Episode Transcript
[00:00:03] Speaker A: Hello and welcome to a Wonder Care podcast. My name is Sheena Mitchell. I am a pharmacist, mom of three, and here to guide you through all of your family health care needs. This week I'm starting my conversation on all things gut health. I'll be covering everything from constipation to diarrhea to ib's to colic. You name it, I'll talk about it. In the space of gut health, there have been more and more probiotic products coming onto the market. This space is really difficult to navigate for consumers. To be honest, it's been quite difficult for me to navigate myself. It's taken me endless hours of scientific research, review deep dives into clinical trials, establishing the facts, and just getting to grips with what we actually know and what are just vague claims about products which may or may not be helpful. The area of study was so, so large that while I spent the last couple of months doing a lot of general probiotic learning, trying to understand the mechanisms and the role that probiotics play in the gut microbiota, I actually have decided to break the conversations down because with probiotics, their actions are very, very specific by strain and per condition. So first of all, I'm going to talk all about constipation, what it is, what might cause it, and I'll be talking about that in the context of both kids, adults and in pregnant women. Then I'm going to give you some general lifestyle advice, and after that I'm going to tell you how to treat it with medical products that are available in your community pharmacy. If you just want a quick fix, the first section will definitely help you. If you struggle with your gut health and you want to learn more about the potential roles of probiotics, then hang around for the whole episode. Because a few months ago, I asked on Instagram undercare IRL what products in the probiotic space that you wanted me to review, and I have taken the ones that were mostly frequently asked about. I don't stock them all, so I had to go outside of my own pharmacy shelves. And I'll tell you which ones actually have an evidence base to support their use in constipation and which ones don't. I want to make it really clear to everyone listening that just because I say one probiotic brand has no role in constipation, that does not mean that it isn't a good product. It's just that I may come to it at a later stage for for example, in IB's or colic or diarrhea, different probiotics impart different effects, so we need to ensure that we're using the right ones to target specific illness or problem that we're dealing with. Okay, so constipation. Let's tuck in.
Trigger warning. This episode will contain the word poo a lot. It's unavoidable. Right. Constipation is where you have changes to how you poo. It includes not pooing as often as you normally do or finding it hard to poo. It's really, really common, and it affects people of all ages. Constipation also includes that feeling where you have done a poo, but not all of the poo has come out. That's called incomplete defecation. The official criteria would be patients who are suffering from hard or lumpy poos, or they're straining when they're going to the toilet, or they have that sense of incomplete evacuation. If you have two or more of these symptoms, then that constitutes constipation, and that is according to the Rome four criteria. It can cause bloating, abdominal discomfort, and in general, have a really negative impact on people's lives. For adults, it's likely to be constipation if you haven't had a poo at least three times during the last week or you're just pooing less than normal. If your poo is unusually large or small, or if it's dry or hard or lumpy, if you have a stomach ache, feel a bit bloated, feel a bit sick, and you feel like you haven't fully emptied your brows. For kids, it's much the same, but their poo can look more like rabbit droppings or little pellets. Some children will have bleeding during or after a poo because their poo is too large and too hard. Children can complain of a poor appetite or general stomach pain that improves after they go to the toilet. If your child is over one soiled pants can actually be another sign of constipation when accidents start to happen in your potentially toilet trained child, runny poo. So diarrhea can actually leak out around hard, constipated poo. That's known as overflow soiling. Okay. I think that is the hardest part for you to listen to. Over.
