Dit is wel een hele lap tekst, maar het geeft antwoord op de vraag hoe probiotica te gebruiken tijdens GAPS:
The topic of probiotics brings up many questions, and a random approach to incorporating them creates many issues. Please be sure to review this entire section before introducing them. Following the tips offered in the following Q&A can save you from unnecessary frustration, discomfort, and expense.
“What are some sources of probiotics?” Probiotics are found in fermented foods such as homemade whey, kefir, yogurt, and fermented vegetables as well as in commercial supplies (i.e., capsules or powder).
“What if I can’t afford a therapeutic dose of a commercial probiotic?” Many people experience excellent healing by using copious home-ferments daily. However, if you are not yet committed to creating and ingesting regular doses of fermented vegetables, fermented fish, yogurt, kefir, fermented coconut water, etc., the expense of a commercial probiotic will be necessary and worthwhile. You can also mix-and-match the homemade and commercial options, taking a smaller or less frequent amount of homemade options while also taking a moderate dose of a commercial probiotic. Regardless of the source of probiotic you choose, be sure to start with just one source at a time, and build the dose of each one slowly.
“Will I heal without a therapeutic dose of a commercial probiotic?” Whether or not you are taking a commercial probiotic, it is impossible for anyone to make projections about your GAPS results. However, at least one mother on one of our online support lists has seen tremendous healing in her son even though he cannot take any supplement, including any bottled probiotic.
“Will a probiotic help me even if I’m not doing the diet?” In her book Gut and Psychology Syndrome (9th edition), Dr. Campbell-McBride said: “Adhering to the diet is absolutely essential [while taking the probiotics]. If you carry on feeding [the] pathogens in the gut with sugar and processed carbohydrates then the probiotic will not have much chance of helping you.”
“I’m intolerant to casein/lactose. Some commercial probiotics contain traces of milk. Should I take it or not?” Most of us are unable to process casein until we have been on GAPS for some time, and most of us are unable to process lactose even after being on GAPS for many months. Despite this, most of us are fine with commercial probiotics that contain either of these. In most cases, those who have reacted to a commercial probiotic started with relatively large amounts (despite the repeated recommendations to start with a tiny amount and work up). Follow the instructions for a “low and slow” introduction and increase, as presented subsequently within this section. Also, feel free to try various brands: International Nutrition can provide a sample of at least one probiotic, and many businesses will provide a refund on supplements if you react to them or notice no benefit. Finally, a simple alternative is offered under the question: “How do I know if I’m reacting to a filler or having die-off?”
“Some commercial probiotics include Bifidus, which Elaine Gottschall said to avoid. Should I not use these products?” Conflicting reports that Elaine Gottschall had accessed gave her concern regarding a potential for Bifidus to overgrow, thus she declared Bifidus “SCD illegal.” Dr. Campbell-McBride feels it is beneficial to use a wide range of strains, including Bifidus, and most people coming to GAPS report no issues with these. While some people feel that Bifidus and other strains of bacteria have been specifically helpful in their healing, some SCDers have said that Bifidus is problematic for them, causing chronic loose stools. If you feel that Bifidus or any other strain is a problem or could be a problem for you, feel free to start with a probiotic which includes only strains you are currently comfortable with. After some months of healing, evaluate whether more strains could be included in your personal program. In the meantime, a simple alternative is offered under the question: “How do I know if I’m reacting to a filler or having die-off?”
“So many of the commercial probiotics include maltodextrin. I thought we weren’t supposed to have maltodextrin.” You’re right; GAPS people should generally not have maltodextrin. However, Dr. Campbell-McBride feels that, for most people, the amount of maltodextrin in a quality probiotic is not enough to worry about. However, some people may find they react to it. A simple alternative is offered under the question: “How do I know if I’m reacting to a filler or having die-off?”
“How do I know if I’m reacting to a filler or having die-off?” Just as with food reactions versus die-off, the answer is, “Generally, you don’t know.” If you have any concerns, you can start with an “SCD legal” probiotic, such as scdophilus from GI Pro Health (www.giprohealth.com).
“What effects will I notice?” The intensity of effects will depend very much on the dose you start at or increase by. Be sure to read the information, presented subsequently, under “How much bottled probiotic should I take?” and “How much should I start with and increase by?” Once you have determined an appropriate amount to start with or increase by, watch for any “die-off” symptoms upon every new dose, including but not limited to fatigue, nausea, bloating, diarrhea, constipation, low-grade fever, headache, flu-like symptoms, or behavioural changes. If any of these are experienced, they should be neither terribly uncomfortable nor persistent. Mild die-off will often resolve within a day or two without intervention. If symptoms are bothersome, reduce your dose to your last tolerated level (or just barely more than that) and, in the meantime, implement one or more of the die-off relief strategies offered in this Guide, such as die-off relief baths, naps, or activated charcoal. Whether die-off is mild or intense, once it has resolved, you might like to “cruise” at your newest dose for a while, enjoying the break from die-off. Increase the dose when you are ready to experience die-off again.
