When to take (or NOT take) Probiotics? Thoughts from a GI Fellow 

I am actively on 2 antibiotics at the moment, so I’ve been taking a probiotic. However, I have rheumatoid arthritis, so I’m on steroids and a biologic. Thanks for pointing out the potential negatives of probiotics. I had no idea they might be bad for me! I’m going to have to ask my rheumatologist what she thinks.

Great info!!🙌

My sister was living in Japan and I was visiting her and she came down with a stomach virus while I was there. Took her to a urgent care and they fixed her right up and sent her home with a prescription of probiotics! They came in individual packets that you mixed with water. I've never seen that happen here in the states.

Standing ovation, Doc! I have listened to well-intentioned friends sing the praises of probiotics for years, but I didn't understand the possible negative effects until my mom was diagnosed with breast cancer. There are two sides to every coin - thank you for pointing out both sides of this one! 👏👏👏

wholeheartedly agree! after a series of antibiotics for uti i developed stomach issue, i had bloated stomach & diarrhea for over 2 weeks. took probiotics and voìla it's gone the next day. the other time some people suggested giving probiotics to my mom who had stomach issues after covid. she just got out of hospital and i knew she was treated with dexamethasone the whole time (10 days) amongst other things. giving bacteria to my still immunocompromised mom didn't seem like a good idea so i'm glad i didn't comply. eventually her stomach issues resolved on its own.

Thank you! I am immunocompromised and a cancer patient and people are always recommending probiotics.

I took alot of probiotics for a month and made my General Anxiety go away.

I educate cancer patients that are going to receive chemotherapy and get asked about this, and vitamin/ supplements, a lot! Thank you so much for clarification and great way to present the info!!!!

I had some luck taking certain probiotics for my atopic dermatitis actually. When I was first recommended that I was surprised but it did work!

I've had some gastroenterologists recommend taking them and others say that they're not that important. 🤷🏻‍♀️ more common advice from them is to just drink more water in general, pay attention to when you're thirsty, and take fiber if you're not getting enough of it in your diet. I was also directed to take iron to help with my gastrointestinal problems after I was low iron anemic on a blood test several months ago. you can also get iron infusions which work much faster than taking iron every day.

Once again, priceless & *important* information for the people. (& another question i didn't know i had) ✨THANK YOU DOC SCHMIDT ✨

Really interesting, especially the part about contraindications for probiotics surrounding structural heart issues. Thank you for taking the time to share this.

Oh my gosh! Never even thought that taking a probiotics could possibly be harmful. I'm immunocompromised so it is good to know to ask my doctor before doing that

I love that you talk about both when to AND when not to take probiotics. I recently took probiotics alongside antibiotics (which I ACTIVELY avoid due to how badly they generally make my stomach feel and mess up my digestion) and it really helped. Note: I did discuss this with my doctor, and she actually prescribed a particular brand that she had thought was best, but I think everyone has the right to choose for themselves.

OMG! THANK YOU!! My boyfriend just started taking a cancer drug, for his psoriatic arthritis! He also very pro ably has an undiagnosed exocrine system challenge, and keeps getting told to take probiotics! They have always done nothing or made his gut worse, so I doubt he would take them now. But, just in case... I am SO GLAD to know this! THANK YOU!! Edit - is this applicable to standard, OTC probiotics? Probiotic yogurt? Where's the line?😒

Interesting! I have tried many probiotics through the years, but my doctor had me try eating Activia regularly, and it actually helped much more than the pills.

This is such crazy good timing! My dentist recommended probiotics as I’m taking clindamycin for an infection and I was wondering if they were doing anything! Thanks for the info doc and congrats on the beautiful baby girl!!

As a chemo nurse I find this helpful. I have patients all the time on chemo that want to take them because of the diarrhea that occurs with many chemo treatments.

Quite helpful. Been taking them since I was a kid because of surgeries/antibiotics but have also been on cortisone in periods, was never told to stop them but now I know if I need cortisone in the future 😅

Thank you doc! My whole family struggles with autoimmune issues and we also all have IBS Crohn's excetera and several of us have found that probiotics help us with the symptoms of those disorders. However I will warn my family that if they get on medication such as high-dose steroids for bad flares that they need to stop the probiotics. Thank you!

I gave the first bit of advice to colleagues who were asking about probiotics. When I heard about nieces being given antibiotics for illnesses, I suggested they take probiotics to counter the effect of the antibiotics. I didn’t know about the immunosuppressed and pregnancy conditions for not taking them. Thanks for that!