If you identify these symptoms as something that you or your child might be struggling with, well, we need to start looking then at what the possible causes are. So there's lots of possible causes, but sometimes it's important to be aware there is no obvious cause. The most common ones would include things like not eating enough fiber, which is found in fruits, vegetables, and cereals. I will come back to fiber later. Actually have a lot to say about fiber, but I'll leave that for now. Also not drinking enough fluids, not moving enough, or spending long periods sitting or lying down. So if you have someone who's unwell, they'd be at increased risk of constipation because they're not up and about. Generally, if you have kids or adults who are less active and not exercising enough, that can increase the risk of constipation. Sometimes both children and adults ignore the urge to go for a poo. You could be busy. It might be convenient for children often. I know, I've heard so many stories about children who just will not poo in the school toilets, so they hold it until they come home. That can cause an increased risk of constipation. Also, any kind of change to your diet or your daily routine can have an impact. And also the introduction of any new medicine, some medicines will also cause constipation. And while sometimes this can be harder to define, stress, anxiety, or depression are all risk factors for constipation. One of the big ones for women is that constipation is really common during pregnancy and after giving birth. It's also more common if you're black or if you're over 65 years of age. I mentioned children there earlier about maybe not wanting to go in school, but also toilet training in general can just be a really difficult time. Children can feel pressured or, you know, you might be constantly interrupting them. All of this can just add to their inability to relax. I always say, definitely make sure that whether they're sitting on the potty or the toilet, make sure that you have a step or something so that their feet are placed firmly on the ground when they're trying to go to the toilet. Just helps a bit. Children can also suffer with constipation if they're anxious or worried, just like adults. So think things like moving house or the arrival of a new baby or starting school add to all this. Children are actually pretty smart. If it hurts them to go to the toilet, they're not going to do it, they're not going to want to. And this actually can create a really vicious circle because they're starting to hold it back and that'll increase their constipation. So it is important to deal with it and keep an eye on what's going on. A lot of people were asking about when you need to see the doctor if you've got constipation. So if you're suffering from significant abdominal pain, so really bad tummy pain, or if you or your child have nausea and vomiting, or if you're suffering with chronic constipation and it's just having an ongoing effect on your appetite, then you do need to see the doctor. Also, you need to see the doctor if there's any bloody diarrhea or any signs of a high temperature. Okay, so what can we do about it?
So here's some general advice for the young and the old, and for anyone who falls in the middle of that space, a healthy diet is really important. Like, it does make sense, and I know we don't want to hear it, but really and truly, if constipation is an issue, put an extra focus on whole foods. Avoid processed foods. I'll talk more about the importance of fiber later, but it's really important to know that fiber is lost in the processing process, and this is having a huge impact on the health of our populations globally. Also, try to avoid or reduce alcohol intake. As I said earlier, get moving. Do more exercise where possible, try to avoid sugar. Sugar can aggravate your digestive tract and actually worsen constipation. Make sure to increase water and fluid intake. Make a really, really big conscious effort to increase your water intake. If you're suffering from hard poos briefly on fiber, just try and make your snacks count. Berries, low salt popcorn, yay. Apples, dried fruits, nuts, pears, strawberries, avocados, oats, bananas, carrot sticks, lentils, kidney beans, chia seeds, dark chocolate has to be 70% to 95% cocoa minimum and low sugar. All of these things are really good sources of fiber and make great snacks. So think things like natural yogurt with few berries mixed through and some chia seeds for good measure. Even when you're baking, you can actually bulk up your recipes with fiber. So simple things like swapping out half of your white flour for whole grain can really make a difference. A good dinner idea that a young child may actually appreciate more than you. Just popping down a load of carrot sticks and lentils in front of them would be nachos with whole grain tortilla chips and then maybe some salsa that has some black beans in it. So try to be creative. There is lots of options out there. Before I go on to