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What Probiotic should I take?

Couple eating in park

Probiotics are the latest supplement craze and have been widely promoted to improve an individual’s health by improving the bacteria balance in the intestines. Recent studies have found that the body’s immune system interacts with the bacteria that live in the intestine and can produce both positive and negative effects. Probiotics improve the balance of bacteria in the intestine to help a number of symptoms and conditions.

Research is difficult to interpret but there have been studies that showed benefits of probiotics in patients with IBS, Travelers Diarrhea, Antibiotic effects on the GI tract, constipation, Inflammatory Bowel Disease, eczema, and possibly some autoimmune disorders.

But, how does one choose the best probiotic? To make matters worst, there are several different strains of probiotics, each product has different amount of bacteria, and then some need to be refrigerated. In general, it is very difficult to choose.

The most common probiotic strains include Lactobacillis, Bifidobacterium and Sacchromycis, which actually is a fungus. There are few studies comparing different strains of probiotics and therefore it is hard to determine which is best for you.

Second, some probiotics are refrigerated and some are liquid and some are in a pill or capsule form. I recommend taking a Probiotic from a reputable manufacturer whose product has been tested at time of ingestion for viability of the bacteria.

Finally, how many bacteria is ideal in a probiotic is something that is not clear and labels are difficult to read. Many patients think that if 1 billion CFU are good 10 billion CFU are better. This is difficult to determine, as there are few clinical studies performed on this topic.

So, in general I recommend discussing Probiotics with your Physician and taking a single strain product that is not refrigerated from a reputable manufacturer who has done studies to make sure the probiotic is viable when swallowed and can survive the acidic environment in the stomach.

-Dr. Howard Schwartz M.D. – Gastroenterologist

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Have Your Heard the News?


Aha! You might be asking what news? The news about the missing Malaysian airliner? The news about Harvard’s basketball team making it past the first round in the NCAA March Madness basketball tournament? No! No I say! Rather, the news, most important news about how chocolate is good for your gastrointestinal system and even for your supporting immune health! For the facts about this most recent chocolate and health study, let’s examine what the researchers from Louisiana State University found.

At the most recent National Meeting of the American Chemical Society, Dr. John Finley and associates presented a most appetizing study. In short, when we eat certain types of chocolate, the bacteria that line the stomach and gastrointestinal system help digest that chocolate and in turn release other compounds that circulate in the body yielding wide array of health benefits.

The bacteria that line the stomach and GI system have their own world and biological functions within all of us “humans”. This system is known as the microbiome. Within the micobiome, the Bifidobacterium and lactic acid bacteria impart positive effects in aiding in food digestion. A side-note here – you might recognize the word or name “bifidobacterium” as this is also a type of probiotic often found in yogurts and specialty dietary supplements.

Both Bifodobacterium and lactic acid helps ferment the compounds within chocolate (polyphenols, for example) and in turn release natural anti-inflammatory compounds to help health throughout the body. No one knows yet if a dark chocolate bar enriched with extra bifidobacterium can replace the trusted Advil® or Naproxen®, however the reality is dark chocolates and probiotics are functional food items/dietary supplements that can yield health benefits.

The food for thought from this first study of interest by Dr. Finley and his group is that dark cocoa might offer health benefits to the body as an anti-inflammatory. These benefits can be extended, if your diet contains a good mix of colorful fruits, vegetables and green tea as these foods also contain healthy polyphenols. Dr. Finley also stated that prebiotics mixed with cocoa (dark chocolate) can potentially improve the body and overall health. One day, we may just see a dark chocolate that contains pro and prebiotics to act as a positive health promoter. Fortunately, if you are interested in being proactive about anti-inflammatory health, you can utilize a pro and prebiotic dietary supplement combined with a small amount of dark chocolate now, and enjoy both the taste and the inner-health benefits.

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To Your Health!

-Doug Kalman PhD, RD


  1. http://www.medicinenet.com/script/main/art.asp?articlekey=177295
  2. http://www.eurekalert.org/pub_releases/2014-03/acs-tpr022414.php

Will Going On A Cruise Endanger Your GI Tract?



Norovirus  is a very contagious virus that can be transmitted from an infected person contaminated food, water, or surface. The virus causes the stomach, intestines or both to get inflamed causing pain diarrhea and vomiting.

Treatment and is supportive as there is no medicine to treat the virus. It is important to stay hydrated and take anti-emetic and anti-diarrhea medication as needed. Finally it is important to use good hygiene not to infect others

The virus seems to be in the news every week for causing outbreaks on cruise ships.  Outbreaks are also common in restaurants, schools, summer camps, and cruises. It is common where a confined group of people eat together. It is quite important for food handlers to wash their hands and where gloves. One should be careful with leafy green such as lettuce, fresh fruits, and shellfish.

