calming the digestive system. (12, 13) It’s best to use fresh ginger, and you can easily make ginger tea by slicing it and simmering it in water until the tea reaches your desired strength.

Antibiotics can also take a toll on your liver, particularly if you’re on them for an extended period of time. Not only is the liver is responsible for processing and detoxifying medications, it also has to deal with extra circulating lipopolysaccharides from the increased bacterial death and intestinal permeability. Milk thistle is one of my favorite supplements for supporting liver health, and can be taken in a pill (like this one) or as a tea. (14, 15) Glycine is also important for liver detox, so be sure to drink that bone broth!

I hope you found this article helpful. As always, I’d love to hear from you in the comment section; just be mindful that I’m busy with my book tour right now, and may not be able to reply to your questions. But many of my readers are extremely knowledgable, and I encourage you to take advantage of the free forum in addition to the comments section to bounce ideas and experiences around.

303 Comments

Join the conversation

  1. I recently had a baby and had to have a c-section due to placenta previa. I took sacc. b, Prescript Assist, and FemDophilus double doses daily for a week afterwards. I also stored my fecal microbiome in the freezer to transplant back to myself afterwards. 8 months later it’s still in the freezer, hehe! I think we should all store our microbiome in the freezer every 6 months or so just in case of an emergency where we would need antibiotics. I also an an organic gardener and made a point during and after pregnancy to sample some compost, and my baby loves to do the same.

    My baby got HLC Neonate the day he was born. So far so good, no autoimmune stuff like older sibling was showing soon after birth.

    Thanks again Chris, you have really helped me to have a healthy pregnancy and baby.

  2. Always interesting to read your articles. Thank you.
    I was wondering what you thought of the Klaire Labs brand (Biotagen) for probiotics and prebiotics ?

    • Biotagen is a good prebiotic that I use in my practice. Klaire makes a number of probiotics. I use their Therbiotic Infant with kids under 2 years old, but I prefer Prescript Assist for adults.

  3. Thanks for another informative article, Chris!

    Just curious…if you recommend potato starch for resistant starch, why can’t one just eat potatoes? Is it due to the saponins (which I believe are largely concentrated in the skin)? Would potato starch have saponins?

    Again, thank you for all of the info!

    • Potatoes that have been cooked and then cooled for 24 hours contain resistant starch, but I think the resistant starch is degraded as soon as you heat them up again. So I think eating 24-hour cooled potatoes is an option for RS, as long as you like cold potatoes! (Potato salad, perhaps?) Not sure how much RS is in a potato though, compared with the potato starch.

      Along the same lines, be sure your potato starch is unmodified, and don’t heat it. Otherwise, it probably won’t contain RS.

  4. This article is very helpful. Thanks for the pro biotic recommendations.

    I thought I would add that many people use Oregano oil as an alternative to antibiotics. No one in out family of 5 (ages 35, 34, 6, 4 and 1) has needed an antibiotic in 6 years. We use therapeutic grade Oil of Oregano (usually topically and if serious internally) for everything that would normally require antibiotics. I have cured numerous bouts of mastitis with Oregano oil. Oregano is also an antifungal, which kills Candida, so yeast overgrowth doesn’t tend to occur as it does in antibiotics. There are numerous studies on PubMed.

    • Good to know, Megan. Do you have any recommendations for using the oil for ear infections? My kids are 10 months and 3 (twins) and they all recently had ear infections for the very first time. The inner ear was infected, so I’ve heard that drops or anything put into the ear doesn’t reach that part. Do you know what to do in this case? They all had Amoxicillin and I hated giving them antibiotics, especially the baby. What are some other uses for Oregano in order to avoid antibiotics? How did you use it with mastitis? Topically? Internally? Thanks!

      • For children with ear aches, you can get immediate results with the help of a classical homeopath. I’d also see the comments above for probiotics for children.

