Diseases, Life style
How functional medicine can help to address chronic health conditions


As a functional medicine practitioner I am very excited about the possibilities it offers. It helps to prevent and reverse chronic disease. With chronic disease such as autoimmune disease, heart conditions, obesity, diabetes on the rise, we have to re-think the conventional disease management concept as it often fails to address them. What inspires me about functional approach is that it triggers my detective mind to look for the underlying cause of disease—instead of just suppressing symptoms. It’s not about looking at the symptoms alone, popping a few pills, moving on and leaving patients hopeless, frustrated and often in pain. It’s about gathering all the clues of your past (health history starting from birth, your physical and emotional childhood environment, your relationships, traumatic events, etc.), your present situation (stress level, nutrition, social life, relationships, physical activities, quality of sleep, symptoms, environmental toxins). Equipped with this information together with the results of laboratory testing, I try to help you uncover how and why your body is not functioning well. It’s about finding the red flags that are causing your immune system to malfunction and removing them step by step. It is a process of eliminating what harms your body while supporting the body with what it needs to function properly.

How Functional and Conventional Medicine Differ

With regards to chronic conditions, functional medicine is primarily focused on optimizing health in a holistic way to recover the impaired function as much as possible. Whereas conventional medicine often only manages disease. Functional medicine takes a collaborative approach with a patient-centered model and not expert, doctor centered model. Patients play an active role in their journey to wellbeing in functional medicine because the patient’s behavior is one of the biggest contributor to chronic disease. In conventional medicine, everyone is often treated the same way, and no biochemical individuality is taken into account. Functional medicine tries to relive symptoms by addressing the cause and not only by suppressing the symptoms with drugs. Within conventional medicine, pharmaceuticals are the primary treatment for majority of chronic conditions (sometimes prescription drugs are unavoidable) whereas functional medicine focuses on a diet, lifestyle, environment and safer treatment options than prescription drugs.

With a functional medicine approach, patients are treated and not diseases are treated. It’s about the treatment of patients and the underlying pattern that give rise to disease.

Each patient is unique and a one-size-fits-all is not always effective. Even patients with the same condition may get different treatments. Imagine, there are two patients suffering from psoriasis. After laboratory testing you learn that the first patient has an intestinal infection and the second patient has an autoimmune disease, that’s what driving their condition. Thus, both patients with the same skin condition will require different treatment to address the root cause of their psoriasis. Initially, the first patient might get antimicrobials (herbs or antibiotics) and probiotics whereas the treatment of a the second patient will primarily be focused on a diet and proper supplements to help regulate the immune system. The same condition, yet two different treatments to address their individual problem. In conventional medicine, these two patients would likely receive the same treatment, such as the steroid cream. The cream could help to some degree in both cases, but since the root cause has not been addressed – the skin problems would likely not go away. This is an example of the disease management and not the treatment of the patient.

Do you want more than just taking a pill that masks the problem and manages the symptoms or do you want to know why those symptoms were there in the first place and what possibly aggravates them? If yes, feel free to get in touch with me by dropping an email at info@probioticdigest.com