talk about fiber and probiotics, I'm going to talk about the treatments for acute short term constipation that are available and are medical. These products are really only meant to be used for a short period of time. So like a few days if your constipation is persisting longer than that, you do need to see the GP. Obviously, if you see the GP, you or your child may well end up being prescribed a laxative for a longer period of time. And lots of people were asking me in my Instagram stories and DM's what is the longest you can be on a laxative? And really and truly it is very much down to the cause. So with laxatives, obviously they can affect your bowel and the reflexes that normally trigger you needing to go to for a poo. So you don't want to be on them for any longer than you need to be, even on prescription. However, do take them under your doctor's advice and I'm going to give loads of information in terms of the space of fiber and probiotic products, which may actually help with time to reduce the need for laxatives. So I suppose what I'm saying is, yes, you may end up on laxatives for a longer period than three to five days, but if you do, it's really important to try and adopt all of the measures I'll talk about later with the hope that it might actually help to create a better gut environment and ease symptoms of constipation. Okay, so in terms of laxatives, the first ones are bulk forming laxatives. So these increase the bulk or weight of the poo and that stimulates your bowel. They usually take about two to three days to work. Brand that you might recognize of this is fiberglass. So fiberglass is orange in flavour and it's a high fiber drink containing the active ingredient ispigula husk, and it helps to relieve constipation and restore regularity. With bulk forming laxatives, it's important not to take them if you are suffering from a blockage of the bowel or any muscle weakness of the bowel wall. Also, I'd avoid them if you have, I suppose, an ongoing slow gush. So if you have basically a naturally occurring reduced gush motility, then bulk forming laxatives are not for you. It's also important to be aware that these mightn't be suitable for you, depending on other medication you're taking. So for, for example, some heart medications, lithium, vitamins, and even things like calcium, iron or zinc. In addition to this, some diabetic medications may be affected and the same with thyroid hormones. So do speak to your community pharmacist or to your gp if you're taking any medication before you take fibrogel over the counter, it's only suitable for children from six and up. So if your child is age six to twelve years, then they're just taking half to one five milspoonful granules dissolved in the water. And for adults and children over twelve, it's one full sachet dissolved in the 240 mils. With these, it's best to take them just after a meal and normally morning and evening. The next type of laxative is probably one of the more commonly used ones and they are osmotic laxatives. Osmotic laxatives draw water from the body into your barrel to soften poo and make it easier to pass again. They take two to three days to work, so you have to have a bit of patience with these because they're drawing water from your body into the bowel. It's so, so important to make sure that you're drinking the two liters of fluids a day. I can't emphasize that enough. Medications that you might know already are lactulose, which comes under the brand name of doofilac or laxose, and also Macrogall. So macrogal is actually available now over the counter in the form of a product called Dulco ease. Up until a couple of years ago, it was only available on prescription. And you might be aware of the brand movacol or melaxal, and they do a pediatric version and an adult version. So with the over the counter one, it's suitable for children from two and it's suitable for pregnant and breastfeeding women. It's a medical device. This basically means that it isn't absorbed by your system, it just passes through drawing water into your bowel and, and then you excrete it with your poo, basically. So with the prescription doses, they're a little bit stronger. So that's your movacol, or if it's for a child, movacol, pediatric. They can be used to help clear a buildup of hard poo in your bowel. And this is known as fecal impaction. This is something that can happen if you've been constipated for a long time. With movacol or melaxol, you do need to see the doctor. Any ongoing or unsuitable doses of any laxative can cause side effects, and these ones are no different. With long term or inappropriate use of constipation, you can end up with diarrhea or vomiting, nausea and an electrolyte imbalance, so you can end up dehydrated. So you do have to be careful and only use these ones as prescribed. A lot of people were asking about the long term use of the prescription products and obviously, you know, hopefully a period of constipation would be resolved within a couple of weeks and you