        • Thanks Megan and Beth! I just recently started purchasing Young Living Essential Oils. Oregano will be my next! We do a lot of bone broths and probiotic foods too. I have an appointment with our nutritionist this Friday to help get recommendations specifically for infants.

          Megan, is the Melrose Oil good for fighting infections? I’ve heard of using Oregano, but I don’t know much about Melrose. I am fairly new to using essential oils. Does rubbing it on the skin still have a pretty powerful effect internally?

          Thanks again!

          • Hi again Christine 🙂
            Yes, I do find that most often applying them topically is enough. They are very powerful.
            Melrose is a blend of Tea tree, rosemary and clove (maybe more- I can’t recall). And Oregano would work behind the ear as well.
            Good luck finding answers.

      • Hi Christine,

        We do a lot of what the articles says already- bone broths and tons of probiotic foods as our base. I am a minimal interventionist, so I prefer to let things play out on their own or treat them minimally. On myself and kids, i usually use essential oils topically. I do use them internally, if I feel it necessary.

        My experience with ear infections is rather limited. I think between my three kids, we’ve only dealt with ear infections 5 times, so I wouldn’t say I’m an expert or anything. I do consider it a success that none of them has ever taken an antibiotic for an ear infection. When they are very young and breastfeeding I squirt breastmilk in their ears. I have also used ear oil (garlic, mullein, thyme and tea tree) in the ear canal. I rub Young Living’s Melrose blend behind their ears at the first sign of infection and then 2-3 times daily for 3 days after symptoms resolve. I also rub Oregano oil diluted 1:4 with olive oil on their feet.

        If I want to give my children an oil internally (I use Thieves blend), I make a paste with honey and powdered slippery elm and then add 2 drops eo to each “lozenge.” Or I simply put a drop of eo on a spoonful of honey.

        For mastitis, I apply tangerine, geranium and oregano topically to my breasts. If the mastitis seems to be getting away from me, I take oregano internally- just a few drops under my tongue, 2-3 times daily.

        I have used it with success on my dog who had an infected bag of fluid on his neck that the Vet lanced and then prescribed an antibiotic for. I gave the puppy one dose which he vomited up and then decided to use Oregano. I gave it to him diluted in capsules for 2 weeks and he healed completely. I have used it for my sick chickens as well. It really is incredible.

        The reason, I started using essential oils was to treat persistent thrush/Candida that not even rx antifungals would kill- but Oregano oil did. The thrush came on after I took an antibiotic for mastitis just after the birth of my first son. I have had mastitis at least 6 times since (because of my tendency towards oversupply) and have always used Oregano with success. Although it is comparable to a broad spectrum antibiotic, I personally feel that it is far less damaging to gut flora. I have not experienced any ill effects and I’m pretty aware of my body. Hope this helps.

  5. Thanks for the info! My baby (10 months) is on Amoxicillin for a severe ear infection. We did everything we could to avoid it. We waited to see if she could clear it herself, and used red light therapy on her ear. It spread to the other ear and she started losing weight, so we had to do it. I HATE that her perfect little belly is now ruined. She used to be the happiest baby in the world and now she won’t sleep, and fusses all day. I think her ears are better, so I don’t think the fussiness is from pain. I know the link between digestive health and the brain, so I’m worried this has effected her personality.

    We spent a long time fixing my 3 year old twins’ digestive systems due to prematurity (which resulted in food allergies/damaged gut lining) and I really don’t want to go through all that again with her.

    She still breast feeds and I plan to for a long time. If I eat the fermented foods, does that translate into the breast milk for her? I am giving her an infant probiotic but it does not have S. boulardii. Is S. boulardii safe to give her? Also, I’ve heard soil based probiotics can be dangerous for some people. Any thoughts on this? Should I/she take them? We’ve used Prescript Assist before for my 3 year olds, but that was before I heard about the possible negative effects.

    Any suggestions for babies?? Please help!! (Btw, my 3 year olds were on Amoxicillin too for the same reason, but I’m more worried about the baby’s digestive health at the moment. I suppose I could do for them what I do for the baby).
    Thanks!!

