Probiotics and C Diff - What Probiotics Should Be Taken With or After Treatment With Antibiotics?

Affiliate Disclosure

probiotics and c diffClostridium difficile (C. diff) infections can follow antibiotic treatment or may be acquired following an innocent hospital stay.

C. diff causes diarrhea and colitis of varying severity and can become life-threatening if the infection moves to the blood. The infection can recur and develop antibiotic-resistance, adding to its potential for harm.

Rates of C. diff have been generally increasing and up to 453,000 individuals are diagnosed with C diff infection per year. The severity of infection has also increased, and it often comes back as much as 20% of the time following treatment. Treatment costs our healthcare system >$5,000,000,000 per year. It accounts for as many as 30,000 deaths per year! (http://www.gastrojournal.org/article/S0016-5085(13)60847-1/pdf)

How can antibiotic treatment lead to an infection?

When you take antibiotics, healthy bugs are killed too. These bugs normally keep a healthy intestinal pH, maintain immune balance, and crowd out bad guys with a diverse ecosystem.

When that diversity is gone, pathogenic organisms like C. diff overgrow and can become infectious.

 

Current Medical Approach to C. diff Infection

Medicine will turn to standard antibiotics to treat a C. diff infection. But as antibiotics can be an initial trigger of C. diff overgrowth in the first place, this approach is sometimes necessary, but not without its limitations.

C. diff is also a natural inhabitant of the gut. It becomes opportunistic and dangerous when all of the other microbes are thrown off (or lacking diversity) that it becomes opportunistic and dangerous. So if you do not address long-term dietary change, and you keep turning to antibiotics, do not maintain healthy probiotics, sooner or later, antibiotic resistance will develop and the future risks can start to compound - especially as you age.

The use of fecal transplants is a new "cutting edge" option for ridding C. diff.  

Yes, the procedure transplants poop from a healthy donor to an infected person. The feces from a healthy donor will contain a diverse balance of healthy microbes. When the feces are transplanted to the infected person, microbe diversity & balance is restored. Research has shown the transplant can restore healthy flora and crowd out opportunistic pathogens like C. diff.

It's increasingly covered by the media and due to the profit-potential of an advanced procedure - you're seeing it pop up in the scientific literature a  lot too. It's discussed not only for gut infections - but for weight loss, diabetes, and other conditions that can relate to the gut and microbiome.

I don't like it. I don't like the false sense of security it creates in our minds.

Why bother changing your lifestyle when you can just borrow poop from someone who has a healthy lifestyle?

And, making it more enticing...the procedure will likely be covered by insurance.

For now, its use is not widespread, and the FDA has limited approval only to those with antibiotic-resistant C. diff infections.

As great as the technology is, I don't love the direction it takes us. Even if it is covered by insurance, the co-pays and fees are still likely to be higher than taking on a supplement and lifestyle approach. And, as soon as you go back to eating the same foods and living the same lifestyle - sooner or later, you'll be back where you started.

A fecal transplant procedure can be expensive and invasive compared to alternatives.

As you might guess, the “yuck factor” of fecal transplants is not favorably viewed by candidates either (1).

You know mainstream media is not going to cover the restorative potential of natural products. Talking about transplanting poop person-to-person is sure to make for click-worthy headlines!

So what proactive options does that leave us with aside from conventional antibiotics?

Probiotics.

Let's consider which probiotics to take during and after antibiotic treatment with C. diff.

Probiotics Taken During or After Antibiotics

Probiotics can help reduce C. diff growth by these  mechanisms:

  • Competition with pathogens for growth,
  • Direct interference with C. diff metabolism
  • Immune stimulation and modulation
  • General maintenance of intestinal health (1; 2).

Saccharomyces boulardii, Lactobacillus acidophilus, Lactobacillus rhamnosus, and Bacillus probiotics (Bacillus coagulans and Bacillus subtilis) can be taken during or after antibiotic treatment to help maintain gut flora, reduce the potential severity virulence of infection, and actively keep C. diff levels at bay.

The use of the probiotic yeast, Saccharomyces boulardii,’ has been well-regarded in the literature (3; 4). Clinical trials demonstrate S. boulardii may prevent C. diff recurrence, but its use may be limited to a first-time infection (5; 6).

Lactobacillus acidophilus and Lactobacillus rhamnosus reduce inflammation and the severity of C. diff-related diarrhea (7; 8).

Lactobacilli probiotics may also have difficulty making it past the acidic stomach intact. Their health benefits may result from immune activation and modulation by dead Lactobacilli cells and not via a true colonization of the intestinal tract. A high-quality and high-dose Lactobacilli product may help overcome this disadvantage.

