'Gastro-oesophageal reflux disease (GORD) – A practitioner’s guide to addressing GORD in clinical practice'
sponsored by OptiBac

Please note, this is a transcript of the questions received and have been reproduced verbatim in relation to any grammatical errors.

Do you have suggested strains for helping with gut repair after chemo?
As a company, we are aware that some customers take our probiotics after chemotherapy to help heal the gut and improve their digestion, although this course of action is based on personal choice and not on any advice that we have given. I must stress that, when taken in this way, the purpose of probiotics would be solely to help to reduce the side effects of the chemotherapy and not to address the cancer itself. All individual cases may vary, so we would have to recommend that the patient’s oncologist is consulted before supplementing with probiotics. If the oncologist gives their consent, I’d recommend our ‘For every day EXTRA Strength’ or ‘For every day MAX’ to support general wellbeing following chemotherapy.  

Would you introduce Bifidobacterium lactis HN019 and Saccharomyces boulardii together or one at a time, so you can see which is working?In the case of SIBO, it is best to just use Saccharomyces boulardii during symptoms. However, in other cases of gut dysbiosis, it may be beneficial to combine Bifidobacterium lactis HN019 and S.boulardii together because S. boulardii passes through the gut and binds to pathogens, removing them from the system, whilst the Bifidobacterium lactis HN019 strain adheres to the gut wall lining and provides a barrier of defence. When used together in this way, they work synergistically to bring balance to the microbiome and support gut health.

What age can the For every day max supplement be used from? I am just thinking of the HN019 strain you mentioned.
The ‘For every day MAX’ probiotic supplement which contains the Bifidobacterium lactis HN019 strain is suitable from 4 years +.

Is there any link between the menopause and GORD?
The effects of hormones on the gastrointestinal system are not well known but many healthcare practitioners believe that digestive disorders can be attributed to hormonal fluctuations. Some research does seem to support the increasing likelihood of GORD symptoms as women age and become menopausal, suggesting an association between declining hormones and GORD.  However, these symptoms have not been adequately analysed in the postmenopausal population and so no conclusions can be made about a direct relationship between GORD and the menopause.

What about the impact of the oral microbiome on the lower oesophageal tract?
Research regarding the effect of the oral microbiome in relation to the oesophageal tract is still in its early stages and so it is not yet possible to reach any definitive conclusions.

If a client may have oesophagitis what would you recommend?
I would recommend following the dietary and lifestyle approaches as listed in the webinar to help the oesophagus to heal. To help with reflux, I would recommend our ‘For every day MAX’ probiotic supplement which has been clinically shown to help with regurgitation. 

How do food sensitivities cause LES – what is the mechanism?
The exact mechanism as to how food sensitivities contribute to the malfunction of the LES is not known, however research does suggest that certain intolerances, (e.g. to lactose or fructose), may contribute to the relaxation of the LES. 
GORD may also be caused by the release of histamine from mast cells, in response to a food allergy, which might promote the onset of GORD through lower oesophageal sphincter contractions.

Would the products you mentioned tonight be suitable for someone with histamine intolerance?
Yes, they can be. Firstly, if you haven’t done so already, try to establish whether your client has any underlying gut issues (which is often the case in histamine intolerance). Ask about bowel movements, abdominal pain, bloating, flatulence etc. The outcome will determine which probiotic supplement you could use to help address these gut issues. A great probiotic for fortifying gut health and calming allergies – as allergies can make histamine intolerance symptoms much worse – is our ‘For every day MAX’ supplement.
Saccharomyces boulardii is also a good one to consider for someone with histamine intolerance, as the overgrowth of pathogenic bacteria may lead to increased histamine production and S. boulardii has been shown to bind to pathogens and remove them from the system. It also has an anti-inflammatory action in the gut which may be helpful for those with chronic gut issues.

How long would you need to take probiotics to see the desired effects? For example Saccharomyces boulardii for SIBO and Candida?Everyone’s gut microbiome is different and so it is hard to give an exact timeframe as to when the desired effects may be seen. I would suggest taking Saccharomyces boulardii until the symptoms subside or the desired effects are achieved. This may be weeks for some people and months for others.