  6. I’ve just landed in bed with what appears to be the flu. Home remedies that REALLY work please? I hate taking medicine, and obviously flu shots.

    • Salt-water gargles for the throat. Tylenol for muscle aches, but no more than 3000 mg per day, (assuming you’re not allergic to Tylenol). Lots of chicken soup, hopefully made with bone broth. Lots of fluids in general. As much rest as you can get.

      If your temp drops after a few days, then a few days later rises steeply, plus you’re feeling short of breath, consider this: one of the worst complications of flu is bacterial pneumonia following in the wake of the virus. Time to see your doc.

  7. I recently was started on triple antibiotic therapy (to continue for a minimum of 3 years ) for a Mycobacterial lung infection. Unfortunately because I have chronic SIBO I have avoided probiotics in general. Do you know if there is a good probiotic choice for me that would be helpful in preventing antibiotic associated diarrhea or Cdiff but will not exacerbate the SIBO?

    • I have some knowledge – by way of experience – with what many of you are asking, as to all of these conditions – and for which most are representative of the untoward (not good) side effects of antibiotic interventions.

      Antibiotics can – and do – “Save Lives” – depending upon the type of infection. If, for example – you suffer a puncture wound, where pathogens are directly introduced into the body – antibiotics are your best answer to prevent – or abort an infection. However, and that being said – the same does not apply to a waterborne – or food borne infection – because here – it is “once again” about biological terrain management, and by way of example – ‘fully one third of all gastrointestinal poisonings are “Viral” and taking an antibiotic – will whack the Immune System – and could lead to death.
      Any overgrowth… whether SBIO – or otherwise – is an ‘Imbalance of Biological Terrain Management – and the singular best response is Prescript-Assist. OH… and I am speaking as Flight Crew Member to the World’s largest Airline… for which I fly ‘exclusively’ to foreign Countries – and for all of us who use P-A (as it is fondly called) – maybe thinking of a Physician Assistant… or Prescription Assistant – we ‘never’ have gut issues – while eating and drinking ‘just about anything’…. Oh Yes… .we may experience a little diarrhea, if we eat something that is quite contrary – but all we do, is to take a few more P-A – and as we say: “Be On Our Way”…. and that is “Not to the Hospital” – but Back to Work.

      Remember: Crowd Out the Pathogen, Consume the Food of the Pathogen, Consume the Pathogen for Food – or emit a metabolite – to Control the Pathogen… End of Story!

    • Yes, Prescript-Assist is safe to take with SIBO which is one reason I recommend it. The same can’t be said for lactic-acid probiotics like acidophilus.

  8. Thanks, Chris–it is great to know that when you take antibiotics all is not lost if you take probiotics. This is the first time I have actually seen this in writing anywhere and I won’t get as stressed out next time I need to take antibiotics–usually for a bladder infection.

    • Joyce, while all is not lost probiotics and prebiotics do not restore the microbiota to the same state it was in before antibiotics. They are a way to mitigate the harm, not erase it. So it’s still wise to avoid them whenever possible, and only take them when necessary.

  9. After learning, couple of years ago, about the devastating effects of antibiotics, I kept asking myself how did I end up having such a healthy digestive system (and good overall health), no intolerances or allergies ever. Growing up in Eastern Europe in the 80’-90’s, I used to take at least two rounds of antibiotics per year, usually more, prescribed by my doctor for sore throat infections. I even took some kind of antibiotic shots (very painful) for about 3 years on and of, at age of 10, for “preventative measures”. Antibiotics are sold over the counter there and people are popping them as candy for simple colds and coughs, even thinking that it’s straightens they’re immune system.
    After reading your article, I now have an idea: we grew all our vegetables, and during the spring and summer I used to play almost every day in the garden and snack on whatever was growing, green apples, peas, tomatoes, carrots, without washing them of course. We consumed lots of pickled vegetables, tubers, yogurt, broths and some kind of fermented drink, similar with kombucha, all of them homemade of course.
    About 8 months ago, being pregnant I had to take antibiotics for a massive tooth abscess. My now 6 month old daughter, has cradle cap and eczema flair ups, recurring colds also a big red spot at the crease of her neck that would not go away with over the counter anti-fungal cream (recommended by her pediatrician).
    I recently learned that it might be due to antibiotic use during the pregnancy.
    I would love your opinion on this.