wouldn't have to use it anymore. But sometimes it can go on, especially in some young children for various reasons. So do speak to the doctor. They may recommend taking it for months on end, basically. And in the meanwhile, as I said, you can use the recommendations that I'm going to give later on to try and help lower the need for the laxative. So the next type of laxative is a stimulant laxative. Stimulant laxatives basically stimulate the muscles in your gut lining to help move poo along. These act a little quicker than the other ones I've mentioned so far, so normally they take about six to 12 hours. Examples of these include dulcolax, which contains bisacoidol, and sennokot, which contains senna. So dulcolax is available without any prescription and it comes in five milligram tablets. And you can actually also get it in a suppository for adults. It is only suitable for adults. So not for kids with this one. And the regular dose would be one or two tablets at night and just swallow them whole with water. If you haven't taken them before, I would definitely try just one tablet first, and then if that doesn't work for your next dose, you can try too. The main thing is you don't want to end up overdoing it and having diarrhea. These should only be used for a max of five days without going to see the doctor to find out what exactly is causing your constipation. And then Senecot is much the same. Although it can be used in children over twelve years of age. There is a liquid form, so the dose would be one or two 5 night. There's also tablets, and one tablet is the equivalent of one 5 ML teaspoon. Again, they're only for occasional constipation and shouldn't really be used for longer than two weeks without talking to your GP. There is one other product which is kind of different that has come onto the market in the last year. I think maybe it's a little bit longer, but I think it's only in the last year and it's called fibocam. So it's made by the same company that make Fibergl, but it is a different product. So fibocam, again, it's a medical device, and all that means you still swallow it like normal. All it means is that it isn't absorbed by your body, it doesn't result in a clinical effect. All it does is use technology to provide a protective film on the walls of your intestine, which helps to soothe them, basically. And it also contains chia seed powder, pea protein, xylo glucone, and magnesium stearate. Xylo glucan is actually a form of dietary fiber, and this particular form of it can actually have an impact lower in the intestine than just in the stomach. So it can help with the rate of digestion. I just want to summarize one thing there. For anyone who is suffering with constipation during pregnancy, you are able to use fiberglass, you are able to use lactulose, and you are able to use dulcoase over the counter. None of these are associated with any harm for your baby, right? Moving on to fiber, I really want to explain why I am so obsessed about making a huge point about fiber. Fiber is the part of plant based food that mostly passes through our digestive systems without being broken down or being digested. There are two types, soluble and insoluble. So soluble, obviously, as the name says, dissolves in water. Insoluble doesn't dissolve in water. Soluble fiber, as it dissolves, creates a gel that can actually improve digestion in a number of ways. It can also help to reduce cholesterol and regulate sugar. This actually lowers your risk of developing diabetes. Insoluble fiber attracts water into the stool. This makes your poo softer, in essence, and makes it easier to pass with less strain on your bowel. It's a really important aspect of your diet to help promote bowel health and regularity. And again, like soluble fiber, it can actually help to support your insulin sensitivity and can reduce your risk for diabetes. But it's not just gut health that dietary fiber plays a role in. The right amount of overall, dietary fiber can actually help reduce the risk of obesity. It helps control body weight control and prevent hypertension. So high blood pressure helps to support a healthy balance of cholesterol, helps prevent diabetes, helps to lower the risk of colon and breast cancer. And that's on top of all of its gut health benefits. Fiber is broken down in your gastrointestinal tract through the process of fermentation. This is the work of the gut bacteria. When fiber is fermented through interaction with our gut microbes, it actually then goes on to influence the type of bacteria that are present within our gut. And it helps to enhance the production of key metabolites, such as short chain fatty acids. So short chain fatty acids are actually really, really important for good gut health. Short chain fatty acids promote overall health and well being. These are what help to regulate lots of our body's natural functions. So it's kind of impossible to talk about fiber without talking about the microbiome and probiotics and all types of gut bacteria.
