The other day, I had a patient with recurring bouts of the dreaded Clostridium difficile associated diarrhea (C diff for short; see here for a more detailed discussion about this infection). This is one of the most serious complications of antibiotic therapy. I saw her in the office after, I think, her third episode of C diff in five months. She was completing the course of antibiotic therapy specific for the C diff infection.
The patient was still having diarrhea but it had subsided quite a bit. She was far from dehydrated, and generally looked the best I had see her in months. So I asked her…”what have you been eating, you look rather well!” She said “Buttermilk.” Then her son chimed in that all she drank was buttermilk. She did not eat any food, and apparently was not drinking anything else. Buttermilk was the only thing she wanted. Her son said she was drinking about half a gallon of buttermilk per day! I found that hard to believe; I could not imagine an adult surviving on milk alone.
This was not just any milk though. It was buttermilk – milk that has been fermented due to the addition of live active cultures. I concluded that her diarrhea had subsided because she was consuming significant amounts of probiotics.
Unfortunately, the diarrhea never completely resolved. In fact, it started to worsen after a few weeks. She went to see a gastroenterologist and it was concluded that she was having persisting diarrhea because she developed lactose intolerance. Because of the prolonged, severe C diff infection, she developed malnutrition. I think the poor nutritional status resulted in her small bowel lining becoming so ‘worn out,’ that it was no longer producing lactase, the enzyme needed to digest lactose. She was instructed to stop drinking buttermilk and almost immediately, the diarrhea resolved.
There are many people who are lactose intolerant. Some are born that way, and others acquire it after an infection, as noted above, or some other inflammatory bowel problem. Probiotics are frequently taken to alleviate gastrointestinal problems.
Yogurt and other dairy products are the classically known probiotic containing foods. However, for lactose intolerant people who wish to consume probiotics in a natural form, as opposed to in pill form, there are options. As beneficial as buttermilk, yogurt, soft cheeses, etc. are for gut health, lactose intolerant persons have to find alternate sources of probiotics if they want to incorporate them into their diet.
Below are 8 examples of probiotic rich foods.
Probiotic containing dairy foods
1, 2 & 3 – buttermilk, yogurt and kefir – these are all variations of fermented milk, containing differing amounts of probiotics. My personal favorite is Kefir – it has this lovely tangy taste. Ideally the label for these products should say “contains live and active cultures.” Yogurt labels may additionally state “Meets National Yogurt Association criteria for live and active culture yogurt.” Better brands of yogurt will contain several strains of probiotics – at least 4 strains is good. Examples include Streptococcus thermophilus, Lactobacillus bulgaricus, Lactobacillus acidophilus, bifidus, and Lactobacillus casei. Lactose free options of these foods are more readily available nowadays.
4 – soft fermented cheeses – examples include Gouda, Swiss, and Parmesan
Probiotic containing non-dairy foods
5 – sauerkraut – this is raw fermented cabbage. It is extremely rich in probiotics, even more so than yogurt and kefir, and may contain over 10 strains. When buying sauerkraut,ensure that it is unpasteurized as heat can kill the live bacteria.
6 – pickles – choose naturally fermented types, using sea salt and water solution (rather than vinegar)
7 – tempeh – this is a patty of fermented soybeans
8 – kombucha – this is a fermented tea, consumed cold (again, to prevent killing the probiotics with heat)
The plus of eating foods containing probiotics is that you get the benefit of additional nutrients in the food, as opposed to just taking a probiotic pill. On the other hand, there is no doubt about the convenience of taking a pill.
In next week’s post, I round up the discussion on probiotics by discussing probiotic supplements, with recommendations about how to choose the one best suited for your needs, in the very confusing nutritional supplement marketplace.
So…what do you think about probiotics so far? Do you go out of your way to incorporate probiotics in your diet? Do you prefer taking a probiotic pill as opposed to eating probiotic rich foods? Tell me what you think in the comments below.