    • Therbiotic Infant from Klaire Labs if they’re under 2 years old. Same recommendations in this article if over 2 years old.

      • Hi
        I’ve been on antibiotics for 9 years treating rosacea, I recently found out I have candida and some serious bad bacteria going on. I’ve stopped my antibiotics for the rosacea as I’m treating the candida at the moment with and intense diet. My rosacea is back and it’s so bad 🙁 I’ve tried creams they don’t work, what if I need to go back on antibiotics, will I still be able to get my insides good again ?

  10. Chris,

    Great book!

    As far as Pre-Script, it would have been my first choice, but the ingredient label states it “contains a proprietary blend of Leonardite and the following microorganisms…” I have yet to convince myself of the safety of Leonardite (humic acid, or more accurately, up to 90% humic acid). Fulvic acids are a particular type of humic acids; see here for an article on the safety — or lack thereof — of fulvic acid:
    http://drcrinnion.com/is-fulvic-acid-effective-for-heavy-metal-removal-is-it-safe/

    Any thoughts on this?

    Thanks and keep up the great work!

    -Kevin

    • What you have been told about ‘many things’ – is only to Educate YOU – To the Degree “Someone Else” wants You to Know!
      Leonardite – named as such, is really “Lignite” – the Ore Structure which is ‘above’ Coal – but fondly named after the N. Dakota University professor Dr. Leonardite – who conducted a small library of research on this Miraculous “Ore” structure.

      As far as Prescript-Assist is concerned – this “Carbon-based Mineral Complex” is the Prebiotic Food Source – providing a readily available food source to the broad spectrum of microorganisms in P-A. Why is this significant? To balance – or ‘regain’ the high ground in the “biological terrain management’ – for to maintain, or re-establish ‘homeostasis’ one of four things must occur – to prevent a “Pathogen” from Taking Over.
      1) Multiply fast enough (called Binary-fission, as to make two organisms, from one) to “Crowd Out” the Pathogen.
      2) During multiplication – there is the necessity to consume ‘food’ – and if the microbes consume the food of the Pathogen – it cannot proliferate.
      3) During Proliferation – and in consuming surrounding food sources… often the Pathogen will be Consumed… and thus – will no longer be controlling the Biological Terrain.
      4) Emit a “metabolite” – or antibiotic – AKA Myco-toxin… which will kill / control (inhibit the further growth) of the Pathogen…. Look Up the Story of “NYSTATIN” – as to how the Streptomyces noursei bacteria came into medicine.

      Other probiotics lack these four ‘basic’ functionality principles – and thus are not even in the Same Galaxy – as is P-A… and yet, Leonardite is important for other factors, as it is a ‘natural chelating agent agent… as it’s heavy metals (if present) are “bound” and will not be absorbed by the body – but as to the contrary – they bind with other heavy metals and transport then from the body. Do your research, and you will substantiate these facts for yourself – and then you will have answers supportive as to why P – A is the World Class Probiotic – Prebiotic, that it is… Bar None!

      When you think – or see – Prescript-Assist…. think “Biological Terrain Management” – and with this comes Harmonization of Gastrointestinal Function.

      • Did you read the link I sent? Because you didn’t respond to any of the issues raised in it. The question is still open to an answer with supporting evidence.

  11. Dear Chris,
    I am a 53 y/o otherwise healthy woman who has been eating paleo for one year. Hip replacement surgery infection at incision site has caused me to be on oral cipro and massive doses IV Vancomycin for six weeks. Side effects are joint swelling, soreness and unusually slow recovery time. Wondering if you had any further suggestions?