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[00:22:06] Speaker A: Short chain fatty acids act as signals to your body, and not just within the gut, but also all around it, including lots of different organs. Without getting too scientific, I think it is important to mention the three main short chain fatty acids that act as signals in our body. They are acetate, propionate and butyrate. Like it's actually amazing. Acetate delivers signals to the lungs, brain, bone marrow and immune cells, and actually the liver and the pancreas too. Propionate works on immune cells and on the gut surface itself, and it's the same with butyrate. All of these actions help so many conditions, and we're still learning about the importance of them. But for constipation, they help to keep your bowel moving. They have a direct impact on gut motility, and they also help to reduce inflammation. For me, it has become really clear and really obvious. And look, I already knew, but now the mechanisms are much more understandable. That processed food and ultra processed food that we are consuming is really, really damaging our health and it's really hard to avoid. But actually, the lack of fiber in processed foods is having a huge role in the development of inflammatory and dysmetabolic processes. When these metabolic processes aren't working properly, we have an increased risk of cardiovascular disease, diabetes, high blood pressure, high cholesterol and stroke. And also they contribute to weight gain and obesity. Constipation is almost a side effect of all of this. It's really sad and really difficult that we are now in a world where we are harming ourselves with what we're putting into our bodies. And the world is not making it easy for us to avoid processed foods. Processed foods are often cheaper and also, they're really, really cleverly and well marketed. They're telling you they're healthy and they're telling you what they have in them. But the problem is they're not telling you what has been removed during the processing process. In Europe, our fiber intake is around a third below the recommended level. If you say that differently, it means that most of us need to increase our dietary fiber intake by around 50%. And while sometimes knowing something and really, truly understanding and believing something are two very different things, we can't just blame food companies that are giving us fiber impoverished foods. We all have a choice regarding our diet, and it is horrendous that a healthy diet generally costs around 25% more than an unhealthy diet. As food consumers, all we can do is hope that our choice of high fiber whole foods in preference to fiber impoverished ultra processed foods has a positive impact on future health and well being. And this might force companies and commercial entities to actually strategize to improve the fiber content of processed foods. We live in a modern western society. Consumer is king. We have to vote with our mouths. We have to vote for the future of health. We have to vote for our children's health. It's not easy. And as a mom of three, I'm not going to tell you that I'm perfect. Of course I'm not. Yes, there are days where I grab pizzas from the freezer section in the supermarket. There are days when I just give them processed snacks because I have them in my handbag for absolute ease. But after spending so much time deep diving into the importance of the role of fiber and its strong relationships to gut bacteria, I just don't think that I can ignore it anymore. And I really, really hope that you can try and join me on this journey. The diets we are eating now are not natural. We're not made to adapt to them. All that's happening is we're getting increased levels of obesity, cancer, autoimmune diseases, diabetes, cardiovascular disease. As a pharmacist, I know medicines are great at providing an extended higher level of quality of life, but why are we then filling ourselves with rubbish so that we will be sick for many of our later years? What is the point in living a longer, unhealthy life? These are the questions I've been asking myself, and it does make me emotional. Actually, I'm upset about the state of the world. There's so much wrong with it, between wars and everything else. But this, this is something that we can actively protect our children against. And I'm sorry, because I know you came here for quick fixes for constipation, and obviously I've highlighted them in the earlier part of this podcast. But without understanding why so many people are constipated, and without understanding what the biggest threat to our health is in ultra processed food, then is there actually a point in continuing to treat acute short term symptoms? If we're not going to help ourselves, who's going to help us?
That brings me on specifically to probiotics. Now, I could sit here for another hour and explain all the different mechanisms in that probiotics work, so I'm not going to do that. However, for those of you really interested in probiotics, I will do a full episode on them in the coming weeks. But for now, a very quick outline and then a discussion on which products that are on the market are actually going to help with constipation symptoms. Because look, ultimately, probiotics is a really weird space. So I want to help you as a consumer to be able to identify which products are reliable and also which products are good, but maybe not for the condition that you're treating for. Okay? So probiotics are defined by the World Health Organization as live microorganisms that, when administered in adequate amounts, confer a healthy benefit on the host. Only characterized strains with a scientifically demonstrated effect on health should be called probiotics. Probiotics are known by three main names, and without this information, you cannot make any assumptions on the clinical effect that a probiotic will have on your body. So I'm going to give you an example here. So, probiotics are known by their genus, then their species, and then the strain. So, for example, an example of genus is bifidobacterium. An example of the species is lactose, and a strain is bb twelve. So that particular strain of bacteria is known as bifidobacterium lactis bb twelve. The problem here is that there are lots of different bifidobacterium lactases, and unfortunately, the strain is actually very, very important because different strains of the same genus and species can have different effects. You might see something like lactobacillus acidophilus and think, oh, I've heard of acidophilus, that must be good. But actually what I'm interested in is what are the numbers that come after that? What strain is it, and what evidence is actually in existence currently to say that it works for a particular health issue? Not only that, we need to know that the dose is appropriate. So the dose in a product should match that of the study that the claim was made in. Probiotics mechanism of action differ vastly and they may not always be understood. There's a lot more research to be done into this, but for now, all I'm dealing with is established studies on large scale randomized control trials which were appropriately conducted. I don't want to see a study on a sample of 60 people. I want to see large studies where clinical effect can actually be taken seriously. Your microbiome refers to the entire habitat of a human human, including microorganisms, for example, bacteria, viruses and their genes. Microbiota is the word used to describe microorganisms of a particular site, such as the gut microbiota. Every single individual will have different gut microbiota and different microbiomes. This can happen for so many reasons, and I'll explain that more at a later stage. It's also good to be aware that it's a misconception that probiotics need to change the existing microbiota of the gut to be effective. They can actually work in so many ways. They can modulate the immune system, they can stop pathogens so harm causing bacteria from attaching to your stomach line. They can adhere to the intestinal mucosa themselves. They can help create a better barrier in the gut. They can produce short chain fatty acids.