What can promote underactive thyroid?
DO YOU SUSPECT HAVING THYROID ISSUES? Thyroid issues are quite common especially among women, with hypothyroidism as the most common thyroid disorder. It is characterized by mental slowing, weight gain, constipation, dry skin, hair loss, cold intolerance, irregular menstruation, infertility, muscle stiffness and pain, depression, dementia, and a wide range of other symptoms. Actually, every cell in our body has receptors for thyroid hormone. These hormones are responsible for the most basic aspects of body function, impacting all major systems of the body. Thyroid hormone directly acts on the brain, the G.I. tract, the cardiovascular system, bone metabolism, red blood cell metabolism, gall bladder and liver function, steroid hormone production, glucose metabolism, lipid and cholesterol metabolism, protein metabolism and body temperature regulation. One of the biggest challenges facing those with hypothyroidism is that it is often under- and misdiagnosed, as many patients with thyroid symptoms have “normal” lab results, yet not optimal if you interpret them properly. What can promote LOW THYROID HORMONES:
  • IMPAIRED GUT HEALTH (poor diet, impaired digestion, low stomach acid, poor bile production, intestinal dysbiosis such as Candida overgrowth, increased intestinal permeability)
  • IMMUNE DYSREGULATION (auto-immune attack)
  • INFLAMMATION (inflammation suppresses the hypothalamus-pituitary-thyroid HPT axis, inflammation decreases both the number and sensitivity of thyroid hormone receptors, inflammation decreases the conversion of T4 to T3. T4 is the inactive form of thyroid hormone. The body has to convert it to the active T3 form before it can be used)
  • CHRONIC STRESS (chronically elevated cortisol contributes to under-conversion of free T4 to free T3)
  • MALNUTRITION (lack of nutrients to allow hormone synthesis, conversion, and functioning, think of selenium, iodine, zinc, vitamin C, tyrosine)
  • BLOOD SUGAR IMBALANCES (hypoglycemia, insulin resistance, healthy thyroid function depends on keeping your blood sugar in a normal range, and keeping your blood sugar in a normal range depends on healthy thyroid function)
  • Blood serum TSH, free T4, free T3, anti-TPO, anti-TG
  • Thyroid ultrasound
In a process of supporting thyroid functioning it’s important to look for the underlying cause(s) of its dysfunction. If you need more, please feel free to get in touch with me via info@probioticdigest.com
Diseases, Microbiome and gut health
Why bile matters? The magic of BILE: fat digestion and detox

Do you have any of the following symptoms?

Fatigue, constipation/diarrhea, incomplete digestion/absorption of fats, headaches, light colored or/and fatty stools, gas and bloating, hormonal imbalances/thyroid disease, detox problems, sleep problems, ear ringing (tinnitus), nausea, bitter taste in the mouth, sciatica like pains, low serum albumin levels, decreased absorption of nutrients, growth failure in children, weight loss, gallbladder issues or your gallbladder was removed.

If yes, then read on.

Why do we need bile?

Bile is a soap-like substance vital for optimal (fat) digestion. It is a complex and unique aqueous product of the liver hepatocytes which is further modified by the activities of the bile duct epithelium. Then bile is collected, concentrated and stored in a gallbladder to be delivered to a small intestine when needed. Bile helps digesting fats and supports removal, flow and metabolism of various substances. Bile is composed in about 95% of water, the remaining constituents are bile salts, cholesterol, amino acids, bilirubin phospholipid, steroids, enzymes, vitamin, porphyrins, as well as heavy metals, environmental toxins, and drugs.

Without quality bile we are at risk of developing health issues as bile is critical for metabolic conversions and flow of vital nutrients as well as elimination of toxic substances:

  • Bile is a major route to excrete harmful substances, toxins
  • Bile salts function to emulsify dietary fats and facilitate their digestion and absorption
  • Bile helps eliminating cholesterol
  • Bile stimulates intestinal innate immune system and supports immunity by excreting immunoglobulin A (IgA), inflammatory cytokines
  • Bile is vital for chole- and entero-hepatic circulation
  • Bile is essential carrier for some hormones and some hormonal conversions, estrogens, vitamin D3 metabolite, prolactin or insulin are excreted with bile
  • Bile excretes vitamins (folate, B6, cyanocobalamin) and contains glutathione, glutamic acid, pheromones and other vital components
  • Bile helps make calcium and iron more absorbable

Common gallbladder and bile related complaints

Fat digestion may be impaired as a result of impaired digestive enzymes production and/or impaired bile production. Common symptoms include burping, bloating, nausea after high-fat meals. Impaired fat digestion contributes to malabsorption of fat soluble vitamins (A, E, D, K). In addition, gallstones can form and typically they are a result of saturation and precipitation of bile component(s) such as cholesterol, pure pigment of calcium bilirubinate, or minerals. Gallstones may be asymptomatic or cause biliary colic with regular pain free intervals of days or months. Real-time ultrasonography is used to diagnose gallstones.