    • Cipro is a fluoroquinolone antibiotic and for some who are genetically susceptible can cause major health problems. Google search for floxies, check out Dr. Jess Armine’s site. He works with floxies a lot. Hope you find some help 🙂

  12. I am taking massive doses of antibiotics currently 1,500 twice a day, for 2 weeks for H pylori. I was reluctant to take them but was told that H pylori can lead to stomach cancer. Have been on GERD med for +10 years, doc wants me off it. I have had no issues with my gut, thankfully. Am I just one of the lucky ones or is my gut compromised and I just don’t know it? Thank you for the information on prebiotics. I take neither pre nor pro but was thinking of starting to take the pro. However, I will research your website for more details and likely change that idea to the prebiotics.

    • If you are taking proton pump inhibitors they reduce the acid, obviously, but that can lead to B12 deficiency and allow bacteria that the acid would kill to have a chance to take hold – H.pylori is the prime example. I have had a few clients with this same issue and they take deglycyrrhizinated licorice, zinc carnosine, aloe vera and L-glutamine for the H.Pylori. For the acid reflux, I would check with someone who does visceral manipulation to help pull down your stomach – if you have a hiatal hernia. Then I would drink Kombucha or apple cider vinegar and eat sauerkraut along with the bone broth. Home brewed is best because pasteurization destroys the health benefits.

    • GERD is caused by bacterial imbalance (SIBO) in the guy and sometimes H. Pylori infection as well. You have to starve out the bad bacteria. Apple cider vinegar and all the other “natural cures” some people recommended to you never worked for me. What does work is the Fast Tract digestion diet, which involves limited the amount of fermentable (gas-causing) foods you eat. More information here: http://digestivehealthinstitute.org/2012/08/17/sibo-diet-and-digestive-health/

  13. Interesting studies. Thanks for providing the links. I’ve been treating chronic Lyme disease and other systemic infections for several years with herbal and nutritional support. Although I didn’t want to, in the last few months I found it necessary to start taking oral antibiotics and now on daily IV antibiotics as well. Surprisingly, my digestion and bowels have been better and more normal than they’ve been in a long time. I’ve found that probiotic supplements along with a good variety of fermented and cultured foods like you mention has benefited me the most, even while taking so many antibiotics. I think the best you can do while on antibiotics is to take supplemental probiotics spaced out as far away from the antibiotics as possible and try to get some type of fermented foods all throughout the day, even if only in small amounts. Klaire Labs Therbiotic Complete, Florastor, and foods like beet kvass, pickles, sauerkraut, yogurt, kefir and kombucha have helped me quite a bit.

  14. Chris,

    Great article. I am suffering from Lyme disease and have been cycling on and off antibiotics for over a year. Do you have any advice in terms of timing for both prebiotics or probiotics (on a daily basis)? Some protocols have me taking antibiotics 3 times a day so it becomes increasingly difficult to space out 5 pills (assuming I am taking probiotics twice) and potentially 6 pills/mixes if I intoduce a prebiotic into the mix (which I will do per your advice). At this point does timing make much of a difference? Finally, I have been following your auto-immune protocol would the potato starch as a prebiotic be a bad call to introduce at this point? Basically should I just go with the Prebiogen? Thanks for all the great work. You have been a life saver. Looking forward to starting your new book. Best of luck with everything.

    Regards,

    Peter

    • There’s no need to take probiotics 2x/d. Given your med schedule, I’d suggest just doing it once a day.

  15. Hi Cris,

    I am from Slovakia (in the middle of europe). We call here potato starch solamyl as well. According to you it is solamyl safe and appropriate source of rezistant starch. What is your opinion. Thanks in advance.

  16. My cat, Moccasin, recently had to have antibiotics, and I hated to give them to her and ruin her little gut, but it was necessary in her situation. However, I have done some cursory research online, and found that pets can have probiotics, too.