So they can make those three fatty acids that I was talking about that have such important signaling roles in our body. Acetic acid, propionic acid and butyrate. So really important. When you're looking at a box of probiotics, it's really important that you are looking at the full strain and that you have information on the number of colony forming units cfus. So cfus are what is used to measure the quantity of good bacteria in a product. One big important, important piece of information, you have to ensure that the cfus are guaranteed up until the expiry date, not at the time that the product was manufactured. Anything can happen after manufacture. So to ensure the stability of the product that you're taking, so that you know what you're getting, you have to make sure that the CFU's are guaranteed until expiry. Another good thing to know is that more is not always better. So you could have loads of different strains of bacteria in there, but actually, if they are not proven to do anything for health benefit, then it's pointless. You're better off with one strain that has clinical efficacy proven than ten strains which may have no health benefit. Absolutely. Sometimes probiotics work well together and interact with each other. But we need evidence and science to back up those actions. We need to stop thinking of probiotics as, oh, sure, I'll just throw loads of bacteria in there, it's got to be good for me. Well, no, we need to actually know what it's going to do when it gets in there. We need to think about probiotics more in terms of their clinical action and ergo, almost more like a medicine. Another important point is that there are some people who shouldn't take probiotics and they are people with severe immune deficiencies and premature infants. If considering a probiotic with a premature infant, it really has to be done under doctor's guidance.
So we have evidence that people suffering with constipation often have a lower amount of bifidobacteria and lactobacilli. Some studies do exist which show that supplementation with specific strains can't emphasize that enough of probiotics can ease constipation. It's thought that it's not the actual bacteria themselves that affect constipation, but the byproducts which are produced by them. So they produce short chain fatty acids which, as I said, are end products of fermentation of non digestible foods, including carbohydrates, and they can increase gut motility. But not all probiotics have this effect, so you can see why so much more research is needed. Brands wise. I got asked to review by you, my wondercare listeners, several brands of probiotics. First one up was Vivio Junior tummies. So these contain bifidobacterium brev and b 632. It also contains vitamin d. So for vivio junior tummies, I could not find any evidence to say that it works for constipation. Absolutely there's evidence for colic and vomiting, but I'll talk about that when I'm talking about those conditions. So that is not one that I would recommend specifically for constipation. The biocult range with biocult, I received lots of studies from them. Unfortunately, the sample size of the studies were very small. They have their own strain kept in a biobank to ensure its purity, which is absolutely great. However, I am of the opinion that they would need to have larger scale studies to show efficacy. So I can't recommend that one specifically for constipation.