If upon starting or increasing a probiotic, you experience no noticeable die-off, still allow a full week at that daily dose before increasing the dose further (the effects may prove cumulative over the week), then increase the dose by a very small amount.
Some people feel no noticeable effect from any dose of probiotics. If this is the case for you, you may feel frustrated and wonder if you are throwing your money away. In this situation, I propose that you may still be benefiting from a therapeutic dose—your body may simply not provide an obvious response. (For some people, this happens with the diet aspect, too. In these cases, when the diet or probiotics are stopped, the person’s health noticeably decreases. This is the only indication these folks have that the diet or a given supplement was indeed making a significant difference.) You might also want to try other brands, to see if another brings an obvious response.
“How much bottled probiotic should I take?” Every commercial probiotic offers a different amount of live bacteria per capsule, so it is not possible to present a starting dose in “number of capsules” because that will depend on which probiotic you choose to use. Although the therapeutic dose is different for everyone, Dr. Campbell-McBride presents the following as a starting point for consideration. Alongside these numbers are offered capsule amounts using the example of Bio-Kult, which has a live unit count of two billion probiotic microorganisms per capsule. You can calculate the equivalent for any brand of your choice.
Age Recommended Dosage
0–12 months 1–2 billion bacterial cells per day (½–1 capsule of Bio-Kult)
1–2 years 2–4 billion bacterial cells per day (1–2 capsules of Bio-Kult)
2–4 years 4–8 billion bacterial cells per day (2–4 capsules of Bio-Kult)
4–10 years 8–12 billion bacterial cells per day (4–6 capsules of Bio-Kult)
12–16 years 12–15 billion bacterial cells per day (6–8 capsules of Bio-Kult)
17 years and older 15–20 billion bacterial cells per day (8–10 capsules of Bio-Kult)
Again, every bottled probiotic has its own potency, so you need to read the bacterial count on a given bottle before determining how many capsules or grams of that particular product will achieve the desired goal.
Dr. Campbell-McBride notes that once you have reached the therapeutic dose, it should be maintained for approximately six months. She states that it takes at least this long to remove the pathogenic flora and to start re-establishing normal gut flora. Again, for minimal die-off and maximum progress, one must start with a fraction of the therapeutic dose (see the following section). Generally, a person will start with a tiny amount of a homemade or commercial probiotic and then work up very slowly. When you notice healing and are satisfied that you are continuing to progress in health, maintain that level of probiotic. There is no benefit in going over the amounts listed, which would simply bring unnecessary expense (and possibly physical overwhelm). Over time, continue increasing your homemade ferments. After six months on the therapeutic dose, with homemade ferments gradually increased in the meantime, start to slowly decrease the commercial probiotic to a maintenance dose; this is usually half of a therapeutic one but with sufficient homemade ferments included, even less may be needed. To determine your maintenance dose, do this: slowly decrease the amount of commercial probiotic you are taking (e.g., by ¼ capsule per week) and watch for any changes in your health. For example, reducing these too quickly triggered both my son and me to stop having bowel movements. Eventually, your maintenance dose may be achievable through fermented foods alone.
“How much should I start with and increase by?” Whatever amount you think is low, start with—and increase by—far less! Some people will need 6 months or more to reach a therapeutic dose.
For an adult whose symptoms are not severe and who is not generally sensitive to supplements and medications, I recommend starting with 500 million live cells or less per day, divided into a morning and evening dose. Again, every commercial probiotic offers a different number of live cells. If using Bio-Kult®, this suggested starting dose is achieved with 1/4 capsule per day (1/8th of a capsule in the morning and 1/8th of a capsule in the evening). Primal Defense Ultra®, on the other hand, offers 5 billion live cells per capsule, so the starting dose would be achieved with 1/10th of a capsule of Primal Defense Ultra® (1/20th capsule in the morning and 1/20th capsule in the evening).
It is important to consider carefully the live cell count offered by the probiotic you are choosing to use, and to determine what portion of the capsule offers 500 million live cells or less. (Google’s search engine will do the math for you. Type in the amount of live cells offered in one capsule divided by 500 million, e.g., “2 billion divided by 500 million”. Divide the capsule by the resulting number.) Take half of that amount in the morning and half in the evening. You will not be able to measure out precisely this portion; an estimate will be fine. When using a portion of a capsule, open it up, tip out the portion needed, re-close the capsule, put the capsule in a tightly closed jar, and put the jar in the fridge. Continue accessing portions from this capsule until it is empty, then start with a new one.
If die-off is tolerable (or not even noticeable), maintain your initial dose for at least 1 week before considering an increase. Once at least 1 week has passed, and any die-off has completely resolved, you might increase your dose by that amount again (e.g., by ¼ capsule of Bio-Kult® to a total of ½ capsule per day).