    I opened up a capsule of acidophilus and sprinkled some on her wet food, and I also gave her a little full-fat plain Greek yogurt. Do you think pets on antibiotics could also have prebiotics? Do you have any pets, Chris?

    • Tarah, Google: Are cat probiotics the same as human probiotics. My understanding is that cats microbiome is populated with different strains than humans so human probiotics may not be the best. I found an article by Dr. Becker on Dr. Mercola’s site that stipulates that. Indeed when I’ve had probiotics sent home with my cat I did not recognize the strains from the zillions of probiotics I’ve take over the years. My vet told me not to use human probiotics for the cat. Additionally it is my understanding that dairy products are not good for cats either as they are intolerant not having the ability to break down milk ‘sugar’. Lactose.

      • Yogurt does not have much lactose and I give my cats some regularly with no ill effects. I have even seen cheese and dried milk on the labels of some cat foods.

        • Just because a manufacturer puts that into a product, doesn’t guarantee it’s good for cats. Sometimes ingredients are included to seduce the buyer of the cat food, not the cat. Just sayin . . .

    • Wellness cat kibble is sprayed down with probiotic bacteria. 80 million colony forming units/pound. Check out the information on the bag. At the beginning, just give the cat a little of this because it may cause loose stools. One of my cats is presently on a 42 day course of doxycycline for mycoplasma. He gets live culture yoghurt every day as well. No diarrhoea.

  17. Your website is informative and I enjoy it very much. However, it is reading my iPad mobile signal and automatically giving me the mobile content rather than the desktop version I would prefer for the iPad. It would be a wonderful improvement if you could offer the choice of either mobile or desktop content on the website rather than an automatic load (and I would have posted this somewhere else, but there does not appear to be another way to contact you). Thanks.

    • Heather, I’m glad you like the site. Unlike some sites that offer a more minimal mobile experience, we are currently loading all of the content on the site regardless of your screen size. That said, given the more limited space on mobile devices, we have to make some layout adjustments as the screen size decreases. One suggestion for you would be to flip the orientation of your iPad. If you view the site in landscape mode (instead of portrait) it will look almost identical to what it would on a desktop. Let me know if that helps!

      • I have been viewing it in landscape and ever since I posted a comment it no longer gives me the sidebar information (popular or recent posts, etc.). Now I have to scroll to the end of articles to see that. Also, I can no longer see the website header, just the article title. Maybe it is just an “error in chair” situation, but I can’t figure out how to get the content to show up in safari the way it did previously.

  18. Is stock the same thing as broth? We get boxes of “Swanson 100% Natural Beef Broth” where the primary ingredient is “beef stock”. I’m sure homemade is much better, but is this stuff at least in the ballpark? It says that it’s fat free, which doesn’t inspire confidence…

    Also, your “getting your hands dirty” link points to http://www.apple.com. I guess you’re an Android fan? 🙂

    • We’ll fix the link, thanks.

      Unfortunately store-bought broth is not remotely the same as homemade, largely because the benefits of stock are primarily in the fat and from the bones, skin, cartilage it’s cooked with. You can add gelatin to store-bought broth to make it more nutritious, but homemade is much better. The good news is it’s fairly easy to make.

        • You can buy really nice broth at the store that is just as good as the homemade stuff. I’ve seen some at my local health food store that even contains gelatin. Unfortunately, they cost like $6 per quart. 3lbs of grass fed beef bones costs about that and you can make maybe 10 qts of broth from it, if not more.

        • Anthony,
          Making your own bone broth is really incredibly easy. All you need is a crock pot (slow cooker) and a chicken carcass. After you eat your roasted chicken, take the carcass and toss it in the slow cooker. Add all sorts of chopped veggies to it, especially onion, carrots, celery, add a bay leaf and some whole black peppercorns, a little sea salt, and cover it all with filtered water. Set the cooker on low for 12 hours. Turn it off, allow to cool for a few hours, then strain. Voila! you have bone broth. The color is magnificent. No store-bought stock/broth will ever come close to the richness and delicious flavor of homemade. Give it a try.