Had a bad case of Candidiasis (from taking antibiotics) a year ago. My OB gave a single dose of antifungal and advice me to eat yogurt. Yogurt really saved me from the annoying rash.

During my breast infection, from bilateral mastectomy, my infectious disease doctor told me to only take a low dose probiotic and only one tablet, a day, and told me he preferred I not take it. I was not a high-risk patient as I was not on chemo or radiation therapy. I find they also cause diarrhea.

Wow, I have actually never heard a doctor warn against probiotics. Good to know.

So when I first got diagnosed with coeliac disease I essentially had very little intestinal lining left and struggled with malabsorption for a good 8months after even when drinking smoothies to try and increase the surface area of foods to aid in digestion. I tried everything and was painfully unwell and I asked my consultant about probiotics as I felt I was not improving despite being on a gluten free and oat free diet. They said there was no evidence to support it but it couldn’t do any harm. After a couple of weeks of starting oral probiotic capsules I began to feel better and a few months after that I was able to eat normal food minus the gluten ofc. Now who’s to say it just took that long for my digestive tract to heal, if it was a placebo or if the probiotics really did help. In my mind they did but I really do believe there should be more research into it. Especially for patients with issues that could cause a loss of gut cultures like I had. I’d recommend it to anyone. I don’t take them anymore but while I was recovering. Overall I’d say it took a good two years to finally be “back to normal”

Oh no! I’m pregnant and I’m taking a daily probiotic. I’ve often found them helpful for keeping things…maintained. Especially during summer months when things get kind of out of balance. I’ll definitely have to ask my doctor if it’s ok to continue.

Cool! This actually helps a lot. What about Prebiotics? Do the same rules apply?

So much info packed in such a short video! Much appreciated 🙃

In my case, it seemed to make losing weight easier after I had taken them for a while. Of course I had added a few other things in there as well, but , after years of taking them, I swear by them.

I eat a couple tablespoons of sauerkraut and drink kombucha everyday idk if it actually does anything but I don't want to stop and I feel true or not it has at least something to do with my becoming much healthier physically and mentally

Talk about the “gut health” trend, immune system in your gut, that doing these things for your gut will cure everything… what’s real and what can I continue to ignore?

Yes, speak to your doctor! But know that it’s quite possible your doctor got all their knowledge on probiotics from this video in the first place!

Thank you Dr Schmidt for giving use helpful understanding of probiotics. God bless you

Also useful to point out that the timing of probiotics is important in the context of antibiotics. I.e. you should space out probiotics and antibiotics by at least a few hours. Taking them together will just result in the antibiotics eliminating all the probiotic bacteria, effectively just wasting your money.

My mom got a nasty C-diff infection following antibiotics. Wish I knew about probiotics back in the ‘90s

Never heard that before! I'm on MTX and Remicade for Crohns and never heard probiotics might not be safe for me! I have had CDiff before though, so it might be a case-by-case thing....crazy!

Does this include probiotics found in things like kefir, sour kraut, etc? Or just specifically supplements/probiotic pills?

I love your videos . I’m impressed how fast you can speak clearly. If this doctor gig falls through maybe become an auctioneer 😂

I’ve had a chronic yeast infection for about a month now and I just bought boric acid and wow 10 hours later I feel so much better, the 1st hour the itching was gone but burning and swelling was still there and holy shit I hate how I can feel the capsule up there but BAS is a godsend 🥰

HEY AS AN ER DOC I NEED TO MAKE SURE MY KNOWLEDGE OF THESE TOPIC WAS CORRECT ! AND IT WAS. PEOPLE LOVE TAKING PROBIOTICS MAJES THEN FEEL NAMASTE . STAY SAFE EVERYONE

I learn something every time I see you, even if it's that being a nurse or doctor sucks 😅 thanks for the info!

Great info! One thing you did not cover though is supplemental probiotics vs “natural” probiotics, such as yogurt or certain kinds of pickled veggies.

Doctor you just answered my question of I should take them. I'm immune suppressed due to having a liver transplant as a baby. Been on anti-rejection med for 29 yrs! Thank you Doctor!!

Thank you for clarification. In changing medications and no one addresses the risks of probiotics

Glad you’re sticking to what you know instead of instructing others on how they should react to COVID. That goes for foot Barbie as well!👏

The one time I got c-diff A & B ( not fun) was when I didn’t take flora-q probiotics during an antibiotic treatment. I’m IGA- so high risk for stomach infections.