For a child or a very ill or very sensitive adult, I recommend starting with even less and increasing at a slower pace. Continuing to use Bio-Kult® in this example, one might start with one-tenth of a capsule or less per day, increasing by just one-tenth of a capsule after a week or more. (This portion of a Bio-Kult® capsule offers approximately 200 million live cells. Again, start with the proportion of your chosen capsule that supplies that amount or less.) Some experience intense die-off with even the smallest amount of probiotic—including an SCD-legal one. They may have to take just the amount that the tip of a vertically inserted knife picks up, or dilute the powder and take only a drop of that liquid. The “low and slow” method of introduction for supplements may be key for these folks:
Day 1: Starting dose of your choice, just once in the day. Ensure a lower amount (e.g., 50 million live cells or less) by using a lower-dose probiotic, taken in any of the following ways: one pinch of powder, or the amount that fits on the tip of a vertically-inserted butter knife, or that amount diluted in water with one sip taken.
Day 2: None
Day 3: If no die-off is experienced, double the Day 1 dose by taking the same dose again, but in both the morning and in the evening.
Day 4: None
Day 5: If no die-off is experienced, increase the morning dose only.
Continue to increase every second day until light die-off is experienced.
When die-off is experienced, stay at that dose until the die-off resolves.
Regardless of your starting point, as you progress you may find you can incorporate a larger increase—perhaps of ¼ capsule, then ½ capsule, then 1 capsule—every four days or so until you have reached the therapeutic dose. However, do not rush this process. Intense die-off can be triggered by relatively small increases, or be noticed only after a week or so of a new dose. It is far more comfortable—and more effective—to move slowly and surely than it is to jump forward, suffer intense die-off, work backward, then start the process over. Increasing once a week is easy to remember and plenty fast enough.
“The info sheet from the company through which I ordered my Bio-Kult said to give my ten-year-old six capsules in week 6.” Unless specifically indicated as applicable to GAPS, information sheets distributed with probiotics relate to general use and do not necessarily apply to people doing GAPS.
“I give my baby eight billion bacterial cells per day. Do you think this is fine?” This is far more than is needed by a baby doing GAPS. This can also cause uncomfortable gas, bloating, and die-off. It also involves an unnecessary degree of expense. Please see the previous questions and answers in this section.
“I recently increased my probiotic from four capsules to five. I feel funny.” In a probiotic with a high count of live cells per capsule, an increase of one capsule can be far too much. When I increased mine early on from 1 capsule to 2, I had intense die-off: it’s simply too much, too quickly. Drop the dose back to the amount you were most recently tolerating well, and work up very slowly.
“I’m on Week 2 of Intro and having every day: 1 cup of kefir, 2 capsules of probiotics, and 3 teaspoons of juice from fermented vegetables with each meal. Why am I not feeling well?” This is an enormous amount of probiotic content for this early point in your healing program. Stop or drastically reduce all probiotics and start them again gently and slowly, one source at a time, as detailed in this Guide.
“When should I take my probiotic?” In most cases, take your probiotic with or shortly after food. An exception to this is if you are including betaine HCL in your program. If including betaine HCL in your program, take the betaine with meals and take your probiotic at a different time, such as first thing in the morning and just before bed. With either approach, take half your daily dose of the probiotic at some point in the morning and half at some point in the evening.
“In terms of bottled probiotics, what do I look for when shopping?” No one commercial probiotic is recommended more than another. In her book Gut and Psychology Syndrome, Dr. Campbell-McBride sets out her recommendations for probiotics in general. Essentially, she likes to see:
As many different species of beneficial bacteria as possible;
A mixture of strains from different groups (e.g., lactobacilli; bifidobacteria; and soil-based organisms);
At least eight billion live bacterial cells per gram;
Each batch tested for strength and bacterial composition, with the manufacturer willing to publish the results;
No enteric coating; and
No fillers that would bother a person.
Most commercial probiotics have SCD-illegal ingredients, such as maltodextrin, fructooligosaccharides (FOS), or oat grass. Any time you choose a product with an SCD-illegal component, you risk a reaction to that ingredient. This is something you have to weigh, research, and/or test for yourself. Also, when researching options, note that some bottled probiotics have a much higher potency than others, so you need to read the bacterial count on a given bottle before determining its true cost, as well as the amount needed. For example, to achieve therapeutic doses, one would need many, many capsules per day of Garden of Life’s Primal Defense® Probiotic Formula, but only a few of Primal Defense® ULTRA Ultimate Probiotic Formula. That’s how varied bacterial counts can be from bottle to bottle, even when produced by the same company.
“What if I’m positive I have an overgrowth of one bacteria and/or an undersupply of another?” Upon consideration of all of the above recommendations, feel free to supplement with the bacteria of your choice.