I tend to use Bacillus probiotics foremost to ensure entry past the gut. Lactobacilli probiotics are also sometimes overgrown in Small Intestinal Bowel Overgrowth (SIBO)- and sometimes can aggravate gut rebalancing early on. Your decision to add them is case-by-case.

Alternatively, levels of Lactobacilli (and other healthy flora) can be promoted indirectly by consuming prebiotics. Prebiotics are fibers and starches that feed and maintain gut flora. Prebiotics can come from diverse vegetables or can be supplemented. Rather than supplementing with Lactobacilli directly, I've turned to a prebiotic approach more over the last few years. It helps to better sustain results long-term in my opinion. Again, prebiotics are a case-by-case decision with SIBO clients - adding them too early can aggravate SIBO.

Focus first on crowding out the bad bacteria and adding healthy diversity - Look to sustain that diversity later.

When you eat, you are eating for two - you and your flora!

With any treatment choice, once you heal the gut, you must maintain it by eating as many different types of vegetables as you can muster. If you go back to a diet that caused an imbalance in the first place - you’re asking for future trouble no matter how comprehensive your care plan.

Monolaurin, Soil-Based Probiotics, and Saccharomyces boulardii 

Antimicrobial Support:

When it comes to C. diff infections, generally I will assume that someone is taking antibiotics, but is concerned about making sure it stays away once addressed.  In other cases, someone may have had a problem in the past and is just concerned about repeat infection.

For natural antimicrobial support, I use Lauricidin (monolaurin). First, it's safe to take alongside conventional antibiotics, and it hasn't been shown to cause microbial resistance.

Monolaurin decreases the growth of gram-positive organisms such as C. diff while also helping to reduce its release of microbial toxins (exotoxins) into the blood.

Monolaurin is unique because it also leaves alone gram-negative bacteria like Lactobacilli. So you essentially clear out bad guys, while leaving the good.

Monolaurin was discovered in breast milk - and helps to maintain gut health in the breastfeeding infant while also protecting from certain bacteria, viruses and yeast. Lauricidin is easy to personalize intake as it comes in bead-like pellets. You can start with just a few pellets and work your way up to the scoop in the jar - taking it three times per day.

Probiotic Support Taken During and After Gut Infection:

Us of soil-probiotics such as Bacillus coagulans is widespread in Europe, but their use is still catching on in the US. Bacillus coagulans is unique in that it has been shown to not only improve outcomes during C. diff. treatment, but also prevent recurrence (9; 10).

Mice treated with vancomycin often experience a recurrence of C. diff symptoms following treatment.  One study demonstrated that mice treated concurrently with Bacillus coagulans survived longer and had better bowel consistency and metabolic markers following vancomycin treatment.(9; 10).

While there are a number of ways to approach C. diff infections naturally and medically, I personally use Lauricidin,  Megasporebiotic & RestorFlora in my gut protocol. This combination gives direct antimicrobial support, and takes advantage of high-dose Bacillus probiotics  (found in Megaspore) and S. boulardii (found in RestorFlora).

I like adding Theralac by Master Supplements as it is a well-rounded probiotic containing both Lactobacillus acidophilus and Lactobacillus rhamnosus - which were mentioned above to help support inflammation and bowel regularity in C. diff clients.

If SIBO or high inflammation is a concern, I may start with TruBifido as it focuses on probiotics predominant in the large bowel - and then, I will transition to Theralac as tolerated. I'll later use supplementary and dietary prebiotics as tolerated to sustain Lactobacilli and Bifidobacteria.

Remember, most Lactobacilli/Bifidobacteria probiotics are killed in the stomach acid. This is why I emphasize spores foremost.

Master Supplements owns patents on their unique "acid-proof" delivery system that protects Lactobacilli and Bifidobacteria probiotics from the stomach acid.

As these are potent formulations - if you start killing too much at once - it can create a back-up in your ability to detoxify the wastes.

As a general rule, start low and work your way up, especially when combining! I may also have to open up the capsules of Megaspore and sprinkle it in food or liquid when first starting. The capsule contents are heat-stable and have no taste.

Other practitioners seem to be getting best results when also adding HU58 to the mix - which is a new product that contains a high dose strain of Bacillus subtilis. HU58 is intended to take alongside Megaspore in support of more difficult (and potentially more serious) gastrointestinal imbalances - such as C. diff.

So if you don't want to mess around, consider adding HU58 alongside Megasporebiotic and RestorFlora. You can also add Theralac if it's also tolerated.