How to support bile production?

Number one is to eat anti-inflammatory real foods, mostly plants and avoid pro-inflammatory processed foods, access sugar and fried foods.

You need nutrients from real foods in order to produce bile, a package of chips will not provide them.

DIET: Include diversity of dietary fiber rich foods such as (raw) vegetables and fruits in your diet as a source of valuable nutrients for you and prebiotic fiber for your gut microbiota. Your liver and bile will benefit from eating cholagogic foods like artichoke, dandelion greens (leafy greens), radish, chicory, from bitter tasting foods, as well as potassium rich foods such as avocado, tomatoes, sweet potatoes, banana and from eating sprouted seeds and nuts. Some of the important components supporting bile production include choline (eggs, meat, shrimps, fish, chicken, shitake), taurine (fish, meat), betaine (beet root, spinach, quinoa, amaranth), vitamin C (fruits and vegetables), vitamin E (dark leafy greens, almonds, sunflower seeds, avocado, olive oil). Worth to mention is that our gut microbiota is involved in bile acids metabolism and formation, therefore taking care of these little gut creatures by feeding them prebiotic rich foods is of importance.

Some people experience a significant improvement after elimination of eggs, pork, onions, or milk from their diet because of the possible allergic component.

SUPPLEMENTS: You may consider supplemental and herbal support to improve liver health, decrease inflammation and promote bile production by including following: turmeric, milk thistle, dandelion root, artichoke, activated charcoal, lipase enzyme, bile salts or ox bile. Consult with your physician or nutritionist before start taking the supplements.

Last but not least, engage in regular physical activity and don’t forget that consumption of enough (six to eight glasses) water daily is necessary to maintain the water content of bile.


  1. “Bile Formation and Secretion” James L. Boyer. Compr Physiol, July 2013, 3 (3); 1035-1078.
  2. “Gallstones” M. T. Murray. G Natural Medicine text book, fourth edition. J. Pizzorno & M Murray. Elsevier 2013.
  3. “Metabolism of Cholesterol and Bile Acids by the Gut Microbiota” Philippe Gérard. Pathogens 2014, 3, 14-24.
Diseases, Nutrition
Do you react to foods?


Food allergies and food sensitivities became more prevalent over the past few decades. Some common food reactions keep raising. It certainly has a lot to do with the way we live (stressed, overstimulated), with the quality of foods and drinks we consume (processed and toxic), the air we breathe in (polluted) or the cosmetics, detergents we use. These factors can make us more vulnerable and susceptible to all sort of maladies. Our bodies have to work hard to process everything from surrounding us environment and ingested foods, to stay in balance and to provide our bodies with what it needs for optimal functioning. When our body is overwhelmed our immune system and other parts may overreact inducing food reactions.

Reactions to foods we may experience include:

  • Psychological reactions (exorphins present in wheat/gluten and diary/casein bind to opioid receptors within our body influencing our brain, our behavior)
  • Toxic reactions (food contamination or food poisoning)
  • Immune-mediated reactions such as food allergies and food sensitivities (type I, II, III, or IV hypersensitivity)
  • Food intolerance reaction (enzyme deficiency)

There is often confusion around what is what and sometimes “allergy”, “intolerance”, and “sensitivity” are used improperly, which may  depend on naming convention as well as on how you look at the reaction to foods; whether you look at the reaction itself or symptoms it causes. Without going into depth and complexity of these reactions, I describe below the key differences.

What are they?

Let’s focus here only on two immune-mediated reactions (IgE & IgG) and food intolerances. Be aware that a person may also experience a combination of food reactions after ingesting one food, which may involve an immune reaction and non-immune reaction, cell-mediated food reactions.