          • Thanks. Maybe I’ll give this a try. I had read recipes saying to cook for 24-48 hours on the stovetop, which sounds like a hassle and I don’t like the idea of leaving the stove on for that long; the crockpot seems much more appealing for this. I’m more interested in beef broth than chicken broth, though; I wonder if just 12 hours would be sufficient for beef bones?

            • 12 hours would be enough for beef bones. For beef you are supposed to roast them a bit first, but I’ve done it without roasting. When you buy the bones (preferable grass fed bones) you want to get joint bones that have some cartilage in the so you will get the nice gel from it. If you can let it go more than 12 hours, that’s good too. You will see the meat and cartilage come off the bones and that means it’s done.

              • I would recommend 3 days on the beef broth! 12 hours is not even enough time for chicken broth. A very low boil is all that is needed. Do not forget to skim the scum off the too in the beginning.

          • That’s a great solution – I stopped carbs and most importantly SUGAR about 5 months ago. Enormous changes, dropped 40 lbs like it was nothing, which was not even the point – no longer get every cold that comes along. I have found that planning to be hungry is an important part of this program – a little forethought and planning. So now, each week, we get a roasted chicken at Costco (as we always did), and when it’s done, do exactly as you recommended, and put away the bone broth in the freezer, so it’s available for soups. Silly to just throw away a perfectly good carcass!

        • Wise Choice Market makes bone broth that they claim is like homemade. It seems we would be able to take them at their word. It’s much more expensive than making your own though.

      • It really is easy to make. And so totally worth it. I love to cook but never realized what I was missing by buying store-bought broth. Since I’ve been making my own, it’s taken my soups to a new level. In fact, it’s so darn good, sometimes just a cup of the broth makes a great “snack”.

      • Chris, I’ve recently started making bone broth with grass-fed bones. You mention fat as being one of the benefits, but one large bone generates an enormous amount of fat. (I just pulled a 2″ plug of solid fat off the top of my jar of broth).

        So what do you do with all that fat? I couldn’t eat it in a soup. Any way to cook with it?

        thanks,
        Peg

        • Hi Peg!

          If you’re using beef bones, the fat you have from making the broth is beef tallow, which is great for cooking! I usually just pull it off the broth once it’s solidified, re-melt it on the stove, strain it (if needed; usually it’s already clean enough for me!), and store it in a jar in the fridge. You can use it to cook pretty much anything savory, but I especially like it if I want to “deep-fry” things. It’s not actually deep-frying, but I use a decent amount of fat when I’m making things like hash browns, and I like using the tallow because it’s very stable and it’s cheap!

        • The farm where I buy my meat and eggs from sells “homemade” chicken stock. Just a thought ….check the farmer’s market if you don’t want to make the stock.

      • Gotta hunch this won’t fly for stock, but I usually use Knorr Bouillon Cubes when making soup. Is there any nutritional value for them? Anything detrimental?

        • Sorry, but those are no good and will give you none of the benefits of homemade broth. Here is the ingredient list: INGREDIENTS: Salt, Monosodium Glutamate, Beef Fat, Partially Hydrogenated Cottonseed Oil, Yeast Extract, Caramel Color, Dehydrated Beef Stock, Dehydrated Vegetables (Onion, Carrots, Parsley), Turmeric, Disodium Inosinate and Disodium Guanylate, Spices.

          Hydrogenated fats, msg, fake coloring, tons of sodium and a bunch of other industrial ingredients. I’d ditch this fast. Homemade broth really is easy to make and you can make a large batch and freeze small amounts in freezer bags.

          • I find that home made bone broth such as chicken or beef seem to be very weak in flavor for soups even after adding spices and vegetables. will adding an Organic Bouillion cancel out the benefits of the bone broth or will it still maintain it’s nutritional value as well as adding flavour?