Just learned a little about probiotics in my micro class, thanks for sharing!!

Take probiotics during and after antibiotics!! I’m 47 and caught C. diff the day I was done my 10 days of antibiotics.

TY! I did not know about not using then under certain circumstances you mentioned. My doctor... did not.

Thank you, I had no Dr. or nurses tell me anything.

I have Long Covid and it is common for us to have GI problems such as bloating and and pain. Some of us have found relief with a very restrictive diet. I found relief with a quality probiotic with prebiotics. When I stopped taking them then my symptoms returned. I started taking them again.

How about the difference between probiotics and 'digestion pills' (I'm sure there's a better name for it, but pills like lactaid and some that contain several different digestive enzymes to be taken with meals) I'm curious to know more about taking digestive enzymes.

Also what many people don’t know is the TYPE of probiotics is very important. People tend to take any kind thinking they are all helpful, when really there are a handful of them (that very frustratingly are in a lot of mainstream and popular products) that actually INCREASE INFLAMMATION and cause even more gastric distress than help! So research what you put into your body!

Thanks for this informative short video. Additional question: Is taking probiotics in addition to gut healthy foods like yogurt, apples etc "overkill"? Is there a potential for that to be too much strain and fiber on the GI system?

My dermatologist states taking NuMedica TriFlora can “reset” your gut and help prevent polyps and sebhorreic keratoses… I haven’t found a formal study suggesting the correlation between probiotics, polyps, and these skin lesions. Do you know of any?

So in that case, should people with compromised immune systems avoid foods that are typically called probiotics, such as fermented foods?

That was very useful information!

I would love you to cover gastric bypass surgery information. Especially for long term patients that had RNYs or early bypass procedures.

Does the same go for PRE-biotics?

I had a pediatric patient with short gut syndrome and full parenteral feeding who got sepsis with one of the bacteria from the supplements. Nurse who was taking care of her in the institution eventually wanted to help her gut

This was so clear. Thanks

My mom's got C. Diff. Her insides are foreshortened and weird from surgeries, her liver ducts are kind of all blocked up, and she has no gallbladder anymore but still gets phantom gallbladder attacks, so the C. Diff she has is.. a little different. I heard that typically, C. Diff poops are green. Hers were tan, pieces like sinking fish flakes, small, and has some mucus-y lookin' stuff with some whispy stuff. She fought it off once with a full course of 400$ antibiotics (insurance paid for it luckily), only to have it come back later on (which she tells me is typical of it). Knew it was back because of the oddly small and frequent, tan fish flakey poops. She immediately called her doctor, went on hold as you do, got the prescription, and.. learned it was a 5,000$ course. The insurance told her they'd have to call her doctor to see if she ACTUALLY needed it, and, I guess they made an amazing case because the insurance emergency approved it that same day. Mom thinks someone at dollar tree, where she works, gave it to her on their dirty money.. and it may have taken hold with little to stop it because she had dental work that got infected prior, and had to take antibiotics, but also had probiotics with it so she thought it was ok. Maybe something with her shortened insides? Idk. Just thought I'd tell a piece of my family's crazy past year, not even mentioning our house fire, contractors that screwed up our house, and not being able to find housing this whole time, having to keep our cats in a dirty warehouse office 45 minutes away that we have to visit everyday to take care of them because it's literally the only place we could find for them.. it's been fun among the pandemic, 3$ gas and crazy housing market, just fun :| Thanks for reading.

Great message and information. Ur a medical sstud bro. And ur a lot of fun to watch. A paramedic.

This was awesome - I had no idea there were people who shouldn't take probiotics

What about probiotics like curd? As an Indian, curd is a part of our everyday diet so we can't really avoid it

Wow! I had recently started considering taking probiotics, but now will think again since I have Crohn's.

I love this... great info.

People- just eat raw sauerkraut or kimchi- or make your own! Fermented foods are good for the gut! And studies have shown this! Make sure you get fresh sauerkraut or kimchi and not the kind that’s pasteurized and on a shelf in a jar. Fresh will be refrigerated. It will also usually say that it’s fresh or raw.

Thank you! Very helpful!

Huh. I'm immune compromised (immuran for crohn's) and my dietitian told me to take probiotics. I might have to prod my doc about this.

Thank you! Very informative 👍

I once took probiotics. My BM is smooth like a well oiled machine.