In many cases, you will be taking an antibiotic concurrently with the supplements. So be mindful that you're not necessarily fully substituting for standard medical care. C. diff is not something you want to toy around with.

Here's what a support protocol might look like during antibiotic treatment (these are educational guidelines & not a substitute for professional advice):

  • Lauricidin
  • Megasporebiotic
  • Theralac
    • Note: TruBifido may be used instead of Theralac if you suspect SIBO, or if your gut tends to be on the more sensitive side with probiotics (usually sensitivity is due to stimulation from Lactobacilli). One isn't "better" than the other - the reasoning is that TruBifido targets large intestine bacteria, while Theralac targets probiotics of the small & large intestines. The small intestinal bacteria (Lactobacilli) tend to be more immune-stimulating in nature.
  • RestorFlora
  • Add HU58 for more potent support if you have elevated concerns, diarrhea, or more moderate symptoms.

Extras:

  • Mega IgG2000 may help mop up wastes, toxins, & debris released during both an infection and the healing process without binding you up like activated charcoal.
  • Candida Control by Enzyme Science is a proteolytic enzyme blend high in protease & cellulase. Cellulase specifically helps digest the debris from Candida or yeast cell membranes. The protease content helps to digest Candida toxins released from yeast metabolism & cell death.

Of course, you do not need to wait until you have C. diff overgrowth to be motivated to fix your gut microbes. Most of us could benefit from some gut reconditioning using these same strategies.

Megasporebiotic has been demonstrated to heal markers of leaky gut in a clinical trial (11). Leaky gut is usually present with any flora imbalance and allows inflammatory proteins and bacterial toxins to easily migrate into the bloodstream.

I love spore probiotics as much as anyone - but don't forget about Bifidobacteria & Lactobacilli! That's why I love using Megaspore in combination with Master Supplements products. Together they provide more complete probiotic diversity without the strains being killed by stomach acid.

What happens after I'm finished with an antibiotic?

Long-term - it's about healing the gut lining and re-establishing microbial diversity in the gut to protect you for the long haul. When the gut is leaky and damaged - you absorb wastes & toxins into the blood that create inflammation throughout the entire body.

If you want to keep poop out of your bloodstream...heal leaky gut! I've collected the 7 Core Strategies to Heal the Gut Lining and Manage Leaky Gut

Using the products above in combination can make a strong difference in outcomes. All have good support behind them for yeast overgrowth too. If you have gut imbalance - it's a strong guess that yeast (such as Candida) is involved as well at least 2/3rds of the time.

Prebiotics are important to maintain gut health long-term once you've cleared pathogens and have slowly added back probiotic diversity. I use MegaPrebiotic by Microbiome Labs, TruFiber by Master Supplements, or Biotagen by Klaire labs. I usually integrate them in that order and then rotate long-term.

I generally work in the blends in that order as tolerated as each will target a different set of flora. The goal is diversity - so I rotate these on monthly basis - & mix it up during the month too.

Start low and work up with prebiotic fibers.

If bloating or constipation occurs with prebiotics, you may be introducing them too early (or too much). If you have this reaction, it shows you need the support - just work with your body's tolerance, and maybe get a little more aggressive with your previous probiotic/antimicrobial strategy.


When treating bacterial overgrowth, you may want to limit prebiotics in food (Low-FODMAP diet) and gradually reintroduce them via supplementation or food sources. This process can take as little as 3-month but can last 6-12 months as you personalize your own strategy.  There are many resources available online to help you with these strategies.

Eventually, you'll transition to a plant-rich, "Paleo-style" diet. I like the general rule of 75% diverse veggies, and 25% of my plate protein/fat/starch. You can increase your starch with activity level. Try new vegetables every chance you get to promote & sustain diversity long-term.

I take Megaspore and will rotate bottles TruBifido, Theralac & TruFlora - a small intestine-focused probiotic. I keep Lauricidin on hand for seasonal support & periodic conditioning of my immune system against stealth infections (such as EBV). I'll add in RestorFlora periodically if I went a little carb-happy over a holiday or dinner out & generally to support probiotic diversity.

6-12 months may sound excessive, yet as tricky as gut restoration can be, the health of your gut is critical to wellness as you age. You may take a step forward and back a few times until you find a strategy that works. The tips above will give you intensive support when you need it - while keeping the strategies affordable for long-term wellness support as you rotate probiotics & prebiotics long-term.

When it comes to the gut and C. difficile, the long path is often the shortest path to reduce the incidence, improve outcomes, and most importantly, prevent recurrence.

Shop Supplements

Dr Alex Rinehart

Most Popular