  19. I’m on the Antibiotic Protocol for a serious autoimmune disorder for the past 3 1/2 years. The treatment has helped my condition tremendously and the alternative is deadly, so I am not likely to give it up.

    What do you suggest I do in terms of probiotics? I currently take either one Culturelle daily or 2 PB-8s. Is that enough?

    • I made some suggestions for probiotics in the article. Prescript Assist and saccharomyces boulardii are good choices when you’re taking antibiotics.

      • I have IBS and use Prescript-Assist with great results. Regarding the Prebiotics I use a product called Heather’s Tummy Fiber, which is Acacia Senegal Fiber. I had tried Inulin, metamucil and it made my cramping worse. I now take Acacia Fiber daily with good results. I now only need to take the Prescript Assist three times a week. At least unless I really have to take antibiotics again!

        • Aloe Muciliginous Polysaccharide (AMP) capsules is a highly concentrated form of Aloe Vera and a natural antibiotic. Use that for IBS. It is used for Diverticulitis also. It works.

        • I use Heather’s Acacia senegal (aka Tummy fiber) as a prebiotic as well. I have IBS symptoms and it helps tremendously. Thanks for posting this. I’m wondering what Chris Kresser thinks of Acacia senegal as a prebiotic.

      • you can use AMP instead. see my posts under diverticulitis topic. they will cure the diverticulitis. no need for antibiotics.

      • what would you suggest?

        My wife dealt with many bouts of sinus infections and was given may doses of antibiotics. She then began having serious gut issues. She switched to a pure paleo eating meats, veggies, butter, coconut oil, etc. things got worse and she eventually was diagnosed with ulcerative colitis earlier this year. They wanted to start here on steroids but she decided to go with a GERD diet with bone broth, cooked carrots and broccoli coconut oils and other GERD foods. She has stopped all grains, sugar, hi carb foods. Trying to stick with It’s been 3-4 months and she has improved greatly. Also her achy hands and feet have stopped aching. Her allergies were gone too. She lost weight and overall the colitis symptoms (mucus and runny stools) and began having regular stools and everything seems to be working right. She has always had higher cholesterol thinking it’s due to FH. Like above the 200’s. she is 49 years old 5’2 120 lbs her BP is like 100/60 and pulse is usually in the 60’s. she is in great shape. She recently had here blood work done so we could see if she had the big fluffy partials. We got the results back and we were very shock.
        Here are the results
        Lipids
        Total 398
        LDL-C 290
        HDL-C 104
        TRI 58
        Non-HDL-C 294

        Particle
        Apo B 198
        LDL-p 3150
        sdLDL-C 65
        SDldl-c 23
        Apo A-1 170
        HDL-P 48.4
        HDL2-C 50
        Apo B:Apo A-1 ratio 1:16
        Lp (a) 22

        Inflamation
        Hs-CRP 0.4
        Lp-PLA 303

        Metabolis
        All were optimal except
        Her free fatty acids were 1.40

        Thyroids
        TSH 1.96
        T4 7.1
        T4 free 1.27
        T3 88

        • I wonder if the coconut oil is raising cholesterol. I hear good things about it but also same bad things regarding cholesterol. Some people think it raises cholesterol. How much does she ingest?

      • i’m wondering if you have a recommended brand(s) for saccharomyces boulardii? my husband started a course of unavoidable antibiotics today and we need to get started on the support for this! thank you for all your great information.

        • i think you just find the best price. the one i have is
          saccharomyces boulardii plus bio mos by swanson

    • Look at VSL#3, expensive but very effective. Once you settle with VSL#3 and you are off antibiotics, Nexabiotic routine is also a good thing.

      Personally, I use VSL#3 DS, Nexabiotic, Probiotic-3 and Prescript Assist. I have Ulcerative Colitis. As stated, I don’t use all of them all the time, VSL#3 to prime and rest for maintenance.

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