Generally, we can distinguish:

  • immediate and often severe immune responses to IgE antibodies for food allergies
  • milder and delayed immune responses to IgG antibodies for food sensitivities
  • metabolic or gastrointestinal responses caused by a lack of enzymes or other inability to digest certain foods for food intolerances

Food allergies (IgE mediated) are associated with immediate-type gastrointestinal hypersensitivity, oral allergy syndrome, acute urticaria and angioedema, allergic rhinitis, acute bronchospasm, and in severe reactions anaphylaxis. Some symptoms include: reddening of the skin (hives, itching); swelling (lips, eyelids), tightness of the throat; impaired breathing; vomiting; or diarrhea. Most of these symptoms appear right after eating the offending food, for example nuts, fruits, raw vegetables, eggs, diary, or chicken. A person is always aware of symptoms and reaction to the allergenic food. In some people it’s a lifelong reaction whereas in others it disappears.

Food sensitivities (IgG mediated) involve delayed (hours, days) allergic-like responses/hypersensitivities that can last for days. The mechanism is based on triggering an immune system by producing IgG antibodies after a repeated exposure to a food antigen. The reaction can be dose-dependent and often involves common foods. Some delayed food sensitivity symptoms can include fatigue, abdominal pain, bloating, vomiting, diarrhea, asthma, joint stiffness, swelling and pain, skin itching, rushes, hives, psoriasis, memory disturbances, behavioral changes or fever. A person is not always aware about having this food reaction as it can be difficult to connect a particular food reaction with its delayed symptoms. It disappears weeks/months after elimination of a trigger food.     

Food intolerances are associated with an inability (often genetically determined) to break down particular food compounds caused by a lack of enzymes or their low expression. This type of reaction does not directly involve the immune system and in some individuals response can be dose-dependent. It typically causes abdominal cramps and pain, diarrhea, bloating, sometimes headaches. The most frequent food intolerances include lactose intolerance, histamine intolerance, or fructose intolerance.

Do reactions to foods have health consequences?

Exposure to foods causing allergic, intolerance reaction or food sensitivities can be a contributing factor in many health conditions such as arthritis, eczema, psoriasis, depression, anxiety, migraine headaches, muscle pain, chronic fatigue, as well as in inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS). So if you have chronic health complaints it is worthwhile to give your food reactions a closer look.


There is a number of ways to test for food reactions and the methods become more sophisticated to meet the growing demand. Different tests are appropriate depending on the immunologic reaction a person is trying to discover. Most common methods include elimination/challenge, skin testing, patch testing, ELISA antibody tests for IgG, IgE, IgG4, and IgA antibodies, biochip technology, and energetic testing methods. Each and every method has its advantages and disadvantages and particular methods investigate only a specific aspect of food reactions. For some people, laboratory testing results can be a great motivational trigger to promote dietary changes serving as a “proof” that a particular food is reactive. Also tests can be recommended to people unwilling or unable to do an elimination diet or for those who can’t easily identify the food related responses. Elimination diet you can do on your own and it is in principle very easy but it takes the time and diligence and can be overwhelming whereas an accurate and reproducible food allergy test allows nutritious foods to remain in a patient’s diet while removing offending foods. If you want to do some testing discuss possibilities with your health care professional. Below I provide the principles of an elimination diet.

Elimination & Challenge Method

The most common solution currently available is to begin identifying potential sensitivities by following an elimination and challenge of the specific foods. The basic idea is to eliminate a suspect food for a period of time to see which symptoms subside and then reintroduce it to see which symptoms reappear.

How to do it:

  1. Eliminate a single suspect food, group of foods (for example nightshades) or the 10 most common food allergens (milk, eggs, wheat, grains, soy, shellfish, peanuts, tree nuts, sugar and alcohol) for a certain period of time (from days to weeks or months)
  2. Reintroduce one food at a time for three days, eaten 1-3 times a day (Note: this type of testing should not be done with foods known to cause a severe or anaphylactic reaction).
  3. Keep a diary to record how you feel for up to three days after a food is reintroduced. Some reactions may appear 24-72 hours after food consumption.
  4. Follow the same steps for each food.

a)  If a food causes a reaction such as brain fog, fatigue, itchy skin, stool changes etc., then eliminate it. Wait with introducing a new food for two-three days.

b)  If you don’t have a reaction, preferably leave that food temporarily out of your diet and put it back into your diet at the end of the food-reintroducing phase.