Would you recommend probiotics for SIBO or isn’t there a risk of feeding and increasing bacteria in the small intestine?
When it comes to using probiotics to address SIBO, practitioners may want to avoid them, being concerned that probiotics may add to the bacterial overgrowth. Medical practitioners often choose to use antibiotics to address SIBO, whereas complementary and alternative practitioners tend to use natural anti-microbial supplements. Either of these is typically used before introducing probiotics.
However, Saccharomyces boulardii is a probiotic YEAST that does not colonise the intestines, so in theory it should not add to the overgrowth and can be beneficial in displacing pathogens. Additionally, the clinical study I shared during the webinar suggests that S. boulardii may be beneficial alongside antibiotic therapy when treating SIBO. In the case of SIBO, S. boulardii is therefore the most appropriate probiotic to use.

Do you make dairy free probiotics?
Yes we do. The following probiotics are completely dairy-free:

• For every day EXTRA Strength
• For every day MAX
• For those on antibiotics 
• Bifidobacteria & fibre
• For daily immunity 
• Saccharomyces boulardii 
• For women 
• For your baby
• For pregnancy

Are the capsules enteric?
None of the capsules in the OptiBac range are enteric coated.
You may have heard that enteric coated capsules are more efficient because they are more capable of surviving stomach acid – a key characteristic of a high-quality probiotic supplement. The capsules in the OptiBac range do not require enteric coating, as the live cultures we use in our products pass through many tests (as well as clinical trials) to ensure they survive to reach the intestines where they are able to colonise and multiply. Instead of ensuring survivability of the capsules, we ensure survivability of the natural bacteria. For this reason, the OptiBac strains are viable in both sachet and capsule form – the latter can be opened and the contents sprinkled into food or drink for those unable to swallow capsules.

 What would you do for ulcerative colitis? Is a high level of probiotics recommended?
For ulcerative colitis, we would recommend Saccharomyces boulardii. This strain has been shown to induce clinical remission in individuals with ulcerative colitis. We would propose taking 1 capsule, three times a day.

 Why do infants get infantile Gord/Gerd?
In babies, it’s common for the lower oesophageal sphincter to be quite loose, as it is not fully developed at this early life stage. This allows stomach contents to travel backwards up the oesophagus. As the baby grows older, this valve usually becomes tighter and the reflux tends to resolve.

Is Saccharomyces boulardii okay for those who are yeast intolerant?
It is possible for people to have allergies or sensitivities to certain types of yeasts and not others. However, if an individual has a known severe yeast allergy, then we would advise they do not take Saccharomyces boulardii, with it being a yeast. Instead, they can take ‘For every day EXTRA Strength’. If the yeast sensitivity is due to Candida overgrowth, then it may be possible to take S. boulardii.

What do you suggest to test for low stomach acid?
I’m only aware of one test called the ‘Heidelberg Test’ which involves swallowing a digital pH capsule to provide stomach acidity readings.

A friend of mine has huge problems with milk.  Why would that be please?
Lactose intolerance is a common digestive problem where the body is unable to digest lactose, a type of sugar predominantly found in milk and dairy products. A casein or milk protein allergy is different to lactose intolerance and occurs when the body mistakenly identifies casein and/or other milk proteins as a threat, triggering the immune system to fight off the ‘invader’. Lactose intolerance, and other food intolerances, are generally a gradual response, that typically manifest as uncomfortable digestive symptoms. They usually only occur when a significant amount of the trigger is consumed: e.g. dairy-intolerant individuals may experience some bloating or other digestive symptoms after drinking a whole glass of milk. A milk protein allergy can be more serious, however, and can cause symptoms such as hives, rashes, breathing difficulties, pain and vomiting. 

Would you use saccharomyces boulardii in someone with fructose malabsorption once they were on a low fructose diet?
I’m not sure if Saccharomyces boulardii would be helpful for fructose malabsorption but from the brief reading I’ve done online, it seems that Bifidobacteria species may be the most helpful probiotics to take for this, because they are able to break down fructose into the short chain fatty acid, acetate. I should stress that the evidence for this theory is largely anecdotal and that the suitability of using probiotics in those with fructose malabsorption is not yet fully understood and needs more research.
An option you might like to consider is our daily probiotic ‘For every day EXTRA Strength’, which contains 2 strains of Bifidobacteria.  In fact, it’s often a good idea to take a probiotic bacterial formula, such as ‘For every day EXTRA Strength’, alongside ‘Saccharomyces boulardii’, as S. boulardii is a probiotic yeast that works in completely different ways to probiotic bacteria – the combination of both is therefore quite complementary. 

Is S. Boulardii appropriate to take for people who have developed antibodies against yeasts due to chronic fungal infections?
It’s quite unusual to have a true allergy to yeasts, and your allergy specialist should offer you advice about the level of sensitivity you have. Those with a strong yeast sensitivity or allergy usually have to avoid all foods that contain yeasts – if you are able to eat foods containing yeast then you may be able to tolerate Saccharomyces boulardii. However, if you are highly allergic to yeast, you should avoid this probiotic.