Symproof. One thing about Symprov is that obviously they talk a lot about how it's the only product that's giving you live bacteria and so it has an expiry date so it doesn't, you know, last very long and it can be quite pricey. I just want to explain that even though capsule products, the probiotics in them, have gone through a process to freeze dried them, in essence, as soon as they are exposed to moisture, so in your mouth, then the bacteria actually become live again. So whether it's in a liquid formulation or in a specialized capsule formulation, either way, you are getting live bacteria. So I just wanted to highlight that in any case, the four strains in symprouve have no evidence in the efficacy for constipation specifically. Obviously, I'll be going back and looking at that every time that I'm researching a different condition. Udos, Udo's choice. So they do an infants blend and super eights, etcetera. They've been around for years and they are kept in the fridge to ensure that they're stable, which, you know, unfortunately, is a bit of a pain, quite frankly. I reached out to them because I couldn't see any information on whether their cultures were guaranteed up until expiry or just at the time of manufacture. They came back to me and said that they actually overload them. And anyway, they are tested at the time of expiry. So they have evidence that the level of bacteria claimed is correct. The super eights have 42 billion bacteria of eight different strains. I couldn't find any evidence to support their use in constipation. And so, again, to give them a fair chance, I wrote them and they said that they don't have studies for Udo's choice strain combinations by specific conditions. They're saying it's not something that the manufacturer provides and that they recommend it as high strength and strain combinations for general gut and bowel health rather than specific conditions. Well, that goes against everything that I have to say about the potential use of probiotics in the future. We need to be using specific strains. All of the research that I did indicates that. So while, yes, there's eight strains, they may all just be doing nothing. So, unfortunately, I can't recommend the udo's range. Next, I looked at the Fabu gut culture. So this contains 8 billion cfus and nine different strains of bacteria. It also contains 500 milligrams of inulin, which is a prebiotic which can help to optimize your natural gut bacteria and chaga mushroom extract, 400 milligram. So I'm not going to comment on the presence of Chaga because I haven't done full research on it. But in terms of the strains, I was having difficulty finding studies for them, but I am waiting to hear back from the company about that because I couldn't find any evidence to support the specific strains that were mentioned in it. But actually, the biggest problem there is that the strains of bacteria are only guaranteed at the time of manufacture. So that particular range, I feel, would be much better off to do stability testing at the end of expiry to guarantee the product throughout. And again, I will come back to that when we're talking about different conditions, but ultimately, with the testing being done and guaranteed at the time of manufacture, it's probably not one that I'd be able to recommend at this present time. The last range that I was asked to review was the optiback range. So the first product I looked at was optiback bifido and fiber. This contains bifidobacterium lactis bb twelve and it has 25 billion colony forming units in it, and they are guaranteed until expiry. They're suitable from one year and they are gluten free. It also contains fructo oligosaccharides, which again can help the bacteria to work a bit better. And the good news about this particular strain is that large studies which were carried out to a high standard show that this product can help with stool consistency and frequency, so it can help to soften stools and also make them more frequent. This was measured using the Bristol stool form and there were randomized trials to show that. Then the optiback baby drops. These contain bifidobacterium brev M 16 b. There is evidence for this particular strain of bifidobacterium brev, which shows that it can reduce abdominal pain and frequency of stools. This product is suitable for babies and can be added to breast milk or formula from birth. It's used is associated with reduced infection and mortality rates. So again, that's another really strongly evidence supported product. Okay, so that's all the specific products that I was asked to review. Obviously, if you want me to include any more in, say for example, my diarrhea, colic ib's studies, then absolutely, just send me a dmundercare irl on Instagram. I want to make it very clear that I do not have any sponsorship for this entire probiotic season with any of these brands. Because for me, this podcast season had to remain completely independent of any probiotic company. I'm not saying that I won't work with them in the future because, you know, girls got to get paid, but as always, my advice will be 1000% honest. Just want to reassure you that that is the information as I see it. I also want to say that the probiotic space is changing all the time and there is nothing to say that new evidence will not become available which shows efficacy of some of these products in constipation. But at the moment, the only ones that I can recommend for specifically for constipation are the optiback bifido and fiber for children over one and for adults, or the optiback baby drops which are suitable from birth. And I also had a lot of questions about whether or not probiotics were safe during pregnancy. But again, just remember that the effects are going to be strain specific, but for constipation it would be the same strains that I'd recommend. I'm going to push up examples of soluble and insoluble fibers on my instagram, so follow me at Wondercare Irl to see them. I will save this episode and all future probiotic commentary in a probiotic highlight there so that you can check out at any stage. I would actually be delighted if you could leave a review of this episode or give it a rating because it is great to hear your feedback and I'm really grateful for all the questions that come in. I hope I've answered them okay. Thank you so much for listening and I'll talk to you again soon.