The food elimination/challenge approach can be time-consuming, carries a risk of producing a severe reaction (especially for IgE-mediated food allergies), can be difficult to reproduce, coincidental factors may affect the outcomes and it may result if false negatives. Therefore, it’s good to have some background info before applying this or any other testing approach.


  1. “Adverse food reaction and functional gastrointestinal disorders: the role of dietetic approach” F. Pasqui et al. J Gastrointestin Liver Dis, September 2015 Vol. 24 No 3.
  2. “Food allergies” Wendy Hodsdon. Natural Medicine text book, fourth edition. J. Pizzorno & M Murray. Elsevier 2013.
  3. “Testing for food reactions: the good, the bad, and the ugly” G. E. Mullin et al. Nutrition in Clinical Practice, Vol. 25 No 2, 2010.
Diseases, Microbiome and gut health
Early antibiotic use may impact health later in life

Antibiotics, once being the best intervention ever, now lead to antimicrobial resistance, posing one of the greatest threats to human health

Antibiotic dilemma

My first experience with an antibiotic dilemma was directly after my first daughter was born. Three hours after giving birth, we were heading home from the hospital, with my daughter in a newborn car seat. About 15 minutes later, I noticed she turned pale and I became suspicious. We returned immediately to the hospital, where the medical team discovered she had a respiratory insufficiency. No one knew the cause of it. She had no fever but doctors, following our approval, gave her antibiotics just in case it was an infection. We were told that if it turned out to be an infection, not giving her antibiotics would risk her life. That was a clear message which made us decide to go for antibiotics. Nobody, however, warned us about the potential consequences of (unnecessary) antibiotic exposure at such a young age.

Eventually, it turned out that it wasn’t an infection. The microbiological tests came back negative. Doctors found no cause of a respiratory insufficiency. I have, however, a theory that placing her in a car seat (bended body, bended head) was a trigger leading to breathing difficulties. The antibiotic she was given at this very critical lifetime might have compromised her gut microbiome establishment and her immune system development, and hence could be the colic as the first sign of it and later on frequent sicknesses. Around her 2nd birthday she had 3 antibiotic courses, one for impetigo and two for ear infections. Each time she was prescribed an antibiotic, I was hesitant to give it to her, wondering what the price she will pay for it in the future. I can imagine many parents face similar situations. Often out of fear and to feel like we are in control, we allow our children to be given antibiotics. In the short term, there is usually an improvement, which makes us believe that the antibiotics were the right choice. Antibiotics are often the only way but we still need to be careful when subjecting our children to antibiotics.

Antibiotics have served their purpose in fighting bacterial infections, there is no doubt about that. Most bacterial infections, causing deaths decades ago, are under control thanks to antibiotics. Antibiotics became a miracle drug and are often generously prescribed. But do we know the long-term effects of antibiotic use? Decades ago, people were dying because of infections. Nowadays they are dying because of non-communicable diseases. Could there be a link between the use of antibiotics and the diseases we currently face? According to a review that just appeared in Cell Host & Microbe scientific journal, the use of antibiotics, especially at early age, may lead to microbial imbalances. These imbalances may contribute to dysbiosis associated diseases, such as obesity, autoimmune diseases and infectious diseases, apart from the already known drug-related adverse events and growing antibiotic resistance.

I want to increase an awareness about their potential long-term effects when administered early in life, based on the review mentioned above.

Children are prescribed antibiotics more than any other prescription drugs

It has been suggested that up to one third of antibiotics are unnecessarily prescribed. I find it alarming and worrisome.

The World Health Organization emphasizes that antibiotic resistance is one of the three greatest threats to human health.

