OFF TO PARIS

Dr. Tofuhead is taking a vacation! I like to put up a new blog post every day, but I realized this morning that it's probably going to be difficult the next few days. As I nurse myself back to some semblance of health after having one of the worst viral colds I've ever met, I'm actually getting on a plane to Paris. It will be a short trip, and I should be back to "Truth in Medicine" in a mere 4 days or so. While in Paris, I'll take notes that may help us all understand health. For example:
1. What's it like to have tons of vacation time, and to have a full-time work week limited to 38 hours, like they do in France?
2. What do the French think of their "Socialized Medicine" system, that provides health coverage for all?
3. Why is it that the French smoke more than Americans, drink more booze than Americans, eat incredibly rich food, and yet live longer than we do and have less coronary disease?
4. Do the French in fact live longer than we do, and have less coronary disease- or is that just a myth?
5. Is there such a thing as "healthy French food?"
These and more wonderfully stimulating topics will be discussed next week when I return. Until then, eat well, sleep long, and get some exercise, dear reader!

PROBIOTICS: BETTER THAN PROBASKETBALL

Man, I can't even catch a mindless break these days. My least favorite basketball team, the San Antonio Spurs, is beating up on the greatest underdog team of the year: the New Orleans Hornets. I fear the Spurs will go on to win the championship again. Oh well, at least the Patriots lost the Super Bowl!

EAR INFECTIONS: MORE LATER
I just spent over an hour expounding on ear infections in adults and children, only to have my internet connection go down and miraculously erase my entire blog of the day. Maybe it's a good thing; I'm not a pediatrician, so it's probably not a great idea for me to discuss ear infections in kids, even though my kid has one. So I'll have to make another post about ear infections in adults later- I'm just tired of thinking about them right now.

PROBIOTICS: NOT JUST HYPE

You've probably heard about probiotics. What are they? Simply put, probiotics are just ingestible bacteria or other microorganisms, such as yeast, that you can take internally. In a probiotic, the microorganisms are alive. For example, a basic yogurt that has active cultures is a "probiotic." These days there are a whole host of designer yogurts, packed with greater concentrations of bacteria and a greater variety of bacteria, designed to go into your digestive tract and "thrive." There are also probiotic tablets; these have dormant bacteria of various varieties, and a few have beneficial yeast organisms as well. Though the tablets are made of dry powder, the organisms become viable when they are in your digestive tract.

The idea behind probiotics is that you need a large number of symbiotic bacteria in your body, particularly within your colon, both to digest food and to fight infections. There are also bacteria colonizing your skin, mouth, and most of your mucus membranes. We honestly don't know what most of the bacteria outside of the colon do; but in the colon, they clearly play a critical role in fighting off pathogens and helping us get nutrients from our food. We know what many of the "good" species of bacteria are that live in our digestive systems, but there are likely hundreds of species that have not been characterized. The bacteria and yeast species in various probiotic supplements are just a few of the ones that have been found in normal humans, and that are thought to be helpful to us.

There are also pathogenic bacteria, or bacteria that can cause disease, living within us, usually in small amounts. Fortunately they are "held in check" by all the good bacteria. In some cases, particularly after we take antibiotic medicines, the pathogenic bacteria or yeast get an upper hand- and that's when you get toxic colitis, yeast infections, antibiotic-associated diarrhea, some gastrointestinal malabsorption syndromes, and in some cases "irritable bowel syndrome." Even more serious diseases such as Crohn's disease and ulcerative colitis probably are worsened at least to some extent by an imbalance between good and bad microorganisms in the digestive system.

Studies of probiotic supplements are promising; so far the studies have been small, but many studies demonstrate convincingly that these supplements may benefit patients with a wide range of digestive disorders. What we don't know is which probiotic supplement is the best, which organisms are the most important, and exactly which conditions are the most amenable to probiotic therapy.

BOTTOM LINE: You might want to try a probiotic supplement if you have a gastrointestinal problem, particularly if you have recently taken a course of antibiotics. Alone, probiotics may not be powerful enough to treat Crohn's disease, ulcerative colitis, severe colon infections, or vaginal yeast infections. But they almost certainly help these conditions, and they may be enough in and of themselves to treat irritable bowel syndrome.

WHICH PROBIOTIC?

Many of the gastroenterologists I know swear by a probiotic called "VSL #3," which has been particularly well-studied and has a nice mix of different beneficial organisms. It used to be available only on the internet, but a patient of mine recently brought in a box of this she had gotten at Walgreen's! Health food store employees often know quite a bit about probiotics as well, though they also know a lot of erroneous information about vitamins and supplements that you don't need. I'll expand on this topic later when I've had a chance to browse some stores and see what's out there. But for now, I don't think you can go wrong with VSL #3.