Probiotics and gut flora are big news at the moment, with so much new research linking gut flora imbalance with a range of chronic diseases and our emotional and mental health. I think it is so fascinating and I’m sure over the next 10 years we will discover more and more about how important it is. In clinic, digestive problems are really common, from irritable bowel syndrome to acid reflux and indigestion; and commonly as I go through someone’s medical history we can begin to see where these problems have come from. There are often give away symptoms which make me suspect gut flora imbalance or dysbiosis, red flags that I look for in the history or particular symptoms. I would always look first for a history of recurrent antibiotic use, this is often in childhood for repeated infections, like tonsillitis; chest or ear infections; acne or for dental abscesses or urine infections in older people. Excess use of antibiotics can cause problems years down the line; often when combined with a high sugar diet, or excess alcohol, stress, or food poisoning/ diarrhoea and sickness bugs. These can all contribute to gut dysbiosis on their own, and in combination are certainly a likely root cause of problems. If I find these in the history, my suspicions will be raised, and then I will start to look for symptoms – the obvious ones are bloating; wind or gas; diarrhoea or constipation; indigestion and sometimes acid reflux or heartburn. All of these would make me suspicious and there may be other systemic signs like fatigue, brain fog, aching, headaches, migraines, allergies, mood disorders or inflammatory conditions like arthritis which may point to the fact that the gut problems are starting to cause conditions elsewhere in the body. Within functional medicine, we are taught the 4 R programme which is a way to restore a healthy digestion and gut function, and it is where I often start when treating chronic disease. One of these ‘R’s is ‘Repopulate’ and we can do this with a number of different foods and supplements. Probiotics can be an important part of the tool kit, but they are not the only one, and some practitioners argue they are never as good as food changes. However, I do believe they have a role in the kick-starting change in the gut flora and are very useful in practice. Probiotics are supplements made up of beneficial bacteria – which go into the gut and will help to rebalance the flora back to a healthy state. I tend to use at the minimum 10 Billion organisms, and routinely will give 30B or 50/60B a day if needed. There are lots to consider – what type of beneficial bacteria they contain; how stable they are when digested and the quality of the products. I tend to use Biocare products, as I find them a good brand; or I will prescribe Megasporebiotic, a practitioner-only brand with a host of excellent research behind it. I would never recommend the cultured drinks which can be found in supermarkets as they do not contain enough beneficial bacteria and are generally full of artificial sweaters. Once gut flora is rebalanced, a healthy state can be encouraged by eating pre-biotic foods such as chicory root, bananas, artichokes and leeks. Food can also be an extremely beneficial way to encourage a shift into a healthier gut flora if it is out of balance, we can use fermented foods like sauerkraut, natural yoghurt, kefir, miso and kombucha. We can eat a range of vegetables, using the idea of the rainbow diet, which is excellent for encouraging a healthy gut flora. Intermittent fasting can help too; chewing well and reducing stress, and trying to avoid antibiotics unless really necessary. If antibiotics are necessary I would certainly advise taking a course of probiotics afterwards, at least 10B a day, and ideally the Biocare 30B. Taking a glass of kefir, a day, is also an excellent strategy and one which is a very positive health habit for young and old.