The 3 most alarming effects of an inappropriate use of antibiotics include:

  • Antibiotic resistance (the prevalence of antibiotic resistance genes increases worldwide and infections caused by resistant bacterial strains lead to increased morbidity, mortality and increased healthcare costs)
  • Antibiotic-related side effects (about 20% of all emergency department visits in the US are because of antimicrobial-related adverse events)
  • Dysbiosis referring to microbial imbalance (recent findings indicate there is an association between exposure to antibiotics at early age and dysbiosis related diseases such as obesity, diabetes, or asthma)

The presence of microorganisms early in life is essential in the neurological, immunological and metabolic development of a child

The early exposure to certain factors - such as to microorganisms, to dietary antigens, hormones, or growth factors - is prerequisite for the development of the immune system, the establishment of healthy digestive function, gut motility, immune tolerance to foods and various antigens, and defense against pathogens. For more information please go to my blog on "Gut microbes in infancy".

This is the time when organs and systems are being developed and trained so they can serve throughout life. If perturbation occurs at early age (especially the first 6 months of life), such as exposure to antibiotics, it may have distinct and long-term consequences.

 The possible effects-scenarios of early (0-6 months of age) exposure to antibiotics:

  • Antibiotics temporarily decrease the bacterial diversity, without affecting the species critical for immune development so the immune system develops normally. On the other hand, the microbial community does not recover completely post-antibiotics and it gains a new state with altered microbial composition and altered metabolic capabilities. As a result, it could lead to obesity. From the animal studies we know that the exposure to sub-therapeutic levels of antibiotics increases adiposity, or fat accumulation. This is one of the reasons why livestock have been fed low doses of antibiotics to increase their body mass. 
  • Antibiotics eliminate the key bacterial species during a critical window of the immune system development, leading to its maturation impairment. During the post-antibiotic recovery the key members of the gut microbiome return to occupy their niches and the microbiome reaches a state of “stasis.” The returned key species let the immune system develop further. However, the immune system remains impaired. As a consequence, the immunity is compromised and may lead to allergy, atopic disorders, and autoimmune diseases. A number of studies associate early antibiotic use, especially multiple courses of broad-spectrum antibiotics, with an increased risk of allergy and atopic disorders. According to a current hypothesis, gut dysbiosis caused by the loss of key bacterial players and overgrowth of pathogens may contribute to the development of allergy, atopic diseases, and autoimmune diseases. The genetic factor is known to be involved in the etiology of autoimmune diseases. However, scientists indicate that the gut microbiome may be as well an important player. There are results to suggest that early exposure to multiple antibiotic courses may increase the risk of juvenile rheumatoid arthritis and inflammatory bowel syndrome. In addition, animal studies showed that exposure to antibiotics led to alterations in the gut microbiome and the loss of keystone species, eventually affecting the immune system.
  • Antibiotics decrease the microbial diversity within the gut and at the same time create a niche for pathogens. The gut is “on fire”: the gut epithelium is inflamed, the pathogens begin to thrive, predisposing to chronic infections. Thus, exposure to antibiotics may cause an increased vulnerability to infections during the post-antibiotic recovery period. Studies with pre-term infants suffering from necrotizing enterocolitis associated this condition with prior-antibiotic use. Clostridium difficile infection in adults is a classic example of the post-antibiotic loss of microbial gut diversity and subsequent pathogenic colonization. It is also known that antibiotic-induced dysbiosis increases the risk of fungus infection, such as Candida albicans. In addition, the post-antibiotic effect has been linked with impaired immunity against the influenza virus.

Summing-up, there are four post-antibiotic types of dysbiosis proposed currently: loss of keystone species, loss of microbial diversity, alterations in metabolic capacity, and blooms of pathogens.

Hopefully, these findings will fuel further research on the post-antibiotic health consequences and will improve antibiotic prescription protocols. For example, doctors should select narrow-spectrum antibiotics to target only designated bacteria based on proper diagnostics.

Lastly, I would like to encourage everyone to read an inspiring book of Dr. Martin Blaser: Missing microbes – how the overuse of antibiotics is fueling our modern plagues. The author will make you rethink the current concept of fighting infections, will make you cherish and appreciate your microbiome and will make you think twice before giving your child antibiotics.