Got a question. Im 39 and got my appendix taken out about a month ago. Ive read that appendix holds good bacteria.Should I be taking probiotics? Thank you for taking the time to read my comment

The only dr against probiotic

My gastroenterologist put me on a 5 month course of Vivomixx after diagnosing me with post infectious IBS which turns out was caused by a trip to China in 2011 (had IBS symptoms for about 6 years before diagnosis). After about 2.5-3 months of taking it my symptoms were improving, and after 4 months it was totally gone and I was back to normal. Honestly life changing, IBS can be debilitating.

What about obstructed bowel patients? Should they be given probiotics instead of antibiotics to prevent bacterial translocation? (Without evidence of active infection).

Could you share a source advising against probiotics in pregnancy? I haven’t heard of that contraindication before, thanks!

I had a doctor tell me I should take probiotics regularly and that he could sell some specially formulated and extra-effective ones to me from his office. I found a new doctor as a result.

Is it safe to eat yogurt? Fermented foods? What about if you have IBS? As usual, you have shared kick ass information, sir. Thank you!

My 9 month old baby is on antibiotics for an ear infection. I still breastfeed her. Should I take probiotics to help her rebuild her gut flora?

Omg thank you!! I actually took em alot cuz I thought with taking antibiotics it wld be a good idea but I am high dose steroid suppressed n had no clue it wld be dangerous or even questionable especially since they're OTC

Very interesting. Thanks.

Could you please refer to the studies you mention in the video description? That would be so helpful 🙂

I never thought about when NOT to

Are probiotics good for people with IBS?

Probiotic supplements (or just some good yogurt with them) will also help if you're prone to getting yeast infections when you take antibiotics! This seriously changed my life, I used to ALWAYS get yeast infections when I took antibiotics.

I've been off and on antibiotcs for several months (including lineziod) due to on infection in my leg post surgical flap placement operation. To avoid C diff, I was told to take probiotics. I'm finally done with the last regiment of lineziod and amoxicillin. When should I stop the probiotics?

Yes... i was scared personally after a medical situation I had and was afraid of getting sepsis (blood infection) for a second time. 😢

Wow! This is really informative , particularly when you shouldn't take probiotics., like immunosuppressed people. VERY INTERESTING!!!

I need them, every day. Had antibiotics years ago. Bunch of times etc. Gives you candida

Holy cow! My doctor told me to take probiotics when I started having diarrhea everyday for months. Got a a new doctor and she referred me to a Gastroenterologist who diagnosed me with Crohn's. I took those probiotics for over a year and they never helped. Glad I stopped.

I have tried multiple medications and supplements, so I know this isnt just a placebo effect, because thats not what I took it for and not what I expected. But the probiotics acutally reduces the brain fog that Ive had for years. It doesnt cure it but it does help as long as I keep taking it. Which I rarely do because they seem to change my personality.

Thank you! I do have a follow up question- you are referring to probiotics supplements should not be taken by some at risk groups (cancer patients, etc.) Does this include probiotics that you would find in yogurt or other foods?

I have a question: How do probiotics and prebiotics affect gut flora? I also think it might be useful to talk about gut flora in general, especially with how it interacts with your body. Especially important questions: does it affect your hunger and what you are hungry for? Does it affect your ability to gain or lose weight? Do colonies of certain microbes cause an increase risk of certain diseases? How can I find out what bacteria I have living in me?

i don’t understand anything but this doctor is good looking 😎

After Appendicitis, I was obviously on VERY strong antibiotics, and they gave me probiotics.

Oh my, I take steroids daily and I thought taking prebiotic would prevent an overgrowth of yeast/fungus in my GI tract...I was totally wrong. Thank you so much Dr Schmidt.

One time, I took clindamycin for a dental issue, but I didn't take any probiotics or anything with it. It irritated my stomach so severely that it stirred up H. pylori living in my gut... which, ironically, was eventually treated with the protocol of clindamycin, pepto bismol, and metronidazole (I was already on PPIs). That was not a fun few months while we got that cleared up though! It was the literally crappy cherry on top of the 2020 sundae.

Really helpful, I’ve been immune suppressed with multiple made for a while and have had to be given antibiotics and suggested probiotics from drs. Do you have any sources for probiotics linked with infection that you could send/share. Or the specific recommendations about immunosuppressed and probiotics?

Wait now I'm confused... I have Pan-Ulcerative Colitis and a tooth infection that won't go away after 5 antibiotics already while I have to wait for my dental appt forever away... now I'm not sure if I need them or not. I have severe UC and am on Biologics.