The best way to enjoy your cruise and not worry about the virus is to carefully wash your hands with soap and water after using the bathroom and before eating or handling food. Alcohol sanitizers are ideal to help prevent the spread of viruses. Make sure fruits and vegetables washed thoroughly and seafood is  cooked through.

Be smart and enjoy your next cruise.

-Dr. Howard Schwartz M.D. – Gastroenterologist

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Ask the Gastroenterologist: IBS

Irritable Bowel Syndrome or IBS is a constellation of abdominal pain that is associated with a change in bowel habits. IBS can be associated with diarrhea or constipation. IBS can be  a mild  “nervous stomach” that is associated with stressful situation or diet or can be extreme and effect the quality of one’s life.

It is common in people under 40 and more common in women than men. Often a physician visit is advised and work up including stool evaluation for bacteria, parasites, and clostridium difficile  is negative. Blood  work is normal including thyroid function and celiac testing.   A careful medical and dietary history should be taken looking for any triggers as well as a pertinent family history. Physical exam is usually normal. In individuals over the age of 40 or with symptoms of concern I will recommend a Colonoscopy, otherwise simple lifestyle and diet modification can be tried.

I will usually next ask the patient to keep a diary listing their food intake, symptoms, and stressors for a 2 week period. I will encourage to drink lost of fluid, avoid fried and spicy food, caffeine, and excessive dairy.

We will next often add a fiber supplement or probiotic. If stress is a predominant factor it should be addressed. Occasionally, antispasmodics such as Bentyl, Pamine, or Levsin will be prescribed.

It is important to take control of your IBS so it does not take over your life.


MN_graphic_ask_ copyChronic diarrhea can be the harbinger of significant medical illnesses. Definitions vary but most would agree that more than 3-4 loose watery bowel movements a day lasting for several weeks.

Certainly in young healthy individuals irritable bowel syndrome or IBS is quite common however. One should be concerned if diarrhea lasts longer than a week and is associated with fever, weight loss, pain, bleeding, or skin rash.

Common causes of chronic diarrhea would include infections, inflammatory bowel disease (Crohns Disease and Ulcerative Colitis), celiac disease, medication or supplements, lactose intolerance, and relation to other medical issues.

It would be important to see a physician and have a thorough history and exam. In addition routine blood work should include CBC, Chemistry, C-reactive protein, Thyroid function, iron, B12, folate, and tissue tranglutaminase (blood test for celiac sprue). Stool analysis should beobtained for white blood cells, culture, ova and para cites, clostridium difficile antibody, and fecal fat. Depending on results of the above a colonoscopy or upper endoscopy should be considered. If a diagnosis is made appropriate medical treatment will be given. Often no underlying cause is given and a diagnosis of Irritable Bowel Syndrome is made. We’ll further discuss IBS next week, so stay tuned.

-Dr. Howard Schwartz M.D. – Gastroenterologist

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Ask the Gastroenterologist: Acute Diarrhea

Dr. Howard Schwartz

Dr. Howard Schwartz

Acute diarrhea is one of the most common reasons for visiting your doctor. Most Americans have 2-3 “attacks” of diarrhea a year.

Common Causes

1. Viral Gastroenterits comes from food and typically is a self limiting illness that last 24-48 hours.
2. Bacteria causes of diarrhea range from a toxin in food to invasive bacteria. Most resolve without treatment in 3-5 days.
3. Food intolerance can range from a reaction to spices and cream to individuals who are intolerant of lactose or sorbitol which is a sugar substitute.
4. Medications and supplements can cause diarrhea. Special concern for clostridium difficile which is an infection that comes from antibiotics.

The best way to treat diarrhea is to avoid it. Try to only eat well cooked food and avoid buffets and food that has not been properly covered and refrigerated. Raw food is of special concern and make sure it is from a good source. Pay attention if symptoms are related to a medication or food so you can avoid in the future. One should be concerned and make sure to seek medical attention if the diarrhea is associated with fever, blood in the stool,severe pain or dehydration. Populations at special risk include the elderly, infants, and people who are immune compromised.

Next Chronic Diarrhea

-Dr. Howard Schwartz M.D. – Gastroenterologist

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Ask the Gastroenterologist

Image courtesy of Jan Tik via Flickr

Image courtesy of Jan Tik via Flickr

How often should a person poop?

Everyone is different but a normal person poops between 3 times a week and 3 times a day.

I always tell patients it’s not the quantity but the quality. Size, shape, consistency, and satisfaction are what counts. Some people poop daily but are abnormal because they have loose stool and diarrhea. Some go 3 times a day but have straining, hard stool, and constipation

A healthy diet together with liquids and exercise are important for normal bowel function. Try to allocate 5-10 minutes at the same time every day to train your body to be regular.

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-Dr. Howard Schwartz M.D. – Gastroenterologist