Diseases, Nutrition
Can probiotics prevent flu and colds?

Respiratory tract infections and probiotics

During the 2013-2014 winter, my family accounted many episodes of Respiratory Tract Infections (RTIs). I, my husband, and both my daughters were experiencing recurrent RTIs, and this saga lasted for about 6 months. My older daughter missed about 60% of her daycare days and my younger one about 90% of daycare because of RTIs. It was a tough burden (physically, emotionally and financially) for me and for my husband. Luckily, the last winter of 2014-2015 was much better; my daughters were only sick a few times and it was quite mild. Having the entire family suffering from recurrent RTIs, it was a wake-up call for me to look for ways to improve our health. The changes we have made were mostly around our diet and included the consumption of probiotic supplements, more fermented food, more vegetables, more salads, more fiber, more bone broths, less sugars, reduced intake of diary milk products, reduced consumption of wheat and gluten, and no processed food.

Even though it's not the season of colds and flu now, I want to give some attention to “RESPIRATORY TRACT INFECTIONS AND PROBIOTICS”. RTIs typically include cold, upper respiratory tract infections, influenza-like illness and flu, the majority of which is caused by a virus.  Associated symptoms include runny nose, sneezing, sore throat, cough, sometimes fever and may last between 5 to 10 days. Children, on average, suffer from 6 to 12 RTI incidents annually, whereas adults average from 1 to 5 incidents. The management of RTIs typically includes the use of over-the-counter medications to relieve some of the symptoms.

The average cost of an RTI incident is by itself low, however the high incidence and recurrence leads to a high burden for the individuals affected, their families, health care practitioners and health care systems worldwide. High recurrences of RTIs affect the quality of life, leading to absenteeism at work or at school, and may involve extra costs such as hiring a baby sitter.

It is well known that a healthy, diverse and balanced diet, regular physical exercise and no stress contribute to one’s wellbeing, but what about probiotics? Can probiotics have an effect on the prevention, recurrence, duration or severity of RTIs?


Probiotics, in comparison to placebo, were shown to contribute to:

- lower risk of RTIs

- lower incidence of RTIs

- reduced number of days with RTIs related symptoms

- reduced antibiotic use

- fewer abstinence days from work, school, or daycare

Below you can find a summary of results from relevant clinical studies.


Based on the results that probiotics may reduce the RTI duration, reduce absenteeism at work, at school, and reduce the use of medications, could the use of probiotics have an economical aspect in the management of RTIs? In order to answer these questions, a health-economic analysis (Lenoir-Wijnkoop et al)  was undertaken to determine the public health and budget consequences of a generalized probiotic intake in France. Scientists used the existing data from the two meta-analyses (Cochrane meta-analysis and YHEC meta-analysis) and applied it to the French population to estimate common RTI events, comparing subjects on and without a probiotics regimen. They looked at the cost savings related to the decreased incidence of RTIs, reduced number of sick days, number of antibiotics courses, sick leave days, and other related costs. Based on one of the analysis, authors estimate that probiotics’ economic impact could save the society, during the 2011-2012 winter, €84.4 million according to the YHEC data, and €253.6 million according to the Cochrane data. The authors emphasize also that the incidence of common RTIs during the 2011-2012 winter was low compared to the average rate over the five last winters.


This is the most important question for the consumer: should I use probiotics for the prevention and management of RTIs? And if yes, then which?

There is no wonder probiotic strain against all RTIs and no wonder probiotic strain that works in all individuals. Everyone’s gut microbial make-up is unique so the probiotics may have different impact. The clinical findings available now are certainly encouraging, but on the other hand, there are also conflicting results where the users seem not to benefit from using probiotics in the prophylaxis and the management of RTIs, such as in a recent study with Bifidobacterium animalis subsp. lactis (Hojsak et al). Therefore, all published data needs to be confirmed in larger and more homogenous study populations. There are differences in study designs, including the various numbers of participants, various group ages, different sex, and different durations of the studies, different probiotic strains given, and different probiotic preparations, at different concentrations and at different times. This heterogeneity makes definite conclusions and recommendations – on whether, when, which probiotic and at what dosage in management of RTIs – difficult. We need to have a better understanding of the effects of different probiotic strains in the prevention and management of RTIs, and more specifically on their immune-modulating potential.