 Any probiotic that would help with issues with eggs?
We do not have a probiotic that has been clinically shown to help with an allergy/intolerance to eggs, but we would generally recommend our ‘For every day EXTRA Strength’, as this has been shown to be beneficial for some allergies.

How important is the CFU in terms of effectiveness?
The quality of the strain or combination of strains in a probiotic supplement should be the first thing to consider over and above the number of billions. There is little point taking a really high strength probiotic if it does not survive well at room temperature until date of expiry and also survive the challenge of stomach acid and bile. Once the probiotic has reached the gut, it must be able to adhere to the gut wall in order to colonise and flourish. Furthermore, it should be able to secrete antimicrobial substances to ward off the overgrowth of other pathogenic bacteria in the gut. These are all basic requirements of a high quality probiotic before we even consider the strength or the number of billions. It would be misguided to select a high billions probiotic, without first considering these crucial quality considerations.
Sometimes a lower strength probiotic can perform as well as, or better than, a high strength probiotic. A study published in 2015 assessed the efficacy of Bifidobacterium lactis BB-12®, which is considered to be the most well documented and researched strain in the entire Bifidobacterium genus. Over 1200 volunteers who suffered with constipation were given either 1 billion B. lactis BB-12®, 10 billion B. lactis BB-12® or placebo each day for 4 weeks. Both groups taking the probiotic strain had a statistically significant improvement in their frequency of bowel movements, compared to the placebo group. Interestingly, no significant difference was found between the 1 billion and the 10 billion group. In this instance, a high strength dose did not perform better than a low strength one. Rather, the overall quality of the strain shone through in the results, regardless of the strength.

Is a low level of vit d a contributory factor in the LES not closing properly?
It could be. Vitamin D is vital for the proper functioning of muscle cells. This means that a deficiency of vitamin D may impair muscle function and theoretically, the function of the LES muscle.

 How long should clients take s boulardi, is it solely for 3 weeks?
Saccharomyces boulardii can be taken as long as necessary until symptoms have subsided.

What is the best time to take probiotics I usually suggest at bedtime?
Most of the OptiBac range are best taken with a meal, and ideally with breakfast.
Research from microbiologists shows that at mealtimes – and especially breakfast time – the stomach’s gastric acidity is naturally at pH 4 or above. The strains in the OptiBac range were developed to survive gastric acidity above (i.e. closer to neutral than) pH 3. In-vitro trials on our live culture strains show a 95-100% survival rate through gastric acidity at this pH level. This is why we recommend taking the majority of our live cultures with your breakfast, as they will have the best survival rate through the body’s gastric acidity.
There are two exceptions to this recommendation and one of them is ‘Saccharomyces boulardii’, as this strain can be taken at any point in the day, with or without a meal because it is very robust. The other exception is ‘Bifidobacteria & fibre’, as this supplement may induce some initial gas and/or bloating (due to the FOS fibres) and may therefore be preferable to take at night. Moreover, you can take up to four sachets per day of this supplement, so if you are taking more than one sachet, it’s best to take one with each meal, and/or one before bed.

What would you recomend for sibo-c?
With regard to SIBO-C, and if your client is following a FODMAP diet, we would recommend ‘For every day MAX’. The strains found in this supplement have been clinically shown to help with gastrointestinal symptoms, and Bifidobacterium lactis HN019 in particular has been shown to improve transit time as well as reduce stomach gurgling, nausea, abdominal pain, irritable bowel, flatulence and constipation.
However, sometimes with SIBO-C it is not always appropriate to commence with probiotics and it is often more appropriate to support the condition with a suitable diet. Medical practitioners often choose to use antibiotics to address SIBO, whereas complementary and alternative medicine practitioners will tend to use natural anti-microbial supplements which are typically used before introducing probiotics. Therefore, our ‘For every day MAX’ supplement can be introduced after the anti-microbial supplements.

Do any of the optibac range contain histamine stimulating probiotic strains?
No. None of our probiotics strains are histamine-producing.

Could the optibac probiotics be useful postinfectious irritable bowel syndrome?
Our usual recommendation would be similar to a typical IBS protocol, for which we usually recommend our ‘For every day EXTRA Strength’ probiotic supplement. The strains found in this supplement have been clinically shown to help with IBS symptoms such as bloating and abdominal pain/cramps.