I believe that if we gain more knowledge we will be able to select the most beneficial probiotic strains for the management of RTIs, based on their proven properties.


To help you to select appropriate probiotic strains, I list below the bacterial strains shown to have, to greater or lesser extent, a beneficial effect in the prevention and/or the management of RTIs.

Lactobacillus strains:
Lactobacillus rhamnosus GG (ATCC53103), Lactobacillus rhamnosus (LC705), Lactobacillus casei (DN-114 001 and 431), Lactobacillus paracasei (8700:2), Lactobacillus gasseri (PA 16/8), Lactobacillus bulgaricus, Lactobacillus acidophilus (CUL21 and CUL60), Lactobacillus plantarum (HEAL9), Lactobacillus brevis (KB290)
Bifidobacterium strains:
Bifidobacterium breve (P), Bifidobacterium lactis (BB-12 and CUL34), Bifidobacterium bifidum (MF20/5, R0071 and CUL20), Bifidobacterium longum (SP 07/3)
Other strains:
Streptococcus thermophilus


The study of Hojsak et al has shown that children (376 children) receiving probiotic Lactobacillus rhamnosus GG were at a lower risk of respiratory tract infections, gastrointestinal infections, vomiting episodes, and diarrhea when compared to the placebo group (366 children). Another study (Rautava et al) with infants (probiotic group) receiving daily formula supplemented with Lactobacillus rhamnosus GG and Bifidobacterium lactis BB-12 until the age of 12 months showed that infants in the probiotic group, in comparison to the placebo group, had lower incidence of RTIs, of ear infections (acute otitis media) and of antibiotic courses. Moreover, Japanese clinicians (Waki et al) demonstrated that schoolchildren receiving a probiotic drink containing Lactobacillus brevis KB290, for 2 months/5 days per week had lower incidence of influenza infections, with a more pronounced affect in children not vaccinated with the influenza vaccine. The authors of this study reported no significant difference in incidence of common cold or gastroenteritis between the probiotic group and the placebo group. Another recent study (Garaiova et al) investigated the efficacy of probiotic consortium containing bacteria (Lactobacillus acidophilus CUL21 and CUL60, Bifidobacterium bifidum CUL20, and Bifidobacterium animalis subsp. lactis CUL34) and 50 mg vitamin C for prevention of respiratory tract infections in 69 healthy children aged 3-6 years. Children received probiotic (28 children) daily or placebo (29 children) daily, for a period of 6 months. The authors observed significantly reduced incidence of upper RTIs, reduced numbers of days with upper RTI associated symptoms, and reduced absenteeism from preschool in the placebo group. In addition, children on probiotic and vitamin C regimen used cough medicines, painkillers, nasal sprays, and antibiotics for shorter periods of time than children receiving a placebo.

Furthermore, probiotics – in comparison to control groups – were found to contribute to the prevention and reduced rate of RTIs, also in reduced antibiotic use, as based on the Cochrane meta-analysis (Hao et al, updated Hao et al) of 10 clinical trials with 3,451 participants (infants, children, and adults). These results, however, did not find any effect on the duration of each single sickness episode. Yet, another data review (King et al) including a meta-analysis revealed the effectiveness of probiotics (Lactobacillus and Bifidobacterium strains) on the duration of RTIs in children and adults. The meta-analysis including 20 clinical trials revealed that participants receiving probiotic, in contrast to placebo participants, had shorter illness episodes by almost a day, had fewer abstinence days from work, school, or daycare.

The above studies report no adverse events associated with probiotic intake. Probiotics used in the studies – Lactobacilli and Bifidobacteria – are generally considered to be safe. Patients at high risk for a probiotic-induced sepsis include immunocompromised patients and premature neonates.